The Prevalence of Diabetes in Rural Areas of High-Income Countries: A Systematic Review and Meta-Analysis Open Access
Sanchez, Isabelle M. (2012)
Abstract
Abstract
The Prevalence of Diabetes in Rural Areas of High-Income
Countries:
A Systematic Review and Meta-Analysis
Though diabetes is currently the fourth leading cause of death recognized among high-income countries (HICs), data from LMICs show that prevalence is growing rapidly in rural areas. Few studies have examined diabetes by residency location in HICs, suggesting possible underestimation. To understand the current magnitude and trends globally, the authors conducted an analysis of diabetes prevalence in rural areas of HICs by performing a systematic review of studies published from 1990 to 2011.
An extensive search of electronic databases (MEDLINE, Embase, Cochrane, CINAHL) yielded 1,513 eligible articles. Two independent reviewers screened studies based on objective protocol considering quality and homogeneity. Of the 171 articles fully examined, 32 articles were analyzed. To estimate the pooled rural prevalence of diabetes across HICs, a meta-analysis was performed; heterogeneity of samples was assessed via meta-regression.
A total of 97,478 persons in HICs generated a pooled rural diabetes prevalence of 9.6% (95% CI=8.3- 10.9), comparable by sex and age. Prevalence increased when grouped by 6-year intervals from 6.9% in 1990-1996 to 9.2% in 1997-2003 to 11.4% in 2004-2011. Of the 12 countries represented, the highest prevalence was found in Poland (17.2%; 15.5-18.9), USA (13.5%; 6.3-20.7), New Zealand (13.4%; 9.2-17.6) and Korea (12.8%; 8.0-17.6). Countries with the lowest prevalence were in Italy (4.8%; 1-8.6) and Sweden (4.4%; 3.6-5.3). By WHO region, the Americas had the highest prevalence (13.1%; 8.9-17.2), followed by Eastern Mediterranean (10.5%, 2.4-18.7), while Europe had the lowest estimate (8.3%; 6.3-10.3).
The widespread burden of diabetes prevalence in rural areas of HICs within the past two decades has escalated from 8.3% in 1985 to 13.7% in 2008 by study year. Re-prioritization of diabetes as a rural disease should be integrated into future research and interventions. For HICs, reducing diabetes prevalence can be a feasible target to minimize disparities, improve quality of life, and reduce economic burden in these regions.
Table of Contents
Table of Contents
Abstract .................................................................................................................. Page 5
Acknowledgements.................................................................................................... 8
Background............................................................................................................. 10
Methods.................................................................................................................. 15
Results.................................................................................................................... 22
Discussion................................................................................................................ 27
References............................................................................................................... 35
Appendix.................................................................................................................. 42
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