"Shifting" risks: the association between rural-to-urban migration and diabetes prevalence in Chennai, India Open Access

Tian, Lulu (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/hm50ts447?locale=en
Published

Abstract

Background: Rural-to-urban migration is a key factor driving urban growth in developing countries. Urbanization may increase risk factors associated with non-communicable diseases such as type 2 diabetes (T2D).

Aims: To investigate the associations between migration status and diabetes risk factors and prevalence in southern India.

Methods: We analyzed data from a representative cross-sectional subsample of 546 adults from Chennai, India. We obtained a comprehensive history of places lived and classified individuals as migrants (lived in rural setting for at least one year before moving to Chennai). Self-reported demographic information, dietary patterns (food frequency questionnaire), and physical activity levels (International Physical Activity Questionnaire) were assessed. Clinical data was collected and anthropometric measurements were used to calculate body mass index (BMI) and waist-to-height-ratio (WHtR). Diabetes was defined through self-reported status or fasting plasma glucose ≥126 mg/dL or a 2-hour post-challenge blood glucose of ≥200 mg/dl or HbA1c ≥6.5%. We compared migrants and non-migrants in terms of risk factors for diabetes. Using logistic regression models, we evaluated the associations between migration status and high WHtR, BMI, physical activity, vegetable consumption, hypertension and high triglycerides, as well as the association between migration status and diabetes prevalence.

Results: Compared to non-migrants, migrants were slightly older and of lower socioeconomic status. Prevalence of diabetes was higher among migrants (30.2% vs. 26.1%) and migration status was associated with a two-fold higher T2D prevalence (OR: 2.1, 95% CI: 1.04-4.4) after adjusting for age, SES, sex, family history, BMI, WHtR, systolic blood pressure and triglycerides. In women, but not men, being a migrant was significantly associated with diabetes (OR: 3.0, 95% CI: 1.1-8.1); in particular, women of low SES were 3 times more likely to have T2D (OR: 3.1, 95% CI; 1.1-8.9).

Conclusion: Rural-to-urban migration was significantly associated with T2D prevalence in an urban subsample from Chennai. The effect of migration was more pronounced in women than men. Aside from migration status, age, BMI, family history of diabetes, systolic blood pressure and elevated triglyceride cholesterol were strong predictors for T2D.

Table of Contents

TABLE OF CONTENTS

CHAPTER I

Literature Review ........................................................................... 1

Diet and physical activity ................................................................. 9

Obesity and adiposity ..................................................................... 12

Hypertension................................................................................15

Dyslipidemia..................................................................................16

Socioeconomic status (SES) ............................................................ 17

Migration, temporality, and T2D ............... ..................... ............... .....18

Age and gender .............................. ..................... ..................... .....19

Migration and T2D ........................... ..................... ..................... .....21

CHAPTER II

Manuscript....................................................................................24

Background...................................................................................25

Methods.......................................................................................28

CARRS..........................................................................................28

Study design.............................................................. ................... 28

Sampling.......................................................................................29

Principal exposure variable..................................... ..................... ..... .29

Data collection............................................................................. .. 31

Defining variables....................................................... . .................... 33

Socio-demographic..........................................................................33

Anthropometric measurements.............................. ..................... ........ 35

Food frequency........................................................ . ...................... 35

Physical activity ........................................................ ...................... 36

Dyslipidemia....................................................................................38

Hypertension...................................................................................38

Diabetes prevalence .................................................. ....................... 39

Analysis..........................................................................................40

Modeling strategy . ................................................... ........................ . 41

Model I ...................................................................... .. ................... 41

Model II ...................................................................... .................... 42

Model III: Gender and migration . ............................ .............................. 43

Results...........................................................................................44

Demographic....................................................................................44

Anthropometric factors and family history.......... . ..................... .............. 45

Dietary patterns .......................................... ..................... ................ 45

Physical activity ........................................................ ...................... . 46

Hypertension and lipid profile ................................ .............................. . 46

Type 2 diabetes, prediabetes, and dysglycemia... .................................. .47

Modeling.........................................................................................48

Migration status and risk factors............................ ............................. 48

Risk factors and T2D prevalence............................. ............................. 49

Strategy I ..................................................................... .................. 50

Strategy II ........................................................ ........ . ..................... 50

Gender and T2D ........................................................ . ...................... 52

Discussion.......................................................................................53

Age................................................................................................53

Socioeconomic status and T2D............................ .. ..................... ......... 54

Anthropometric indicators....................................... ..................... ....... 55

Food and physical activity...................................... ..................... ....... 56

Lipid profiles ........................................................ ..... ........................ 57

Sex-specific differences ............................................. ........................ 58

Missing data ........................................................ ............................ 59

Strengths........................................................................................61

Limitations.......................................................................................62

Conclusion.......................................................................................64

Chapter III

Public Health Implications .................................................... ......... ....... 66

Appendix

Table 1. ........................................................ ............................... 72

Table 2. . ........................................................ .............................. 74

Table 3. . ........................................................ .............................. 75

Table 4. . ........................................................ .............................. 77

Table 5 . . ........................................................ .............................. 78

Table 5 (Contd)........................................................................... .79

Table 6. . ........................................................ .............................. 80

Table 7. . ........................................................ .............................. 82

Table 8: . ........................................................ .............................. 84

Table 9. . ........................................................ .............................. 86

Table 10 a................................................................................... 87

Table 10 b................................................................................... 89

Table 11. . ........................................................ ............................ 92

Figure 1. Overall prevalence of diabetes, prediabetes, and normoglycemia in migrants

and non-migrants...........................................................................94

Figure 2. Prediabetes: IGT, IFG, and elevated HbA1cs in migrants

and non-migrants............................................................................96

Figure 3. Migration Survey . . ............................................................. .96

References..................................................................................98

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