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Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment

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dc.contributor.author Braverman-Bronstein, Ariela
dc.contributor.author Hessel, Philipp
dc.contributor.author González-Uribe, Catalina
dc.contributor.author Kroker, Maria F.
dc.contributor.author Diez-Canseco Montero, Francisco
dc.contributor.author Langellier, Brent
dc.contributor.author Lucumi, Diego I.
dc.contributor.author Rodríguez-Osiac, Lorena
dc.contributor.author Trotta, Andrés
dc.contributor.author Diez-Roux, AnaV.
dc.date.accessioned 2021-10-04T23:00:55Z
dc.date.available 2021-10-04T23:00:55Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/9788
dc.description.abstract Diabetes prevalence continues to increase in urban areas of low-income and middle-income countries (LMIC). Evidence from high-income countries suggests an inverse association between educational attainment and diabetes, but research in LMIC is limited. We investigated educational differences in diabetes prevalence across 232 Latin American (LA) cities, and the extent to which these inequities vary across countries/cities and are modified by city socioeconomic factors. Using harmonised health survey and census data for 110 498 city dwellers from eight LA countries, we estimated the association between education and diabetes. We considered effect modification by city Social Environment Index (SEI) as a proxy for city-level development using multilevel models, considering heterogeneity by sex and country. In women, there was an inverse dose–response relationship between education and diabetes (OR: 0.80 per level increase in education, 95% CI 0.75 to 0.85), consistent across countries and not modified by SEI. In men, Argentina, Brazil, Colombia, Chile and Mexico showed an inverse association (pooled OR: 0.92; 95% CI 0.86 to 0.99). Peru, Panama and El Salvador showed a positive relationship (pooled OR 1.24; 95% CI 1.04 to 1.49). For men, these associations were further modified by city-SEI: in countries with an inverse association, it became stronger as city-SEI increased. In countries where the association was positive, it became weaker as city-SEI increased. Social inequities in diabetes inequalities increase as cities develop. To achieve non-communicable disease-related sustainable development goals in LMIC, there is an urgent need to develop policies aimed at reducing these educational inequities en_US
dc.language.iso eng
dc.publisher BMJ Publishing Group
dc.relation.ispartofseries Journal of Epidemiology and Community Health
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject diabetes en_US
dc.subject education en_US
dc.subject epidemiology en_US
dc.subject social inequalities en_US
dc.subject urbanisation en_US
dc.title Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1136/jech-2020-216116
dc.relation.issn 1470-2738


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