Article

Diabetologia

, Volume 55, Issue 12, pp 3182-3192

Open Access This content is freely available online to anyone, anywhere at any time.

Multilevel examination of diabetes in modernising China: what elements of urbanisation are most associated with diabetes?

  • S. M. AttardAffiliated withDepartment of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
  • , A. H. HerringAffiliated withDepartment of Biostatistics, Gillings School of Global Public Health, University of North Carolina, University of North Carolina
  • , E. J. Mayer-DavisAffiliated withDepartment of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel HillDepartment of Medicine, UNC School of Medicine, University of North Carolina
  • , B. M. PopkinAffiliated withDepartment of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
  • , J. B. MeigsAffiliated withGeneral Medicine Division, Massachusetts General Hospital and Harvard Medical School
  • , P. Gordon-LarsenAffiliated withDepartment of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Email author 

Abstract

Aims/hypothesis

The purpose of this study was to examine the association between urbanisation-related factors and diabetes prevalence in China.

Methods

Anthropometry, fasting blood glucose (FBG) and community-level data were collected for 7,741 adults (18–90 years) across 217 communities and nine provinces in the 2009 China Health and Nutrition Survey to examine diabetes (FBG ≥7.0 mmol/l or doctor diagnosis). Sex-stratified multilevel models, clustered at the community and province levels and controlling for individual-level age and household income were used to examine the association between diabetes and: (1) a multicomponent urbanisation measure reflecting overall modernisation and (2) 12 separate components of urbanisation (e.g., population density, employment, markets, infrastructure and social factors).

Results

Prevalent diabetes was higher in more-urbanised (men 12%; women 9%) vs less-urbanised (men 6%; women 5%) areas. In sex-stratified multilevel models adjusting for residential community and province, age and household income, there was a twofold higher diabetes prevalence in urban vs rural areas (men OR 2.02, 95% CI 1.47, 2.78; women, OR 1.94, 95% CI 1.35, 2.79). All urbanisation components were positively associated with diabetes, with variation across components (e.g. men, economic and income diversity, OR 1.42, 95% CI 1.20, 1.66; women, transportation infrastructure, OR 1.18, 95% CI 1.06, 1.32). Community-level variation in diabetes was comparatively greater for women (intraclass correlation [ICC] 0.03–0.05) vs men (ICC ≤0.01); province-level variation was greater for men (men 0.03–0.04; women 0.02).

Conclusions/interpretation

Diabetes prevention and treatment efforts are needed particularly in urbanised areas of China. Community economic factors, modern markets, communications and transportation infrastructure might present opportunities for such efforts.

Keywords

China Modernisation Multilevel analysis Nutrition transition Type 2 diabetes