Rural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study...

Area of Science:

• Global Health
• Epidemiology
• Health Systems Research

Background:

• Diabetes prevalence is rising rapidly in rural low- and middle-income countries (LMICs).
• Limited data exist on health system performance for equitable diabetes care in rural LMICs.
• Assessing rural-urban disparities in diabetes care and control is crucial.

Purpose of the Study:

• To evaluate rural-urban differences in diabetes care and control across LMICs.
• To identify inequities in health system performance for rural diabetes patients.

Main Methods:

• Pooled individual-level data from nationally representative health surveys in 42 countries.
• Poisson regression models used to estimate age-adjusted differences in performance measure achievement.
• Analysis examined differences across pooled sample, by sex, and by country.

Main Results:

• Rural populations had 15-30% lower relative risk of achieving diabetes diagnosis and treatment performance measures compared to urban populations.
• Rural individuals with diagnosed diabetes showed lower relative risk for glycemic (14%), blood pressure (-6%), and cholesterol (23%) control.
• Rural women experienced greater deficits in diabetes control measures than urban women.

Conclusions:

• Substantial inequities exist in diabetes care and control for rural populations in LMICs.
• Health system strengthening programs must address the specific challenges faced by rural populations with diabetes.
• Policies should aim to improve equitable access and quality of diabetes care in underserved rural areas.