Study paints a grim picture of diabetes-poverty link

Our Bureau Mumbai | Updated on October 19, 2020

Baseline mortality higher among those with diabetes in low-income countries

Diabetes is generally known as a lifestyle disease, but a recent study has found that mortality due to diabetes was less in high-income countries than low income countries (LIC).

The study found that cardiac events like heart attacks and strokes were high in people with diabetes, across regions, be it high, middle or low income regions, said Dr RM Anjana, the first author of the 21-country study that included India.

But the novel finding was that “baseline mortality” was higher in LIC among those with diabetes, she told BusinessLine. In other words, death from heart-related and other diseases was higher among those with diabetes in LIC, as compared to MIC and HICs. She attributed the findings to a combination of factors, including access to healthcare, use of medication, awareness and diet and exercise. Dr Anjana is Managing Director, Dr Mohan’s Diabetes Specialities Centre and Vice-President of Madras Diabetes Research Foundation (MDRF).

India amongst LIC

“We report here on the low use of antidiabetic, antihypertensive and lipid lowering drugs in LIC compared to MIC and HIC even among those with CVD (cardio-vascular disease) and diabetes. Thus, there is an urgent need to ensure access, and adherence to, CVD risk lowering medications if the mortality rates in LIC and MIC have to improve to the levels currently seen in HIC,” she said. The study classified India, Bangladesh, Pakistan, Tanzania and Zimbabwe as LIC.

Findings of PURE study

The Prospective Urban Rural Epidemiology (PURE) study is coordinated by the Population Health Research Institute (PHRI), Hamilton Health Sciences and McMaster University, Canada. It covered 1,43,567 people in the 35-70 age group. The HICs included were Canada, Saudi Arabia, Sweden and United Arab Emirates and MICs were Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, Palestine, the Philippines, Poland, South Africa and Turkey. An analysis of the findings, while categorising countries based on their wealth index, found that even within the LIC, mortality was higher in those with lowest wealth index compared to the upper two tertiles of wealth, whereas such a clear pattern with the wealth index was not observed in the MIC and HIC.

Dr V Mohan, Chairman of the eponymous diabetes centre and President, MDRF, said the study found the highest mortality rates in LIC individuals in the lowest tertile of personal wealth. “The probable reason why there was no clear correlation between mortality rates and wealth index among the HIC and MIC could be that there is a more equitable distribution of healthcare in those countries due to availability of social security systems, insurance and other facilities, whereas in the LIC, there is absence of universal health insurance systems and social support mechanisms”.

Need for quality care

Dr Salim Yusuf, Principal Investigator of the PURE Study from PHRI and senior author of the study, pointed out that the findings from the study were significant since they provided new data on the overall and cardiovascular-linked mortality rates in people with and without diabetes from regions of the world belonging to different socio economic levels. The study points to the need for quality care through a universal health care package, especially among economically weaker sections in LICs.

Published on October 19, 2020

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