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Epidemiology/Health Services Research
Interaction between sex and rurality on the prevalence of diabetes in Guyana: a nationally representative study
  1. Calvin Ke1,
  2. Shamdeo Persaud2,
  3. Kavita Singh3,
  4. Brian Ostrow4,
  5. Gerald Lebovic5,6,
  6. Cesar Hincapié5,7,
  7. Julia Lowe1,8
  1. 1Division of Enodcrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Chief Medical Officer, Ministry of Public Health, Georgetown, Guyana
  3. 3Chronic Diseases Unit, Ministry of Public Health, Georgetown, Guyana
  4. 4Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  5. 5Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
  6. 6Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  7. 7Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
  8. 8School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
  1. Correspondence to Calvin Ke; calvin.ke{at}mail.utoronto.ca

Abstract

Introduction Diabetes prevalence has never been measured in Guyana. We conducted a nationally representative cross-sectional study to estimate the prevalence of diabetes and pre-diabetes, and the association between sex and diabetes.

Research design and methods In 2016, the Ministry of Public Health led Guyana’s first national STEPS survey among adults aged 18–69 years. Half of the participants were randomly selected for hemoglobin A1c and fasting blood glucose testing. We estimated the prevalence of diabetes and pre-diabetes and measured the association between sex and diabetes prevalence using logistic regression to compute adjusted ORs.

Results We included 805 adults (511 women, 294 men, mean age 41.8 (SD 14.4) years). The national prevalence of diabetes was 18.1% (95% CI: 15.4% to 20.8%), with higher rates among women (21.4%, 95% CI: 18.0% to 24.7%) than men (15.1%, 95% CI: 10.9% to 19.3%). Sex-specific diabetes prevalence varied significantly across urban and rural areas (p=0.002 for interaction). In rural areas, diabetes was twice as common among women (24.1%, 95% CI: 20.1% to 28.2%) compared with men (11.8%, 95% CI: 7.7% to 15.9%). After adjusting for prespecified covariates, rural women had double the odds of diabetes compared with rural men (OR 2.1, 95% CI: 1.20 to 3.82). This prevalence pattern was reversed in urban areas (diabetes prevalence, women: 13.9%, 95% CI: 8.7% to 19.0%; men: 22.0%, 95% CI: 12.9% to 31.1%), with urban women having half the odds of diabetes compared with urban men (OR 0.4, 95% CI: 0.20 to 0.99). We estimated that nearly one-third of women and over a quarter of men had diabetes or pre-diabetes.

Conclusions The burden of diabetes in Guyana is considerably higher than previously estimated, with an unexpectedly high prevalence among women—particularly in rural areas.

  • adult diabetes
  • gender differences
  • epidemiology
  • rural
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001349

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    Footnotes

    • Presented at This study has been previously presented in abstract form at the International Diabetes Federation Congress 2019 held in Busan, Korea (December 2–6, 2019).

    • Contributors CK, BO, and JL conceptualized the study. SP and KS were involved in data acquisition. CK analyzed the data and wrote the first draft. All of the authors were involved in data interpretation, critical revisions of the paper, and approval of the final version. JL is the guarantor of this work, and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This study received funding from the World Diabetes Foundation (WDF 14-862), funding and technical support from the Pan American Health Organization, and funding from the Banting and Best Diabetes Centre Sun Life Financial Impact Challenge Grant with financial support from all its partners. CK is supported by the Canadian Institutes of Health Research, the Canadian Society of Endocrinology and Metabolism, and the South Asian Network Supporting Awareness and Research.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Ethical Review Committee of Guyana’s Ministry of Public Health (FWA00014641 protocol 278).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. The data for this study are held by the Ministry of Public Health, Guyana.