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Spatiotemporal variation in diabetes mortality in China: multilevel evidence from 2006 and 2012.

Zhou M, Astell-Burt T, Yin P, Feng X, Page A, Liu Y, Liu J, Li Y, Liu S, Wang L, Wang L, Wang L - BMC Public Health (2015)

Bottom Line: Age and gender stratified annual diabetes mortality counts for 161 counties were extracted from the China Mortality Surveillance System and interrogated using multilevel negative binomial regression.A Median Rate Ratio of 1.47, slope variance of 0.006 (SE 0.001) and covariance of 0.268 (SE 0.007) indicated spatiotemporal variation.No association was observed with smoking, overconsumption of red meat, high mean sedentary time, systolic blood pressure, cholesterol, and diabetes prevalence.

View Article: PubMed Central - PubMed

Affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China. maigengzhou@126.com.

ABSTRACT

Background: Despite previous studies reporting spatial in equality in diabetes prevalence across China, potential geographic variations in diabetes mortality have not been explored.

Methods: Age and gender stratified annual diabetes mortality counts for 161 counties were extracted from the China Mortality Surveillance System and interrogated using multilevel negative binomial regression. Random slopes were used to investigate spatiotemporal variation and the proportion of variance explained was used to assess the relative importance of geographical region, urbanization, mean temperature, local diabetes prevalence, behavioral risk factors and relevant biomarkers.

Results: Diabetes mortality tended to reduce between 2006 and 2012, though there appeared to be an increase in diabetes mortality in urban (age standardized rate (ASR) 2006-2012: 10.5-13.6) and rural (ASR 10.8-13.0) areas in the Southwest region. A Median Rate Ratio of 1.47, slope variance of 0.006 (SE 0.001) and covariance of 0.268 (SE 0.007) indicated spatiotemporal variation. Fully adjusted models accounted for 37% of this geographical variation, with diabetes mortality higher in the Northwest (RR 2.55, 95% CI 1.74, 3.73) and Northeast (RR 2.68, 95% CI 1.70, 4.21) compared with the South. Diabetes mortality was higher in urbanized areas (RR tertile 3 versus tertile 1 ('RRt3vs1') 1.39, 95% CI 1.17, 1.66), with higher mean body mass index (RRt3vs1 1.46, 95% CI 1.18, 1.80) and with higher average temperatures (RR 1.05 95% CI 1.03, 1.08). Diabetes mortality was lower where consumption of alcohol was excessive (RRt3vs1 0.84, 95% CI 0.72, 0.99). No association was observed with smoking, overconsumption of red meat, high mean sedentary time, systolic blood pressure, cholesterol, and diabetes prevalence.

Conclusions: Declines in diabetes mortality between 2006 and 2012 have been unequally distributed across China, which may imply differentials in diagnosis, management, and the provision of services that warrant further investigation.

No MeSH data available.


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Diabetes mortality trends during 2006–2012 in male/female and urban/rural
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Fig1: Diabetes mortality trends during 2006–2012 in male/female and urban/rural

Mentions: Age-standardized diabetes mortality rates among people aged 20 years and older decreased 12 % (from 15.65 to 13.78 per 100,000) from 2006 to 2012 (Table 1). Gender differences were also observed, with diabetes mortality decreasing more slowly for males (0.8 per 100,000) than females (3.0 per 100,000). The disparity between urban and rural residence was notable. Diabetes mortality during the study period decreased by 2 % (from 12.92 to 12.72) in rural areas, but decreased by 25 % (from 20.24 to 15.21) in urban areas. Gender and urban/rural stratified analyses showed the mortality was consistently lowest in rural males during the study period, followed by rural females (Figure 1). The mortality of urban females decreased sharply compared to urban males, although the mortality of urban females was higher than urban males in 2006(21.7 and 18.73 per 100000 respectively), and the mortality of urban females was lower than that of urban male at the end of the period.Table 1


Spatiotemporal variation in diabetes mortality in China: multilevel evidence from 2006 and 2012.

Zhou M, Astell-Burt T, Yin P, Feng X, Page A, Liu Y, Liu J, Li Y, Liu S, Wang L, Wang L, Wang L - BMC Public Health (2015)

Diabetes mortality trends during 2006–2012 in male/female and urban/rural
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4496807&req=5

Fig1: Diabetes mortality trends during 2006–2012 in male/female and urban/rural
Mentions: Age-standardized diabetes mortality rates among people aged 20 years and older decreased 12 % (from 15.65 to 13.78 per 100,000) from 2006 to 2012 (Table 1). Gender differences were also observed, with diabetes mortality decreasing more slowly for males (0.8 per 100,000) than females (3.0 per 100,000). The disparity between urban and rural residence was notable. Diabetes mortality during the study period decreased by 2 % (from 12.92 to 12.72) in rural areas, but decreased by 25 % (from 20.24 to 15.21) in urban areas. Gender and urban/rural stratified analyses showed the mortality was consistently lowest in rural males during the study period, followed by rural females (Figure 1). The mortality of urban females decreased sharply compared to urban males, although the mortality of urban females was higher than urban males in 2006(21.7 and 18.73 per 100000 respectively), and the mortality of urban females was lower than that of urban male at the end of the period.Table 1

Bottom Line: Age and gender stratified annual diabetes mortality counts for 161 counties were extracted from the China Mortality Surveillance System and interrogated using multilevel negative binomial regression.A Median Rate Ratio of 1.47, slope variance of 0.006 (SE 0.001) and covariance of 0.268 (SE 0.007) indicated spatiotemporal variation.No association was observed with smoking, overconsumption of red meat, high mean sedentary time, systolic blood pressure, cholesterol, and diabetes prevalence.

View Article: PubMed Central - PubMed

Affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China. maigengzhou@126.com.

ABSTRACT

Background: Despite previous studies reporting spatial in equality in diabetes prevalence across China, potential geographic variations in diabetes mortality have not been explored.

Methods: Age and gender stratified annual diabetes mortality counts for 161 counties were extracted from the China Mortality Surveillance System and interrogated using multilevel negative binomial regression. Random slopes were used to investigate spatiotemporal variation and the proportion of variance explained was used to assess the relative importance of geographical region, urbanization, mean temperature, local diabetes prevalence, behavioral risk factors and relevant biomarkers.

Results: Diabetes mortality tended to reduce between 2006 and 2012, though there appeared to be an increase in diabetes mortality in urban (age standardized rate (ASR) 2006-2012: 10.5-13.6) and rural (ASR 10.8-13.0) areas in the Southwest region. A Median Rate Ratio of 1.47, slope variance of 0.006 (SE 0.001) and covariance of 0.268 (SE 0.007) indicated spatiotemporal variation. Fully adjusted models accounted for 37% of this geographical variation, with diabetes mortality higher in the Northwest (RR 2.55, 95% CI 1.74, 3.73) and Northeast (RR 2.68, 95% CI 1.70, 4.21) compared with the South. Diabetes mortality was higher in urbanized areas (RR tertile 3 versus tertile 1 ('RRt3vs1') 1.39, 95% CI 1.17, 1.66), with higher mean body mass index (RRt3vs1 1.46, 95% CI 1.18, 1.80) and with higher average temperatures (RR 1.05 95% CI 1.03, 1.08). Diabetes mortality was lower where consumption of alcohol was excessive (RRt3vs1 0.84, 95% CI 0.72, 0.99). No association was observed with smoking, overconsumption of red meat, high mean sedentary time, systolic blood pressure, cholesterol, and diabetes prevalence.

Conclusions: Declines in diabetes mortality between 2006 and 2012 have been unequally distributed across China, which may imply differentials in diagnosis, management, and the provision of services that warrant further investigation.

No MeSH data available.


Related in: MedlinePlus