Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 123 West Franklin Street, Chapel Hill, NC 27516-3997, USA.
Diabetologia. 2012 Dec;55(12):3182-92. doi: 10.1007/s00125-012-2697-8. Epub 2012 Aug 26.
AIMS/HYPOTHESIS: The purpose of this study was to examine the association between urbanisation-related factors and diabetes prevalence in China.
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).
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.
目的/假设：本研究旨在探讨与城市化相关的因素与中国糖尿病患病率之间的关系。
2009 年中国健康与营养调查收集了 217 个社区和 9 个省份的 7741 名 18-90 岁成年人的人体测量学、空腹血糖（FBG）和社区水平数据，以检查糖尿病（FBG≥7.0mmol/l 或医生诊断）。采用分层多水平模型，以社区和省为聚类水平，控制个体水平的年龄和家庭收入，以检查糖尿病与以下因素的关系：（1）反映整体现代化的多成分城市化指标，（2）城市化的 12 个单独成分（例如，人口密度、就业、市场、基础设施和社会因素）。
在城市化程度较高的地区（男性 12%，女性 9%），糖尿病的患病率高于城市化程度较低的地区（男性 6%，女性 5%）。在按性别分层的多水平模型中，调整居住社区和省份、年龄和家庭收入后，城市地区的糖尿病患病率是农村地区的两倍（男性 OR 2.02，95%CI 1.47，2.78；女性 OR 1.94，95%CI 1.35，2.79）。所有城市化成分与糖尿病呈正相关，且各成分之间存在差异（例如，男性，经济和收入多样性，OR 1.42，95%CI 1.20，1.66；女性，交通基础设施，OR 1.18，95%CI 1.06，1.32）。与男性相比（男性 ICC≤0.01），女性的社区糖尿病差异较大（ICC 0.03-0.05）；与女性相比（女性 ICC 0.02），男性的省级差异较大（男性 ICC 0.03-0.04）。
结论/解释：中国需要在城市化地区特别开展糖尿病预防和治疗工作。社区经济因素、现代市场、通信和交通基础设施可能为这些努力提供机会。
