Aswathy S, Lohidas V, Paul Nimitha, Anish T S, Narayanan Tinu, Oldenburg Brian
Professor, Dept of Community Medicine, Amrita Institute of Medical sciences, Amrita University, Kochi, Kerala, India.
Lecturer in Biostatistics, Dept of Community Medicine, Amrita Institute of Medical sciences, Amrita University, Kochi, Kerala, India.
J Endocrinol Diabetes. 2017;4(3). doi: 10.15226/2374-6890/4/3/00181. Epub 2017 Sep 15.
Varying prevalence rates of type 2 diabetes have been observed in different parts of the southern state of Kerala, India which is in an advanced stage of epidemiologic transition. Social patterning is evident in diabetes and therefore it was decided to undertake a study on estimating the prevalence of diabetes and associated social determinants.
The adopted local self administration unit of the Medical College which is also the field practice area with a population of 25,096 was taken for the study. All the households in the area were visited and the details regarding self reported diabetes was collected after obtaining informed consent and analysis done by multivariate logistic regression.
The prevalence of self reported diabetes in this coastal area was found to be low at 7.4%. Type 2 diabetes was also found to occur significantly earlier among the respondents belonging to the below poverty line. Age above 40 years (OR 2 95% CI 1.5-2.7, p=.000), marital status (OR 1.9 95% CI 1.1-2.1, p=.006) presence of comorbidities (OR 635 95% CI 389-969, p=.000), more than 8 years of schooling (OR 0.64 95% CI 0.46-0.86, p=.004), living conditions as represented by presence of household source of drinking water(OR 1.4 95% CI 1.01-1.5) were found to be independent predictors. Though there was increasing trend of diabetes among the forward caste line families after backward logistic regression this disappeared leaving behind the proxy of socioeconomic status, household source of drinking water.
Though, the state of Kerala is in an advanced stage of epidemiologic transition, coastal areas are still in the earlier phases of transition with low prevalence of type 2 diabetes mellitus. Higher education and better living conditions are important social determinants of diabetes though further studies are necessary to delineate the impact of economic status and education.
在印度南部喀拉拉邦的不同地区，观察到2型糖尿病的患病率各不相同，该邦正处于流行病学转变的高级阶段。糖尿病存在明显的社会模式，因此决定开展一项研究，以估计糖尿病的患病率及相关社会决定因素。
本研究采用医学院的当地自我管理单位，该单位也是实地实践区域，人口为25,096。走访了该地区的所有家庭，在获得知情同意后收集了自我报告的糖尿病详细信息，并通过多变量逻辑回归进行分析。
在这个沿海地区，自我报告的糖尿病患病率较低，为7.4%。还发现，属于贫困线以下的受访者中2型糖尿病发病明显更早。40岁以上（比值比2，95%置信区间1.5 - 2.7，p = .000）、婚姻状况（比值比1.9，95%置信区间1.1 - 2.1，p = .006）、存在合并症（比值比635，95%置信区间389 - 969，p = .000）、受教育年限超过8年（比值比0.64，95%置信区间0.46 - 0.86，p = .004）、以家庭饮用水源表示的生活条件（比值比1.4，95%置信区间1.01 - 1.5）被发现是独立预测因素。尽管在向后逻辑回归后，高种姓家庭中糖尿病有上升趋势，但这一趋势消失了，仅留下社会经济地位的替代指标——家庭饮用水源。
尽管喀拉拉邦处于流行病学转变的高级阶段，但沿海地区仍处于转变的早期阶段，2型糖尿病患病率较低。高等教育和更好的生活条件是糖尿病的重要社会决定因素，不过仍需进一步研究来阐明经济状况和教育的影响。
