Haruyama Rei, Rahman Md Shafiur, Rahman Md Mahfuzur, Khim Sam Ath, Moadsiri Ada, Chham Savina, Chhim Srean, Kol Hero, Phy Maly
Japan Institute for Health Security, Bureau of Global Health Cooperation, Tokyo, Japan.
Noncommunicable Disease Control Project, Japan International Cooperation Agency, Phnom Penh, Cambodia.
J Glob Health. 2025 Aug 22;15:04251. doi: 10.7189/jogh.15.04251.
In this study, we aimed to quantify the magnitude of educational and economic disparities and examine risk factors associated with diabetes and impaired fasting glucose in Cambodia.
We used data from the 2023 STEPwise approach to noncommunicable risk factor surveillance to analyse 3660 participants aged 18-69 years. We quantified the extent of disparities using the regression-based slope index of inequality (SII) and relative index of inequality (RII). We used multi-level modified Poisson regression models to identify the potential risk factors.
Overall, the prevalence of diabetes and impaired fasting glucose was 6.4% (95% confidence interval (CI) = 5.6, 7.3) and 4.4% (95% CI = 3.6, 5.3). The magnitude of educational inequality in the prevalence of diabetes was significant, with the disease more concentrated among the non-educated population (SII = -7.6; 95% CI = -12.0, -3.3). Economic inequality in diabetes prevalence was less pronounced than education-based inequality at the national level (SII = -0.7; 95% CI = -4.5, 3.0); however, rural areas showed a concentration of diabetes among economically disadvantaged groups (SII = -4.7; 95% CI = -9.1, -0.3). Key factors associated with diabetes were advanced age ≥40 years, overweight (prevalence ratio (PR) = 1.4; 95% CI = 1.0, 2.0), obesity (PR = 1.7; 95% CI = 1.1, 2.5), comorbid hypertension (PR = 2.4; 95% CI = 1.8, 3.1), and daily alcohol consumption (PR = 2.0; 95% CI = 1.2, 3.3). Daily sugar-sweetened beverage consumption (PR = 1.8; 95% CI = 1.1, 3.1) also showed an increased risk of undiagnosed diabetes.
The significant educational and economic disparities underscore the need for targeted interventions aimed at supporting non-educated and economically poor populations. Strengthening public health measures to address key risk factors, particularly alcohol and sugar-sweetened beverage consumption, is essential to curbing the growing burden of diabetes in Cambodia.
在本研究中，我们旨在量化柬埔寨教育和经济差距的程度，并研究与糖尿病和空腹血糖受损相关的风险因素。
我们使用了2023年非传染性风险因素监测的逐步方法数据，分析了3660名年龄在18 - 69岁之间的参与者。我们使用基于回归的不平等斜率指数（SII）和不平等相对指数（RII）来量化差距程度。我们使用多层次修正泊松回归模型来识别潜在的风险因素。
总体而言，糖尿病和空腹血糖受损的患病率分别为6.4%（95%置信区间（CI）= 5.6, 7.3）和4.4%（95% CI = 3.6, 5.3）。糖尿病患病率的教育不平等程度显著，该疾病在未受过教育的人群中更为集中（SII = -7.6；95% CI = -12.0, -3.3）。在国家层面，糖尿病患病率的经济不平等不如基于教育的不平等明显（SII = -0.7；95% CI = -4.5, 3.0）；然而，农村地区糖尿病在经济弱势群体中更为集中（SII = -4.7；95% CI = -9.1, -0.3）。与糖尿病相关的关键因素包括年龄≥40岁、超重（患病率比（PR）= 1.4；95% CI = 1.0, 2.0）、肥胖（PR = 1.7；95% CI = 1.1, 2.5）、合并高血压（PR = 2.4；95% CI = 1.8, 3.1）以及每日饮酒（PR = 2.0；95% CI = 1.2, 3.3）。每日饮用含糖饮料（PR = 1.8；95% CI = 1.1, 3.1）也显示出未确诊糖尿病的风险增加。
显著的教育和经济差距凸显了针对未受过教育和经济贫困人群进行有针对性干预的必要性。加强公共卫生措施以应对关键风险因素，特别是饮酒和饮用含糖饮料，对于遏制柬埔寨日益增长的糖尿病负担至关重要。
