Country Characteristics and Variation in Diabetes Prevalence among Asian Countries – an Ecological Study

OBJECTIVES: To determine the variation in diabetes prevalence across Asian countries and its relationship with the quality of health system and socioeconomic characteristics of the country. METHODOLOGY: An ecological analysis was conducted using publicly available data from the World Bank, the World Health Organization and the International Diabetes Federation. Geographical variation in diabetes prevalence across countries was examined using control charts while the relationships between country-level determinants and diabetes prevalence were investigated using linear regression analysis. RESULTS: The control chart shows special-cause variation in diabetes prevalence in 21 (58%) of the Asian countries; nine countries were below the 99.8% control limits while twelve were above it. Fifteen (42%) countries suggest common-cause variation. Three country characteristics independently associated with diabetes prevalence were hypertension prevalence (OR 0.39, 95% CI 0.22 to 0.55; p-value<0.001), obesity prevalence (OR 0.15, 95% CI 0.13 to 0.18; p-value<0.001), and quality of health care governance (OR 0.18, 95% CI 0.04 to 0.34; p-value=0.02). CONCLUSIONS: There is a considerable geographical variation in diabetes prevalence across Asian countries. A substantial part of this variation could be explained by differences in the quality of health care governance, hypertension prevalence and obesity prevalence.