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The Prevalence of Diabetes Among Overweight and Obese Individuals is Higher in Poorer than in Richer Neighbourhoods

      ABSTRACT

      OBJECTIVE

      Diabetes is increasing in prevalence worldwide. This study investigated whether the elevated prevalence of diabetes in lower-income neighbourhoods could be explained by higher rates of overweight and obesity.

      METHODS

      A total of 7434 patients who attended respiratory clinics in 2 Ontario cities were linked to administrative databases to ascertain diagnoses of diabetes, chronic obstructive pulmonary disease and asthma. Body mass index (BMI) was obtained from clinic databases and median neighbourhood income from the Canadian census. Prevalence ratios were estimated by log-linear multiple binary regression.

      RESULTS

      BMI and neighbourhood income were independently associated with the prevalence of diabetes. At any level of BMI, subjects living in richer neighbourhoods were less likely to have been diagnosed with diabetes than subjects in poorer neighbourhoods.

      CONCLUSION

      In addition to body weight, neighbourhood income-related factors are associated with the risk of diabetes. These may include diet, physical activity and pollution exposures. Additional etiologic research is required to explain the income-related differential. From a resource perspective, the health care system will need to invest resources in low-income neighbourhoods to provide counselling and treatment for those individuals at risk for diabetes or for those already diagnosed.

      RÉSUMÉ

      OBJECTIF

      La prévalence mondiale du diabète augmente. Cette étude a évalué si la hausse de la prévalence du diabète dans les quartiers à faible revenu pouvait être attribuée aux taux élevés d'embonpoint et d'obésité qu'on y retrouve.

      MÉTHODES

      Un total de 7434 patients de cliniques de pneumologie de deux villes ontariennes ont été reliés à des bases de données administratives pour confirmer les diagnostics de diabète, de bronchopneumopathie chronique obstructive et d'asthme. On a obtenu l'indice de masse corporelle (IMC) dans les bases de données des cliniques et le revenu médian du quartier dans le recensement du Canada. Les rapports de prévalence ont été évalués par régression multiple et binaire log-linéaire.

      RÉSULTATS

      L'IMC et le revenu médian du quartier ont été indépendamment associés à la prévalence du diabète. Quel que soit l'IMC, les sujets qui habitaient un quartier riche étaient moins susceptibles d'être atteints de diabète que ceux qui habitaient un quartier pauvre.

      CONCLUSION

      En plus du poids corporel, des facteurs liés au revenu médian du quartier sont associés au risque de diabète, dont l'alimentation, l'activité physique et l'exposition à la pollution. La recherche étiologique devra se poursuivre pour expliquer la différence liée au revenu. Le système de santé devra investir des ressources dans les quartiers à faible revenu pour que les personnes exposées au diabète et celles qui en sont déjà atteintes puissent être conseillées et traitées.

      KEYWORDS

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