Impacts of Socioeconomic Variables on Prevalence and Duration of Diabetes in Bangladeshi Adults

The analysis presented here was to identify some responsible variables for the prevalence of diabetes for different duration in Bangladeshi adults. For this, 995 adults of ages 18 years and above whom visited different diagnostic centres in both urban and semi-urban areas were interviewed. Out of 995 respondents, 67.0% were diabetic patients and they were suffering for, on an average, 6.59 years with standard deviation of 4.06 years. The percentage of adults suffering for minimum 10 years was 17.1. The corresponding percentage was significantly higher for males (23.5%), single adults (27.5%0, elderly people (63.1%), farmers (22.1%) and business persons (20.1%), adults of families having medium income(17.9%), smokers (25.5%), adults involved in sedentary activity (23.3%), obese adults (30.3%) and hypertensive adults (64.4%).The risk of prevalence of diabetes for males was 14% more as it was for females. Similar higher risk was observed for single persons (43%), elderly people (36%), literate people (19%), businessmen ( 11%), obese adults ( 13%), smokers (10%), adults involved in sedentary activity ( 16%) and hypertensive adults ( 26%), The binary logistic regression analysis indicated that gender variation, marital status, age, occupation, body mass index, and blood pressure were the responsible variables for the prevalence of diabetes.


Introduction
Diabetes is one of the 4 groups of non-communicable diseases identified by WHO and it is the major risk factor for cardiovascular disease, vascular disorders including retinopathy, and nephropathy, peripheral vascular disease, stroke, and coronary artery disease [1][2][3][4]. Diabetes kills 1.6 million people annually and the figure will be increasing gradually [5][6]. The number of diabetic population is in increasing trend since 1980. At that time it was 108 million and it arose to 122 million in 2014. The figure will be increased up to 700 million in 2045 [7]. Sixty per cent of world diabetic population are from Asian countries [8]. The prevalence of diabetes among adults of ages 18 years and above in the world has arisen from 4.7% in 1980 to 8.5% in 2014. The upward trend of rate of increase is noted in low and middle income countries. Bangladesh is an Asian country and is moving towards middle income countries. It was reported that the prevalence of diabetes in Bangladeshi adults of ages 20-79 years was 7.4% [9][10]. The prevalence will be 13% by 2030 [11][12]. In a separate study, the prevalence rate of diabetes among adults of some affluent families of Bangladesh was noted 43.9%. In another study conducted among some patients of urban and semi-urban areas of Bangladesh during 2016-17 27.7% diabetic patients were recorded [13]. In other studies also upward trend in rate of prevalence of diabetes was noted [14][15][16].
From the above discussion it is clear that diabetes is the major risk factor for different health hazards for people. Thus, obesity and diabetes are considered by WHO as epidemic worldwide [17]. In one study the biological risk factors of diabetes were discussed in detail [18]. The other risk factors were also reported in different studies in both home and abroad [19][20][21][22][23][24][25]. However, the problem of diabetes cannot be avoided, but its prevalence rate can be reduced if proper action plan is taken to improve the socioeconomic condition of the people. It was documented , both in home and abroad, that gender variation, family income and family expenditure, lower level of education, physical inactivity, dietary habit, sedentary activity, non-adherence in controlling high sugar level, etc. were the risk factors for obesity and hence for diabetes [26][27][28][29][30][31]. The present work was an attempt to identify some socioeconomic variables responsible for the prevalence of diabetes in Bangladeshi adults.

Methodology
To fulfil the objective of the study the analysis was done using the data collected from 498 males and 497 females of 18 years and above, totalling 995 respondents. These adults were investigated by some nurses and medical assistants working in some objectively selected diagnostic centres located in both urban and semi-urban areas of Bangladesh. The respondents of this study maintained the national sex ratio 50.1: 49.9 of male and female population of Bangladesh [32]. The sample also covered 464 urban and 531 rural people. The data were recorded during the session 2018-19. The data on different socioeconomic variables of each investigated respondent were recorded through a pre-designed and pre-tested questionnaire containing different questions related to residence, religion, gender, marital status, age, education, occupation, family income, and family expenditure. Beside these demographic data, other information were on life-style, viz. physical work, smoking habit, consumption of process food, and involvement in sedentary activity. The information of prevalence of any of the non-communicable diseases, duration of diabetes, and the stages of treatment of the disease including cost of treatment were also recorded. Some of the socioeconomic variables were qualitative and some were quantitative in nature, but all the variables were noted in nominal scale for ease of analysis. The data of weight (in kg) divided by height (in m 2 ) was used to measure the value of body mass index (BMI) to identify obese adults (if BMI ≥ 27.5; underweight, if BMI< 18.5; normal, if 18.5 ≤BMI< 23.0; overweight, if 23.0 <BMI< 27.5) [33]. They were also divided into 4 groups according to their blood pressure level (BP, mmHg). One group is of optimal (BP< 120/80), one is normal (BP< 130/85), another is high normal (BP< 140/90) and last one is hypertensive (BP ≥ 140/90) adults [34][35].
To identify the influence of the variables on prevalence of diabetes the risk ratio for diabetic patients of higher rate for a particular level of a socioeconomic variable was calculated. The association of socioeconomic variable with prevalence of different duration of diabetes was calculated. The significant association was decided if p-value of any Chi-square statistic ≤ 0.05 [P ( 2 χ ) ≤0.05].
Finally, binary logistic model was fitted to identify the influencing variable for prevalence of diabetes. All the statistical calculations were performed using SPSS version 25.

Result
The percentage of sample diabetic respondents was 67.0; 29.2% were suffering for less than 5 years, 20.7% were suffering for 5 to less than 10 years and another 17.1% were the diabetic patients for 10 years and above [

Results of Logistic Regression
The above presented results indicated that some of the socioeconomic variables were significantly associated with prevalence of diabetes for different durations. It meant that some variables had impact on prevalence. To identify those variables binary logistic regression model was fitted using the variables residence, religion, gender, marital status, age, occupation, family income, family expenditure, smoking habit, physical activity, consumption of process food, sedentary activity, blood pressure, and body mass index as independent variables. Though not significant regression was noted [Hosmer Lemshow Test, 2 χ =6.315, p-value= 0.612; Nagelkarke R-square=0.164], the variables gender, marital status, age, occupation, body mass index, and blood pressure had significant impacts on prevalence of diabetes. The results were shown in Table 2.

Discussion
Diabetes is one of the non-curable non-communicative diseases. It prevailed among 9.3% (463 million people, estimated) worldwide in 2019. The prevalence rate will be increased to 10.2% by 2030 and 10.8% (700 million people) by 2045 [36]. Most of the diabetic patients were in the age group 40-59 years. In another study it was reported that prevalence was higher among people of ages 61-65 years [37]. The reported risk factors for this disease are urbanization, age, illiteracy, lower economic condition, physical inactivity, smoking habit, alcoholism, obesity, and family history, etc. This study was an attempt to identify some socioeconomic variables responsible for prevalence of diabetes for different durations among adults of ages 18 years and above.
The results included in the study were the analytical information of data collected from adults residing in both urban and rural localities. The respondents were investigated from some pre-selected diagnostic centres. There were 67.0% diabetic patients, the percentages of rural and urban diabetic patients were 67.2 and 66.8, respectively. These two groups of adults were at similar risk of prevalence of diabetes. Muslim (85.2%) and non-Muslim (14.8%) adults were also at similar risk of prevalence. Similar risk of prevalence for religious groups was observed in another study also [38][39][40]. Higher risk of prevalence was noted for married adults (93.1%) compared to the risk of single adults. Similar result was observed in another study. The prevalence rate of diabetes was 85.1% among elderly people of ages 50 years and above. A big group (63.1%) of them were suffering for at least 10 years. Their risk of prevalence was 36% more than it was for others. Increasing trend of prevalence was noted with the increase in ages. Similar results were reported in other studies also [41]. Lower level of education including other factors was the risk factor for diabetes. But this study indicated that illiterate adults (6.5%) had lower risk of prevalence. Higher proportion (72.6%) of businessmen (23.5%) were diabetic patients and they had higher risk of prevalence. The prevalence rates for different occupational group were significantly different. This group usually did not do physical work. The different studies documented that physical inactivity is the risk factor for diabetes. However, inverse relationship between physical work and prevalence of diabetes was noted in this analysis. Family income, family expenditure, food habit, smoking habit and utilization of time are the lifestyle factors and these are also influencing factors for diabetes [42]. This study indicated that adults of lowest income group of families had higher risk of prevalence of diabetes. The percentage of smokers was 33.1. They were more exposed to the problem of diabetes [R.R. =1.16]. The prevalence was independent of habit of process food consumption. But higher risk [ R.R.=1.16] of prevalence was observed in adults involved in sedentary activity ( 44.4%) . In many studies in both home and abroad it was noted that obesity and diabetes were significantly associated. This study also indicated that with the increase in level of obesity the prevalence of diabetes was increasing and more (30.3%) obese adults were suffering for longer duration. Similar was the case for hypertensive adults. They were 26.0% more exposed to the problem. The rate of prevalence of diabetes was significantly increasing with the increase in level of blood pressure. Similar findings were observed in other studies [43].
Many socioeconomic variables were found associated with prevalence of diabetes. But significant impact of each of the variables, viz.gender variation, marital status, age, occupation, body mass index, and blood pressure was noted through Logistic regression analysis.

Conclusion
The information presented here were the analytical results of data collected from 995 Bangladeshi adults of 18 years and above. The data on different socioeconomic variables were collected to identify the responsible variables for the prevalence of diabetes for different durations. In the sample there were 67.0% diabetic patients and 17.1% were suffering for 10 years and above. The percentage of diabetic patients among 46.6% urban residents was 66.8 and among 85.2% Muslims it was 71.5%. But the risk of prevalence of the disease was similar for two religious groups and for both urban and rural residents. The prevalence rate among male (50.1%) respondents was 71.5% and among married persons (93.1%) it was 68.5%. The risks of prevalence for both these groups were higher as these were for their counter parts. The prevalence rate was 85.1% among elderly people (19.6%). The rate was in increasing trend with the increase in age. The elderly people had 36% more risk of prevalence. Illiterate people (6.5%) were at lower risk of the disease. Higher risk of prevalence was also noted for businessmen (23.5%), for adults of lowest income group of families (70.4%) and for lowest spending group of families (71.4%). But lower economy was not the cause of risk of prevalence. Smokers (33.1%) and adults involved in sedentary activity (44.4%) had higher risk of prevalence of diabetes. Higher proportion (25.5%) of smokers and adults involved in sedentary activity (23.3%) were suffering for at least 10 years. Smoking habit and sedentary activity were also the two risk factors for longer duration of diabetes. This study indicated that consumption of process food and physical inactivity were not the risk factors for prevalence. But obesity and hypertension were the risk factors for the prevalence. Longer duration of diabetes was noted among higher group of obese and hypertensive adults. The prevalence rate was increasing with the increase in level obesity and level of blood pressure. Finally, significant impact of the variable gender variation, age, marital status, occupation, body mass index, and blood pressure was observed on prevalence of diabetes.
As upward social mobility in the society and also in the country is prevailed, obesity, hypertension and diabetes cannot be avoided. These three health hazards are interrelated. These are influenced by many socioeconomic characteristics. So, attention should be focused to control the negative effects of these three health hazards. If anyone becomes successful in reducing body mass index, he or she will be successful in reducing diabetes. For this, people should be advised to maintain some norms for leading healthy life. These are: • Avoid first food, excessive salt and high fatty food and sugarbased food, and try to develop the habit of taking home made food as per as possible • Do any type of physical work and physical exercise • Walk whenever it is possible • Avoid sedentary activity as per as possible • Consult doctor whenever it is necessary and try to adhere strictly the suggestion of the medical practitioner to maintain the body weight • Try to maintain the blood sugar level below danger level • Avoid smoking and drinking alcohol Government health planners and health workers including rural social workers can do a lot to encourage the people to lead healthy life.