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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Spatiotemporal variation in diabetes mortality in China: multilevel evidence from 2006 and 2012

Authors: Maigeng Zhou, Thomas Astell-Burt, Peng Yin, Xiaoqi Feng, Andrew Page, Yunning Liu, Jiangmei Liu, Yichong Li, Shiwei Liu, Limin Wang, Lijun Wang, Linhong Wang

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Despite previous studies reporting spatial in equality in diabetes prevalence across China, potential geographic variations in diabetes mortality have not been explored.

Methods

Age and gender stratified annual diabetes mortality counts for 161 counties were extracted from the China Mortality Surveillance System and interrogated using multilevel negative binomial regression. Random slopes were used to investigate spatiotemporal variation and the proportion of variance explained was used to assess the relative importance of geographical region, urbanization, mean temperature, local diabetes prevalence, behavioral risk factors and relevant biomarkers.

Results

Diabetes mortality tended to reduce between 2006 and 2012, though there appeared to be an increase in diabetes mortality in urban (age standardized rate (ASR) 2006–2012: 10.5–13.6) and rural (ASR 10.8–13.0) areas in the Southwest region. A Median Rate Ratio of 1.47, slope variance of 0.006 (SE 0.001) and covariance of 0.268 (SE 0.007) indicated spatiotemporal variation. Fully adjusted models accounted for 37 % of this geographical variation, with diabetes mortality higher in the Northwest (RR 2.55, 95 % CI 1.74, 3.73) and Northeast (RR 2.68, 95 % CI 1.70, 4.21) compared with the South. Diabetes mortality was higher in urbanized areas (RR tertile 3 versus tertile 1 (‘RRt3vs1’) 1.39, 95 % CI 1.17, 1.66), with higher mean body mass index (RRt3vs1 1.46, 95 % CI 1.18, 1.80) and with higher average temperatures (RR 1.05 95 % CI 1.03, 1.08). Diabetes mortality was lower where consumption of alcohol was excessive (RRt3vs1 0.84, 95 % CI 0.72, 0.99). No association was observed with smoking, overconsumption of red meat, high mean sedentary time, systolic blood pressure, cholesterol, and diabetes prevalence.

Conclusions

Declines in diabetes mortality between 2006 and 2012 have been unequally distributed across China, which may imply differentials in diagnosis, management, and the provision of services that warrant further investigation.
Appendix
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Metadata
Title
Spatiotemporal variation in diabetes mortality in China: multilevel evidence from 2006 and 2012
Authors
Maigeng Zhou
Thomas Astell-Burt
Peng Yin
Xiaoqi Feng
Andrew Page
Yunning Liu
Jiangmei Liu
Yichong Li
Shiwei Liu
Limin Wang
Lijun Wang
Linhong Wang
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1982-0

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