PREVALENCE AND SOCIODEMOGRAPHIC INEQUALITIES IN DEVELOPING TYPE 2 DIABETES MULTIMORBIDITIES IN SERBIA
Abstract
Introduction: The number of people living with diabetes is increasing worldwide, with the majority of those affected residing in low- and middle-income countries. Type 2 diabetes mellitus (T2DM) is often associated with the co-occurrence of one or more long-term conditions (LTCs), which might be affected by patients’ socioeconomic characteristics, however, to what extent, it is as yet unknown in Serbia. Therefore, we have aimed to examine the prevalence and impact of sociodemographic factors on T2DM multimorbidity in Serbia.
Method: Secondary data analysis of the Serbian National Health Surveys 2013 and 2019 was conducted in a population older than 45 years. Multinomial logistic regression models were used to investigate relative risk ratios with 95% confidence intervals and corresponding predicted probabilities between the sociodemographic profiles of participants in different disease groups (with/without T2DM and one or more LTCs).
Results: The prevalence of T2DM comorbidity and multimorbidity was 8.8% and 29.5%, respectively. Most often, T2DM co-occurred with stroke, myocardial infarction, and liver cirrhosis. Multimorbidity was associated with older age, the female gender, lower level of education, and lower income. The biggest gender gap was identified in the predicted probabilities for having T2DM and two or more LTCs among the subjects with the lowest level of education (women: p = 0.333 vs. men: p = 0.208) and in the lowest income quintile (women: p = 0.366 vs. men: p = 0.236), while the gender gap was not identified among those with at least a bachelor's degree (women: p = 0.258 vs. men: p = 0.260).
Conclusion: A comprehensive approach to identifying and subgrouping populations based on their risk of LTCs yields valuable insights that can facilitate early detection and disease management.
References
Key global findings 2021. [Internet]. 2021. [Accessed: 20 June 2024]. Available from: https://diabetesatlas .org/
Seewoodhary J, Benavides RV, Silveira A. Tropical medicine and diabetes: an integrative paradigm. Practical Diabetes. 2022; 39(5): 40–43. https://doi.org/10.1002/pdi.2420.
Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, et al. Multimorbidity. Nat Rev Dis Primers. 2022 Jul; 8(1). https://doi.org/10.1038/s41572-022-00376-4.
Guthrie B, Payne K, Alderson P, McMurdo MET, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012 Oct; 345: e6341. https://doi.org/10.1136/bmj.e6341.
Lam AA, Lepe A, Wild SH, Jackson C. Diabetes comorbidities in low-and middle-income countries: An umbrella review. Journal of Global Health. 2021 Jul;11:04040. https://doi.org/10.7189/jogh.11.04040.
Jovic D, Vukovic D, Marinkovic J. Prevalence and patterns of multi-morbidity in Serbian adults: A cross-sectional study. PLoS ONE. 2016 Feb; 11(2):1–14. https://doi.org/10.1371/journal.pone.0148646.
Institute of Public Health of Serbia. National Health Survey 2006. Belgrade: Institute of Public Health of Serbia Dr Milan Jovanovic Batut” 2007. [Internet]. Available from: https://www.batut.org.rs/download/publikacije/National%20Health%20Survey%20Serbia%202006.pdf
Statistical Office of the Republic of Serbia. The 2019 Serbian National Health Survey. Belgrade: Statistical Office of the Republic of Serbia, 2021. [Internet]. Available from: https://publikacije.stat.gov.rs/G2021/pdfE/G20216003.pdf
Ministry of Health of the Republic of Serbia. Results of the National Health Survey of the Republic of Serbia 2013. Belgrade: Ministry of Health of the Republic of Serbia, 2014. [Internet]. Available from: http://www.batut.org.rs/download/publikacije/2013SerbiaHealthSurvey.pdf
Janković J, Simić S, Marinković J. Inequalities that hurt: demographic, socio-economic and health status inequalities in the utilization of health services in Serbia. Eur J Public Health. 2010 Aug;20(4):389-96. doi: 10.1093/eurpub/ckp189.
Cicek M, Buckley J, Pearson-Stuttard J, Gregg EW. Characterizing Multimorbidity from Type 2 Diabetes: Insights from Clustering Approaches. Endocrinol Metab Clin North Am. 2021 Sep;50(3):531-558. doi: 10.1016/j.ecl.2021.05.012.
Khan A, Uddin S, Srinivasan U. Comorbidity network for chronic disease: A novel approach to understand type 2 diabetes progression. Int J Med Inform. 2018 Jul;115:1-9. doi: 10.1016/j.ijmedinf.2018.04.001.
Singh K, Patel SA, Biswas S, Shivashankar R, Kondal D, Ajay VS, et al. Multimorbidity in South Asian adults: prevalence, risk factors and mortality. J Public Health (Oxf). 2019 Mar 1;41(1):80-89. doi: 10.1093/pubmed/fdy017.
Afshar S, Roderick PJ, Kowal P, Dimitrov BD, Hill AG. Global Patterns of Multimorbidity: A Comparison of 28 Countries Using the World Health Surveys In: Springer, Cham; 2017:381–402.
Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, et al. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med. 2019 Jul 25;17(1):145. doi: 10.1186/s12916-019-1373-y.
Seng JJB, Kwan YH, Lee VSY, Tan CS, Zainudin SB, Thumboo J, et al. Differential Health Care Use, Diabetes-Related Complications, and Mortality Among Five Unique Classes of Patients With Type 2 Diabetes in Singapore: A Latent Class Analysis of 71,125 Patients. Diabetes Care. 2020 May;43(5):1048-1056. doi: 10.2337/dc19-2519.
Gruneir A, Markle-Reid M, Fisher K, Reimer H, Ma X, Ploeg J. Comorbidity Burden and Health Services Use in Community-Living Older Adults with Diabetes Mellitus: A Retrospective Cohort Study. Can J Diabetes. 2016 Feb;40(1):35-42. doi: 10.1016/j.jcjd.2015.09.002.
Alonso-Morán E, Orueta JF, Esteban JI, Axpe JM, González ML, Polanco NT, et al. Multimorbidity in people with type 2 diabetes in the Basque Country (Spain): Prevalence, comorbidity clusters and comparison with other chronic patients. Eur J Intern Med. 2015 Apr;26(3):197-202. doi: 10.1016/j.ejim.2015.02.005.
Jankovic J, Mirkovic M, Jovic-Vranes A, Santric-Milicevic M, Terzic-Supic Z. Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study. Public Health. 2018 Feb;155:35-42. doi: 10.1016/j.puhe.2017.11.014.
Bender AM, Vrangbæk K, Lange T, Brønnum-Hansen H, Andersen I. Joint effects of educational attainment, type 2 diabetes and coexisting morbidity on disability pension: results from a longitudinal, nationwide, register-based study. Diabetologia. 2021 Dec;64(12):2762-2772. doi: 10.1007/s00125-021-05559-4.
Jie JH, Li D, Jia LN, Chen Y, Yang Y, Zheng B, et al. Activities of daily living and its influencing factors for older people with type 2 diabetes mellitus in urban communities of Fuzhou, China. Front Public Health. 2022 Sep 26;10:948533. doi: 10.3389/fpubh.2022.948533.
