| Diabetes is a kind of metabolic diseases with complex etiology,insidious onset,long duration and serious damage to health.It has become one of the foremost public health challenges in the global with globalization,urbanization,aging of the population,and change in lifestyle.In the recent decades,the prevalence of diabetes is increasing steadily which have great effect on people's health and life in China.Yunnan Province,a southwest region of China,has the highest diversity of minorities and highest number of unique ethnic ones in China.Howerver,there has been no study of impact of socioeconomic status on diabetes prevalence,control and self-management in unique ethnic minorities of Yunnan province.ObjectiveTo investigate the prevalence,awareness,treatment,control,and self-management of diabetes;the prevalence of risk factors and awareness of related knowledge of the disease among Na Xi,Li Su,Dai and Jing Po ethnic groups in Yunnan Province.To identity the socioeconomic difference in prevalence,awareness,treatment,control,and self-management of diabetes among these four unique ethnic minorities.The results of the study will offer valuable references for the prevention and control of diabetes in the ethnic regions of Yunnan Province.MethodsA multi-stage stratified random sampling method was employed to select a representative sample of 5532 ethnic minority residents aged 35 and over from Na Xi,Li Su,Dai and Jing Po ethnic minorities groups in Yunnan Province between August 2013 and August 2014.To get related information and data,a questionnaire survey and physical examination were carried out among the participants.Chi-square test was used to contrastive analysis of the prevalence,awareness,treatment,control,and self-management of diabetes;the prevalence of risk factors and awareness of related knowledge of the disease among four unique ethnic minorities.Principal component analysis was used to construct the socioeconomic comprehensive index.Multivariate logistic regression was also used to explore the socioeconomic difference in prevalence,awareness,treatment,control,and self-management of diabetes.Multilevel modeling was used to examine socioeconomic factors on prevalence,awareness,treatment,control,and self-management of the disease.Results1.Na Xi,Li Su,Dai and Jing Po ethnic groups,the standardized prevalence rate of diabetes was 3.9%,2.7%,7.6%and 4.3%,awareness rate was 55.7%,66.7%,56.1%and 41.6%,treatment rate was 39.1%,29.1%,41.9%and 30.8%,and control rate was 21.9%,20.5%,23.2%and 12.8%,respectively.Dai ethnic minority had highest prevalence rate,whereas Li Su ethnic minority had lowest(P<0.05).Li Su ethnic minority had highest awareness rate,whereas Jing Po ethnic minority was the lowest(P<0.05).Dai ethnic minority had highest treatment rate and Li Su ethnic minority had the lowest(P<0.05).The rate of monitoring blood glucose was 55.0%,12.5%,39.7%and 20.0%,and the rate of compliance to anti-diabetic drugs was 60.0%,41.7%,82.1%and 68.0%among four ethnic minorities diabetic patients,respectively.The highest rate of monitoring blood glucose was found in Na Xi ethnic minority whereas Li Su was the lowest(P<0.05).Additionally,the highest rate of compliance to anti-diabetic drugs was found in Dai ethnic minority,whereas the lowest was found in Li Su ethnic minority(P<0.05).There was no significant differences in control rate and taking measures to control diabetes including diet control,increased physical activity,weight control or weight loss,and quit smoking among four ethnic minorities diabetic patients(P>0.05).2.The overall prevalence,awareness,treatment,and control rate of diabetes was 4.7%,63.7%,48.1%and 24.8%among four ethnic minorities,respectively.The prevalence,awareness and treatment rate of diabetes increased with increasing age(P<0.01).The prevalence rate of diabetes decreased with increasing level of education(P<0.05),whereas treatment and control rate increased with increasing level of education(P<0.05).Ethnic minorities with better access to medical service and better household assets had higher prevalence and treatment rate of diabetes than their counterparts(P<0.05).As to self-management behaviors,the overall rate of monitoring blood glucose,medication adherence,diet control,increased physical activity,weight control or weight loss and quit smoking was 36.5%,68.9%,82.6%,18.0%,37.1%and 7.8%,respectively.Diabetic patients with higher level of education,better household assets and better access to.medical services had higher rate of monitoring blood glucose and medication adherence;Physical activity increased with increasing level of education(P<0.05).3.The overall awareness rate about diabetes-related knowledge was less than 15%among four ethnic minorities.The highest awareness rate about typical symptoms,risk factors and management knowledge of diabetes was found in Dai ethnic minority,whereas the lowest rate was seen in Jing Po(P?0.01).The top 6 prevalent risk factors were central obesity(39.2%),smoking(37.8%),high-fat diet intake(37.8%),hypertension(33.9%),drinking(33.2%),physical inactivity(32.8%).The highest rate of family history of the diseases,overweight,obesity,central obesity,hypertension,physical inactivity and inadequate intake of vegetables and fruit were found in Dai ethnic minority whereas Li Su was the lowest(P<0.01).Dai ethnic minority had highest rate of high-fat diet intake,whereas Jing Po had the lowest(P<0.01).Jing Po ethnic minority had highest rate of smoking and drinking,whereas Na Xi had the lowest(P<0.01).Li Su minority had the highest rate of irregular diets whereas Dai was the lowest(P<0.01).4.Socioeconomic status(SES)was found to be positively associated with the rate of diabetic prevalence,treatment and control,monitoring blood glucose,and medication adherence.The possibility of having diabetes among individual with mid-high level and the highest level-SES was 1.22 and 1.15 times higher than that of the lowest-SES,respectively;the possibility of treating diabetes was 2.19 and 1.86 times and sugar under control was 1.99 and 1.60 times higher than that of the lowest-SES,respectively.The possibility of monitoring blood glucose among diabetic patients with mid-high level and the highest level of SES was 1.91 and 2.02 times and medication adherence was 2.13 was 1.97 times higher than that of the lowest-SES,respectively.5.The results of multilevel modeling showed that diabetic patients with higher levels of education had higher awareness rate(OR=1.87,P<0.01);the patients with higher levels of education,better household assets and access to medical service had higher treatment rate(OR was 4.89,2.81,and 7.09,respectively;P<0.05).The patients with higher educational level,and better access to medical service had a greater probability of compliance to prescribed medicines(OR was 4.83,and 4.14,respectively;P<0.01).The patients with higher educational level,and higher household assets were more likely to monitor blood glucose(OR was 6.45,and 3.29,respectively;P?O.01).Residents from a higher-income township were more likely to be diabetic,have higher rate of treatment,and monitor blood glucose(OR was 1.84,3.04,and 4.34,respectively;P<0.05).Conclusions1.The overall prevalence rate of diabetes is medium under level,whereas the rates of awareness,treatment,control,and self-management are relatively low among Na Xi,Li Su,Dai and Jing Po ethnic groups in Yunnan province.There are significant ethnic disparity in rates of diabetic prevalence,awareness,treatment and self-management behaviors.2.Low levels of diabetes-related knowledge,and high prevalence rate of diabetic risk factors is found among four ethnic minorities.Significant ethnic differences in awareness rates of diabetes-related knowledge,and prevalence rate of diabetic risk factors exist among four different ethnicity.3.There are significant socioeconomic difference in prevalence,treatment,control,and self-management behavior 'of diabetes:Ethnic minorities with higher level of SES had higher rates of prevalence,treatment,control,and better self-management behaviors than their counterparts.4.Future prevention and intervention programs for diabetes should be focused on both individual-level and township-level socioeconomic factors in ethnic minorities areas of Yunnan Province. |
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