Educational and economic disparities and risk factors associated with diabetes and impaired fasting glucose in Cambodia: analysis of a national population-based study

Abstract

BACKGROUND: In this study, we aimed to quantify the magnitude of educational and economic disparities and examine risk factors associated with diabetes and impaired fasting glucose in Cambodia. METHODS: We used data from the 2023 STEPwise approach to noncommunicable risk factor surveillance to analyse 3660 participants aged 18-69 years. We quantified the extent of disparities using the regression-based slope index of inequality (SII) and relative index of inequality (RII). We used multi-level modified Poisson regression models to identify the potential risk factors. RESULTS: Overall, the prevalence of diabetes and impaired fasting glucose was 6.4% (95% confidence interval (CI) = 5.6, 7.3) and 4.4% (95% CI = 3.6, 5.3). The magnitude of educational inequality in the prevalence of diabetes was significant, with the disease more concentrated among the non-educated population (SII = -7.6; 95% CI = -12.0, -3.3). Economic inequality in diabetes prevalence was less pronounced than education-based inequality at the national level (SII = -0.7; 95% CI = -4.5, 3.0); however, rural areas showed a concentration of diabetes among economically disadvantaged groups (SII = -4.7; 95% CI = -9.1, -0.3). Key factors associated with diabetes were advanced age ≥40 years, overweight (prevalence ratio (PR) = 1.4; 95% CI = 1.0, 2.0), obesity (PR = 1.7; 95% CI = 1.1, 2.5), comorbid hypertension (PR = 2.4; 95% CI = 1.8, 3.1), and daily alcohol consumption (PR = 2.0; 95% CI = 1.2, 3.3). Daily sugar-sweetened beverage consumption (PR = 1.8; 95% CI = 1.1, 3.1) also showed an increased risk of undiagnosed diabetes. CONCLUSIONS: The significant educational and economic disparities underscore the need for targeted interventions aimed at supporting non-educated and economically poor populations. Strengthening public health measures to address key risk factors, particularly alcohol and sugar-sweetened beverage consumption, is essential to curbing the growing burden of diabetes in Cambodia.