Urban-Rural Differences in the Trends of Type 1 and Type 2 Diabetes Among Adults Who Received Medical Treatment from Public Hospitals in Resource-Poor Community Tigray, Ethiopia

Abstract

Objective

This study carried out to describe urban-rural differences in the trend of type 1 and type 2 diabetes among adults who have received medical treatment from public hospitals over the last five years.

Methods

The trends of adult diabetes assessed from September 1, 2013, to August 31, 2018, using hospital-based retrospective medical records of 299,806 adult patients in the adult medical outpatient and emergency units. Data were collected using a uniform data abstraction format. An extended Mantel-Haenszel chi-square test of the linear trend used to examine the trend over time.

Results

Of the total 299,806 adult patients, 3056 (1.02% (95% CI: 0.98–1.06)) patients were confirmed diabetes patients. The overall trend in the proportion of diabetes had increased from 6.8 to 14.3 per 1000 adult patients. The trend of type 1 diabetes increased for both urban from 1.0 to 2.2 per 1000 adult urban residents and rural from 1.2 to 2.6 per 1000 adult rural residents, with statistically a significant increase (χ²= 9.1, P=0.002) and (χ²=17.8, P<0.001) for linear trend, respectively. The trend of type 2 diabetes increased for both urban from 6.9 to 14.0 per 1000 adult urban residents and rural from 4.0 to 9.5 per 1000 adult rural residents, with a statistically significant increase (χ²=68.4, P<0.001) and (χ²=74.2, P<0.001) for linear trend, respectively. The higher increase in the proportion of both type 1 and type 2 diabetes observed among women patients.

Conclusion

The trend in the proportion of type 1 and type 2 diabetes increasing for both urban and rural residents, with a higher increase observed among women. These findings highlight health-care professionals and policymakers to design effective public health policies to treat each type of disease.

Keywords:

• urban
• rural
• trend
• type 1 diabetes
• type 2 diabetes

Acknowledgments

The sudden death of Professor Fikre Enquo Selassie is extremely painful and hurting. He was not only a good professor of epidemiology and biostatistics but also, he had a unique human entity to his family, students and staff. It pains me to notify you that my supervisor, professor Fikre, left for his heavenly abode on October 28, 2019, on account of sudden death. Professor Fikre was heartily involved in all activities of the study from the proposal development to manuscript approval for publication. The authors express their gratitude to the Addis Ababa University for funding this project. Additionally, we would like to express our heartfelt thanks to the selected public hospitals’ administrative bodies, staff, data collectors and supervisors and Tigray Regional Health Bureau office for granting access to these data.

Author Contributions

All authors contributed from the development of the proposal to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. Specifically, GG conceived the idea and developed the study proposal, did the fieldwork, analyzed data, interpreted the findings, and led the manuscript writing. FEQ was involved in proposal development, planning the fieldwork, data analysis and interpretation, manuscript editing and manuscript review. ND and HY were involved in proposal development, planning the fieldwork, data interpretation, manuscript editing, and manuscript review.

Disclosure

The authors report no conflicts of interest in this work.