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dc.contributor.authorZhou, M.
dc.contributor.authorAstell-Burt, T.
dc.contributor.authorYin, P.
dc.contributor.authorFeng, X.
dc.contributor.authorPage, A.
dc.contributor.authorLiu, Y.
dc.contributor.authorLiu, J.
dc.contributor.authorLi, Y.
dc.contributor.authorLiu, S.
dc.contributor.authorWang, L.
dc.contributor.authorWang, L.
dc.contributor.authorWang, L.
dc.date.accessioned2015-07-24T09:10:03Z
dc.date.available2015-07-24T09:10:03Z
dc.date.issued2015-07-10
dc.identifier204800330
dc.identifier1c7349f4-9e8e-4f10-ac98-46b04fc48003
dc.identifier84936879453
dc.identifier000357640100005
dc.identifier.citationZhou , M , Astell-Burt , T , Yin , P , Feng , X , Page , A , Liu , Y , Liu , J , Li , Y , Liu , S , Wang , L , Wang , L & Wang , L 2015 , ' Spatiotemporal variation in diabetes mortality in China : multilevel evidence from 2006 and 2012 ' , BMC Public Health , vol. 15 , no. 1 . https://doi.org/10.1186/s12889-015-1982-0en
dc.identifier.issn1471-2458
dc.identifier.urihttps://hdl.handle.net/10023/7017
dc.descriptionThis study was funded by China National Science & Technology Pillar Program 2013(2013BAI04B02) from Ministry of Science and Technology, and The Australia-China Science and Research Fund (ACSRF17120).en
dc.description.abstractBackground: 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.
dc.format.extent923432
dc.language.isoeng
dc.relation.ispartofBMC Public Healthen
dc.subjectDiabetesen
dc.subjectMortalityen
dc.subjectGeographical variationen
dc.subjectTrendsen
dc.subjectRisk factorsen
dc.subjectG Geography (General)en
dc.subjectR Medicine (General)en
dc.subject3rd-DASen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.subjectSDG 11 - Sustainable Cities and Communitiesen
dc.subject.lccG1en
dc.subject.lccR1en
dc.titleSpatiotemporal variation in diabetes mortality in China : multilevel evidence from 2006 and 2012en
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Geography and Geosciencesen
dc.identifier.doihttps://doi.org/10.1186/s12889-015-1982-0
dc.description.statusPeer revieweden
dc.identifier.urlhttp://www.biomedcentral.com/1471-2458/15/633/additionalen


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