Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

• DOI: 10.2337/dc20-0886
• Publication Date: 2020-10-16T04:25:13Z
• Authors: Ranjit Mohan Anjana; Viswanathan Mohan; Sumathy Rangarajan; Hertzel C. Gerstein; Ulagamadesan Venk...; Patrick Sheridan; Gilles R. Dagenais; Scott A. Lear; Koon Teo; Kubilay Karsidag; Khalid F. Alhabib; Khalid Yusoff; Noorhassim Ismail; Prem K. Mony; Patricio Lopez-Ja...; Jephat Chifamba; Lia M. Palileo-Vi...; Romaina Iqbal; Afzalhussein Yusu...; Iolanthe M. Kruger; Annika Rosengren; Ahmad Bahonar; Katarzyna Zatonska; Karen Yeates; Rajeev Gupta; Wei Li; Lihua Hu; M. Omar Rahman; P.V.M. Lakshmi; Thomas Iype; Alvaro Avezum; Rafael Diaz; Fernando Lanas; Salim Yusuf
• Keywords: National Death Index; Risk of mortality

OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with without diabetes in countries differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 aged 35–70 years from 4 high-income (HIC), 12 middle-income (MIC), 5 low-income (LIC). mean follow-up was 9.0 ± 3.0 years. RESULTS Among those diabetes, CVD (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), 13.8, 7.2, 4.2 5.7, 2.2, 1.0 0.001) were considerably higher LIC compared HIC. Within LIC, the lowest tertile wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast MIC, increased remained unchanged even after adjustment for behavioral risk factors treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] 1.78 [1.36–2.34]). CONCLUSIONS rates, markedly remaining treatments. There is an urgent need improve access care reduce excess particularly poorer strata society.