Exploratory spatial analysis of diabetes mortality and its relationship with the socioeconomic conditions of Colombian municipalities

Type 2 diabetes mellitus prevalence has increased worldwide, especially in low- and middle-income countries. This study aimed to evaluate in the Colombian context whether the geographic variations of mortality due to type 2 diabetes mellitus are random or statistically significant and to measure the effect of the socioeconomic conditions of municipalities on these variations. An ecological study of trends for regions and subregions was undertaken considering two periods (2003-2009 and 2010-2016). The study population consisted of adults of 20 to 79 years old residing in each of Colombia’s municipalities during the period 2003-2016. Smoothed and standardized mortality rates were obtained by fitting a hierarchical Bayesian model, which considers the spatial structure of the data. Four socioeconomic variables related to municipal deprivation and development were included into the model to obtain their relative risk (RR) and 95% credible intervals. Mortality due to type 2 diabetes mellitus decrease between 2003 and 2016 in Colombia, both nationally and regionally. In addition, there was a clear positive association between mortality due to diabetes mellitus and the level of municipal development; the wealthiest and most developed municipalities had higher mortality risks.

2型糖尿病（Type 2 diabetes mellitus）的患病率在全球范围内持续攀升，在中低收入国家中尤为突出。本研究以哥伦比亚为研究场景，旨在评估该国2型糖尿病所致死亡的地理分布差异是否为随机分布，抑或具有统计学显著性，并量化市级行政区的社会经济状况对该类分布差异的影响效应。本研究采用区域与次区域趋势生态学研究设计，纳入2003-2009年及2010-2016年两个研究时段。研究队列涵盖2003-2016年间居住于哥伦比亚各市级行政区的20至79岁成年人群。通过拟合考虑数据空间结构的分层贝叶斯模型，获得经平滑处理与标准化的死亡率。模型纳入四项与市级行政区贫困及发展水平相关的社会经济变量，以计算各变量的相对风险（relative risk, RR）及95%可信区间。2003至2016年间，哥伦比亚全国及各区域的2型糖尿病所致死亡率均呈下降态势。此外，糖尿病所致死亡率与市级行政区发展水平呈显著正相关：经济最发达、最为富裕的市级行政区，其死亡风险更高。