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Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study
  1. Juliet Addo1,
  2. Charles Agyemang2,
  3. Ama de-Graft Aikins3,
  4. Erik Beune2,
  5. Matthias B Schulze4,
  6. Ina Danquah4,
  7. Cecilia Galbete4,
  8. Mary Nicolaou2,
  9. Karlijn Meeks2,
  10. Kerstin Klipstein-Grobusch5,6,
  11. Silver Bahendaka7,
  12. Frank P Mockenhaupt8,
  13. Ellis Owusu-Dabo9,
  14. Anton Kunst2,
  15. Karien Stronks2,
  16. Liam Smeeth1
  1. 1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
  4. 4Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
  5. 5Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  6. 6Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  7. 7International Diabetes Federation, Kampala, Uganda
  8. 8Institute of Tropical Medicine and International Health, Charité—University Medicine Berlin, Berlin, Germany
  9. 9Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  1. Correspondence to Dr Juliet Addo, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street London, London WC1E7HT, UK; juliet.addo{at}


Background The prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana.

Methods Data were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25–70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe.

Results A total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations.

Conclusions The association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations.

  • Epidemiology of diabetes

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  • Contributors JA and LS planned the study. JA, AdGA, EB, KM, FPM and EOD conducted the data collection in the various locations and reported on the work presented. JA drafted the initial manuscript with intellectual input from CA, AdGA, EB, MBS, ID, CG, MN, KM, KKG, SB, FPM, EOD, AK and KS. JA submitted the study. JA and LS are responsible for the overall content as guarantors.

  • Funding This work was supported by the European Commission under the Framework Programme (Grant Number: 278901). LS's contribution was supported by the Wellcome Trust, grant number WT082178.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval Ethics committees of the London School of Hygiene and Tropical Medicine, University of Amsterdam, University of Ghana, Kwame Nkrumah University of Science and Technology, University Medicine Berlin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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