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Status and disparities of diabetes among urban and rural residents aged 40 years and older: insight from a population-based study in northeast China, 2017–2019
  1. Liying Xing1,2,
  2. Yuanmeng Tian2,
  3. Li Jing2,
  4. Min Lin3,
  5. Zhi Du1,
  6. Qun Sun4,
  7. Dong Dai5,
  8. Lei Shi6,
  9. Zuosen Yang2,
  10. Shuang Liu7
  1. 1Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
  2. 2Department of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, China
  3. 3Department of Cardiology, Central Hospital of Ben Xi City, Benxi, China
  4. 4Department of Chronic Disease, Disease Control and Prevention of Chao Yang City, Shenyang, China
  5. 5Department of Chronic Disease, Disease Control and Prevention of Dan Dong City, Dandong, China
  6. 6Department of Chronic Disease, Disease Control and Prevention of Liao Yang City, Liaoyang, China
  7. 7Department of Cardiovascular Ultrasound, China Medical University First Hospital, Shenyang, Liaoning, China
  1. Correspondence to Dr Shuang Liu, Cardiovascular Ultrasound, China Medical University First Hospital, Shenyang 110001, Liaoning, China; liushuang_cmu1h{at}


Objectives To evaluate the up-to-date epidemiology of diabetes in northeast China.

Methods The cross-sectional study was conducted between September 2017 and March 2019 using a multistage, stratified and cluster random sampling method. 18 796 participants (28.9% urban and 71.1% rural) aged ≥40 years were enrolled. Diabetes and pre-diabetes were diagnosed according to the history, fasting plasma glucose (FPG) and glycosylated haemoglobin A1c (HbA1c) levels.

Results The prevalence of diabetes was 17.1%, higher in urban than in rural residents (20.2% vs 15.8%, p<0.001). Meanwhile, the prevalence of pre-diabetes was 44.3%, higher in rural than in urban areas (49.4% vs 31.8%, p<0.001). The overall FPG and HbA1c were 6.10±1.94 mmol/L and 5.59%±1.08%. The FPG level was higher in rural area than in urban areas (6.15±1.83 mmol/L vs 5.97±2.18 mmol/L, p<0.001). Among participants with diabetes, 47.5% were aware of their diabetes condition; 39.5% were taking antidiabetic medications and 36.8% of people had their diabetes controlled. The awareness and treatment rates in rural areas were lower than those in urban areas (47.3% vs 57.5%, 34.4% vs 49.5%, p<0.001). Patients with diabetic, especially those in rural areas, tended to have multiple risk factors including hypertension (71.7%), overweight or obesity (69.6%) and dyslipidaemia (52.8%).

Conclusion A considerable burden of diabetes was observed in northeast China, with high percentage of untreated diabetes, high prevalence of pre-diabetes, high overall FPG level and multiple uncontrolled risk factors in patients with diabetics. Therefore, region-specific strategies on prevention and management of diabetes should be emphasised.

  • diabetes
  • epidemiology of diabetes
  • epidemiology

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  • Contributors SL and LX were responsible for the concept and design of the study. LX was responsible for the study coordination and conduct. LX and SL contributed to the drafting of the manuscript. LJ, YT, ML and ZD collected and analysed the data. LX, QS, DD, LS, ZY and ZD interpreted the data. All authors read and approved the final manuscript.

  • Funding This study was supported by the Department of Science and Technology of Liaoning Province (2018225065, 2019JH2/10300001) and the National Natural Science Foundation of China (81701699).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was granted approval by the Central Ethics Committee at the China National Center for Cardiovascular Disease (Beijing, China). Written informed consent was obtained from all participants.

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

  • Data availability statement Data are available upon reasonable request. The data sets used and analysed during this study are available from the corresponding author on reasonable request. Shuang Liu, MD, Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, 110001, China. Tel: +86-139-4034-0992, Fax: +86-24-23388556, E-mail: