Educational and economic disparities and risk factors associated with diabetes and impaired fasting glucose in Cambodia: analysis of a national population-based study

Background
In this study, we aimed to quantify the magnitude of educational and economic disparities and examine risk factors associated with diabetes and impaired fasting glucose in Cambodia.

Methods
We used data from the 2023 STEPwise approach to noncommunicable risk factor surveillance to analyse 3660 participants aged 18–69 years. We quantified the extent of disparities using the regression-based slope index of inequality (SII) and relative index of inequality (RII). We used multi-level modified Poisson regression models to identify the potential risk factors.

Results
Overall, the prevalence of diabetes and impaired fasting glucose was 6.4% (95% confidence interval (CI) = 5.6, 7.3) and 4.4% (95% CI = 3.6, 5.3). The magnitude of educational inequality in the prevalence of diabetes was significant, with the disease more concentrated among the non-educated population (SII = –7.6; 95% CI = –12.0, –3.3). Economic inequality in diabetes prevalence was less pronounced than education-based inequality at the national level (SII = –0.7; 95% CI = –4.5, 3.0); however, rural areas showed a concentration of diabetes among economically disadvantaged groups (SII = –4.7; 95% CI = –9.1, –0.3). Key factors associated with diabetes were advanced age ≥40 years, overweight (prevalence ratio (PR) = 1.4; 95% CI = 1.0, 2.0), obesity (PR = 1.7; 95% CI = 1.1, 2.5), comorbid hypertension (PR = 2.4; 95% CI = 1.8, 3.1), and daily alcohol consumption (PR = 2.0; 95% CI = 1.2, 3.3). Daily sugar-sweetened beverage consumption (PR = 1.8; 95% CI = 1.1, 3.1) also showed an increased risk of undiagnosed diabetes.

Conclusions
The significant educational and economic disparities underscore the need for targeted interventions aimed at supporting non-educated and economically poor populations. Strengthening public health measures to address key risk factors, particularly alcohol and sugar-sweetened beverage consumption, is essential to curbing the growing burden of diabetes in Cambodia.