Socioeconomic Inequalities of Undiagnosed Diabetes in a Resource-Poor Setting: Insights from the Cross-Sectional Bangladesh Demographic and Health Survey 2011

Diabetes mellitus is rising disproportionately but is not frequently diagnosed until complications appear, which results in adverse health consequences. We estimated the prevalence of undiagnosed diabetes among adult diabetic patients and associated socioeconomic inequalities in Bangladesh. We used nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2011 data. Among patients with diabetes, we identified undiagnosed cases as having fasting plasma glucose 7.0 mmol/L, never having taken prescribed medicine and being told by health professionals. Among 938 patients with diabetes, 53.4% remained undiagnosed. The poorest (75.9%) and rural (59.0%) patients had significantly higher undiagnosed cases than the richest (36.0%) and urban (42.5%), respectively. Multiple logistic regression analysis revealed that the likelihood of being undiagnosed was lower among patients with age 70 years vs. 35-39 years (adjusted odds ratio (AOR) = 0.35; 95% confidence interval (CI) 0.19, 0.64) and patients with higher education vs. no education (AOR = 0.36; 95% CI 0.21, 0.62). Conversely, a high level of physical activity and being in a poor socioeconomic quintile were associated with a higher risk of remaining undiagnosed for diabetes. The Concentration Index (C) also showed that undiagnosed diabetes was largely distributed among the socioeconomically worse-off group in Bangladesh (C = -0.35). Nationwide diabetes screening programs may reduce this problem in Bangladesh and other similar low-income settings.