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  • Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participants
    Publication . Danaei, G; Fahimi, S; Lu, Y; Zhou, B; Hajifathalian, K; Di Cesare, M; Lo, WC; Reis-Santos, B; Cowan, MJ; Shaw, JE; Bentham, J; Mohammad, K; Mohan, V; Mohd Yusoff, MF; Møller, NC; Molnár, D; Aguilar-Salinas, CA; Mondo, CK; Moreno, LA; Morgan, K; El Ati, J; Jonas, JB; Moschonis, G; Mossakowska, M; Mostafa, A; Mota, J; Muiesan, ML; Müller-Nurasyid, M; Mursu, J; Ahmadvand, A; Nagel, G; Námešná, J; Joshi, P; Elosua, R; Nang, EE; Nangia, VB; Navarrete-Muñoz, EM; Ndiaye, NC; Nervi, F; Nguyen, ND; Nieto-Martínez, RE; Alvarado, L; Al Nsour, M; Kafatos, A; Ning, G; Lin, JK; Ninomiya, T; Noale, M; Noto, D; Ochoa-Avilés, M; Oh, K; Onat, A; Osmond, C; Otero, JA; Kalter-Leibovici, O; Palmieri, L; Alkerwi, A; Erasmus, RT; Panda-Jonas, S; Panza, F; Parsaeian, M; Peixoto, SV; Pereira, AC; Peters, A; Peykari, N; Kasaeian, A; Pilav, A; Pitakaka, F; Piwonska, A; Erem, C; Amouyel, P; Piwonski, J; Plans-Rubió, P; Porta, M; Portegies, ML; Poustchi, H; Katz, J; Pradeepa, R; Price, JF; Punab, M; Qasrawi, RF; Ergor, G; Qorbani, M; Andersen, L. B.; Raitakari, O; Ramachandra Rao, S; Ramachandran, A; Kaur, P; Ramos, R; Rampal, S; Rathmann, W; Redon, J; Reganit, PF; Eriksen, L; Rigo, F; Robinson, SM; Anderssen, S. A.; Robitaille, C; Kavousi, M; Rodríguez, LA; Rodríguez-Artalejo, F; del Cristo Rodriguez-Perez, M; Rojas-Martinez, R; Romaguera, D; Rosengren, A; Escobedo-de la Peña, J; Rubinstein, A; Ornelas, Rui; Ruiz-Betancourt, BS; Kelishadi, R; Andrade, DS; Rutkowski, M; Sabanayagam, C; Sachdev, HS; Saidi, O; Sakarya, S; Salanave, B; Fall, CH; Salonen, JT; Salvetti, M; Ali, MK; Sánchez-Abanto, J; Santos, RN; Anjana, RM; Santos, R; Sardinha, LB; Scazufca, M; Schargrodsky, H; Scheidt-Nave, C; Farzadfar, F; Shaw, JE; Dhana, K; Shibuya, K; Shin, Y; Shiri, R; Siantar, R; Aounallah-Skhiri, H; Sibai, AM; Simon, M; Simons, J; Simons, LA; Felix-Redondo, FJ; Kengne, AP; Sjostrom, M; Slowikowska-Hilczer, J; Slusarczyk, P; Smeeth, L; Snijder, MB; Solfrizzi, V; Aris, T; Sonestedt, E; Soumare, A; Staessen, JA; Kersting, M; Ferguson, TS; Steene-Johannessen, J; Stehle, P; Stein, AD; Stessman, J; Stöckl, D; Stokwiszewski, J; Strufaldi, MW; Arlappa, N; Sun, CA; Khader, YS; Sundström, J; Fernández-Bergés, D; Suriyawongpaisal, P; Sy, RG; Tai, ES; Tarawneh, M; Tarqui-Mamani, CB; Thijs, L; Tolstrup, JS; Topbas, M; Khang, YH; Arveiler, D; Torrent, M; Bixby, H; Traissac, P; Trinh, OT; Tulloch-Reid, MK; Tuomainen, TP; Turley, ML; Tzourio, C; Ueda, P; Kiechl, S; Ukoli, FM; Ulmer, H; Assah, FK; Ferrari, M; Valdivia, G; van Valkengoed, IG; Vanderschueren, D; Vanuzzo, D; Vega, T; Velasquez-Melendez, G; Kim, J; Veronesi, G; Verschuren, M; Vioque, J; Virtanen, J; Ferreccio, C; Avdicová, M; Visvikis-Siest, S; Viswanathan, B; Vollenweider, P; Voutilainen, S; Kiyohara, Y; Wade, AN; Wagner, A; Walton, J; Mohamud, WN; Wang, MD; Finn, JD; Wang, YX; Balakrishna, N; Wannamethee, SG; Weerasekera, D; Kolsteren, P; Whincup, PH; Widhalm, K; Wiecek, A; Wilks, RJ; Willeit, J; Wojtyniak, B; Föger, B; Wong, TY; Woo, J; Bandosz, P; Korrovits, P; Woodward, M; Wu, AG; Wu, FC; Wu, SL; Xu, H; Yang, X; Ye, X; Foo, LH; Yoshihara, A; Younger-Coleman, NO; Koskinen, S; Zambon, S; Barbagallo, CM; Zargar, AH; Zdrojewski, T; Zhao, W; Zheng, Y; Barceló, A; Batieha, AM; Fouad, HM; Baur, LA; Di Castelnuovo, AF; Ben Romdhane, H; Bernabe-Ortiz, A; Bhargava, SK; Bi, Y; Bjerregaard, P; Björkelund, C; Blake, M; Blokstra, A; Bo, S; Francis, DK; Ezzati, M; Boehm, BO; Boissonnet, CP; Bovet, P; Brajkovich, I; Breckenkamp, J; Brewster, LM; Brian, GR; Bruno, G; Bugge, A; Cabrera de León, A; Kratzer, W; Franco Mdo, C; Can, G; Cândido, AP; Capuano, V; Carvalho, M. J.; Casanueva, FF; Caserta, CA; Castetbon, K; Chamukuttan, S; Chaturvedi, N; Kromhout, D; Chen, CJ; Frontera, G; Chen, F; Chen, S; Cheng, CY; Chetrit, A; Chiou, ST; Cho, Y; Chudek, J; Cifkova, R; Kula, K; Claessens, F; Concin, H; Furusawa, T; Cooper, C; Cooper, R; Costanzo, S; Cottel, D; Cowell, C; Crujeiras, AB; D'Arrigo, G; Kurjata, P; Dallongeville, J; Dankner, R; Dauchet, L; Magliano, D; de Gaetano, G; De Henauw, S; Deepa, M; Dehghan, A; Gaciong, Z; Galbarczyk, A; Kyobutungi, C; Garnett, SP; Gaspoz, JM; Gasull, M; Gates, L; Geleijnse, JM; Ghasemain, A; Giampaoli, S; Gianfagna, F; Bovet, P; Giovannelli, J; Lachat, C; Gonzalez Gross, M; González Rivas, JP; Gorbea, MB; Gottrand, F; Grant, JF; Grodzicki, T; Grøntved, A; Gruden, G; Gu, D; Miranda, JJ; Laid, Y; Guan, OP; Guerrero, R; Guessous, I; Guimaraes, AL; Gutierrez, L; Hardy, R; Hari Kumar, R; Heidemann, C; Hihtaniemi, IT; Ho, SY; Lam, TH; Khang, YH; Ho, SC; Hofman, A; Horimoto, AR; Hormiga, CM; Horta, BL; Houti, L; Hussieni, AS; Huybrechts, I; Hwalla, N; Lanska, V; Iacoviello, L; Stevens, GA; Iannone, AG; Ibrahim, MM; Ikeda, N; Ikram, MA; Irazola, VE; Islam, M; Iwasaki, M; Jacobs, JM; Djalalinia, S; Jafar, T; Jasienska, G; Riley, LM; Jiang, CQ; Lappas, G; Abdeen, ZA; Laxmaiah, A; Leclercq, C; Lee, J; Lee, J; Lehtimäki, T; Lekhraj, R; León-Muñoz, LM; Li, Y; Doua, K; Lim, WY; Lima-Costa, MF; Kadir, KA; Lin, HH; Lin, X; Lissner, L; Lorbeer, R; Lozano, JE; Lundqvist, A; Lytsy, P; Drygas, W; Ma, G; Machado-Coelho, GL; Machi, S; Abu-Rmeileh, M; Maggi, S; Magliano, D; Makdisse, M; Mallikharjuna v, K; Manios, Y; Manzato, E; Du, Y; Margozzini, P; Marques-Vidal, P; Martorell, R; Masoodi, SR; Acosta-Cazares, B; Matsha, TE; Mbanya, JC; McFarlane, SR; McGarvey, ST; McLachlan, S; Egbagbe, EE; McNulty, BA; Mediene-Benchekor, S; Meirhaeghe, A; Menezes, AM; Merat, S; Aekplakorn, W; Meshram, II; Mi, J; Miquel, JF; Miranda, JJ; Eggertsen, R; Mohamed, MK
    Background Diabetes has been defi ned on the basis of diff erent biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the eff ect of diff erent diagnostic defi nitions on both the population prevalence of diabetes and the classifi cation of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in diff erent regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defi ning diabetes. Diabetes was defi ned using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT defi nitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using diff erent defi nitions graphically and by regression analyses. We calculated sensitivity and specifi city of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specifi city in each survey, and then pooled results using a random-eff ects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2–6 percentage points at diff erent prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age–sex–survey groups and higher in another 41·6%; in the other 15·6%, the two defi nitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants’ age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specifi c communities. Diabetes defi ned as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3–54·3%) and a pooled specifi city of 99·74% (99·71–99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defi ned based on FPG or-2hOGTT was 30·5% (28·7–32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation Diff erent biomarkers and defi nitions for diabetes can provide diff erent estimates of population prevalence of diabetes, and diff erentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based defi nition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
    2015Journal article Open access Show more
  • Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants
    Publication . Zhou, B; Lu, Y; Hajifathalian, K; Bentham, J; Di Cesare, M; Danaei, G; Bixby, H; Cowan, MJ; Ali, MK; Taddei, C.; Lo, WC; Ninomiya, T; Noale, M; Noto, D; Nsour, MA; Ochoa-Avilés, AM; De Henauw, S; Oh, K; Onat, A; Ordunez, P; Hormiga, CM; Lin, X; Adams, R; Osmond, C; Otero, JA; Owusu-Dabo, E; Pahomova, E; Palmieri, L; Panda-Jonas, S; Deepa, M; Panza, F; Parsaeian, M; Lissner, L; Mbanya, JC; Peixoto, SV; Pelletier, C; Aekplakorn, W; Peltonen, M; Peters, A; Peykari, N; Pham, ST; Pilav, A; Dehghan, A; Lorbeer, R; Pitakaka, F; Cifkova, R; Piwonska, A; Piwonski, J; Plans-Rubió, P; Porta, M; Aguilar-Salinas, CA; Portegies, ML; Poustchi, H; Pradeepa, R; Lozano, JE; Price, JF; Deschamps, V; Horta, BL; Punab, M; Qasrawi, RF; Qorbani, M; Radisauskas, R; Rahman, M; Raitakari, O; Agyemang, C; Luksiene, D; Rao, SR; Ramachandran, A; Ramke, J; Houti, L; Dhana, K; Ramos, R; Rampal, S; Rathmann, W; Redon, J; Reganit, PF; Paciorek, CJ; Rigo, F; Robinson, SM; Ahmadvand, A; Robitaille, C; Howitt, C; Rodríguez-Artalejo, F; Di Castelnuovo, AF; Rodriguez-Perez Mdel, C; Rodríguez-Villamizar, LA; Rojas-Martinez, R; Lundqvist, A; Ronkainen, K; Rosengren, A; Rubinstein, A; Ornelas, Rui; Ruiz-Betancourt, BS; Htay, TT; Al-Othman, AR; Russo Horimoto, RV; Stevens, GA; Rutkowski, M; Lytsy, P; Sabanayagam, C; Sachdev, HS; Saidi, O; Sakarya, S; Salanave, B; Salonen, JT; Htet, AS; Salvetti, M; Sánchez-Abanto, J; Alkerwi, A; Ma, G; Djalalinia, S; Santos, D; Santos, R. N. dos; Santos, R; Saramies, JL; Sardinha, LB; Sarrafzadegan, N; Htike, MM; Saum, KU; Scazufca, M; Crujeiras, AB; Schargrodsky, H; Scheidt-Nave, C; Doua, K; Amouyel, P; Sein, AA; Sharma, SK; Shaw, JE; Shibuya, K; Hu, Y; Shin, Y; Hata, J; Shiri, R; Siantar, R; Sibai, AM; Simon, M; Drygas, W; Simons, J; Amuzu, A; Simons, LA; Sjostrom, M; Hussieni, AS; Machado-Coelho, GL; Slowikowska-Hilczer, J; Slusarczyk, P; Smeeth, L; Snijder, MB; So, HK; Sobngwi, E; Du, Y; Söderberg, S; Solfrizzi, V; Andersen, LB; Machi, S; Huybrechts, I; Sonestedt, E; Soumare, A; Staessen, JA; Stathopoulou, MG; Steene-Johannessen, J; Stehle, P; Stein, AD; Dzerve, V; Stessman, J; Maggi, S; Stöckl, D; Hwalla, N; Stokwiszewski, J; Anderssen, S. A.; Stronks, K; Strufaldi, MW; Sun, CA; Sundström, J; Sung, YT; Suriyawongpaisal, P; Magliano, DJ; Egbagbe, EE; Sy, RG; Claessens, F; Tai, ES; Tamosiunas, A; Tang, L; Anjana, RM; Tarawneh, M; Tarqui-Mamani, CB; Taylor, A; Makdisse, M; Theobald, H; Thijs, L; Eggertsen, R; McGarvey, ST; Thuesen, BH; Tolonen, HK; Tolstrup, JS; Topbas, M; Torrent, M; Aounallah-Skhiri, H; Mallikharjuna Rao, K; Traissac, P; Trinh, OT; Tulloch-Reid, MK; Tuomainen, TP; Iacoviello, L; El Ati, J; Turley, ML; Tzourio, C; Ueda, P; Ukoli, FA; Manios, Y; Ulmer, H; Uusitalo, HM; Aris, T; Valdivia, G; Valvi, D; Iannone, AG; van Rossem, L; Elosua, R; van Valkengoed, IG; Vanderschueren, D; Bennett, JE; Vanuzzo, D; Vega, T; Velasquez-Melendez, G; Veronesi, G; Verschuren, WM; Arlappa, N; Ibrahim, MM; Verstraeten, R; Viet, L; Erasmus, RT; Manzato, E; Vioque, J; Virtanen, JK; Visvikis-Siest, S; Viswanathan, B; Vollenweider, P; Voutilainen, S; Vrijheid, M; Ikeda, N; Wade, AN; Arveiler, D; Margozzini, P; Wagner, A; Riley, LM; Walton, J; Wan Mohamud, WN; Wang, F; Wang, MD; Wang, Q; Wang, YX; Ikram, MA; Wannamethee, SG; He, J; Weerasekera, D; Whincup, PH; Assah, FK; Erem, C; Widhalm, K; Wiecek, A; Wijga, AH; Wilks, RJ; Willeit, J; Irazola, VE; D'Arrigo, G; Wilsgaard, T; Wojtyniak, B; Wong, TY; Woo, J; Woodward, M; Ergor, G; Avdicová, M; Wu, FC; Wu, SL; Xu, H; Marques-Vidal, P; Islam, M; Yan, W; Yang, X; Ye, X; Yoshihara, A; Younger-Coleman, NO; Zambon, S; Eriksen, L; Zargar, AH; Azizi, F; Martorell, R; Zdrojewski, T; Iwasaki, M; Zhao, W; Zheng, Y; Zuñiga Cisneros, J; Balakrishna, N; Bandosz, P; Barbagallo, CM; Barceló, A; Escobedo-de la Peña, J; Masoodi, SR; Batieha, AM; Baur, LA; Jacobs, JM; Romdhane, HB; Benet, M; Bernabe-Ortiz, A; Bharadwaj, S; Bhargava, SK; Bi, Y; Bjerregaard, P; Mathiesen, EB; Bjertness, E; Fall, CH; Bjertness, MB; Concin, H; Björkelund, C; Blokstra, A; Bo, S; Boehm, BO; Boissonnet, CP; Bovet, P; Matsha, TE; Brajkovich, I; Breckenkamp, J; Brenner, H; Farzadfar, F; Jafar, T; Brewster, LM; Brian, GR; Bruno, G; Bugge, A; Cabrera de León, A; Mbanya, JC; Can, G; Cândido, AP; Capuano, V; Carlsson, AC; Carvalho, M. J.; Mohan, V; Felix-Redondo, FJ; Casanueva, FF; Casas, JP; Caserta, CA; McFarlane, SR; Castetbon, K; Chamukuttan, S; Chaturvedi, N; Chen, CJ; Chen, F; Chen, S; Jamil, KM; Cheng, CY; Ferguson, TS; Chetrit, A; McGarvey, ST; Chiou, ST; Cho, Y; Chudek, J; Fernández-Bergés, D; Ferrari, M; Miranda, JJ; Ferreccio, C; Jasienska, G; Feskens, EJ; Finn, JD; Ezzati, M; Föger, B; Foo, LH; Forslund, AS; Fouad, HM; Francis, DK; Franco Mdo, C; Franco, OH; Bjerregaard, P; Jiang, CQ; Frontera, G; Heidemann, C; Furusawa, T; Gaciong, Z; Garnett, SP; Gaspoz, JM; Gasull, M; Gates, L; Geleijnse, JM; Ghasemian, A; Ghimire, A; Jonas, JB; McLachlan, S; Rivera, JA; Giampaoli, S; Gianfagna, F; Giovannelli, J; Giwercman, A; Gross, MG; González Rivas, JP; Gorbea, MB; Gottrand, F; Grafnetter, D; Reis-Santos, B; Joshi, P; Grodzicki, T; Fouad, HM; Grøntved, A; Gruden, G; Gu, D; Guan, OP; Guerrero, R; Guessous, I; Guimaraes, AL; McNulty, BA; Gutierrez, L; Kafatos, A; Hambleton, IR; Hardy, R; Ma, G; Hari Kumar, R; Kalter-Leibovici, O; Kasaeian, A; Cooper, C; Katz, J; Mediene-Benchekor, S; Kaur, P; Onat, A; Kavousi, M; Keinänen-Kiukaanniemi, S; Kelishadi, R; Kengne, AP; Kersting, M; Khader, YS; Khalili, D; Cooper, R; Meirhaeghe, A; Khang, YH; Kiechl, S; Kim, J; Pilav, A; Kolsteren, P; Korrovits, P; Kratzer, W; Kromhout, D; Kujala, UM; Kula, K; Menezes, AM; Costanzo, S; Kyobutungi, C; Laatikainen, T; Lachat, C; Laid, Y; Ramachandran, A; Lam, TH; Landrove, O; Lanska, V; Lappas, G; Merat, S; Laxmaiah, A; Cottel, D; Leclercq, C; Lee, J; Lee, J; Lehtimäki, T; Lekhraj, R; Romdhane, HB; León-Muñoz, LM; Li, Y; Meshram, II; Lim, WY; Lima-Costa, MF; Cowell, C; Lin, HH; Mi, J; Miquel, JF; Herrala, S; Miranda, JJ; Abdeen, ZA; Dallongeville, J; Mohamed, MK; Mohammad, K; Mohammadifard, N; Mohan, V; Mohd Yusoff, MF; Møller, NC; Molnár, D; Hihtaniemi, IT; Mondo, CK; Morejon, A; Moreno, LA; Dankner, R; Abdul Kadir, K; Morgan, K; Moschonis, G; Mossakowska, M; Mostafa, A; Mota, J; Ho, SY; Motta, J; Mu, TT; Muiesan, ML; Müller-Nurasyid, M; Dauchet, L; Mursu, J; Abu-Rmeileh, NM; Nagel, G; Námešná, J; Nang, EE; Ho, SC; NangThetia, VB; Navarrete-Muñoz, EM; Ndiaye, NC; Nenko, I; Nervi, F; de Gaetano, G; Nguyen, ND; Nguyen, QN; Acosta-Cazares, B; Nieto-Martínez, RE; Hofman, A; Ning, G
    Background One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are aff ecting the number of adults with diabetes. Methods We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defi ned as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.
    2016Journal article Open access Show more