BACKGROUND
The mechanisms that link diabetes to disability may vary across populations.
OBJECTIVE
This study investigated gender by place differences in the behavioral and medical mechanisms behind the link between diabetes (DM) and disability in eight countries.
METHODS
We borrowed data from Research on Early Life and Aging Trends and Effects (RELATE). This analysis included adults from eight countries including Barbados, Brazil, Costa Rica, Chile, Cuba, Puerto Rico, Mexico, and Uruguay. Diabetes was the independent variable, disability (activities of daily living) was the dependent variable, socioeconomics, obesity, health behaviors, and comorbidities were covariates, and gender was the moderator. We used country by gender specific- logistic regressions to test the effect of DM on disability after adjusting for socioeconomics (Model 1), socioeconomics, health behaviors, and obesity (Model 2), and socioeconomics, obesity, health behaviors, and medical comorbid conditions (Model 3).
RESULTS
Gender by country specific patterns of association between DM and disability were observed in Puerto Rico, Mexico, Brazil, Chile, and Cuba. In Puerto Rico, in men, DM – ADL could be explained by health behaviors and obesity, for women, however, the impact of DM on ADL was above all confounders for women. In Mexico, for men, DM was not associated with disability, however, for women, there was a link which could be explained by health behaviors and obesity. In Brazil, for men, DM – ADL limitation link could be fully explained by health behaviors and obesity, for women, however, DM was not associated with ADL at all. In Chile, for men, DM was not associated with ADL limitation, for women, however, there was an association between DM and ADL limitation which could not be explained by health behaviors, obesity, or comorbid medical conditions. In Cuba, for men, health behaviors and obesity fully mediated the effect of DM on ADL, for women, however, this link was mediated by comorbid medical conditions.
CONCLUSIONS
Gender by place differences exist in the link between DM and disability, as well as behavioral and medical mechanisms behind such link. These findings advocate for the intersectionality approach in studying burden of illnesses such as DM.