O R I G I N A L A R T I C L E Community- Based Epidemiological Study on Diabetes in Pu-Li, Taiwan PESUS CHOU, DRPH HSU-HSI CHEN, MS KWANG-JEN HSIAO, PHD OBJECTIVE— To determine the prevalence and possible risk factors associated with diabetes in Pu-Li, Taiwan. RESEARCH DESIGN AND METHODS— The project was a community-based cross-sectional study with stratified cluster sampling of residents >30 yr of age. Medi- cal students conducted home-visit interviews with public health nurses, drew fasting blood samples from 1738 of 2573 registered residents >30 yr of age in Pu-Li, Taiwan. RESULTS — The prevalence of diabetes, including those with a history of diabetes and newly diagnosed cases determined by modified World Health Organization criteria, was 12.4%. With the standard world population of Segi, the age-adjusted prevalences were 6.9% for previous diabetes and 4.4% for new diabetes. The age- specific prevalence of diabetes increased significantly with age for new diabetes cases but not for previously diagnosed cases. To study factors associated with diabetes, we first applied univariate analysis. Stratified analyses by age and sex were used for interaction assessment. A significant interaction effect on diabetes was found between age and sex. Logistic regression was used for multivariate analysis. The final model showed that, after controlling for all other covariates, the significant factors associated with diabetes were family history of diabetes (father and/or mother, yes vs. no, odds ratio [OR] 3.13, 95% confidence interval [CI] 1.17-8.33), obesity (yes vs. no, OR 2.69, 95% CI 1.09-6.63), and age (continuous, OR 1.04, 95% CI 1.00-1.08). Locality and physical activity were not significantly correlated with diabetes. CONCLUSIONS— The age-adjusted prevalence of diabetes in Pu-Li were 6.9% for previous diabetes and 4.4% for new diabetes. Possible risk factors associated with diabetes with logistic regression were family history of diabetes, obesity, and age. Locality and physical activity were not significantly correlated with diabetes. A s the elderly population has increased, life-styles have changed, and diagnostic methods have improved, diabetes prevalence has increased worldwide (1). In Taiwan, diabetes was the 15th leading cause of death in 1974, accounting for a FROM THE INSTITUTE OF PUBLIC HEALTH, NATIONAL YANG-MING MEDICAL COLLEGE, TAIPEI, TAIWAN. ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO PESUS CHOU, DRPH, NATIONAL YANG-MING MEDICAL COLLEGE, INSTITUTE OF PUBLIC HEALTH, SHIH-PAI, TAIPEI (11221), TAIWAN. RECEIVED FOR PUBLICATION 26 JULY 1990 AND ACCEPTED IN REVISED FORM 22 MAY 1991. mortality rate of 4.81/100,000 (2). However, mortality from diabetes in- creased to 19.62/100,000, and the dis- ease was the 5 th leading cause of death in 1988 (3). The importance of early detection and early treatment and iden- tification of risk factors for diabetes and its control is evident. Many studies of diabetes control have focused on its clinical aspects. However, community- based control programs more frequently focus on establishing prevalence of dia- betes, identifying risk factors, and refer- ring, treating, and educating diabetes patients, especially in the developing countries (4). The community-based Pu-Li study targeted all registered resi- dents >30 yr of age to estimate the prevalence of diabetes and to investi- gate possible risk factors associated with diabetes such as age, obesity, fam- ily history, locality, and physical activ- ity. RESEARCH DESIGN AND METHODS— Fifty-six of 365 towns in Taiwan with population sizes be- tween 50,000 and 100,000 were con- sidered for study (5). After considering population stability, geographic area, and local support, Pu-Li was chosen as the study community. Pu-Li, in a well- circumscribed basin at the center of Taiwan, has a population of 84,000. Participation of local people in public health affairs has been active and en- thusiastic during the past 20 yr. The target population was all residents >30 yr of age. Stratified cluster sampling was used to select study subjects. The town, which has 31 neighborhoods, was divided by population density to classify residents as urban (>5000 pop- ulation/km 2 ), suburban (1000-5000/ km 2 ), and rural (<1000/km 2 ). From each stratum, one neighborhood of —400 households was selected. The eli- gible study subjects for each of the three neighborhoods were 785 for Nan- Men (7903/km 2 ), 879 for Pa-Chen (2487/km 2 ), and 909 for Her-Chen DIABETES CARE, VOLUME 15, NUMBER 1, JANUARY 1992 81 Downloaded from http://diabetesjournals.org/care/article-pdf/15/1/81/440811/15-1-81.pdf by guest on 20 November 2023