Individual and Contextual Socioeconomic Position on Type 2 Diabetes Risk in LMICs: A Multilevel Analysis

Abstract

Type 2 diabetes mellitus (T2DM) represents a growing public health challenge in low- and middle-income countries (LMICs), where urbanization and socioeconomic disparities amplify its burden. This study examined the influence of individual- and neighborhood-level socioeconomic factors on T2DM risk using a multilevel framework. Cross-sectional data from 14 nationally representative Demographic and Health Surveys conducted between 2013 and 2023 were analyzed, including 1,090,328 individuals within 38,174 neighborhoods. Multilevel logistic regression models were fitted to estimate associations between socioeconomic indicators and T2DM risk. Contextual variation was quantified using variance partition coefficients and median odds ratios. Higher individual-level wealth was associated with increased odds of T2DM (OR = 1.30, 95% CI: 1.24–1.36), while education showed no protective association. At the neighborhood level, urban residence (OR = 1.09, 95% CI: 1.01–1.17) and greater community socioeconomic disadvantage were independently associated with higher T2DM risk. Neighborhood factors accounted for 32.2% of the total variance, and moving to a higher-risk neighborhood was associated with a 3.29-fold increase in median odds. Socioeconomic contexts at both individual and contextual levels independently shape T2DM risk in LMICs, underscoring the importance of place-based public health strategies alongside individual-level interventions.