Diabetes
Cash transfers and cumulative incidence of diabetes and elevated glucose in South Africa: Evidence from the HAALSA Indepth cohort Maria Klein* Maria Klein Klein Klein Klein Klein Indiana University Bloomington
INTRODUCTION: Lower household income is associated with earlier onset of diabetes. It follows that household income supports such as cash transfer programs could reduce diabetes risk. Cash transfer programs are effective at improving child and maternal health outcomes through increased food security and health services utilization. The same pathways could also improve diabetes-associated outcomes, but cash transfer impact specific to diabetes is not well studied. Thus, the objective of this study was to determine the association between cash transfer access and cumulative incidence of diabetes and elevated glucose.
METHODS: We used a population-based sample of 5059 people aged 40+ from Health and Aging in Africa: Longitudinal Studies in South Africa (HAALSA Indepth). Our exposure was cumulative household cash transfer (HCT) available to HAALSA Indepth participants between 2000 and their Wave 1 interview (2014/2015). Our outcomes were the cumulative incidences of self-reported and biomarker-indicated 1) diabetes and 2) elevated glucose between Waves 1 and 3 (2021/22). We assessed the relationship between continuous HCT and outcomes with log-binomial and modified Poisson models. Models were fit with inverse probability weights to account for attrition, mortality, and refusal of point of care measurement. We specified unadjusted models and models adjusted for age and sex.
RESULTS: Between Waves 1 and 3, cumulative incidences of diabetes and elevated glucose were 16.8% and 37.4%, respectively. Each R10,000 increase in cumulative HCT was associated with reduced cumulative incidence of diabetes [aCIR (95% CI): 0.96 (0.94, 0.98); p=<0.001] and elevated glucose [aCIR (95% CI): 0.97 (0.96, 0.99); p=0.001].
DISCUSSION: Our findings suggest that greater household cash transfer access is associated with reduced risk of diabetes and elevated glucose. To our knowledge, this is the first study on cash transfer income and diabetes risk in sub-Saharan Africa.