Social determinants of diabetes in Pakistan: analysing the epidemic in the World’s most affected Nation

Diabetes mellitus (DM) has become a global health challenge, affecting 537 million adults worldwide in 2021. An estimated 30.8% of Pakistan’s population is diabetic, which has emerged as a serious medical challenge and strain on the already stressed healthcare system. This study examines the association between a rich set of demographics, socioeconomic, and environmental factors and diabetes in Pakistan by using nationally representative data from the Pakistan Social and Living Standards Measurement (PSLM) survey conducted in 2018-19. We find that being above 45 years of age, uneducated, living in urban area, being in higher wealth brackets, and being housewife increase the odds of being diabetic. We also present novel evidence that environmental factors such as access to safe drinking water and using traditional cooking fuel are linked with the odds of being diabetic. These findings highlight behavioral and environmental pathways that policymakers may target to control the epidemic. Community level interventions such as health education campaigns for housewives, walking and bicycle lanes in cities, and free screening of adults above 45 years of age may help mitigate the burden of diabetes in developing countries like Pakistan.