The Relationship Between Household Cash Transfer Access and Cumulative Incidence of Diabetes and Prediabetes in Rural South Africa

Introduction: Cash transfer programs could reduce diabetes risk by decreasing chronic stress and increasing food security, physical activity, and preventive care, but there is an evidence gap on the relationship between cash transfer access and diabetes and prediabetes incidence. Methods: We used data from the Health and Ageing in Africa: Longitudinal Studies in South Africa (HAALSA) Indepth cohort of Black South Africans ages 40+ (N=5059). We fit log binomial models to estimate the relationship between household cash transfer eligibility (HCT) and cumulative incidence of diabetes and prediabetes between 2014/15 and 2021/22. We performed quantile regression to estimate change in continuous glucose values across the glucose distribution with additional HCT. Results: No association was observed between HCT and diabetes risk. Each additional unit of HCT was associated with reduced prediabetes risk [aCIR (95% CI): 0.94 (0.90, 0.98); p=0.007]. The largest reduction in glucose values associated with additional HCT was at the highest end of the glucose distribution. Discussion: Our observations suggest household cash transfer access reduces risk of prediabetes but not diabetes. However, household cash transfer access was associated with the largest decrease in glucose for the most severely glucose-impaired, implying the potential for HCT to reduce risk of hyperglycemic complications.