A Population-Based Study of Diabetes Incidence by Ethnicity and Age: Support for the Development of Ethnic-Specific Prevention Strategies

Giving a voice to "the silent killer": a knowledge, attitude and practice study of diabetes among French Guiana's Parikweneh people

BACKGROUND

The prevalence of type 2 diabetes (T2D) in the French overseas department of French Guiana, South America, nearly doubles that in its European counterpart, Metropolitan France. This region is demographically diverse and includes several populations of Indigenous Peoples. Although such populations are at particular risk of developing T2D across the Americas, very little is known about their health status in French Guiana, and accurate numbers of diabetic patients do not exist.

METHODS

In light of a potential public health crisis, an ethnomedicinal study of diabetes experienced by Indigenous Parikweneh was conducted to provide better insight into the knowledge, attitudes and practices (KAP) related to this quickly emerging disease in French Guiana. Altogether, 75 interviews were conducted with community members and Elders, as well as healthcare professionals and administrators providing services to the Parikweneh population of Macouria and Saint-Georges de l'Oyapock.

RESULTS

Interviews suggest a high incidence of T2D in this population, with cases that have risen quickly since the mid-twentieth century. Parikweneh participants linked the development of the illness to dietary changes, notably through the introduction of new and sweet foods. Recognizing the complexity of diabetes and its symptoms, diabetic patients highlighted the importance of biomedical treatments and follow-ups, though they frequently alternated or used them concomitantly with Parikweneh medicines. With the help of biomedical tools (i.e. glucometer), local medicinal practices mirrored biomedical approaches through dietary adaptation and the use of medicinal animals and plants for glycaemic control and the treatment of complications from the disease.

CONCLUSION

Parikweneh are appropriating T2D into their knowledge system and adapting their health system in response to this relatively new health concern. A greater understanding of local practices and perceptions relating to T2D among medical staff may therefore be beneficial for meeting patients' needs, providing greater autonomy in their health path, and improving treatment outcomes.

Predictive Modelling of Diabetes Risk in Population Groups Defined by Socioeconomic and Lifestyle Factors in Canada: A Cross-Sectional Study

Objectives

This study modelled diabetes risk for population groups in Canada defined by socioeconomic and lifestyle characteristics and investigated inequities in diabetes risk using a validated population risk prediction algorithm.

Methods

We defined population groups, informed by determinants of health frameworks. We applied the Diabetes Population Risk Tool (DPoRT) to 2017/2018 Canadian Community Health Survey data to predict 10-year diabetes risk and cases across population groups. We modelled a preventive intervention scenario to estimate reductions in diabetes for population groups and impacts on the inequity in diabetes risk across income and education.

Results

The population group with at least one lifestyle and at least one socioeconomic/structural risk factor had the highest estimated 10-year diabetes risk and number of new cases. When an intervention with a 5% relative risk reduction was modelled for this population group, diabetes risk decreased by 0.5% (females) and 0.7% (males) and the inequity in diabetes risk across income and education levels was reduced.

Conclusion

Preventative interventions that address socioeconomic and structural risk factors have potential to reduce inequities in diabetes risk and overall diabetes burden.

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

BACKGROUND AND OBJECTIVES

Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada.

METHODS

We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function.

RESULTS

We included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (-4.79%; -7.86 to -1.72) or have visits to a specialist (-1.68%; -3.12 to -0.24). There was minimal variation by region of origin or time since immigration in immigrants.

DISCUSSION

Compared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors.

Determinants, Prevention, and Incidence of Cardiovascular Disease Among Immigrant and Refugee Populations

Immigration policies shape the composition, socioeconomic characteristics, and health of migrant populations. The health of migrants is also influenced by a confluence of social, economic, environmental, and political factors. Immigrants and refugees often face various barriers to accessing health care because of factors such as lack of familiarity with navigating the health care system, language barriers, systemic racism, and gaps in health insurance. Social determinants of health and access to primary care health services likely influence the burden of cardiovascular risk factors among immigrants. The relatively low burden of many cardiovascular risk factors in many immigrant populations likely contributes to the generally lower incidence rates of acute myocardial infarction, heart failure, and stroke in immigrants compared with nonimmigrants, although cardiovascular disease incidence rates vary substantially by country of origin. The "healthy immigrant effect" is the hypothesis that immigrants to high-income countries, such as Canada, are healthier than nonimmigrants in the host population. However, this effect may not apply universally across all immigrants, including recent refugees, immigrants without formal education, and unmarried immigrants. As unfolding sociopolitical events generate new waves of global migration, policymakers and health care providers need to focus on addressing social and structural determinants of health to better manage cardiovascular risk factors and prevent cardiovascular disease, especially among the most marginalized immigrants and refugees.

Adaptations in the transformation of cassava (Manihot esculenta Crantz; Euphorbiaceae) for consumption in the dietary management of diabetes: the case of Palikur, or Parikwene People, from French Guiana

Introduction

In the French overseas department of French Guiana, in South America, nutrition therapy for the management of diabetes is based on French guidelines. However, this region is demographically diverse and includes several populations of Indigenous Peoples, Parikwene among others, also called Palikur. Due to socio-economical, cultural, and geographical differences, along with distinctions in the local food system, dietary recommendations, which many consider in the context of post-colonial power dynamics, are not well suited to local populations. In the absence of suitable recommendations, it is hypothesized that local populations will adapt their dietary practices considering diabetes as an emerging health problem.

Methods

Seventy-five interviews were conducted with community members and Elders, as well as healthcare professionals and administrators providing services to the Parikwene population of Macouria and Saint-Georges de l'Oyapock communes. Data regarding the representation of cassava (Manihot esculenta Crantz) consumption and diabetes were collected via semi-structured interviews and participant observation (i.e., observation and participation in community activities), namely via participating in activities related to the transformation of cassava tubers at swidden and fallow fields.

Results and Discussion

Parikwene have adapted the transformation of cassava tubers for their consumption in the management of diabetes.The importance of cassava tubers as a staple and core food to the Parikwene food system was established by identifying it as a cultural keystone species. Narratives illustrated conflicting perceptions regarding the implication of cassava consumption in the development of diabetes. Adaptations to the operational sequence involved in the transformation of cassava tubers led to the production of distinct cassava roasted semolina (i.e., couac), based on organoleptic properties (i.e., sweet, and acidic couac). Preferences for the consumption of acidic couac were grounded in the Parikwene knowledge system, as well as attention to diabetes related symptoms and glucometer readings.

Conclusion

These results provide important insights related to knowledge, attitudes, and practices in developing locally and culturally adapted approaches to providing dietary recommendations in the treatment of diabetes.

Trends in glucose testing among individuals without diabetes in Ontario between 2010 and 2017: a population-based cohort study

BACKGROUND

Early identification of people with diabetes or prediabetes enables greater opportunities for glycemic control and management strategies to prevent related complications. To identify gaps in screening for these conditions, we examined population trends in receipt of timely glucose testing overall and in specific clinical subgroups.

METHODS

Using linked administrative databases, we conducted a retrospective cohort study of people aged 40 years and older without diabetes at baseline. Our primary outcome was up-to-date glucose testing, defined as having received testing at least once in the 3 years before each index year from 2010 to 2017, using linked administrative databases of people residing in Ontario, Canada. We calculated rates of up-to-date testing by age group, sex, ethnicity (South Asian, Chinese, general population) and comorbidities (hypertension, hyperlipidemia, cardiovascular disease).

RESULTS

Over the 8-year study period, up-to-date glucose testing rates were stable at 67% for men and 77% for women (both relative risk 1.00 per year; 95% confidence interval 1.00-1.00). Testing rates were significantly lower in men than in women (all age groups p < 0.001) and lower in younger than older age groups (except those aged ≥ 80 yr). South Asian people had the highest testing rates, although among people aged 70 years or older, testing was highest in the general population (p < 0.001). Among people with hypertension, hyperlipidemia and cardiovascular disease, annual testing rates were also stable, but only 58% overall among people with hypertension.

INTERPRETATION

We found lower glucose testing rates in younger men and people with hypertension. Our findings reinforce the need for initiatives to increase awareness of glycemic testing.

Migration and diabetes incidence among Chinese adults in Canada, China, Hong Kong, and Taiwan: An international population-based comparative study from 2000 to 2017

AIMS

We conducted an international population-based study comparing the incidence of young- (age 20-39 years) and usual- (age ≥ 40 years) onset diabetes among Chinese-Canadian immigrants; their source populations (mainland China, Hong Kong, Taiwan); and other Canadians.

METHODS

Using population-based data (2000-17; n = 3.4 million cases), we calculated incidence rates and incidence rate ratios comparing the average incidence for each cohort.

RESULTS

The average incidence of young-onset diabetes (YOD) among immigrants from China, Hong Kong, and Taiwan was 165.5, 121.0, and 78.4 per 100,000 person-years respectively. Immigrants from China and Hong Kong had higher YOD incidence than their source populations (RR China: 2.59, 2.44-2.74; Hong Kong: 1.64, 1.49-1.81), while immigrants from Taiwan had lower rates versus Taiwan (RR 0.63, 0.45-0.86). YOD incidence among immigrants from China increased sharply by 8.3% (3.3-13.6%) per year from 2011 onward-over twice the annual increase among non-Chinese Canadians. The average incidence rates of usual-onset diabetes among immigrants from China, Hong Kong, and Taiwan were higher than (RR 1.77, 1.73-1.81), similar to (0.98, 0.96-1.01), and lower than (0.36, 0.32-0.40) those in each source population respectively.

CONCLUSIONS

Diabetes incidence among Chinese migrants is unexpectedly heterogeneous, varying according age at migration, territory of origin, and the occurrence of diabetes in the source population.

Social and economic influences on disparities in the health of racial and ethnic group Canadian immigrants

OBJECTIVE

To examine social, economic, and migratory influences on the health of racial and ethnic minority groups in Canada, with a special focus on Caribbean immigrants.

METHODS

Combined annual cycles (2011-2016) of the Canadian Community Health Survey (CCHS) data totaling over 300,000 adult Canadian residents were aggregated. Descriptive statistics and multivariable logistic regression models were used to examine the prevalence and associated factors of (1) cardiovascular disease diagnosed by a healthcare professional, and (2) self-rated general health among racial and ethnic groups.

RESULTS

Caribbeans in general, Black and other non-White Canadians had significantly higher odds (adjusted for age/sex) of reporting any cardiovascular disease compared with White Canadians. Only non-Caribbean Blacks had higher odds of self-rated fair or poor general health compared with White Canadians. Multivariate logistic regression models revealed that after controlling for social and demographic factors, immigration status and years since migration, Caribbean non-Blacks and Black Caribbeans were at higher odds of having a doctor-reported cardiovascular health condition compared with White Canadians. Caribbean non-Blacks also had higher odds of fair or poor self-rated health than White Canadians.

CONCLUSION

The results of this study highlight the need for additional investigations of other potential influences on physical health statuses, especially among migrants and those of African ancestry who might be more prone to adverse health outcomes.