High prevalence of diabetes among immigrants from non-European countries in Sweden

The prevalence of chronic diseases in international immigrants: a systematic review and meta-analysis

Aims:

The purpose of this study is systematically to review and synthesise available prevalence data of major chronic diseases in international immigrants.

Methods:

Four electronic databases were searched to retrieve peer-reviewed original articles published in English between January 2000 and December 2020. Cross-sectional, cohort, or longitudinal studies that reported the prevalence of cardiovascular disease, any type of cancer, chronic obstructive pulmonary disease, and type 2 diabetes among immigrant adults were included. We calculated pooled prevalence using random-effects meta-analyses.

Results:

Of 13,363 articles retrieved, 24 met the eligibility criteria. The pooled prevalence of diabetes was 9.0% (95% confidence interval (CI) 7.6–10.4) with a higher prevalence in North American countries 11.1% (95% CI 8.0–14.1) than in the other destination countries: 6.6% (95% CI 5.1–8.1) including Italy, Sweden, The Netherlands, Australia, and Israel. The pooled prevalence of cardiovascular diseases and respiratory diseases was 7.7% (95% CI 5.7–9.6) and 6.5% (95% CI 2.3–10.7), respectively. Only two articles reported the prevalence of cancers (2.7% and 3.8%). We found high heterogeneity among all studies regardless of the disease.

Conclusions:

The prevalence of diabetes was higher than other chronic diseases in international immigrants. There is a strong need to enhance health information systems to understand the magnitude of chronic diseases among different immigrant subgroups.

Web-based support for individuals with type 2 diabetes - a feasibility study

BACKGROUND

Self-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The primary aim of the study was to evaluate the feasibility and describe patients' and caregivers' experiences of using the web- and smartphone-based system Triabetes. The secondary aim was to investigate if the use of the system could improve patients' clinical outcomes.

METHODS

Feasibility was assessed with describing recruitment rate and the participant´s views of using the system. Laboratory and anthropometry data were also collected.

RESULTS

The study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it easier and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values.

CONCLUSIONS

Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful but suggested several improvements. Summarized lessons learned from this study are following: (1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; (2) the tool must be easy and less time consuming to use; (3) the technical structure needs to be improved and automatic recording of data must be improved.

Early detection of type 2 diabetes in socioeconomically disadvantaged areas in Stockholm - comparing reach of community and facility-based screening

BACKGROUND

Type 2 diabetes and its high-risk stage, prediabetes, are often undiagnosed. Early detection of these conditions is of importance to avoid organ complications due to the metabolic disturbances associated with diabetes. Diabetes screening can detect persons unaware of diabetes risk and the elevated glucose levels can potentially be reversed through lifestyle modification and medication. There are mainly two approaches to diabetes screening: opportunistic facility-based screening at health facilities and community screening.

OBJECTIVE

To determine the difference in population reach and participant characteristics between community- and facility-based screening for detection of type 2 diabetes and persons at high risk of developing diabetes.

METHODS

Finnish diabetes risk score (FINDRISC) is a risk assessment tool used by two diabetes projects to conduct community- and facility-based screenings in disadvantaged suburbs of Stockholm. In this study, descriptive and limited inferential statistics were carried out analyzing data from 2,564 FINDRISC forms from four study areas. Community- and facility-based screening was compared in terms of participant characteristics and with population data from the respective areas to determine their reach.

RESULTS

Our study found that persons born in Africa and Asia were reached through community screening to a higher extent than with facility-based screening, while persons born in Sweden and other European countries were reached more often by facility-based screening. Also, younger persons were reached more frequently through community screening compared with facility-based screening. Both types of screening reached more women than men.

CONCLUSION

Community-based screening and facility-based screening were complementary methods in reaching different population groups at high risk of developing type 2 diabetes. Community screening in particular reached more hard-to-reach groups with unfavorable risk profiles, making it a critical strategy for T2D prevention. More men should be recruited to intervention studies and screening initiatives to achieve a gender balance.

Can Self-Determination Explain Dietary Patterns Among Adults at Risk of or with Type 2 Diabetes? A Cross-Sectional Study in Socio-Economically Disadvantaged Areas in Stockholm

Type 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, research on SDT, T2D and diet has been widely overlooked in socio-economically disadvantaged populations. This study aims to identify the main dietary patterns of adults at risk of and with T2D from two socio-economically disadvantaged Stockholm areas and to determine the association between those patterns and selected SDT constructs (relatedness, autonomy motivation and competence). Cross-sectional data of 147 participants was collected via questionnaires. Exploratory Factor Analysis was used to identify participants’ main dietary patterns. Multiple linear regressions were conducted to assess associations between the SDT and diet behaviours, and path analysis was used to explore mediations. Two dietary patterns (healthy and unhealthy) were identified. Competence construct was most strongly associated with healthy diet. Autonomous motivation and competence mediated the effect of relatedness on diet behaviour. In conclusion, social surroundings can promote adults at high risk of or with T2D to sustain healthy diets by supporting their autonomous motivation and competence.

Extent of the association between self-rated health and place of birth: a cross-sectional study among people at high risk of developing pre-diabetes and diabetes in Sweden

OBJECTIVE

The first aim was to determine the extent of the relationship between place of birth and self-rated health (SRH) in primary healthcare patients born outside Sweden and those born in Sweden. The second aim was to investigate whether socioeconomic and lifestyle factors explained any differences.

SETTING

Two academic primary healthcare centres in Stockholm County, Sweden.

PARTICIPANTS

825 patients at high risk of developing pre-diabetes and diabetes, aged 18-74 years, attending academic healthcare centres in areas with large numbers of immigrants, 56.8% born abroad and 43.2% born in Sweden. Patients with a diagnosis of diabetes were excluded. Inclusion criteria were based on previous research showing that people born in Middle Eastern and Asian countries who live in Sweden have a high prevalence of and risk for diabetes.

OUTCOME

SRH was dichotomised as optimal (very good/good) and suboptimal (fair/bad/very bad) and compared in those born outside Sweden and in Sweden.

RESULTS

There was a statistically significant difference in the SRH of the two groups (p=0.008). Logistic regression analysis showed a crude OR for reduced SRH of 1.46 (95% CI 1.10 to 1.92) in patients born outside Sweden. After controlling for education, employment and marital status, the OR increased to 1.50 (95% CI 1.11 to 2.02). After controlling for physical activity and smoking, it decreased to 1.36 (95% CI 1.00 to 1.85).

CONCLUSION

Socioeconomic and lifestyle factors influenced SRH. It could therefore be useful for clinicians to consider these factors when providing care for patients born outside Sweden and resettled in areas with large numbers of immigrants.

Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm

Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders' interactions and engagement in NCDs prevention and management. Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D). Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis. Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner. Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.

Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm

Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.

Multimorbidity and mortality thereof, among non-western refugees and family reunification immigrants in Denmark - a register based cohort study

Background

The prevalence of multimorbidity, defined by having two or more chronic diseases, is increasing in many Western countries. Simultaneously, the migrant population in Western countries has increased, making up a growing proportion of European populations. This study aims i) to determine the quantity and quality of multimorbidity patterns among refugees and family reunification immigrants from non-Western countries compared to Danish-born, and ii) to compare the mortality burden among those with multimorbidity in the two groups.

Methods

Through the Danish Immigration Service, we conducted a historically prospective cohort study. We identified a total of 101,894 adult migrants who were sub-categorised into refugees and family reunification immigrants, and matched them to a Danish-born comparison group 1:6 on age and sex. Through the Danish National Patient Registry, we obtained information on all in- and outpatient data on hospitalised and ambulatory patients. To assess multimorbidity we used Charlson Comorbidity Index based on ICD-10 codes, together with ICD-10 diagnostic categories for psychiatric disease. We used Cox regression analysis to calculate risk of multimorbidity and risk of mortality in people with multimorbidity.

Results

Overall refugees had higher risk of multimorbidity compared to Danish-born, while family reunification immigrants had a lower risk. When adjusting for civil status and mean income, the risk was lower for all migrant groups compared to Danish-born. Risk of mortality in people with multimorbidity, was lower for all migrant groups, compared to Danish-born.

Conclusion

Refugees are an at-risk group for multimorbidity, however, mortality among those with multimorbidity is lower in all migrant groups compared to Danish-born.

Health-Related Quality of Life, Subjective Health Complaints, Psychological Distress and Coping in Pakistani Immigrant Women With and Without the Metabolic Syndrome : The InnvaDiab-DEPLAN Study on Pakistani Immigrant Women Living in Oslo, Norway

The increasingly high number of immigrants from South-East Asia with The Metabolic Syndrome (MetS) is an important challenge for the public health sector. Impaired glucose is essential in MetS. The blood glucose concentration is not only governed by diet and physical activity, but also by psychological distress which could contribute to the development of MetS. The aim of this study is to describe health-related quality of life, subjective health complaints (SHC), psychological distress, and coping in Pakistani immigrant women, with and without MetS. As a part of an randomized controlled intervention study in Oslo, Norway, female Pakistani immigrants (n = 198) answered questionnaires regarding health related quality of life, SHC, psychological distress, and coping. Blood variables were determined and a standardized oral glucose tolerance test was performed. The participants had a high score on SHC and psychological distress. About 40% of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. Those with MetS also had more SHC, depressive symptoms, higher levels of somatisation, and scored significantly lower on the coping strategy of active problem solving. Pakistani immigrant women seem to have a high prevalence of SHC and psychological distress, especially those with MetS.

Differences in diabetes prevalence and inequalities in disease management and glycaemic control by immigrant status: a population-based study (Italy)

Background

The diabetes prevalence increases at an alarming rate around the world and understanding disparities in occurrence, care management, and health outcomes may be a starting point towards achieving more effective strategies to prevent and manage it. The aims of this study are to compare immigrants and Italians in terms of the differences in diabetes prevalence and to evaluate inequalities in disease management and glycaemic control by using information included in Reggio Emilia diabetes register.

Methods

We retrieved from the diabetes register subjects aged 20–74 on December 31^st, 2009. Using citizenship, we created three main groups: Italy, High Developed Countries (HDC), and High Migration Pressure Countries (HMPC). These were split into sub-regions of origin. We calculated age-adjusted prevalence by gender and sub-region. Using logistic regression model, we analyzed the association between area of origin and following indicators: 1) not being in care of diabetes clinics; 2) not having glycated haemoglobin (HbA1c) test in 2010; 3) among those tested, having a HbA1c value > = 9% (75 mmol/mol).

Results

We found 15,889 Italian and 1,295 HMPC citizens with diabetes. HMPC citizens had higher age-adjusted prevalence of diabetes than Italians (females 5.0% vs 3.6%; males 6.5% vs 5.5%). The excess was mostly due to a strong excess in immigrants from Southern Asia (females 9.7%, males 10.2%) and Northern Africa (females 9.3%, males 5.9%). HMPC citizens were cared for by diabetes clinics in a similar proportion than Italians (OR: 1.08; 95% CI: 0.93-1.25), but had a greater odds of not being tested for HbA1c (OR: 1.51; 95% CI: 1.34-1.71), as well as of having HbA1c values equal to or over 9% (OR: 2.06; 95% CI: 1.80-3.14). The outcomes were poorer in HMPC females for the first two outcomes, while there was no difference for the HbA1c values (Wald test for heterogeneity p = 0.0850; p = 0.0156; p = 0.6635, respectively).

Conclusions

Our findings highlight the need for gender-oriented actions for prevention and early diagnosis of the diabetes to contrast the higher risk in Northern Africans and Southern Asians. Further studies are required to determine whether the protocols in use are adequate for different immigrant groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1403-4) contains supplementary material, which is available to authorized users.

Country of birth-specific and gender differences in prevalence of diabetes in Sweden

OBJECTIVE

The aim was to investigate country or region of birth-specific prevalence and gender differences of diabetes in residents in Sweden, using Swedish-born men and women as referent.

METHODS

The Apolipoprotein MOrtality RISk (AMORIS) cohort was used (184,000 men and 151,453 women) aged between 20 and 80 years, with data from the CALAB laboratory, Stockholm, 1985-1996. Diabetes was defined as fasting glucose ≥ 7.0 mmol/L or a hospital diagnosis of diabetes. Country of birth was obtained by linkage to Swedish Censuses 1970-1990. Standardized prevalence rate ratios (SPRR) with 95% confidence intervals (95% CI) were estimated.

RESULTS

Five groups of women and one group of men had a significantly higher prevalence than Swedish-born (based on SPRR): women born in Iraq (6.0 (95% CI 1.3-28.9)), North Africa (6.9 (95% CI 3.1-15.3)), South Asia (3.1 (95% CI 1.0-10.0)), Syria (5.3 (95% CI 1.8-16.0)), Turkey (3.7 (95% CI 1.2-10.9)) and men born in other Middle Eastern countries (2.3 (95% CI 1.0-5.5)). Swedish-born men had a higher age-standardized prevalence of diabetes (3.9%) than Swedish born women (2.5%). A higher prevalence among men was also seen in other Western countries. In contrast, a higher age-standardized prevalence among women was observed in immigrants from Turkey (8.9% vs. 3.1%, p<0.001), Syria (13.1% vs. 4.0%, p=0.002), and North Africa (16.8% vs. 6.6%, p<0.001).

CONCLUSION

Female immigrants to Sweden from Iraq, North Africa, South Asia, Syria, and Turkey have an increased prevalence of diabetes of substantial public health concern.

Quantifying the association between tuberculosis and diabetes in the US: a case-control analysis

Historically, an association between tuberculosis and diabetes was recognised clinically, and the recent global rise in diabetes prevalence has reignited interest. We therefore quantified the tuberculosis-diabetes association using US survey data. A case-control analysis was performed using cross-sectional data from the second National Health and Nutrition Examination Survey (1976-1980; civilian non-institutionalised US population aged 20-74). Cases were respondents ever diagnosed with tuberculosis, and controls were respondents who reported never receiving a tuberculosis diagnosis. Exposure to diabetes and intermediate hyperglycaemia was defined using a self-reported measure, an oral glucose tolerance test, or both. We used logistic regression to estimate an adjusted odds ratio, controlling for potential major confounders. In relation to the main exposure measure, the adjusted odds ratio for the association between tuberculosis and diabetes varied between 2.31 (95% confidence interval 1.36-3.93) and 2.36 (95% confidence interval 1.40-3.97), depending on the model. No association was found for intermediate hyperglycaemia, with adjusted odds ratio varying between 1.33 (95% confidence interval 0.49-3.64) and 1.34 (95% confidence interval 0.50-3.62), depending on model. Irrespective of the exposure measure and the confounders controlled for, diabetes was associated with an increased tuberculosis risk. This study may underestimate the true association due to exposure misclassification.

[Poorer diabetes control among the immigrant population than among the autochthonous population]

INTRODUCTION

Ethnic differences are known to exist in the prevalence of diabetes, but little is known about possible differences in the degree of diabetes control among ethnic groups. The aim of this study was to determine whether there are differences in diabetes detection and control between immigrants and the autochthonous population in our health region.

METHODS

We performed a cross-sectional, observational, population-based study of all patients diagnosed with diabetes mellitus type 2 registered and treated in 2010. We analyzed diabetes quality indicators and used multivariate logistic regression models adjusted for age, sex and number of visits. The adjustment method was forced and the absence of collinearity was identified through the ROC curve and Hosmer and Lemeshow's test.

RESULTS

There were 77,999 autochthonous patients (6,846 diabetics) and 30,748 immigrant patients (415 diabetics). A total of 8.78% of the autochthonous patients were diabetic versus 1.35% of immigrants (p <0.001). HbA1c <7.5% was found in 68.04% of the native population compared with 54.76% of immigrants. The probability of achieving optimal HbA1c control was 27% lower in immigrants (adjusted OR=0.73), while the probability of achieving good HbA1c control was 30% lower in the immigrant cohort. The model showed moderate discrimination (ROC =0.65 and Hosmer and Lemeshow's contrast, p>0.05).

CONCLUSIONS

Diabetes control and quality indicators are poorer in some immigrant groups.

Neighborhood deprivation and inequities in coronary heart disease among patients with diabetes mellitus: a multilevel study of 334,000 patients

We used multilevel models to investigate whether the odds of coronary heart disease (CHD) is higher in patients with diabetes mellitus (DM) living in deprived neighborhoods versus those living in wealthy neighborhoods. The Swedish nationwide prescription register was used to identify 334,000 patients aged 30 years and older with DM. The OR of CHD was significantly higher among patients with DM living in deprived neighborhoods than among patients with DM living in wealthy neighborhoods. These findings are useful for clinicians working in deprived neighborhoods. Future research could focus on how to reduce inequities in CHD among patients with DM.

Cardiovascular disease by diabetes status in five ethnic minority groups compared to ethnic Norwegians

Background

The population in Norway has become multi-ethnic due to migration from Asia and Africa over the recent decades. The aim of the present study was to explore differences in the self-reported prevalence of cardiovascular disease (CVD) and associated risk factors by diabetes status in five ethnic minority groups compared to ethnic Norwegians.

Methods

Pooled data from three population-based cross-sectional studies conducted in Oslo between 2000 and 2002 was used. Of 54,473 invited individuals 24,749 (45.4%) participated. The participants self-reported health status, underwent a clinical examination and blood samples were drawn. A total of 17,854 individuals aged 30 to 61 years born in Norway, Sri-Lanka, Pakistan, Iran, Vietnam or Turkey were included in the study. Chi-square tests, one-way ANOVAs, ANCOVAs, multiple and logistic regression were used.

Results

Age- and gender-standardized prevalence of self-reported CVD varied between 5.8% and 8.2% for the ethnic minority groups, compared to 2.9% among ethnic Norwegians (p < 0.001). Prevalence of self-reported diabetes varied from 3.0% to 15.0% for the ethnic minority groups versus 1.8% for ethnic Norwegians (p < 0.001). Among individuals without diabetes, the CVD prevalence was 6.0% versus 2.6% for ethnic minorities and Norwegians, respectively (p < 0.001). Corresponding CVD prevalence rates among individuals with diabetes were 15.3% vs. 12.6% (p = 0.364). For individuals without diabetes, the odds ratio (OR) for CVD in the ethnic minority groups remained significantly higher (range 1.5-2.6) than ethnic Norwegians (p < 0.05), after adjustment for age, gender, education, employment, and body height, except for Turkish individuals. Regardless of diabetes status, obesity and physical inactivity were prevalent in the majority of ethnic minority groups, whereas systolic- and diastolic- blood pressures were higher in Norwegians. In nearly all ethnic groups, individuals with diabetes had higher triglycerides, waist-to-hip ratio (WHR), and body mass index compared to individuals without diabetes. Age, diabetes, hypertension, hypercholesterolemia, and WHR were significant predictors of CVD in both ethnic Norwegians and ethnic minorities, but significant ethnic differences were found for age, diabetes, and hypercholesterolemia.

Conclusions

Ethnic differences in the prevalence of CVD were prominent for individuals without diabetes. Primary CVD prevention including identification of undiagnosed diabetes should be prioritized for ethnic minorities without known diabetes.

Social support as described by foreign-born persons diagnosed with type 2 diabetes mellitus and living in Sweden

The aim of this study was to explore and describe the meaning of support and its impact on the life situation of foreign-born persons diagnosed with type 2 diabetes mellitus and living in Sweden in relation to gender, age, and the duration of the disease. Mixed methods were used on a purposive sample of 34 foreign-born adults who had been diagnosed with type 2 diabetes mellitus. Qualitative data were collected by semi-structured interviews and quantitative data were collected by the Norbeck Social Support Questionnaire (NSSQ). The meaning of "support" was described by the participants as medical support, information support, and aiding support to learn to manage diabetes. Support influenced the participants' entire life and their need for it was related to the severity of the diabetes and differences regarding age and gender. The participants scored low on the NSSQ regarding total emotional support, total aid, and total function and 42% had lost an important relationship during the last year. Their marital status had no impact on emotional support but aid was significant. Medical support, with regular follow-up and information, is important in obtaining affirmation and aids in learning to manage diabetes mellitus.

Country of birth, socioeconomic factors, and risk factor control in patients with type 2 diabetes: a Swedish study from 25 primary health-care centres

BACKGROUND

Few large-scale studies have examined the association between sociodemographic factors and the probability of reaching the recommended levels of haemoglobin A1c (HbA(1c)) and blood lipids in patients with type 2 diabetes. The aim was to investigate whether sociodemographic characteristics of patients with type 2 diabetes affected the odds that they would reach recommended levels of blood lipids and HbA(1c).

METHODS

This study included 2912 men and 2136 women, in the age group of 35-74, with diagnosed type 2 diabetes from 25 primary health-care centres in Stockholm, Sweden. National population registers were linked to clinical data from electronic records and logistic regression was used to estimate odds ratios.

RESULTS

Less than half of the men and women with diabetes reached the recommended levels of HbA(1c). Even fewer reached the recommended levels for total cholesterol and low-density lipoprotein cholesterol. The gender differences favoured women, for HbA(1c) and men, for blood lipids. Individuals with the lowest income levels were less likely to reach the recommended level of HbA(1c). Country of birth showed that immigrants from Middle Eastern countries and other countries had lower odds of reaching the recommended levels of HbA(1c).

CONCLUSION

This study confirmed that risk factor control among patients with type 2 diabetes treated in primary health care is inadequate and that sociodemographic factors were associated with metabolic control. Future studies could include new strategies for the control of modifiable risk factors in patients with type 2 diabetes.

Migration background: a risk factor for caries development during adolescence

The influence of child and parental migration background on the risk of approximal caries increment in Swedish adolescents was investigated. This retrospective longitudinal register-based cohort study included all 13-yr-old adolescents (n = 18,142) who were resident in the County of Stockholm, Sweden, in 2000, and followed them up to 19 yr of age. At follow-up, 15,538 subjects were examined. Caries data [decayed, missing, and filled teeth/surfaces (DMFT/S)], were collected from a dental database. Socio-demographic determinants were collected from Swedish National Registers. After adjustments for socio-demographic confounders, logistic regression analysis revealed that adolescents with foreign-born parents, irrespective of whether the child was born in Sweden or abroad, exhibited a significantly elevated risk for approximal caries increment (DMFSa > 0), and developed, on average, 0.53 and 1.14 more approximal caries lesions, respectively, compared with their counterparts with Swedish-born parents. Furthermore, adolescents born in eastern Europe exhibited an increased risk for approximal caries increment (DMFSa > 0) and developed, on average, 1.06 more approximal caries lesions compared with Swedish-born adolescents. In conclusion, parental migration background must be considered as a risk factor for caries development during adolescence, irrespective of whether or not the adolescent was born in Sweden.

Quality of care for patients with type 2 diabetes in general practice according to patients' ethnic background: a cross-sectional study from Oslo, Norway

Background

In recent decades immigration to Norway from Asia, Africa and Eastern Europe has increased rapidly. The aim of this study was to assess the quality of care for type 2 diabetes mellitus (T2DM) patients from these ethnic minority groups compared with the care received by Norwegians.

Methods

In 2006, electronic medical record data were screened at 11 practices (49 GPs; 58857 patients). 1653 T2DM patients cared for in general practice were identified. Ethnicity was defined as self-reported country of birth. Chi-squared tests, one-way ANOVAs, multiple regression, linear mixed effect models and generalized linear mixed models were used.

Results

Diabetes was diagnosed at a younger age in patients from the ethnic minority groups (South Asians (SA): mean age 44.9 years, Middle East/North Africa (MENA): 47.2 years, East Asians (EA): 52.0 years, others: 49.0 years) compared with Norwegians (59.7 years, p < 0.001). HbA1c, systolic blood pressure (SBP) and s-cholesterol were measured in >85% of patients in all groups with minor differences between minority groups and Norwegians. A greater proportion of the minority groups were prescribed hypoglycaemic medications compared with Norwegians (≥79% vs. 72%, p < 0.001). After adjusting for age, gender, diabetes duration, practice and physician unit, HbA1c (geometric mean) for Norwegians was 6.9% compared to 7.3-7.5% in the minority groups (p < 0.05). The proportion with poor glycaemic control (HbA1c > 9%) was higher in minority groups (SA: 19.6%, MENA: 18.9% vs. Norwegians: 5.6%, p < 0.001. No significant ethnic differences were found in the proportions reaching the combined target: HbA1c ≤ 7.5%, SBP ≤ 140 mmHg, diastolic blood pressure (DBP) ≤ 85 mmHg and total s-cholesterol ≤5.0 mmol/L (Norwegians: 25.5%, SA: 24.9%, MENA: 26.9%, EA: 26.1%, others:17.5%).

Conclusions

Mean age at the time of diagnosis of T2DM was 8-15 years younger in minority groups compared with Norwegians. Recording of important processes of care measures is high in all groups. Only one in four of most patient groups achieved all four treatment targets and prescribing habits may be sub-optimal. Patients from minority groups have worse glycaemic control than Norwegians which implies that it might be necessary to improve the guidelines to meet the needs of specific ethnic groups.

Problems of diabetes management in the immigrant population in Germany

AIM

To compare prospectively the effect of diabetes management in the immigrant and the native population in Berlin, Germany.

METHODS

Diabetes patients attending a metabolic outpatient clinic in an area with a high immigrant population were studied at the start of the training program and after 12 months of participation.

RESULTS

1607 of 2099 patients with at least one post-training visit (76.6%) provided analysable data. Of these 362 (22.5%) were immigrants. Initial hemoglobin A1c (HbA1c) was higher in the immigrants. Immigrants were 5 years younger and had a more recent diagnosis of diabetes. HbA1c fell by 1.4 and 1.5 percentage points in the immigrants and natives, leaving a greater proportion of the immigrants above the target value of 6.5%. Analysis of patients matched according to baseline HbA1c, sex and age showed a smaller decrease in mean HbA(1c) for the immigrants. The percent of patients with hypertension, obesity, dyslipidaemia or diabetic complications was comparable in both groups initially and after 12 months.

CONCLUSION

Immigrants had a higher HbA1c concentration at baseline and after 12 months compared to natives, despite a similar decline in HbA1c percentage points. More investigations are warranted to identify the causes, such as dietary habits, language difficulties, education and others.

Cardiovascular risk factors in Assyrians/Syrians and native Swedes with type 2 diabetes: a population-based epidemiological study

BACKGROUND

A large number of people throughout the world have diabetes and the prevalence is increasing. Persons with diabetes have a twice higher risk of cardiovascular disease than those without diabetes. There is a lack of studies focusing on cardiovascular risk factors in Assyrians/Syrians with type 2 diabetes. The aim of this study is to estimate the prevalence of some cardiovascular risk factors among Assyrians/Syrians and native Swedes with type 2 diabetes and to study whether the association between ethnicity and cardio-vascular risk factors remains after adjustment for age, gender, employment status and housing tenure.

METHODS

In the Swedish town of Södertälje 173 Assyrians/Syrians and 181 ethnic Swedes with type 2 diabetes participated in a study evaluating cardiovascular risk factors such as increased haemoglobin A1c (HbA1c), high blood lipids (total serum cholesterol and triglycerides), hypertension and high urinary albumin. The associations between the outcome variables and sociodemographic characteristics were estimated using unconditional logistic regression.

RESULTS

The prevalence of increased triglycerides in Swedish-born subjects and Assyrian-Syrians was 61.5% and 39.7% respectively. Swedes had a prevalence of hypertension 76.8% compared to 57.8% in Assyrians/Syrians. In the final logistic models adjusted for gender, age, housing and employment the odds ratio (OR) for Swedish-born subjects for increased triglycerides was 2.80 (95% CI1.61-4.87) and for hypertension 2.32 (95% CI 1.35-4.00) compared to Assyrians-Syrians.

CONCLUSION

Ethnic Swedes had higher prevalence of increased triglycerides and hypertension than Assyrians/Syrians. Total cholesterol, HbA1c and urinary albumin did not differ between the two ethnic groups.

Unintentional injuries in children of Danish and foreign-born mothers

Aims: Unintentional injuries in children of foreign-born mothers were studied and compared with those in children of Danish-born mothers. Methods: A population of 173,504 children living in 32 municipalities in Denmark was followed from 1998 to 2003. Detailed information on childhood unintentional injuries from hospital records was linked to register data on parents’ education, country of origin, income, family type, etc. Poisson regression was used to analyse differences in injury risk between children of different origins. Results: We found 133,649 injuries, of which 15,389 occurred in children of foreign-born mothers. The injury rates in children of Western and non-Western origin were 0.83 (0.70—0.98) times and 0.84 (0.79— 0.90) times that of children of Danish-born mothers, respectively. The difference was largest in children of families with unemployed parents. The injury rate in girls of non-Western origin was 29% lower than in girls of Danish origin, while the rate in boys of non-Western origin was only 5% lower than in boys of Danish origin. This gender difference was particularly pronounced for sports and traffic injuries. Children of non-Western origin had a three-fold higher rate of burns caused by hot water, tea or oil than children of Danish origin. Conclusions: Prevention of injuries in children of non-Western origin should especially focus on scalds from tea, oil, and hot water.

Estimation of diabetes prevalence among immigrants from the Middle East in Sweden by using three different data sources

AIMS

To estimate diabetes prevalence in immigrants from the Middle East in Sweden compared with Swedish-born subjects. This group accounts for around 15% of Sweden's non-European immigrants.

METHODS

Three samples were used: self-reported diabetes in a random sample (SALLS sample) of subjects aged 35-64 years in Sweden (n=22,032); known diabetes among patients aged 35-64 years in primary care (PC) at four primary healthcare centers in Stockholm County (n=30,679); and known and newly diagnosed diabetes in a random population sample of subjects aged 60 years in Stockholm County (n=4106).

RESULTS

The odds ratio (OR) for subjects from the Middle East was: 1.69 (95% confidence interval [CI] 0.96-2.99) in the SALLS sample; 4.43 (95% CI 3.38-5.56) in the PC sample; and 3.96 (95% CI 1.98-7.92) in the age-60 sample, compared with native Swedes. Subjects from European and other Organization for Economic Cooperation and Development (OECD) countries showed an excess risk only in the SALLS sample (1.43, 95% CI 1.11-1.83).

CONCLUSIONS

Immigrants from the Middle East showed a four-fold higher risk of diabetes compared with Swedish-born subjects in two of the three data sources. More studies are needed to confirm these results, but the findings call for targeted preventative strategies in this population group.