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Backe MB, Kallestrup P, Rasmussen K, Jørgensen ME, Pedersen ML. Burden of selected chronic non-communicable diseases in a primary healthcare setting in Nuuk, Greenland, compared to a Danish suburb. Scand J Prim Health Care 2024; 42:435-441. [PMID: 38578458 PMCID: PMC11332282 DOI: 10.1080/02813432.2024.2334746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. METHODS The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. RESULTS In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. CONCLUSION In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum.
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Affiliation(s)
- Marie Balslev Backe
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Per Kallestrup
- Skødstrup Lægepraksis, General Practice Clinic, Skødstrup, Denmark
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Kurt Rasmussen
- Skødstrup Lægepraksis, General Practice Clinic, Skødstrup, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Center for Public Health in Greenland, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Bjerregaard P, Svartá DL, Ottendahl CB, Larsen CVL. Increasing health inequality among Inuit in Greenland from 1993 to 2018: Different patterns for household assets, urbanization and a sociocultural index as indicators of social position. SSM Popul Health 2024; 25:101635. [PMID: 38486800 PMCID: PMC10937147 DOI: 10.1016/j.ssmph.2024.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/05/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Income inequality affects population health and wellbeing negatively. In Greenland, health inequality has been shown to exist among social groups, regionally and according to urbanization, and between Inuit and migrants from Denmark. The purpose of the study was to compare the changes in health inequality from 1993 to 2018 according to three measures of social position, i.e. a socioeconomic measure (household assets), a measure of urbanization and a composite sociocultural index. We hypothesized that social inequality in health increased parallel to the increasing economic inequality in Greenland. The sample was based on four population health surveys conducted among the Inuit in Greenland in 1993, 2005-2010, 2014 and 2018. The total number of interviews was 9024 and the total number of individuals interviewed was 5829, as participants were invited to several surveys as part of a cohort. As statistical measure of social disparity we used the slope index of inequality (SII) adjusted for age and sex. Analyses were performed with daily smoking, suicidal thoughts and obesity as health outcomes. Daily smoking was most prevalent among participants with low social position whereas obesity was most prevalent among participants with high social position. With household assets as indicator of social position, the results showed high and increasing social inequality for both daily smoking and obesity. Social inequality for daily smoking increased over time also for urbanization and the sociocultural index. The hypothesis that social inequality increased over time was thus confirmed for daily smoking and obesity but not for suicidal thoughts. With the results from the present study there is solid evidence to guide prevention and health care towards social equality in health.
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Affiliation(s)
- Peter Bjerregaard
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Durita Lyngsø Svartá
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Charlotte Brandstrup Ottendahl
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
- Institute of Health and Nature, University of Greenland, Manutooq 1, 3905 Nuussuaq, Greenland
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Bjerregaard P, Larsen CVL, Olesen I, Ottendahl CB, Backer V, Senftleber N, Christensen MMB, Larsen TJ, Byberg S, Hansen T, Jørgensen ME. The Greenland population health survey 2018 - methods of a prospective study of risk factors for lifestyle related diseases and social determinants of health amongst Inuit. Int J Circumpolar Health 2022; 81:2090067. [PMID: 35711125 PMCID: PMC9225753 DOI: 10.1080/22423982.2022.2090067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Since 1993, regular population health surveys in Greenland have supported and monitored the public health strategy of Greenland and have monitored cardiometabolic and lung diseases. The most recent of these surveys included 2539 persons aged 15+ from 20 communities spread over the whole country. The survey instruments included personal interviews, self-administered questionnaires, blood sampling, anthropometric measurements, blood pressure, ECG, oral glucose test, pulmonary function, hand grip strength and chair stand test. Blood samples were analysed for glucose, glycated haemoglobin (HbA1c), insulin, incretin hormones, cholesterol, kidney function, fatty acids in erythrocyte membranes and mercury, urine for albumin-creatinine ratio, and aliquots were stored at -80°C for future use. Data were furthermore collected for studies of the gut microbiome and diabetes complications. Survey participants were followed up with register data. The potential of the study is to contribute to the continued monitoring of risk factors and health conditions as part of Greenland's public health strategy and to study the epidemiology of cardiometabolic diseases and other chronic diseases and behavioural risk factors. The next population health survey is planned for 2024. The emphasis of the article is on the methods of the study and results will be presented in other publications.
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Affiliation(s)
- Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Ingelise Olesen
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | | | - Vibeke Backer
- Department of otorhinolaryngology Head & Neck surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Ninna Senftleber
- Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
| | | | - Trine Jul Larsen
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Institute of Health and Nature, University of Greenland, Nuuk, Greenland.,Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
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Kong C, Yang L, Gong H, Wang L, Li H, Li Y, Wei B, Nima C, Deji Y, Zhao S, Guo M, Gu L, Yu J, Gesang Z, Li R. Dietary and Food Consumption Patterns and Their Associated Factors in the Tibetan Plateau Population: Results from 73 Counties with Agriculture and Animal Husbandry in Tibet, China. Nutrients 2022; 14:1955. [PMID: 35565921 PMCID: PMC9103862 DOI: 10.3390/nu14091955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Dietary imbalances are an important cause of morbidity and mortality, both in China and globally. Abnormal element content in the natural environment and the unbalanced dietary structure of populations coexist in the Tibetan Plateau. This study analyzed the dietary and food consumption patterns of 617 Tibetan residents and their associated factors. Cluster analysis revealed three modes of dietary pattern; the food consumption scores (FCSs) of subjects in modes with relatively high consumption frequency of staple food and relatively singular dietary structure were the lowest. Although the FCSs of most subjects were acceptable (FCS > 35), subjects with relatively low FCSs were more dependent on locally cultivated highland barley that is probably low in selenium. Hierarchical linear models revealed both individual−family and regional factors were significantly related (p values < 0.05) with the food consumption of subjects as follows: age, travel time from township to county, and cultivation area of highland barley were negatively related; numbers of individuals aged 40−60 years and pork, beef, and mutton production were positively related. Individuals with secondary or higher education had higher FCSs. A single indicator may be incomprehensive in dietary and food consumption studies. For people with a relatively unbalanced diet, an analysis of the main foods they consume is critical. Dietary and food consumption patterns might have relatively large inter-regional and intra-regional variations; therefore, factors that influence it might be multi-level and multi-scale.
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Affiliation(s)
- Chang Kong
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
| | - Linsheng Yang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Hongqiang Gong
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
| | - Li Wang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
| | - Hairong Li
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yonghua Li
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
| | - Binggan Wei
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
| | - Cangjue Nima
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
| | - Yangzong Deji
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
| | - Shengcheng Zhao
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
| | - Min Guo
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
| | - Lijuan Gu
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
| | - Jiangping Yu
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; (C.K.); (L.Y.); (L.W.); (Y.L.); (B.W.); (L.G.); (J.Y.)
| | - Zongji Gesang
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
| | - Rujun Li
- Tibet Center of Disease Control and Prevention, Lhasa 850030, China; (H.G.); (C.N.); (Y.D.); (S.Z.); (M.G.); (Z.G.); (R.L.)
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Bjerregaard P, Olesen I, Larsen CVL. Association of food insecurity with dietary patterns and expenditure on food, alcohol and tobacco amongst indigenous Inuit in Greenland: results from a population health survey. BMC Public Health 2021; 21:1094. [PMID: 34098910 PMCID: PMC8186081 DOI: 10.1186/s12889-021-11123-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amongst the indigenous Greenlandic Inuit, the experience of food insecurity has been attributed to a lack of money to buy enough food of sufficient quality to sustain a family, although a preference for alcohol and tobacco over food has also been cited. The purpose of the article was to compare dietary patterns and expenditure on food, alcoholic beverages and tobacco between survey participants who reported food insecurity and those who did not. METHODS A countrywide cross-sectional health survey was carried out among 1886 adult Greenlandic Inuit in 2018. Diet was estimated by a food frequency questionnaire. Food insecurity status was based on the household hunger scale. Analyses were carried out by univariate general linear models adjusted for age, sex and social position. RESULTS Nine percent of the participants reported food insecurity. Food insecurity was higher among younger participants, men and participants with low social position. Food insecure participants more often chose an unhealthy dietary pattern (43% vs. 32%) and they reported a higher energy intake. The food insecure spent the same amount of money on food as other participants but less on nutritious food and more on non-nutritious food. The cost per kilojoule (kJ) of the food of the food insecure was lower than that of the food secure (DKK 8.0 and 9.0 per 1000 kJ, respectively). The food insecure participants also spent considerably more on alcohol and tobacco. CONCLUSIONS The results suggest that it is not only unemployment and lack of money that creates food insecurity and unhealthy dietary patterns in Greenland. Food insecure participants gave higher priority to buying non-nutritious food, alcohol and tobacco than did food secure participants. There seems to be at least two population subgroups in Greenland with poverty and substance use, respectively, as the immediate determinants for food insecurity. The results are important for the design of interventions against food insecurity and unhealthy dietary patterns.
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Affiliation(s)
- Peter Bjerregaard
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Ingelise Olesen
- Institute for Nursing and Health Research, University of Greenland, P.0. Box 1061, Manutooq 1, 3905, Nuussuaq, Greenland
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
- Institute for Nursing and Health Research, University of Greenland, P.0. Box 1061, Manutooq 1, 3905, Nuussuaq, Greenland
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