Global region of birth is an independent risk factor for type 2 diabetes in Stockholm, Sweden

Abstract

In Stockholm, type 2 diabetes (T2D) is a public health concern and much more prevalent in areas with a high proportion of foreign-born individuals. One in five individuals in Stockholm County are born outside of Sweden, and we therefore investigated if global region of birth was associated with diabetes risk, adjusting for established risk factors. Cross-sectional data from the population-based Stockholm Public Health Survey 2010 ( N = 69 115) was combined with registry-based information on country of birth grouped into eight global geographical regions. Cases of T2D were identified through self-reported physician-diagnosed diabetes and age at diagnosis. Region of birth was the independent risk factor and multivariable logistic regression analysis was performed adjusting for the risk factors age, sex, weight status, educational level, multiple dietary factors, tobacco, alcohol and physical activity. T2D prevalence was 5.1% in the sample. Relative to Swedish-born participants, higher odds ratio (OR) were found in those born in Asia [OR 3.2, 95% confidence interval (CI) 2.2-4.7], Sub-Saharan Africa (OR 2.5, 95% CI 1.5-4.1) and North Africa/the Middle East (OR 2.1, 95% CI 1.6-2.8), after adjustment for established risk factors. Participants from Eastern Europe and Latin America had an elevated risk but this did not remain after adjustment for other risk factors. Region of birth was found to be an independent risk factor for T2D for participants born in Asia, Africa and the Middle East. This increased risk should be taken into consideration when allocating resources for prevention, detection and care.

Consumption of fruit and vegetables and the risk of type 2 diabetes: a 4-year longitudinal study among Swedish adults

“…Education was recoded as ‘basic education’ corresponding to 9 years or fewer, ‘secondary education’ corresponding to 10–12 years of schooling and ‘college or university education’ – named as ‘higher education’. Alcohol consumption was categorised into ‘no’, ‘low’, ‘medium’ and ‘high’ with different cut-off points for men and women, and those were ‘0’, ‘>0 to ≤24 g/d’, ‘>24 to ≤60 g/d’ and ‘>60 g/d’ for men; and ‘0’, ‘0 to ≤15⋅4 g/d’, ‘>15⋅4 to ≤50 g/d’ and ‘> 50 g/d’ for women, respectively (5) . Smoking status was created with the variables ever smoked (‘Have you ever smoked as good as daily, for at least 6 months?’ Answer with ‘yes’ or ‘no’) and current smoking (‘Are you currently smoking daily?’ Answer with ‘yes’ or ‘no’) and categorised into ‘never smoked’, ‘current smoker’ and ‘former smoker’ (5) .…”

“…Answer with 'yes' or 'no') and current smoking ('Are you currently smoking daily?' Answer with 'yes' or 'no') and categorised into 'never smoked', 'current smoker' and 'former smoker' (5) . Physical activity during the last 12 months was assessed through a combination of the following variables: walking/cycling, exercise, daily activities and/or work, domestic tasks, and sedentary activities.…”

“…Fourth, the response rate at follow-up was relatively high, which provides high statistical power. Finally, since all participants live in the same region (Stockholm County), there were no differences in potential macro-environmental confounders such as climate, environmental contamination and access to health facilities (5) . This study also has some limitations.…”

“…Risk factors of T2D other than diet include family history of diabetes, overweight and obesity, higher age, low education, smoking, low physical activity and country of birth (4,5) . In all age groups in Sweden, T2D is more prevalent in men than in women (6) and there is a steep social gradient to the disadvantage of people with low socio-economic status (7) .…”

A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial

“…When it comes to adults, higher rates of obesity and low physical activity are found in groups with low socio-economic position (SEP), and it has been speculated that these factors are the main causes behind the higher prevalence and earlier onset of type-2 diabetes (T2D) among adults with low SEP [ 15 ]. Furthermore, studies have shown that immigrants to Sweden have a significantly higher risk of T2D than Swedish-born individuals even when adjusted for established risk factors [ 16 ]. Today it is recognised that development of both obesity and T2D is driven by interacting genetic and environmental factors and is preventable to a large extent [ 17 ].…”