Patients with type 2 diabetes aged 35–64 years at four primary health care centres in Stockholm County, Sweden: Prevalence and complications in relation to gender and socio-economic status

https://doi.org/10.1016/j.diabres.2003.08.011Get rights and content

Abstract

This study estimates the prevalence of known diabetes, and complications of type 2 diabetes, among subjects aged 35–64 years, in relation to socio-economic factors and gender at four primary health care centres (PHCCs) in Stockholm County, Sweden. A total of 685 diabetic subjects aged 35–64 years of age were identified in primary care by diagnosis using electronic patient records. Data were supplied from medical records, and postal questionnaires. The prevalence of known diabetes among subjects aged 35–65 years differed between the PHCCs, with standardised rates between 1.7 and 3.6%, with the highest figure at the PHCC in an underprivileged area. The prevalence was higher among men (2.8% versus 1.7%). A subgroup of the patients, i.e. 389 subjects aged 35–64 years with type 2 diabetes, was studied with regard to complications. Higher education level was protective for microvascular complications (OR 0.50; CI 0.25–1.00). In addition, microvascular complications were predicted by male sex, duration, HbA1c, and hypertension, and macrovascular complications by male sex, age, and hypertension. Prevalence of known diabetes and microvascular complications in type 2 diabetes, are associated with lower socio-economic status and male sex.

Introduction

The prevalence of diabetes world-wide was estimated to be 4.0% in 1995 in adults ≥20 years of age, with an expected increase to 5.4% by 2025 [1]. There are, however, great differences between different populations, with a prevalence in adults ≥20 years of age from 1.1% in Sub-Saharan Africa to 24.0% in Nauru. In Sweden, the prevalence in the whole population has been estimated to be 3.2% [2].

There are also local variations, with higher prevalence of type 2 diabetes in socially deprived areas [3], [4], [5], [6], or with lower socio-economic status [7], [8], [9], although the opposite has been found in one study from Bangladesh [10]. The reason for the higher prevalence of type 2 diabetes among subjects with lower socio-economic status could be unhealthy life style, i.e. higher rates of obesity, physical inactivity and smoking [11], nutritional inadequacies and psychological stress [12]. Malmstrom et al. found a higher rate of obesity, smoking and physical inactivity in social deprived areas [13]. The risk for type 2 diabetes has also been found to vary between different ethnic populations [8], [14].

Higher morbidity and mortality in diabetic subjects has also been associated with low socio-economic status in the UK [15], [16], but in a study in Finland no such association was found [17]. The Finnish study concluded, that health education for diabetic people seemed to be effective in all socio-economic strata.

Difference in prevalence of diabetes with gender has been discussed. In a recently published review it was stated, that type 2 diabetes was more common among women, as were the complications of diabetes [18]. However, in a review by Gale a shift during the 20th century from female excess to an equal prevalence or even a male preponderance in early middle age was shown [19]. In a meta-analysis from 2002, Kanaya et al. showed that the excess relative risk of coronary heart disease (CHD) mortality in women versus men with diabetes was absent after adjusting for classic CHD risk factors, but that men had more CHD deaths attributable to diabetes than women [20].

In 1998, the United Kingdom Prospective Diabetes Study (UKPDS) found associations between hyperglycaemia, hypertension, dyslipidaemia and smoking with macrovascular and microvascular complications [21], [22], [23].

The aim of this study was to assess the prevalence rate of known diabetes, and rate of complications, at four primary health care centres (PHCCs) in Stockholm County, in relation to gender and socio-economic factors.

Section snippets

Methods

The population in Stockholm County varies by geographical district as regards demographic and socio-economic factors, and is served by around 180 PHCCs. Four PHCCs were chosen, and agreed, to participate in the study, to reflect these difference, Table 1 (data from Stockholm County Council). The study shown in this paper was combined with a questionnaire study of coping with diabetes, with special regard to gender differences.

A total of 1600 diabetic patients of all ages were identified, out of

Results

The rates of known diabetes at the PHCCs in the age range 35–64 years are shown in Table 2, with both crude rates and rates standardised to the whole population in Stockholm County. Overall, the frequency of known diabetes was higher at PHCC B, i.e. the PHCC serving a population with lower socio-economic status (lowest mean income, lowest educational level, highest rates of sick leave, disability pension, social assistance and unemployment) and higher rate of foreign-born subjects, and higher

Discussion

Our results show that there were differences regarding the prevalence of known diabetes between the PHCCs, with the highest rate at the PHCC serving a socially underprivileged population, i.e. with low educational level, low income, high rates of sick leave, disability pension, social assistance and unemployment, and a high rate of immigrants. In addition, higher educational level seemed to be a protective factor against complications.

There are some limitations in this study. One is that our

Acknowledgements

This study was supported by grants from Stockholm County Council, and the Swedish Diabetes Association.

References (41)

  • H. King et al.

    Global burden of diabetes. 1995–2025: prevalence, numerical estimates, and projections

    Diabetes Care

    (1998)
  • B. Berger et al.

    The prevalence of diabetes in a Swedish population of 280,411 inhabitants. A report from the Skaraborg Diabetes Registry

    Diabetes Care

    (1998)
  • P. Meadows

    Variation of diabetes mellitus prevalence in general practice and its relation to deprivation

    Diabet. Med.

    (1995)
  • A.A. Ismail et al.

    Capture-recapture-adjusted prevalence rates of type 2 diabetes are related to social deprivation

    QJM

    (1999)
  • J.M. Evans et al.

    Socio-economic status, obesity and prevalence of types 1 and 2 diabetes mellitus

    Diabet. Med.

    (2000)
  • V. Connolly et al.

    Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas

    J. Epidemiol. Commun. Health

    (2000)
  • J.M. Robbins et al.

    Socioeconomic status and type 2 diabetes in African American and non- Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey

    Am. J. Publ. Health

    (2001)
  • M. abu Sayeed et al.

    Effect of socioeconomic risk factors on the difference in prevalence of diabetes between rural and urban populations in Bangladesh

    Diabetes Care

    (1997)
  • J.S. Feinstein

    The relationship between socioeconomic status and health: a review of the literature

    Milbank Q

    (1993)
  • M. Malmstrom et al.

    Neighborhood environment and self-reported health status: a multilevel analysis

    Am. J. Publ. Health

    (1999)
  • Cited by (0)

    View full text