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
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.
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