Skip to main content

Advertisement

SpringerLink
Log in

Secular trends and educational differences in the incidence of type 2 diabetes in Finland, 1972–2007

  • DIABETES MELLITUS
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Type 2 diabetes prevalence is rising globally, and varies by socio-economic position. Amongst other factors, rising prevalence may reflect increasing incidence. Worldwide, few studies have examined population-level longitudinal trends in incident type 2 diabetes, and reports on secular trends in diabetes incidence by socio-economic measures such as educational attainment are lacking. Finland has a long-standing, comprehensive disease surveillance infrastructure. Using data collected over four decades from serial FINRISK surveys, the National Drug Reimbursement Register and the National Causes of Death Register, we examined secular trends in type 2 diabetes incidence in Finland from the 1970s to 2007. The diabetes status of 38,689 FINRISK participants aged 30–59 years at baseline assessment and without diagnosed diabetes at the time was followed for 10 years. Among men, incidence of diagnosed, pharmacologically managed type 2 diabetes increased over time. Compared with men surveyed in the 1970s, diabetes incidence was higher among men in the 1980s (adjusted HR 1.44, 95 % CI 1.13–1.84) and 1990s (adjusted HR 1.72, 1.32–2.24). Body mass index explained some, but not all of this variation. Increases occurred predominantly among men with low (adjusted HR 1980s: 2.07, 95 % CI 1.28–3.35; adjusted HR 1990s: 2.12, 95 % CI 1.28–3.53) and middle (adjusted HR 1980s: 1.30, 95 % CI 0.85–1.99; adjusted HR 1990s: 1.65, 95 % CI 1.05–2.60) educational attainment. No secular changes were apparent among women. This rising diabetes incidence among men over recent decades has occurred despite Finland’s sustained health promotion efforts. Renewed public health campaigns are urgently required. In addition to population-level initiatives, lower educational strata should be specifically targeted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

HR:

Hazard ratio

NDRR:

National Drug Reimbursement Register

PYAR:

Person-years at risk

References

  1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.

    Article  CAS  PubMed  Google Scholar 

  2. Vartiainen E, Laatikainen T, Peltonen M, Juolevi A, Männistö S, Sundvall J, et al. Thirty-five-year trends in cardiovascular risk factors in Finland. Int J Epidemiol. 2010;39:504–18.

    Article  PubMed  Google Scholar 

  3. Saaristo TE, Barengo NC, Korpi-Hyövälti E, Oksa H, Puolijoki H, Saltevo JT, et al. High prevalence of obesity, central obesity and abnormal glucose tolerance in the middle-aged Finnish population. BMC Public Health. 2008;8:423.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Laakso M, Reunanen A, Klaukka T, Aromaa A, Maatela J, Pyorala K. Changes in the prevalence and incidence of diabetes mellitus in Finnish adults, 1970–1987. Am J Epidemiol. 1991;133(9):850–7.

    CAS  PubMed  Google Scholar 

  5. Yliharsila H, Lindstrom J, Eriksson JG, Jousilahti P, Valle TT, Sundvall J, et al. Prevalence of diabetes and impaired glucose regulation in 45- to 64-year-old individuals in three areas of Finland. Diabet Med. 2005;22:88–91.

    Article  CAS  PubMed  Google Scholar 

  6. Sund R, Koski S, FinDM II. On the register-based measurement of the prevalence and incidence of diabetes and its long-term complications. A technical report. Tampere: Finnish Diabetes Association; 2009.

    Google Scholar 

  7. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. The Lancet. 2011;377(9765):557–67.

    Article  Google Scholar 

  8. Lahti-Koski M, Seppänen-Nuijten E, Männistö S, Härkänen T, Rissanen H, Knekt P, et al. Twenty-year changes in the prevalence of obesity among Finnish adults. Obes Rev. 2010;11(3):171–6.

  9. Wikstrom K, Lindstrom J, Tuomilehto J, Saaristo TE, Korpi-Hyovalti E, Oksa H, et al. Socio-economic differences in dysglycemia and lifestyle-related risk factors in the Finnish middle-aged population. Eur J Public Health. 2011;21(6):768–74.

    Article  PubMed  Google Scholar 

  10. Espelt A, Borrell C, Roskam AJ, Rodríguez-Sanz M, Stirbu I, Dalmau-Bueno A, et al. Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia. 2008;51(11):1971–9.

    Article  CAS  PubMed  Google Scholar 

  11. Espelt A, Borrell C, Palencia L, Goday A, Spadea T, Gnavi R, et al. Socioeconomic inequalities in the incidence and prevalence of type 2 diabetes mellitus in Europe. Gac Sanit. 2013;27(6):494–501.

    Article  PubMed  Google Scholar 

  12. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am J Prev Med. 2006;30(5):371–7.

    Article  PubMed  Google Scholar 

  13. Magliano DJ, Barr EL, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, et al. Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care. 2008;31(2):267–72.

    Article  PubMed  Google Scholar 

  14. Carstensen B, Kristensen JK, Ottosen P, Borch-Johnsen K. The Danish National Diabetes Register: trends in incidence, prevalence and mortality. Diabetologia. 2008;51(12):2187–96.

    Article  CAS  PubMed  Google Scholar 

  15. Chang CH, Shau WY, Jiang YD, Li HY, Chang TJ, Sheu WH, et al. Type 2 diabetes prevalence and incidence among adults in Taiwan during 1999–2004: a national health insurance data set study. Diabet Med. 2010;27(6):636–43.

  16. Pavkov ME, Hanson RL, Knowler WC, Bennett PH, Krakoff J, Nelson RG. Changing patterns of type 2 diabetes incidence among Pima Indians. Diabetes Care. 2007;30:1758–63.

    Article  PubMed  Google Scholar 

  17. Fox CS, Pencina MJ, Meigs JB, Vasan RS, Levitzky YS, D’Agostino RB Sr. Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham Heart Study. Circulation. 2006;113(25):2914–8.

    Article  PubMed  Google Scholar 

  18. Burke JP, O’Brien P, Ransom J, Palumbo PJ, Lydick E, Yawn BP, et al. Impact of case ascertainment on recent trends in diabetes incidence in Rochester, Minnesota. Am J Epidemiol. 2002;155(9):859–65.

    Article  PubMed  Google Scholar 

  19. Burke JP, Williams K, Gaskill SP, Hazuda HP, Haffner SM, Stern MP. Rapid rise in the incidence of type 2 diabetes from 1987 to 1996: results from the San Antonio Heart Study. Arch Intern Med. 1999;159(13):1450–6.

    Article  CAS  PubMed  Google Scholar 

  20. Franco M, Bilal U, Ordunez P, Benet M, Morejon A, Caballero B, et al. Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980–2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ. 2013;346:f1515.

  21. Leibson CL, O’Brien PC, Atkinson E, Palumbo PJ, Melton LJ III. Relative contributions of incidence and survival to increasing prevalence of adult-onset diabetes mellitus: a population-based study. Am J Epidemiol. 1997;146(1):12–22.

    Article  CAS  PubMed  Google Scholar 

  22. Kouvonen AM, Vaananen A, Woods SA, Heponiemi T, Koskinen A, Toppinen-Tanner S. Sense of coherence and diabetes: a prospective occupational cohort study. BMC Public Health. 2008;8:46.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Strandberg TE, Salomaa V. Factors related to the development of diabetes during a 20-year follow-up. A prospective study in a homogeneous group of middle-aged men. Nutr Metab Cardiovasc Dis. 2000;10(5):239–46.

    CAS  PubMed  Google Scholar 

  24. Kaprio J, Tuomilehto J, Koskenvuo M, Romanov K, Reunanen A, Eriksson J, et al. Concordance for type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in a population-based cohort of twins in Finland. Diabetologia. 1992;35:1060–7.

    Article  CAS  PubMed  Google Scholar 

  25. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011;40:804–18.

    Article  PubMed  Google Scholar 

  26. Sacerdote C, Ricceri F, Rolandsson O, Baldi I, Chirlaque M-D, Feskens E, et al. Lower educational level is a predictor of incident type 2 diabetes in European countries: the EPIC-InterAct study. Int J Epidemiol. 2012;41(4):1162–73.

    Article  PubMed  Google Scholar 

  27. Lee TC, Glynn RJ, Pena JM, Paynter NP, Conen D, Ridker PM, et al. Socioeconomic status and incident type 2 diabetes mellitus: data from the Women’s Health Study. PLoS One. 2011;6(12):e27670.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Lammi N, Blomstedt PA, Moltchanova E, Eriksson JG, Tuomilehto J, Karvonen M. Marked temporal increase in the incidence of type 1 and type 2 diabetes among young adults in Finland. Diabetologia. 2008;51:897–9.

    Article  CAS  PubMed  Google Scholar 

  29. Rajala U, Keinanen-Kiukaanniemi S, Uusimaki A, Reikula K, Kivela SL. Prevalence of diabetes mellitus and impaired glucose tolerance in a middle-aged Finnish population. Scand J Prim Health Care. 1995;13:222–8.

    Article  CAS  PubMed  Google Scholar 

  30. Hardoon SL, Morris RW, Thomas MC, Wannamethee SG, Lennon LT, Whincup PH. Is the recent rise in type 2 diabetes incidence from 1984 to 2007 explained by the trend in increasing BMI? Diabetes Care. 2010;33:1494–6.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Koro CE, Bowlin SJ, Bourgeois N, Fedder DO. Glycemic control from 1988 to 2000 among US adults diagnosed with type 2 diabetes: a preliminary report. Diabetes Care. 2004;27(1):17–20.

    Article  PubMed  Google Scholar 

  32. Sinclair AJ, Alexander CM, Davies MJ, Zhao C, Mavros P. Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes. BMC Endocr Disord. 2012;12:1.

  33. Tolonen H, Dobson A, Kulathinal S. Effect on trend estimates of the difference between survey respondents and non-respondents: results from 27 populations in the WHO MONICA Project. Eur J Epidemiol. 2005;20(11):887–98.

    Article  PubMed  Google Scholar 

  34. Jousilahti P, Salomaa V, Kuulasmaa K, Niemela M, Vartiainen E. Total and cause specific mortality among participants and non-participants of population-based health surveys: a comprehensive follow up of 54 372 Finnish men and women. J Epidemiol Community Health. 2005;59:310–5.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Harald K, Salomaa V, Jousilahti P, Koskinen S, Vartiainen E. Non-participation and mortality in different socioeconomic groups: the FINRISK population surveys in 1972–92. J Epidemiol Community Health. 2007;61:449–54.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Gomez-Ambrosi J, Silva C, Galofre JC, Escalada J, Santos S, Millan D, et al. Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes. 2012;36:286–94.

    Article  CAS  Google Scholar 

  37. Lindstrom J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinanen-Kiukaanniemi S, et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013;56:284–93.

    Article  CAS  PubMed  Google Scholar 

  38. Wikström K, Peltonen M, Eriksson JG, Aunola S, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, et al. Educational attainment and effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study. Diabetes Res Clin Pract. 2009;86(1):e1–5.

    Article  PubMed  Google Scholar 

  39. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by financing from the Academy of Finland (Grant Number 129293). This work was undertaken during M.A.’s participation on the Victorian Public Health Training Scheme, funded by the Department of Health, Victoria, Australia. The views and opinions are those of the authors and do not necessarily represent those of the Department of Health. We wish to thank Prof. James Dunbar, Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University; and Prof. Michael Abramson and Dr. Robert Hall, Department of Epidemiology and Preventive Medicine, Monash University, for their useful comments during the preparation of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Marian Abouzeid

  2. National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland

    Katja Wikström, Markku Peltonen, Jaana Lindström, Katja Borodulin & Tiina Laatikainen

  3. Department of Public Health, Hjelt Institute, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland

    Ossi Rahkonen

  4. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, Kuopio, Finland

    Tiina Laatikainen

  5. Hospital District of North Karelia, Tikkamäentie 16, Joensuu, Finland

    Tiina Laatikainen

  6. Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia

    Tiina Laatikainen

Authors
  1. Marian Abouzeid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katja Wikström
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Markku Peltonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaana Lindström
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katja Borodulin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ossi Rahkonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tiina Laatikainen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marian Abouzeid.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 44 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abouzeid, M., Wikström, K., Peltonen, M. et al. Secular trends and educational differences in the incidence of type 2 diabetes in Finland, 1972–2007. Eur J Epidemiol 30, 649–659 (2015). https://doi.org/10.1007/s10654-015-0008-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-015-0008-7

Keywords

Search

Navigation