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.
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Abbreviations
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- HR:
-
Hazard ratio
- NDRR:
-
National Drug Reimbursement Register
- PYAR:
-
Person-years at risk
References
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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
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DOI: https://doi.org/10.1007/s10654-015-0008-7