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Diabetes among migrants in Denmark: Incidence, mortality, and prevalence based on a longitudinal register study of the entire Danish population

  • Author Footnotes
    1 Equal contribution.
    Gregers Stig Andersen
    Correspondence
    Corresponding author at: Niels Steensens vej 6, 2820 Gentofte, Denmark.
    Footnotes
    1 Equal contribution.
    Affiliations
    Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark
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  • Author Footnotes
    1 Equal contribution.
    Zaza Kamper-Jørgensen
    Footnotes
    1 Equal contribution.
    Affiliations
    Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark

    Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark

    Section of Global Health, Department of Public Health, Faculty of Medicine and Health Sciences, University of Copenhagen, Denmark
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  • Bendix Carstensen
    Affiliations
    Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark
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  • Marie Norredam
    Affiliations
    Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark

    Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
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  • Ib Christian Bygbjerg
    Affiliations
    Section of Global Health, Department of Public Health, Faculty of Medicine and Health Sciences, University of Copenhagen, Denmark
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  • Marit Eika Jørgensen
    Affiliations
    Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark

    Center for Health Research in Greenland, University of Southern Denmark, Denmark
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  • Author Footnotes
    1 Equal contribution.
Published:September 30, 2016DOI:https://doi.org/10.1016/j.diabres.2016.09.020

      Highlights

      • This register based study covers the entire Danish population.
      • Non-western migrants have a higher incidence of diabetes compared to native Danes.
      • The standardised mortality ratio is higher among non-western migrants.
      • Increased prevalence among non-western migrants is to some extent explained by increased incidence.
      • Findings call for screening and prevention strategies targeted migrant populations.

      Abstract

      Objective

      Studies of diabetes in migrant populations have shown a higher prevalence compared to their respective countries of origin and to people natively born in the host country, but there is little population-based data on diabetes incidence and mortality in migrant populations. The aim of the current study was (1) to describe the incidence rates and prevalence of diabetes among first generation migrants in Denmark compared to the Danish background population, and (2) to compare standardised mortality rates (SMRs) for individuals with and without diabetes according to country of origin.

      Research design and methods

      Information was obtained from linkage of the National Diabetes Register with mortality statistics and information from the Central Personal Register on country of origin. Age- and sex-specific estimates of prevalence, incidence rates, mortality rates and SMRs relative to the part of the population without diabetes were calculated based on follow up of the entire Danish population.

      Results

      Compared with native born Danes, the incidence of diabetes was about 2.5 times higher among migrants from Africa, Asia, and the Middle East, and these migrant groups also showed significantly higher prevalence. The standardised mortality rates (SMR) were higher particularly above 50 years of age among most migrant groups compared with native born Danes, and with a higher annual increase.

      Conclusions

      The highest diabetes incidence rates and prevalence estimates were observed among migrants from Africa, Asia, and the Middle East, and the annual increase in SMRs was higher in these groups compared to native born Danes.

      Keywords

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      References

        • Venkataraman R.
        • Nanda N.C.
        • Baweja G.
        • Parikh N.
        • Bhatia V.
        Prevalence of diabetes mellitus and related conditions in Asian Indians living in the United States.
        Am J Cardiol. 2004; 94: 977-980
        • Maskarinec G.
        • Grandinetti A.
        • Matsuura G.
        • Sharma S.
        • Mau M.
        • Henderson B.E.
        • et al.
        Diabetes prevalence and body mass index differ by ethnicity: the multiethnic cohort.
        Ethn Dis. 2009; 19: 49-55
        • Agyemang C.
        • Kunst A.E.
        • Bhopal R.
        • Anujuo K.
        • Zaninotto P.
        • Nazroo J.
        • et al.
        Diabetes prevalence in populations of South Asian Indian and African origins: a comparison of England and the Netherlands.
        Epidemiology. 2011; 22: 563-567
        • Misra R.
        • Patel T.
        • Kotha P.
        • Raji A.
        • Ganda O.
        • Banerji M.
        • et al.
        Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study.
        J Diabetes Complications. 2010; 24: 145-153
        • Kanaya A.M.
        • Herrington D.
        • Vittinghoff E.
        • Ewing S.K.
        • Liu K.
        • Blaha M.J.
        • et al.
        Understanding the high prevalence of diabetes in U.S. South Asians compared with four racial/ethnic groups: the MASALA and MESA studies.
        Diabetes Care. 2014; 37: 1621-1628
        • Schneider K.L.
        • Clark M.A.
        • Rakowski W.
        • Lapane K.L.
        Evaluating the impact of non-response bias in the Behavioral Risk Factor Surveillance System (BRFSS).
        J Epidemiol Community Health. 2012; 66: 290-295
        • Lanting L.C.
        • Joung I.M.A.
        • Mackenbach J.P.
        • Lamberts S.W.J.
        • Bootsma A.H.
        Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review.
        Diabetes Care. 2005; 28: 2280-2288
        • Vandenheede H.
        • Deboosere P.
        • Espelt A.
        • Bopp M.
        • Borrell C.
        • Costa G.
        • et al.
        Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender.
        Int J Public Health. 2015; 60: 401-410
        • Vandenheede H.
        • Deboosere P.
        • Stirbu I.
        • Agyemang C.O.
        • Harding S.
        • Juel K.
        • et al.
        Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change.
        Eur J Epidemiol. 2012; 27: 109-117
        • Mather H.M.
        • Chaturvedi N.
        • Fuller J.H.
        Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK.
        Diabetic Med. 1998; 15: 53-59
      1. Kvalitetsdeklaration for Indvandrere og efterkommere 1. January 2014. Copenhagen, Denmark: Statistics Denmark; 2014

        • Carstensen B.
        • Kristensen J.K.
        • Ottosen P.
        • Borch-Johnsen K.
        Steering Group of the National Diabetes R. The Danish National Diabetes Register: trends in incidence, prevalence and mortality.
        Diabetologia. 2008; 51: 2187-2196
        • Carstensen B.
        Age-period-cohort models for the Lexis diagram.
        Stat Med. 2007; 26: 3018-3045
        • Kristensen J.K.
        • Bak J.F.
        • Wittrup I.
        • Lauritzen T.
        Diabetes prevalence and quality of diabetes care among Lebanese or Turkish immigrants compared to a native Danish population.
        Primary Care Diabetes. 2007; 1: 159-165
        • Moustgaard H.
        • Bjerregaard P.
        • Borch-Johnsen K.
        • Jorgensen M.E.
        Diabetes among Inuit migrants in Denmark.
        Int J Circumpolar Health. 2005; 64: 354-364
        • Brancati F.L.
        • Kao W.H.
        • Folsom A.R.
        • Watson R.L.
        • Szklo M.
        Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis Risk in Communities Study.
        JAMA. 2000; 283: 2253-2259
        • Tillin T.
        • Hughes A.D.
        • Godsland I.F.
        • Whincup P.
        • Forouhi N.G.
        • Welsh P.
        • et al.
        Insulin resistance and truncal obesity as important determinants of the greater incidence of diabetes in Indian Asians and African Caribbeans compared with Europeans the Southall and Brent REvisited (SABRE) cohort.
        Diabetes Care. 2013; 36: 383-393
        • Ramachandran A.
        • Chamukuttan S.
        • Shetty S.A.
        • Arun N.
        • Susairaj P.
        Obesity in Asia – is it different from rest of the world.
        Diabetes/Metab Res Rev. 2012; 28: 47-51
        • Choi S.E.
        • Chow V.H.
        • Chung S.J.
        • Wong N.D.
        Do risk factors explain the increased prevalence of type 2 diabetes among California Asian adults?.
        J Immigr Minor Health. 2010; 13: 803-808
        • Staimez L.R.
        • Weber M.B.
        • Ranjani H.
        • Ali M.K.
        • Echouffo-Tcheugui J.B.
        • Phillips L.S.
        • et al.
        Evidence of reduced beta-cell function in Asian Indians with mild dysglycemia.
        Diabetes Care. 2013; 36: 2772-2778
        • Razum O.
        • Twardella D.
        Time travel with Oliver Twist–towards an explanation for a paradoxically low mortality among recent immigrants.
        Trop Med Int Health: TM & IH. 2002; 7: 4-10
        • Norredam M.
        • Hansen O.H.
        • Petersen J.H.
        • Kunst A.E.
        • Kristiansen M.
        • Krasnik A.
        • et al.
        Remigration of migrants with severe disease: myth or reality?–a register-based cohort study.
        Eur J Public Health. 2015; 25: 84-89
        • Norredam M.
        • Agyemang C.
        • Hoejbjerg Hansen O.K.
        • Petersen J.H.
        • Byberg S.
        • Krasnik A.
        • et al.
        Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the ’healthy migrant effect’ hypothesis.
        Trop Med Int Health: TM & IH. 2014; 19: 958-967
      2. Doyle M, Blake M. Methodological issues in quantitative research with minority ethnic populations. Eighth conference on health survey research methods Hyattsville, MD; 2004.

        • Nielsen S.S.
        • Hempler N.F.
        • Waldorff F.B.
        • Kreiner S.
        • Krasnik A.
        Is there equity in use of healthcare services among immigrants, their descendents, and ethnic Danes?.
        Scand J Public Health. 2012; 40: 260-270
        • Green A.
        • Sortso C.
        • Jensen P.B.
        • Emneus M.
        Validation of the Danish national diabetes register.
        Clin Epidemiol. 2015; 7: 5-15