BMC Medicine
Volume 17, Issue 1, 2019

Ethnic differences in prediabetes incidence among immigrants to Canada: A population-based cohort study (Article) (Open Access)

Fazli G.S.* , Moineddin R. , Bierman A.S. , Booth G.L.
  • a MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5C 1N8, Canada, Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, ON M5T 3M7, Canada
  • b Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada, Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, Toronto, ON M5T 1W7, Canada
  • c Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, ON M5T 3M7, Canada
  • d MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5C 1N8, Canada, Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada, Department of Medicine, University of Toronto, 1 Kings College Circle, Toronto, ON M5S 1A8, Canada, Institute of Health Policy Management and Evaluation, University of Toronto, 155 College Street Health Science Building, Toronto, ON M5T 3M7, Canada

Abstract

Background: Prediabetes appears to be increasing worldwide. This study examined the incidence of prediabetes among immigrants to Canada of different ethnic origins and the age at which ethnic differences emerged. Methods: We assembled a cohort of Ontario adults (≥ 20 years) with normoglycemia based on glucose testing performed between 2002 and 2011 through a single commercial laboratory database (N = 1,772,180). Immigration data were used to assign ethnicity based on country of origin, mother tongue, and surname. Individuals were followed until December 2013 for the development of prediabetes, defined using either the World Health Organization/Diabetes Canada (WHO/DC) or American Diabetes Association (ADA) thresholds. Multivariate competing risk regression models were derived to examine the effect of ethnicity and immigration status on prediabetes incidence. Results: After a median follow-up of 8.0 years, 337,608 individuals developed prediabetes. Using definitions based on WHO/DC, the adjusted cumulative incidence of prediabetes was 40% (HR 1.40, CI 1.38-1.41) higher for immigrants relative to long-term Canadian residents (21.2% vs 16.0%, p < 0.001) and nearly twofold higher among South Asian than Western European immigrants (23.6%; HR 1.95, CI1.87-2.03 vs 13.1%; referent). Cumulative incidence rates based on ADA thresholds were considerably higher (47.1% and 32.3% among South Asians and Western Europeans, respectively). Ethnic differences emerged at young ages. South Asians aged 20-34 years had a similar prediabetes incidence as Europeans who were 15 years older (35-49 years), regardless of which prediabetes definition was used (WHO/DC 14.4% vs 15.7%; ADA 38.0% vs 33.0%). Conclusion: Prediabetes incidence was substantially higher among non-European immigrants to Canada, highlighting the need for early prevention strategies in these populations. © 2019 The Author(s).

Author Keywords

Immigrant health Ethnicity Population-based study Prediabetes Epidemiology

Index Keywords

immigrant South Asian follow up human risk assessment middle aged Cohort Studies Asian continental ancestry group Ethnic Groups ethnic group Western European ethnology Young Adult Humans migrant ethnic difference male Canada Emigrants and Immigrants female Incidence Article Ontario major clinical study adult migration Prediabetic State age distribution world health organization cohort analysis Emigration and Immigration impaired glucose tolerance
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85066398954&doi=10.1186%2fs12916-019-1337-2&partnerID=40&md5=46b9b701c94fb2c8059dc43139431659
DOI: 10.1186/s12916-019-1337-2
ISSN: 17417015
Original Language: English