title: Prevalence, risk factors and co-morbidities of diabetes among adults in rural Saskatchewan: the influence of farm residence and agriculture-related exposures.
abstract: BACKGROUND
  Although rural Canadians are reported to have higher rates of diabetes than others, little is known about the relative influence of known versus agriculture-related risk factors. The purpose of this research was to carry out a comprehensive study of prevalence, risk factors and co-morbidities of diabetes among adults in rural Saskatchewan and to determine possible differences between those living on and off farms.
  
  
  METHODS
  In 2010, we conducted a baseline mail-out survey (Saskatchewan Rural Health Study) of 11,982 households located in the province's four agricultural quadrants. In addition to self-reported physician-diagnosed diabetes, the questionnaire collected information from farm and small town cohorts on possible diabetes determinants including lifestyle, family history, early life factors and environmental/agricultural-related exposures. Clustering effect within households was adjusted using Generalized Estimating Equations approach.
  
  
  RESULTS
  Responses were obtained from 4624 (42%) households comprising 8208 males and females aged 18 years or older and 7847 self-described Caucasian participants (7708 with complete information). The overall age-standardized diabetes prevalence for the latter was 6.35% but people whose primary residence was on farms had significantly lower diabetes prevalence than those living in non-farm locations (5.11% versus 7.33% respectively; p<0.0001). Diabetes risk increased with age and affected almost 17% of those older than 65 (OR 2.57; CI' 1.63, 4.04 compared to those aged 18-45). Other known independent risk factors included family history of diabetes (OR 2.50 [CI's 1.94, 3.23] if father; OR 3.11 [CI's 2.44, 3.98] if mother), obesity (OR 2.66; CI's 1.86, 3.78), as well as lower socioeconomic status, minimal/no alcohol intake and smoking. The most original finding was that exposure to insecticides conferred an increased risk for diabetes among males (OR 1.83; CI's 1.15, 2.91). Finally, the co-morbidities with the strongest independent association with diabetes were heart disease and hypertension.
  
  
  CONCLUSIONS
  While known diabetes risk factors are important determinants of diabetes in the agricultural zones of Saskatchewan, on-farm residence is protective and appears related to increased outdoor activities. In contrast, we have now shown for the first time that exposure to insecticides is an independent risk factor for diabetes among men in rural Canada.
authors.affiliation: Department of Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W0, Canada. roland.dyck@usask.ca
authors.forename: Roland
authors.initials: R
authors.lastname: Dyck
authors.forename: Chandima
authors.initials: C
authors.lastname: Karunanayake
authors.forename: Punam
authors.initials: P
authors.lastname: Pahwa
authors.forename: Louise
authors.initials: L
authors.lastname: Hagel
authors.forename: Josh
authors.initials: J
authors.lastname: Lawson
authors.forename: Donna
authors.initials: D
authors.lastname: Rennie
authors.forename: James
authors.initials: J
authors.lastname: Dosman
mesh_terms: D000328:Adult; D000383:Agriculture; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012525:Saskatchewan / Q000453:epidemiology; D011795:Surveys and Questionnaires