title: Secular trends and educational differences in the incidence of type 2 diabetes in Finland, 1972-2007.
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.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. marian.abouzeid@gmail.com.
authors.forename: Marian
authors.initials: M
authors.lastname: Abouzeid
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Wikström
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Lindström
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Borodulin
authors.affiliation: Department of Public Health, Hjelt Institute, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland.
authors.forename: Ossi
authors.initials: O
authors.lastname: Rahkonen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.|Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, Kuopio, Finland.|Hospital District of North Karelia, Tikkamäentie 16, Joensuu, Finland.|Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, VIC, Australia.
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Education; Incidence; Socio-economic position; Trends; Type 2 diabetes
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