Ethnic variation in the conversion of prediabetes to diabetes among immigrant populations relative to Canadian-born residents: a population-based cohort study

Abstract

Objective: The aim of this study was to compare absolute and relative rates of conversion from prediabetes to diabetes among non-European immigrants to Europeans and Canadian-born residents, overall, and by age and level of glycemia.

Research design and methods: We conducted a retrospective cohort population-based study using administrative health databases from Ontario, Canada, to identify immigrants (n=23 465) and Canadian born (n=1 11 085) aged ≥20 years with prediabetes based on laboratory tests conducted between 2002 and 2011. Individuals were followed until 31 December 2013 for the development of diabetes using a validated algorithm. Immigration data was used to assign ethnicity based on country of origin, mother tongue, and surname. Fine and Gray's survival models were used to compare diabetes incidence across ethnic groups overall and by age and glucose category.

Results: Over a median follow-up of 5.2 years, 8186 immigrants and 39 722 Canadian-born residents developed diabetes (7.1 vs 6.1 per 100 person-years, respectively). High-risk immigrant populations such as South Asians (HR: 1.72, 95% CI 1.55 to 1.99) and Southeast Asians (HR: 1.65, 95% CI 1.46 to 1.86) had highest risk of converting to diabetes compared with Western Europeans (referent). Among immigrants aged 20-34 years, the adjusted cumulative incidence ranged from 18.4% among Eastern Europeans to 52.3% among Southeast Asians. Conversion rates increased with age in all groups but were consistently high among South Asians, Southeast Asians and Sub-Saharan African/Caribbeans after the age of 35 years. On average, South Asians converted to diabetes 3.1-4.6 years earlier than Western Europeans and at an equivalent rate of conversion to Western Europeans who had a 0.5 mmol/L higher baseline fasting glucose value.

Conclusions: High-risk ethnic groups converted to diabetes more rapidly, at younger ages, and at lower fasting glucose values than European populations, leading to a shorter window for diabetes prevention.

Keywords: epidemiology; ethnic differences; pre-diabetes; progression.

Figure 1

Adjusted cumulative incidence function for diabetes among immigrants, by ethnicity and age groups. Adjusted for age, sex, ethnicity, area income, education, marital status, immigration visa category, and duration. New cases of diabetes were determined based on entry into the Ontario Diabetes Database. Cases censored at time when diabetes was ascertained, lost health care coverage, died, or 31 December 2013. All lines based on line of best fit using a polynomial equation, R² >0.99 for each.

Figure 2

Adjusted a cumulative incidence of diabetes among immigrants, by fasting glucose category at baseline. Adjusted for age, sex, ethnicity, area income, education, marital status, immigration visa category, and duration. New cases of diabetes were determined based on entry into the Ontario Diabetes Database. Cases censored at time when diabetes was ascertained, lost health care coverage, died, or 31 December 2013. All lines based on line of best fit using a polynomial equation, R²>0.99 for each.

Figure 3

Adjusted cumulative incidence function for diabetes among South Asians and Western Europeans, by fasting glucose category. Adjusted for age, sex, ethnicity, area income, education, marital status, immigration visa category and duration. New cases of diabetes were determined based onentry into the Ontario Diabetes Database. Cases censored at time when diabetes was ascertained, lost health care coverage, died, or 31 December 2013. All lines based on line of best fit using a polynomial equation, R²>0.99 for each.