Abstract
BackgroundAlthough 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.MethodsIn 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.ResultsResponses 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.ConclusionsWhile 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.
Highlights
Over the past several decades, type 2 diabetes mellitus has emerged as one of the most important chronic diseases affecting Canadian adults [1], largely related to changing lifestyles and other environmental factors associated with increasing rates of overweight/obesity [2]
Overall unadjusted diabetes prevalence was similar between Saskatchewan0s agricultural zones, it ranged from 8.0% in the northwest
We did not observe the higher prevalence of diabetes among males in rural Saskatchewan as we had for the province overall [5] but did find that people whose primary residence was on farms had significantly lower diabetes prevalence than those living in non-farm locations
Summary
Over the past several decades, type 2 diabetes mellitus has emerged as one of the most important chronic diseases affecting Canadian adults [1], largely related to changing lifestyles and other environmental factors associated with increasing rates of overweight/obesity [2]. Diabetes accounts for a substantial proportion of the morbidity caused by blindness, lower limb amputations and end stage renal failure as well as deaths caused by coronary artery disease and stroke [3]. These chronic complications have an enormous impact on affected individuals and their families and consume an increasing share of health care resources [3]. 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
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