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Risk factors, incidence, and prevalence of diabetes among rural farm and non-farm residents of Saskatchewan, Canada; a population-based longitudinal cohort study

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Abstract

Purpose

Saskatchewan has a high prevalence of diabetes. It is the largest, rurally populated, predominantly agricultural province in Canada. This research aims to determine the risk factors associated with the incidence and longitudinal changes in the prevalence of diabetes among Saskatchewan’s adult rural farm and non-farm residents.

Methods

The Saskatchewan Rural Health Study (SRHS) is a prospective cohort study conducted in two phases: a baseline survey (2010, 8261 participants) and a follow-up survey (2014, 4867 participants). Generalized estimation equations and survival analysis techniques were used to determine diabetes prevalence and incidence risk factors, respectively.

Results

Incidence of diabetes among rural residents was 2.75%. Positive family history, high BMI, sleep apnea and an abnormal Epworth Sleepiness Score (ESS) were significant predictors for diabetes incidence. A substantial increase (1.98%) of diabetes prevalence was observed after four years of follow-up. Risk factors of diabetes prevalence were increasing age, male, low income, positive family history, high BMI, hypertension and heart attack.

Conclusion

A mix of individual and contextual factors interacting in complex pathways were responsible for the high incidence and prevalence of diabetes among rural residents. The most original finding of that study was a positive association of sleep apnea, and ESS with incident diabetes warrants further research to identify a causal linkage. Increased diabetes risk among rural male insecticide users indicates an adverse consequence of unprotected chemical exposures in the agricultural field. Urgent population-based preventive measures should initiate to slow the increasing trend of diabetes prevalence among rural residents.

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Acknowledgments

The Saskatchewan Rural Health Study Team consists of: James Dosman, MD (Designated Principal Investigator, University of Saskatchewan (UofS), Saskatoon, SK Canada); Punam Pahwa, PhD (Co-Principal Investigator, UofS, Saskatoon SK Canada); John Gordon, PhD (Co-Principal Investigator, UofS, Saskatoon SK Canada); Yue Chen, PhD (University of Ottawa, Ottawa Canada); Roland Dyck, MD (UofS, Saskatoon SK Canada); Louise Hagel (Project Manager, UofS, Saskatoon SK Canada); Bonnie Janzen, PhD (UofS, Saskatoon SK Canada); Chandima Karunanayake, PhD (UofS, Saskatoon SK Canada); Shelley Kirychuk, PhD (UofS, Saskatoon SK Canada); Niels Koehncke, MD (UofS, Saskatoon SK Canada); Joshua Lawson, PhD, (UofS, Saskatoon SK Canada); William Pickett, PhD (Queen’s University, Kingston ON Canada); Roger Pitblado, PhD (Professor Emeritus, Laurentian University, Sudbury ON Canada); Donna Rennie, RN, PhD, (UofS, Saskatoon SK Canada); Ambikaipakan Senthilselvan, PhD (University of Alberta, Edmonton, AB, Canada). We are grateful for the contributions of all the participants who donated their time to complete and return the survey.

All sources of support requiring acknowledgement

Canadian Institutes of Health Research.

Funding

was received from Canadian Institutes of Health Research “Saskatchewan Rural Health Study”, Canadian Institutes of Health Research MOP-187209-POP-CCAA-11829.

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Authors and Affiliations

  1. Department of Community Health and Epidemiology, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada

    Md Saiful Alam, Bonnie Janzen & Punam Pahwa

  2. Department of Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N0W0, Canada

    Roland Dyck

  3. Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada

    Chandima Karunanayake, James Dosman & Punam Pahwa

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  1. Md Saiful Alam
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  4. Chandima Karunanayake
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Contributions

SA conducted all the analysis, interpretation, discussion and writing of this manuscript under the supervision of PP. RD, BJ, CK, and JD reviewed the manuscript and assisting in preparing the manuscript by providing feedback.

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Correspondence to Punam Pahwa.

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Appendix

Appendix

Fig. 4
figure 4

Theoretical framework for this study. Legend of Assessment Methods: 1. Survey questionnaire (farm and small-town cohorts); 2 Clinical assessment (sub-sample of both cohorts); 3. Environmental assessments; 4. Health care utilization records.

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Alam, M.S., Dyck, R., Janzen, B. et al. Risk factors, incidence, and prevalence of diabetes among rural farm and non-farm residents of Saskatchewan, Canada; a population-based longitudinal cohort study. J Diabetes Metab Disord 19, 1563–1582 (2020). https://doi.org/10.1007/s40200-020-00693-z

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