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Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes

Fredheim, Siri; Delli, Ahmed LU ; Rida, Heba; Drivvoll, Ann-Kristin; Skrivarhaug, Torild; Bjarnason, Ragnar; Thorsson, Arni; Lindblad, Bengt and Svensson, Jannet (2014) In Pediatric Diabetes 15(7). p.519-527
Abstract
Background/Objective: Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe. Research design and methods: We investigated patients aged 0-15 yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries). Results: The cohort (n= 11,908, 53.0% boys, onset age 7.7 (3.9) yr, diabetes duration 6.1 (3.6) yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to... (More)
Background/Objective: Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe. Research design and methods: We investigated patients aged 0-15 yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries). Results: The cohort (n= 11,908, 53.0% boys, onset age 7.7 (3.9) yr, diabetes duration 6.1 (3.6) yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to country of residence were: 5.7% (D), 2.7% (I), 5.5% (N), and 9.4% (S). Sex distribution and BMI z-score did not differ between Nordic and non-Nordic patients, but non-Nordic patients were 0.5 yr younger at onset than Nordic patients (p< 0.0006). Non-Nordic patients had a lower number of daily insulin bolus injections and higher daily insulin doses compared to their Nordic peers. Patients of non-Nordic origin had slightly higher HbA1c levels (0.6-2.9 mmol/mol, p< 0.001) and, with the exception of Norway, were less frequently treated with CSII (p= 0.002) after adjusting for confounders. Conclusions: The reported differences in glycemic regulation between Nordic and non-Nordic type 1 diabetes children and adolescents in four Nordic countries are diminutive, but persist after accounting for treatment intensity. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Denmark, ethnicity, Iceland, Nordic, Norway, population register, Sweden, treatment, type 1 diabetes
in
Pediatric Diabetes
volume
15
issue
7
pages
519 - 527
publisher
Wiley-Blackwell
external identifiers
  • wos:000345035200007
  • scopus:84907951216
ISSN
1399-543X
DOI
10.1111/pedi.12157
language
English
LU publication?
yes
id
4567378d-c02e-4f8d-ae80-fb283f6aa321 (old id 4865411)
date added to LUP
2015-01-07 10:31:32
date last changed
2017-09-10 03:19:28
@article{4567378d-c02e-4f8d-ae80-fb283f6aa321,
  abstract     = {Background/Objective: Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe. Research design and methods: We investigated patients aged 0-15 yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries). Results: The cohort (n= 11,908, 53.0% boys, onset age 7.7 (3.9) yr, diabetes duration 6.1 (3.6) yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to country of residence were: 5.7% (D), 2.7% (I), 5.5% (N), and 9.4% (S). Sex distribution and BMI z-score did not differ between Nordic and non-Nordic patients, but non-Nordic patients were 0.5 yr younger at onset than Nordic patients (p&lt; 0.0006). Non-Nordic patients had a lower number of daily insulin bolus injections and higher daily insulin doses compared to their Nordic peers. Patients of non-Nordic origin had slightly higher HbA1c levels (0.6-2.9 mmol/mol, p&lt; 0.001) and, with the exception of Norway, were less frequently treated with CSII (p= 0.002) after adjusting for confounders. Conclusions: The reported differences in glycemic regulation between Nordic and non-Nordic type 1 diabetes children and adolescents in four Nordic countries are diminutive, but persist after accounting for treatment intensity.},
  author       = {Fredheim, Siri and Delli, Ahmed and Rida, Heba and Drivvoll, Ann-Kristin and Skrivarhaug, Torild and Bjarnason, Ragnar and Thorsson, Arni and Lindblad, Bengt and Svensson, Jannet},
  issn         = {1399-543X},
  keyword      = {Denmark,ethnicity,Iceland,Nordic,Norway,population register,Sweden,treatment,type 1 diabetes},
  language     = {eng},
  number       = {7},
  pages        = {519--527},
  publisher    = {Wiley-Blackwell},
  series       = {Pediatric Diabetes},
  title        = {Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes},
  url          = {http://dx.doi.org/10.1111/pedi.12157},
  volume       = {15},
  year         = {2014},
}