Type 2 diabetes is one of our biggest public diseases and contributes to an increased risk of morbidity and premature death . The disease is increasing globally, but especially in several non-European regions .
In Sweden, however, the incidence does not seem to buy, and the prevalence is relatively stable at 5 percent . In recent decades, Sweden’s population has changed over time. Today, one in five Swedish citizens is born abroad, and the largest immigrant groups originate, especially in the Middle East.
Population-based studies conducted in Sweden have shown that non-Western immigrants have twice the risk of developing type 2 diabetes and being affected at much younger ages than non-immigrant Swedes [4, 5].
Diabetic risk factors
Contributing factors to the increased risk of diabetes and previous diabetes are multifaceted. Among other things, migrants are often referred to live in socio-economically vulnerable areas, which I can do to increase the risk of developing diabetes [6, 7].
In addition, first-generation non-Western immigrants generally have a high heritability for type 2 diabetes (> 50 percent have one or more first-degree relatives with diabetes), which may reflect a high genetic risk.  and in combination with physical inactivity and obesity contribute to previous diabetes [4, 9, 10].
Because early diabetes diagnosis is a strong prognostic marker of mortality, the purpose of this study, which was recently published in the scientific journal Diabetologia , to compare mortality in incident type 2 diabetes in first and second generation immigrants with people without a migration background. In addition, we wanted to investigate whether the length of stay in Sweden for first-generation immigrants also affected mortality.
Mortality in the first generation
I studied included all individuals with a residence permit in Sweden as prescriptions for glucose-lowering drugs from January 2006 to December 2013. They were followed until December 2016 with regard to total mortality and until December 2012 with regard to cause-specific mortality. A total of 138,085 individuals in the study met the inclusion criteria. 74 percent were native Swedes, 21 percent were first-generation immigrants and 5 percent second-generation immigrants.
The total mortality during the 10-year follow-up was 20 percent lower among first-generation immigrants compared with native Swedes. The risk was particularly low among first-generation non-Western immigrants, who had over 50 percent lower relative total mortality risk (Figure 1), over 60 percent lower relative mortality risk related to cardiovascular disease, and 30 percent lower relative cancer mortality.
But the study also shows that time in Sweden had a major impact on total mortality. First-generation immigrants who spent less than 24 years in Sweden had almost 50 percent lower mortality than people without a migration background, while the difference in risk rather disappeared among first-generation immigrants who spent more than 24 years in Sweden. These findings that time in Sweden has a negative impact on survival were strengthened by the fact that second-generation immigrants had an 11 percent higher relative risk of total mortality than people without a migration background.
The main findings of the study are that total and cause-related mortality in type 2 diabetes is lower in first-generation immigrants than in people without a migration background, but the survival benefit assures over time, and second-generation immigrants have a higher mortality rate than people without a migration background.
What can explain these findings?
Exposed socio-economy and early onset of diabetes are driving factors in the western population group to increased diabetes risk and higher diabetes-related mortality. Given that first- and second-generation immigrants in the study showed significantly lower age at onset of diabetes (about 10–15 years earlier than native Swedes) and that the socio-economy was more strained among non-Western immigrants, these findings are paradoxical. But in our study we can show that we can perform socioeconomics and early diabetes does not affect the mortality of first generation immigrants to the same extent as in people without a migration background, which we believe has an impact on our end results.
We have not been able to study the impact of lifestyle skills, comorbidity and metabolic factors that may also contribute to the observers being sent to mortality we see. So we can only speculate that co-morbidity in cardiovascular disease may be lower among first-generation immigrants and contribute to lower mortality. Previous population studies in Sweden have shown that people who immigrated from the Middle East has a lower hypertonic risk Compare with non-immigrants , but also that their kidney function is better . In the ANDIS study (All new diabetics in Skåne) we see, for example, that immigrants from Iraq with newly discovered diabetes do not suffer from kidney complications to the same extent as people without an immigrant background, which could theoretically contribute to a higher survival for the Iraqi-born group . Furthermore, free can be important. A recent study, which measured the distribution of healthy and unhealthy lipid levels, showed a higher proportion of unsaturated fats in the non-Western immigrant group. , which I could suggest a healthier diet and reduced cardiovascular risk. Alcohol can also be important in this context. Alcohol is a strong risk factor for premature death , and alcohol consumption is lower among non-Western immigrants, which can thus be a contributing health factor in this context.
All data were adjusted for differences in age at diagnosis, gender, socioeconomic factors, and type 2 diabetes treatment. The strength of this study is that it most certainly covers all newly diagnosed type 2 diabetes patients in Sweden and that data are recently collected and fresh.
Western lifestyle and epigenetics?
The global political instability in the Middle East and Asia will in all probability continue and contribute to forcing people to flee. When people adapt to Western culture, it can lead to more traditional habits gradually being abandoned and lifestyle habits adapted to the new culture. Interaction between genes and the environment often interacts and can contribute to diabetes and cardiovascular disease . For example, have studies in Sweden has shown that immigrants have an increased incidence of coronary heart disease in Sweden than in their home countries, which may support this theory . We can only speculate that adapting to the Western environment has an impact on the survival of first- and second-generation immigrants who develop diabetes, but it remains to be investigated in future studies.
Potential bonds or disputes: None stated.
Läkartidningen. 2021,118: 20177