Incidence and prevalence of type 2 diabetes by occupation: results from all Swedish employees

Abstract

Aims/hypothesisThe workplace is a potentially important arena for prevention of type 2 diabetes and the first step is to identify occupations where the disease is common and/or risk is high. Therefore, our aim was to analyse incidence and prevalence of type 2 diabetes across all occupational groups in Sweden.MethodsThis nationwide study included all Swedish citizens born between 1937 and 1979 and gainfully employed between 2001 and 2013 (N = 4,550,892), and followed for a diagnosis of diabetes from 2006 to 2015 (n = 201,717) through national registers. Prevalence in 2013 (mean age 51 years; range 35–67) and age-standardised incidence (per 1000 person-years) were analysed across the 30 most common occupations among men and women. Information on BMI, physical fitness and smoking was obtained through the National Conscription (mean age 18) and Medical Birth Registers (mean age 29).ResultsPrevalence of type 2 diabetes was 5.2% in men and 3.2% in women; in men it was highest among motor vehicle drivers (8.8%) and in women it was highest among manufacturing workers (6.4%). Incidence varied dramatically across occupational groups. In men, it was highest among manufacturing workers (9.41) and professional drivers (9.32) and lowest among university teachers (3.44). In women, incidence was highest in manufacturing workers (7.20) and cleaners (6.18) and lowest in physiotherapists (2.20). We found major differences in the prevalence of being overweight and smoking and in the level of physical fitness across these occupational groups even at young ages.Conclusions/interpretationProfessional drivers, manufacturing workers and cleaners have a threefold increased risk of type 2 diabetes compared with university teachers and physiotherapists. These differences most likely reflect dramatic differences in the prevalence of lifestyle risk factors. If workplace interventions could reduce weight and increase physical activity among employees in these occupations, major health gains may be made.Electronic supplementary materialThe online version of this article (10.1007/s00125-019-04997-5) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Lifestyle-associated health risk indicators across a wide range of occupational groups: a cross-sectional analysis in 72 855 workers

“…Our ndings are not consistent with U.S. data where blue collar workers had higher cardiorespiratory tness compared to white-collar and service personnel (11), and with a smaller Swiss study which found no differences in cardiorespiratory tness between major occupational groups (9). However, partly consistent with the present study, a previous Swedish study reported low physical tness for male conscripts whose future occupation would be motor vehicle drivers, agricultural and other mobile plant operators (8).…”

“…One reason for this could be that these two indicators share the weight characteristic in their formulae, although they can still be seen as separate risk indicators (24). Previous studies have reported similar ndings, with higher obesity prevalence for women with occupations with low social position (25) and in male conscripts with future typical blue collar occupations had higher prevalence of obesity than other occupations (8). Also hypertension shared the similar pattern as low cardiorespiratory tness and obesity, which may partly be attributed to that excess body fat is a strong predictor of hypertension, but at the same time covariation with other risk indicators that may be part of the aetiology of hypertension, such as smoking (26).…”

“…As these are heterogeneous groups of occupations with a diversity of work situations that could have an effect on health outcomes. For instance, previous reports have indicated variations in overweight, smoking and occupational physical activity between a larger range of occupational groups (9,10,8). Other studies found differences in physical activity but con icting results of cardiorespiratory tness between occupational groups (9,11).…”

Lifestyle-associated health risk indicators across a wide range of occupational groups: a cross-sectional analysis in 72,855 workers

“…The sub-categorisation into white- and blue-collar occupations may mislead as these are heterogeneous groups of occupations with a diversity of work situations that could have an effect on health outcomes [ 8 – 10 ]. For instance, previous reports have indicated variations in overweight, smoking as well as occupational and leisure time physical activity between a larger range of occupational groups [ 8 – 10 ], with conflicting results of differences in cardiorespiratory fitness [ 8 , 11 ]. A recent Swedish study reported large differences in diabetes type 2 incidence between the 30 most common occupations.…”

“…A recent Swedish study reported large differences in diabetes type 2 incidence between the 30 most common occupations. The authors pointed at variations in underlying lifestyle related factors to possibly influence the variation in diabetes incidence between occupational groups, however had no data to study this [ 10 ]. Hence, for a clearer picture, further evaluation of differences between occupational groups regarding lifestyle-associated health risks for disease occurrence in high-powered cohorts are needed.…”