Mortality rates and cardiovascular disease burden in type 2 diabetes by occupation, results from all Swedish employees in 2002–2015

Abstract

Objective To identify occupations where employees with type 2 diabetes have a high risk of cardiovascular disease (CVD) and mortality, and their prevalence of CVD risk factors. This study can contribute in the creation of targeted interventions at the workplace. Research design and methods This nationwide registry-based study included all employees with type 2 diabetes born in Sweden in 1937–1979 (n = 180,620) and followed up in 2002–2015. We calculated age-standardized incidence (per 100,000 person-years) of all-cause and CVD mortality, ischemic heart disease (IHD) and stroke across the 30 most common occupations. Information on prognostic factors was retrieved from the National Diabetes Register. Results In males with type 2 diabetes, mortality rates were highest in manufacturing workers (1782) and machine operators (1329), and lowest in specialist managers (633). The risk of death at age 61–70 years was 21.8% in manufacturing workers and 8.5% in managers. In females with type 2 diabetes, mortality rates were highest in manufacturing workers (1150) and cleaners (876), and lowest in writers and artists (458); the risk of death at age 61–70 years was 12.4% in manufacturing workers and 4.3% in writers and artists. The same occupations also had relatively high incidences of CVD mortality, IHD and stroke. Occupational groups with poor prognosis had high prevalence of CVD risk factors including poor glycemic control, smoking and obesity. Conclusions Manufacturing workers, machine operators and cleaners with type 2 diabetes have two to three times higher mortality rates than managers, writers and artists with type 2 diabetes. Major health gains would be made if targeted workplace interventions could reduce CVD risk factors in these occupations.

Work-related factors among people with diabetes and the risk of cardiovascular diseases: A systematic review

“…Carlsson et al included the employees in Sweden to explore the occupation that poses a higher risk of CVD among workers with diabetes. 16 Among male workers with diabetes, the manufacturing laborers were at the highest 10‐year CVD mortality risk (HR 8.7, 95% CI: 6.4–11.3), 10‐year IHD risk (HR 24.7, 95% CI: 20.4–29.3), and 10‐year stroke risk (HR 9.6, 95% CI: 7.0–12.7) compared to other workers. The manufacturing laborers were at the highest 10‐year CVD mortality risk (HR 3.3, 95% CI: 1.7–5.3), 10‐year IHD risk (HR 11.5, 95% CI: 7.7–16.2), and 10‐year stroke risk (HR 4.6, 95% CI: 2.5–7.3) compared to other professions among female workers with diabetes as well.…”

“…All five studies were conducted in high‐income countries. The geographic region covered the region of the Americas (United States of America), 15 European region (Finland, Sweden), 3 , 16 and Western Pacific region (Singapore, Republic of Korea). 17 , 18 The study design of the included articles was cross‐sectional, comparative cross‐sectional, and cohort study.…”

“…Though the comparative cross‐sectional study was a brief report, 17 it described the study participants, measurement of exposure, confounders sufficiently, and used appropriate statistical techniques. The cohort studies 3 , 16 , 18 were also rated as high quality due to well‐reported characteristics and methodological rigor.…”

“…The selection of participants was graded as high risk of bias in the cross‐sectional studies, 15 , 17 whereas graded as low risk of bias in the cohort studies. 3 , 16 , 18 All five studies measured the confounders and exposures appropriately and were ranked as low risk of bias. None of the studies mentioned the blinding of outcome assessment and therefore, ranked as unclear risk of bias.…”

“…The overall quality of the included articles was good except for one cross‐sectional study, 15 which failed to express methodological rigor when assessed critically. Work‐related factors such as lower occupational status, 15 , 16 occupational driving, 17 manufacturing work, 16 long working hours 18 were found to be associated with CVD among diabetic patients. Occupational physical activity and occupational commuting decreased the risk of CVD mortality.…”