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Incidence and Longitudinal Changes in the Prevalence of Diabetes among Rural Residents of Saskatchewan, Canada



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Background: Saskatchewan is one of the largest rurally populated provinces in Canada with a high prevalence of diabetes in the rural population. Current knowledge about risk factors of diabetes prevalence among the rural residents and the First Nations populations in Saskatchewan is primarily based on cross-sectional studies. Additionally, information regarding risk factors associated with the incidence of diabetes among Canadian rural and First Nation populations is limited. Purpose: The purpose of this study was to extensively assess predictors and longitudinal changes associated with the incidence and prevalence of diabetes among rural residents and First Nations in Saskatchewan, Canada. Additionally, we wanted to determine differences in rates and risk factors of diabetes between First Nations and rural residents in Saskatchewan. Methods: Both the Saskatchewan rural health study (SRHS) and First Nation Lung Health Project (FNLHP) were prospective cohort studies. SRHS was conducted in two phases: a baseline survey (2010, n=8261) and a follow-up survey (2014, n=4867). The FNLHP was also conducted in two phases: baseline survey (2012/13, n=874) and a follow-up survey (2016, n=839) Results: The prevalence of diabetes increased from the baseline to follow-up in rural residents and First Nation populations, and non-farm rural residents had a higher prevalence of diabetes than rural farm residents. Apart from common modifiable risk factors, agricultural chemical-related exposures were responsible for the high prevalence of diabetes among rural residents but proven non-significant for the incidence of diabetes. A unique finding of our study was that sleep apnea significantly increases the risk of developing new diabetes cases among rural residents, which is non-significant for the prevalence of diabetes. Additionally, diabetes was prevalent among First Nation women, compared to men, and the finding was reversed for rural residents. Unemployment and high BMI were the most significant factors for the high prevalence of diabetes among First Nation Populations. However, severe perceived discrimination acted as a protective factor for diabetes prevalence, and the underlying mechanism was unclear. Conclusion: Both individual and contextual factors were responsible for the high incidence and prevalence of diabetes among the rural residents and First Nation populations of Saskatchewan, which demands urgent long term and population-based community health initiatives.



Rural Saskatchewan, First Nation Populations, Social Determinants of Health, Agricultural exposures, Colonization, Risk factors, Incidence, Prevalence, Diabetes



Master of Science (M.Sc.)


Community Health and Epidemiology


Community and Population Health Science


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