Background
Methods
Data source
The Diabetes Population Risk Tool (DPoRT)
Study variables
Statistical analysis
Results
Study population
Females | Males | Differences between females and males | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Overall (n, weighted) | Low Risk (%) | Moderate Risk (%) | High Risk (%) | Overall (n, weighted) | Low Risk (%) | Moderate Risk (%) | High Risk (%) | Low Risk | Moderate Risk | High Risk | |
Socioeconomic status | |||||||||||
Education, Highest attained in household | |||||||||||
Less than secondary | 314,654 | 31.4 | 49.4 | 19.2 | 323,506 | 27.1 | 47.2 | 25.7 |
p = 0.002 |
p = 0.006 |
p = 0.034 |
Secondary school graduation | 854,063 | 40.6 | 45.7 | 13.6 | 894,214 | 34.3 | 45.4 | 20.3 | |||
Some post-secondary | 356,749 | 49.5 | 43.0 | 7.4 | 341,555 | 44.3 | 42.4 | 13.3 | |||
Post-secondary graduation | 7,495,265 | 58.7 | 34.8 | 6.4 | 7,264,029 | 42.9 | 44.0 | 13.2 | |||
Household income quintile | |||||||||||
Quintile 1 (lowest 20 %) | 1,676,952 | 50.7 | 39.4 | 9.9 | 1,301,012 | 45.9 | 39.6 | 14.5 |
p = 0.030 |
p < 0.001 |
p < 0.001 |
Quintile 2 | 1,737,598 | 52.7 | 39.0 | 8.3 | 1,566,842 | 40.5 | 42.6 | 16.9 | |||
Quintile 3 | 1,922,377 | 54.7 | 37.4 | 7.8 | 1,814,805 | 44.1 | 41.0 | 14.8 | |||
Quintile 4 | 1,986,387 | 56.4 | 36.9 | 6.7 | 2,199,854 | 42.6 | 42.6 | 14.8 | |||
Quintile 5 (highest 20 %) | 2,060,668 | 62.5 | 32.0 | 5.5 | 2,493,332 | 38.8 | 49.3 | 11.9 | |||
Food security | |||||||||||
Food secure | 8,504,214 | 66.9 | 29.1 | 4.0 | 8,690,076 | 41.8 | 44.1 | 14.1 |
p = 0.066 |
p < 0.001 |
p < 0.001 |
Moderately insecure | 595,581 | 58.4 | 35.2 | 6.4 | 508,832 | 46.5 | 36.7 | 16.8 | |||
Severely insecure | 258,119 | 47.5 | 42.1 | 10.3 | 163,891 | 39.2 | 43.5 | 17.3 | |||
Demographics | |||||||||||
Ethnicity | |||||||||||
White | 7,276,422 | 59.5 | 34.3 | 6.2 | 7,210,856 | 43.9 | 43.8 | 12.2 |
p = 0.006 |
p < 0.001 |
p = 0.460 |
Non-white | 2,135,270 | 42.5 | 45.4 | 12.1 | 2,194,476 | 35.6 | 43.2 | 21.2 | |||
Immigrant status | |||||||||||
Yes | 7,240,573 | 59.2 | 34.5 | 6.4 | 7,070,795 | 43.8 | 43.5 | 12.7 |
p = 0.001 |
p = 0.001 |
p = 0.293 |
No | 2,171,119 | 44.0 | 44.6 | 11.4 | 2,278,513 | 36.8 | 44.2 | 19.0 | |||
Health, behavior, attitudes | |||||||||||
Self-perceived health | |||||||||||
Excellent | 2,110,877 | 68.4 | 28.9 | 2.6 | 2,171,360 | 53.3 | 39.6 | 7.1 |
p < 0.001 |
p < 0.001 |
p < 0.001 |
Very good | 3,918,268 | 59.9 | 35.2 | 4.9 | 3,917,345 | 44.2 | 43.7 | 12.1 | |||
Good | 2,523,097 | 45.4 | 42.5 | 12.1 | 2,591,761 | 34.6 | 46.0 | 19.4 | |||
Fair | 665,897 | 35.3 | 47.5 | 17.2 | 570,411 | 24.4 | 46.2 | 29.4 | |||
Poor | 189,992 | 34.7 | 44.3 | 21.0 | 141,213 | 16.7 | 49.1 | 34.2 | |||
Total physical activity level (leisure and transportation)a
| |||||||||||
Active | 2,636,812 | 66.9 | 29.1 | 4.0 | 2,956,217 | 49.7 | 44.1 | 14.1 |
p < 0.001 |
p < 0.001 |
p = 0.002 |
Moderately active | 2,546,977 | 58.4 | 35.2 | 6.4 | 2,454,829 | 41.7 | 36.7 | 16.8 | |||
Inactive | 4,126,345 | 47.5 | 42.1 | 10.3 | 3,925,487 | 36.2 | 43.5 | 17.3 | |||
Smoking status | |||||||||||
Current | 1,942,810 | 57.3 | 36.5 | 6.2 | 2,444,004 | 43.5 | 43.8 | 12.7 |
p < 0.001 |
p < 0.001 |
p < 0.001 |
Former | 2,163,606 | 50.0 | 40.0 | 9.9 | 2,381,000 | 29.1 | 50.0 | 20.9 | |||
Never | 4,032,660 | 55.9 | 36.6 | 7.5 | 3,099,374 | 48.8 | 39.0 | 12.2 | |||
Satisfaction with life | |||||||||||
Very satisfied/satisfied | 8,676,427 | 57.2 | 36.3 | 6.6 | 8,717,436 | 42.7 | 43.5 | 13.8 |
p = 0.489 |
p = 0.161 |
p < 0.001 |
Neutral | 414,434 | 43.9 | 39.0 | 17.2 | 429,938 | 32.0 | 47.4 | 20.5 | |||
Dissatisfied/very dissatisfied | 238,404 | 37.6 | 42.7 | 19.7 | 229,700 | 35.2 | 41.8 | 23.0 | |||
Can-marg indicesb
| |||||||||||
Material deprivation | |||||||||||
Quintile 1 (least deprived | 2,283,994 | 63.4 | 31.7 | 4.9 | 2,257,736 | 42.4 | 45.9 | 11.7 |
p < 0.001 |
p < 0.001 |
p = 0.224 |
Quintile 2 | 2,065,506 | 55.6 | 36.7 | 7.6 | 2,007,398 | 43.4 | 42.3 | 14.3 | |||
Quintile 3 | 1,910,718 | 53.7 | 38.1 | 8.2 | 1,892,162 | 41.2 | 43.0 | 15.9 | |||
Quintile 4 | 1,668,042 | 52.8 | 39.0 | 8.3 | 1,652,956 | 42.5 | 42.1 | 15.4 | |||
Quintile 5 (most deprived) | 1,483,432 | 49.7 | 40.6 | 9.8 | 1,595,080 | 40.1 | 44.8 | 15.1 | |||
Ethnic concentration | |||||||||||
Quintile 1 (least concentrated) | 1,369,771 | 52.4 | 39.2 | 8.4 | 1,385,597 | 35.5 | 47.9 | 16.6 |
p = 0.026 |
p = 0.230 |
p = 0.028 |
Quintile 2 | 1,630,547 | 56.9 | 35.5 | 7.6 | 1,630,486 | 39.6 | 46.0 | 14.4 | |||
Quintile 3 | 1,844,042 | 58.1 | 36.2 | 5.7 | 1,835,057 | 43.8 | 41.5 | 14.6 | |||
Quintile 4 | 2,105,588 | 57.3 | 35.2 | 7.5 | 2,035,845 | 45.7 | 41.9 | 12.4 | |||
Quintile 5 (most concentrated) | 1,461,744 | 53.4 | 38.2 | 8.4 | 2,518,346 | 42.8 | 42.8 | 14.4 |
Associations of individual-level household education, income, and food security with DPoRT risk
Moderate risk | ||||
---|---|---|---|---|
Females | Males | |||
Age-adjusted | Fully-adjusted | Age-adjusted | Fully-adjusted | |
Highest level of household education | ||||
Less than secondary | 2.37 (1.93-2.92, p < 0.0001)* | 2.04 (1.63-2.55), p < 0.0001* | 1.47 (1.10-1.98), p = 0.0103* | 1.39 (1.01-1.92), p = 0.0430* |
Secondary graduation | 1.87 (1.61-2.17, p < 0.0001)* | 1.77 (1.50-2.09), p < 0.0001* | 1.47 (1.20-1.81), p = 0.0002* | 1.47 (1.15-1.87), p = 0.0022* |
Some post-secondary | 1.82 (1.42-2.33, p < 0.0001)* | 1.83 (1.42-2.36), p < 0.0001* | 1.28 (0.95-1.72), p = 0.1026 | 1.34 (0.98-1.84), p = 0.0642* |
Post-secondary grad | Reference | Reference | Reference | Reference |
Household income quintile | ||||
Quintile 1 (lowest) | 2.11 (1.84-2.43), p < 0.0001* | 1.43 (1.22-1.67), p < 0.0001* | 1.59 (1.30-1.95), p < 0.0001* | 1.05 (0.84-1.33), p = 0.6624 |
Quintile 2 | 1.79 (1.57-2.03), p < 0.0001* | 1.36 (1.16-1.59), p = 0.0002 | 1.67 (1.40-2.00), p < 0.0001* | 1.25 (1.01-1.56), p = 0.0430* |
Quintile 3 | 1.55 (1.37-1.76), p < 0.0001* | 1.36 (1.19-1.56), p < 0.0001* | 1.19 (1.02-1.40), p = 0.0325* | 0.99 (0.82-1.20), p = 0.9239 |
Quintile 4 | 1.40 (1.23-1.59), p < 0.0001* | 1.39 (1.20-1.60), p < 0.0001* | 1.18 (1.01-1.38), p = 0.0406* | 1.17 (0.98-1.39), p = 0.0796 |
Quintile 5 (highest) | Reference | Reference | Reference | Reference |
Food security | ||||
Food secure | Reference | Reference | Reference | Reference |
Moderately insecure | 1.77 (1.45-2.16), p < 0.0001* | 1.57 (1.26-1.95), p < 0.0001* | 1.00 (0.77-1.31), p = 0.9767 | 0.76 (0.56-1.03), p = 0.0808 |
Severely insecure | 1.54 (1.22-1.95), p = 0.0003* | 1.30 (1.00-1.69), p = 0.0532 | 1.40 (0.98-2.00), p = 0.0636 | 1.16 (0.76-1.76), p = 0.4885 |
High risk | ||||
---|---|---|---|---|
Females | Males | |||
Age-adjusted | Fully-adjusted | Age-adjusted | Fully-adjusted | |
Highest level of household education | ||||
Less than secondary | 4.18 (3.10-5.68), p < 0.0001* | 3.10 (2.19-4.40), p < 0.0001* | 2.47 (1.72-3.53), p < 0.0001* | 2.17 (1.42-3.32), p = 0.0004* |
Secondary graduation | 2.80 (2.22-3.53), p < 0.0001* | 2.84 (2.20-3.67), p < 0.0001* | 2.18 (1.71-2.76), p < 0.0001* | 2.22 (1.66-2.98), p < 0.0001* |
Some post-secondary | 1.92 (1.24-2.98), p = 0.0037* | 2.11 (1.29-3.46), p = 0.0029* | 1.34 (0.93-1.92), p = 0.1182 | 1.43 (0.94-2.18), p = 0.0974 |
Post-secondary grad | Reference | Reference | Reference | Reference |
Household income quintile | ||||
Quintile 1 (lowest) | 3.67 (2.84-4.74), p < 0.0001* | 1.37 (1.01-1.86), p = 0.0418* | 2.92 (2.24-3.79), p < 0.0001* | 1.15 (0.84-1.57), p = 0.3818 |
Quintile 2 | 2.36 (1.81-3.09), p < 0.0001*,¥
| 1.38 (1.02-1.87), p = 0.0346* | 3.28 (2.54-4.23), p < 0.0001*,¥
| 1.63 (1.21-2.19), p = 0.0013* |
Quintile 3 | 1.97 (1.51-2.57), p < 0.0001* | 1.38 (1.04-1.85), p = 0.0280* | 1.95 (1.54-2.47), p < 0.0001* | 1.34 (1.02-1.77), p = 0.0353* |
Quintile 4 | 1.50 (1.17-1.94), p < 0.0001* | 1.36 (1.03-1.79), p = 0.0327* | 1.86 (1.51-2.30), p < 0.0001* | 1.57 (1.24-2.00), p = 0.0002* |
Quintile 5 (highest) | Reference | Reference | Reference | Reference |
Food security | ||||
Food secure | Reference | Reference | Reference | Reference |
Moderately insecure | 2.79 (2.01-3.86), p < 0.0001* | 1.56 (1.08-2.27), p = 0.0194* | 1.58 (1.09-2.30), p = 0.0161* | 1.04 (0.62-1.74), p = 0.8839 |
Severely insecure | 4.68 (3.25-6.74), p < 0.0001* | 2.64 (1.78-3.92), p < 0.0001* | 1.95 (1.29-2.97), p = 0.0017* | 1.22 (0.71-2.10), p = 0.4815 |
Associations of CAN-Marg material deprivation and ethnic concentration indices with DPoRT risk
Moderate risk | ||||
---|---|---|---|---|
Females | Males | |||
Age-adjusteda
| Fully-adjustedb
| Age-adjustedb
| Fully-adjustedb
| |
CAN-Marg Material deprivation | ||||
Q1 (least deprived) | Reference | Reference | Reference | Reference |
Quintile 2 | 1.32 (1.15-1.51), p < 0.0001* | 1.33 (1.15-1.54), p = 0.0002 | 1.07 (0.91-1.25), p = 0.4336 | 1.03 (0.85-1.26), p = 0.7371 |
Quintile 3 | 1.44 (1.24-1.67), p < 0.0001* | 1.39 (1.19-1.63), p < 0.0001 | 1.08 (0.93-1.27), p = 0.3245 | 1.07 (0.88-1.28), p = 0.5052 |
Quintile 4 | 1.60 (1.40-1.82), p < 0.0001* | 1.51 (1.30-1.76), p < 0.0001 | 1.19 (1.01-1.41), p = 0.0376* | 1.14 (0.93-1.40), p = 0.2019 |
Q5 (most deprived) | 1.78 (1.55-2.04), p < 0.0001* | 1.64 (1.39-1.94), p < 0.0001 | 1.39 (1.16-1.66), p = 0.0003* | 1.13 (0.91-1.41), p = 0.2537 |
CAN-Marg Ethnic concentration | ||||
Q1 (least concentrated) | Reference | Reference | Reference | Reference |
Quintile 2 | 0.86 (0.76-0.97), p = 0.0111* | 0.81 (0.70-0.94), p = 0.0041* | 0.96 (0.83-1.12), p = 0.5972 | 0.95 (0.80-1.13), p = 0.5740 |
Quintile 3 | 0.89 (0.78-1.01), p = 0.0697 | 0.84 (0.73-0.96), p = 0.0134* | 0.83 (0.70-0.99), p = 0.0323* | 0.86 (0.72-1.03), p = 0.1055 |
Quintile 4 | 1.01 (0.88-1.15), p = 0.9164 | 0.85 (0.73-0.99), p = 0.0326* | 0.98 (0.83-1.16), p = 0.8281 | 0.89 (0.74-1.08), p = 0.2437 |
Q5 (most concentrated) | 1.23 (1.07-1.41), p = 0.0031* | 0.75 (0.63-0.89), p = 0.0011*,¥
| 1.40 (1.17-1.67), p = 0.0002* | 0.95 (0.76-1.18), p = 0.6351 |
High risk | ||||
---|---|---|---|---|
Females | Males | |||
Age-adjusted | Fully-adjusted | Age-adjusted | Fully-adjusted | |
CAN-Marg Material deprivation | ||||
Q1 (least deprived) | Reference | Reference | Reference | Reference |
Quintile 2 | 1.75 (1.35, 2.27), p < 0.0001* | 1.75 (1.29, 2.37), p = 0.0003* | 1.47 (1.13, 1.92), p = 0.0047* | 1.38 (1.02, 1.86), p = 0.0348* |
Quintile 3 | 1.99 (1.53, 2.58), p < 0.0001* | 1.71 (1.29, 2.29), p = 0.0002* | 1.57 (1.23, 2.01), p = 0.0003* | 1.58 (1.19, 2.10), p = 0.0014* |
Quintile 4 | 2.35 (1.81, 3.06), p < 0.0001* | 2.03 (1.50, 2.76), p < 0.0001* | 1.82 (1.43, 2.32), p < 0.0001* | 1.61 (1.22, 2.14), p = 0.0009* |
Q5 (most deprived) | 2.91 (2.23, 3.78), p < 0.0001* | 2.39 (1.77, 3.23), p < 0.0001* | 2.00 (1.54, 2.60), p < 0.0001* | 1.33 (0.98, 1.81), p = 0.0643 |
CAN-Marg Ethnic concentration | ||||
Q1 (least concentrated) | Reference | Reference | Reference | Reference |
Quintile 2 | 0.88 (0.71, 1.10), p = 0.2623 | 0.80 (0.63, 1.02), p = 0.0711 | 0.90 (0.72, 1.13), p = 0.3716 | 0.93 (0.72, 1.19), p = 0.5768 |
Quintile 3 | 0.69 (0.55, 0.86), p = 0.0011*,¥
| 0.56 (0.43, 0.73), p < 0.0001*,¥
| 0.92 (0.73, 1.17), p = 0.4912 | 0.97 (0.74, 1.27), p = 0.8240¥
|
Quintile 4 | 1.21 (0.94, 1.57), p = 0.1402 | 0.93 (0.69, 1.24), p = 0.6006 | 0.95 (0.75, 1.21), p = 0.6840 | 0.79 (0.60, 1.04), p = 0.0927 |
Q5 (most concentrated) | 1.63 (1.27, 2.09), p = 0.0001* | 0.63 (0.47, 0.86), p = 0.0040* | 1.81 (1.41, 2.32), p < 0.0001* | 0.66 (0.48, 0.90), p = 0.0097* |
Discussion
Mechanisms
Study limitations
Implications
Key messages
-
Articulating population-level future diabetes risk informs primary prevention strategies.
-
Women are more sensitive to social context with respect to future diabetes risk.
-
Area-level material deprivation predicts high risk, while ethnic concentration is protective.