Health, health care utilization and living conditions in foreign-born diabetic patients in southern Sweden

Objectives. To compare foreign- and Swedish-born diabetic subjects regarding health care utilization, complications, clinical and socio-economic characteristics. Design. Cross-sectional study. Setting. All known diabetic patients living in six defined primary health care districts. Subjects. Of 1861 identified subjects aged >25 years 90.1%, 113 foreign- and 1564 Swedish- born subjects participated. Mean time of residence in Sweden was 32 ± 1.2 years, 93% >10 years. Main outcome measures. A standardized interview, a physical examination and an evaluation of medical records. Results. No differences were found regarding living conditions or health care utilization, with the exception of higher use of home-care from public authorities in Swedish-born subjects (P < 0.05) despite no difference in dependency on help according to Katz's ADL index. There were no major differences in objective health (glycaemic control and complications related to diabetes) with the exception of lower frequency of sensory neuropathy (P < 0.01) and peripheral vascular disease (P < 0.05) in foreign-born subjects. The prevalence of diabetes was 2.1% (95% CI 1.7-2.5) in the foreign-born and 2.6 % (95% CI 2.5-2.7) in Swedes. Foreign-born individuals were five years younger (P < 0.001), were more often diagnosed ≤30 years (P < 0.05), had a two years' shorter duration of disease (P < 0.001) and were less often treated with insulin (P < 0.01). Treatment with insulin was related to the duration and presence of complications related to diabetes. Conclusions. There were no major differences in objective health or use of health care in European migrants with diabetes mellitus, mainly Scandinavians, with short cultural distance and long residence in Sweden compared to Swedish-born diabetic patients.