The Greenland population health survey 2018 – methods of a prospective study of risk factors for lifestyle related diseases and social determinants of health amongst Inuit

ABSTRACT

Since 1993, regular population health surveys in Greenland have supported and monitored the public health strategy of Greenland and have monitored cardiometabolic and lung diseases. The most recent of these surveys included 2539 persons aged 15+ from 20 communities spread over the whole country. The survey instruments included personal interviews, self-administered questionnaires, blood sampling, anthropometric measurements, blood pressure, ECG, oral glucose test, pulmonary function, hand grip strength and chair stand test. Blood samples were analysed for glucose, glycated haemoglobin (HbA1c), insulin, incretin hormones, cholesterol, kidney function, fatty acids in erythrocyte membranes and mercury, urine for albumin-creatinine ratio, and aliquots were stored at −80°C for future use. Data were furthermore collected for studies of the gut microbiome and diabetes complications. Survey participants were followed up with register data. The potential of the study is to contribute to the continued monitoring of risk factors and health conditions as part of Greenland’s public health strategy and to study the epidemiology of cardiometabolic diseases and other chronic diseases and behavioural risk factors. The next population health survey is planned for 2024. The emphasis of the article is on the methods of the study and results will be presented in other publications.

KEYWORDS:

• Inuit
• Greenland
• social determinants
• cardiometabolic diseases
• airway diseases
• risk factors
• population health survey

Acknowledgments

We thank the interviewers, examiners, local citizens who helped make the survey feasible, and the participants who willingly gave their time.

Data availability statement

Until the establishment of facilities for data deposition is available in Greenland, data will be deposited at the Danish National Archives from where it will be made available anonymously upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics

The main study was approved by the ethical review committee for Greenland (KVUG 2017-05). The study on diabetes complications and on gut microbiome were approved by the same committee (KVUG 2017-11 and KVUG 2017-13). Participants were informed about the study objectives and procedures verbally and in writing and signed a written consent form including consent to pass results on to the local health centre. Participants provided permission to have their samples stored in the biobank to be used for future analyses within the overarching survey themes: cardiometabolic- and lung disease and its risk factors. Approval from local community leadership is not part of the ethical review process in Greenland and was not obtained. Parental consent is not required for participants aged 15 years and older. The study addresses health issues of high priority for public health in Greenland. The challenge in genetic research in indigenous populations is that it raises complex psychological, ethical, social, and political issues. These issues were raised recently in a user survey of genetics in diabetes research [55]. Generally, the communities fully support the research with a specific request to investigate the significance of traditional and modern Inuit lifestyle in order to understand how advising individuals regarding diet and lifestyle can be linked in a culturally appropriate way about health effects and genes.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/22423982.2022.2090067

Additional information

Funding

The questionnaire study was funded by the Department of Health and the Department of Social and Legal Affairs of the Greenland government. The clinical data collection was funded by the Novo Nordisk Foundation [NNF 17SH0027192, and NNF 17OC0028136 and NNF15OC0016544] and by Steno Diabetes Center Copenhagen which is partially funded by an unrestricted donation from the Novo Nordisk Foundation; pulmonary testing was funded by V. Backer. Analyses of blood mercury was funded by the Environmental Protection Agency in Denmark (Miljøstyrelsen) (J.nr. 2019 – 8461).