Burden of selected chronic non-communicable diseases in a primary healthcare setting in Nuuk, Greenland, compared to a Danish suburb.

INTRODUCTION: Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. METHODS: The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. RESULTS: In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. CONCLUSION: In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum.

The prevalence and disease course of autoimmune liver diseases in Greenland.

Autoimmune liver diseases are rare serious diseases causing chronic inflammation and fibrosis in the liver parenchyma and bile ducts. Yet, the prevalence and burden of autoimmune liver diseases are largely unexplored in Arctic native populations. We investigated the prevalence and management of autoimmune liver diseases in Greenland using nationwide cross-sectional register data and subsequent medical chart reviews validating diagnoses and extracting liver histology examinations and medical treatments. The overall prevalence of autoimmune liver diseases in Greenland was 24.6 per 100,000 (95% CI: 14.7-41.3). This was based on 7 patients with autoimmune hepatitis (AIH) (12.3 per 100,000), 3 patients with primary biliary cholangitis (PBC) (5.3 per 100,000), 4 patients with AIH/PBC overlap disease (7.0 per 100,000), and no patients with primary sclerosing cholangitis. All diagnoses were confirmed by liver histology examinations. Medical treatments adhered to internal recommendations and induced complete remission in most patients with AIH, and complete or partial remission in 1 patient with PBC and 3 patients with AIH/PBC overlap disease. One patient had established cirrhosis at the time of diagnosis, while 2 patients progressed to cirrhosis. In conclusion, the prevalence of autoimmune liver diseases was lower in Greenland than in Scandinavia and among Alaska Inuit.

Living with chronic obstructive pulmonary disease or type 2 diabetes in Greenland - a qualitative interpretive description study.

Non-communicable diseases such as chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) represent major challenges for health systems all over the world. In an interview study, we explored patient experiences and perspectives of being diagnosed and living with COPD or T2D in Greenland. Participants (n = 24) were selected by purposeful sampling and recruited by phone. We conducted individual semi-structured interviews at the National Hospital in Nuuk and the four regional hospitals. Interviews were audio-recorded, transcribed verbatim, and analysed using interpretive description. Three themes emerged: shock and shame on receiving the diagnosis, coping with a changed life, and varying needs for care and communication. We found that being diagnosed with COPD or T2D required a rapid change in the participants' everyday lives and lifestyle behaviours. Some self-managed their disease well and were able to transfer their knowledge and integrate it into their daily lives, while others struggled to make lifestyle changes. Additionally, living with COPD or T2D could be related to silence and shame. The findings contribute to a better understanding of living with COPD or T2D in the Arctic region and the development of future, culturally-adapted patient education initiatives.

High quality of diabetes care in Greenland since the launch of Steno Diabetes Center Greenland 2020 - geographical disparities need attention.

The aim of this study was to estimate the prevalence of diagnosed diabetes in Greenland and evaluate quality of care according to sex, region and healthcare unit within regions. Data on all inhabitants registered with diabetes were extracted from the electronic medical record. We found a crude prevalence of diagnosed diabetes in the population aged ≥ 20 years to be 4.7%, and the prevalence of diabetes standardised to the WHO world population was 4.0%. Compared to males, a significantly higher proportion of females had mean glycated haemoglobin (HbA1c) level below 7% (68.9% vs. 57.5%) and blood pressure below 140/90 mmHg (83.4% vs. 73.5%). Regarding healthcare unit within regions, quality of care was higher in regional cities compared to smaller cities, concerning proportion of persons having blood pressure measured regularly (86.0% vs. 71.7%), urine tested for albuminuria (70.6% vs. 51.2%), receiving eye examination (86.9% vs. 79.5%) and foot examination (87.9% vs. 79.4%). In conclusion, the prevalence of diagnosed diabetes in Greenland is the highest reported yet. The overall quality of diabetes care was high and significantly improved compared to 2018. We observed geographical inequality in diabetes care and improvements in the quality of care in specific remote locations are necessary to minimise health care disparities.

Reporting chronic kidney disease in Greenland.

Background: Chronic kidney disease (CKD) is a major health burden affecting more than 10% of the global population. It is a multifactorial disease with many risk factors attributed lifestyle diseases. The prevalence of CKD in Greenland is unknown; however, the prevalence of risk factors contributing to CKD is increasing.Objectives: To estimate the prevalence of CKD in Greenland.Methods: The study was a cross-sectional register-study including all Greenlandic residents aged ≥20 years with serum creatinine analysis within the last 2 years. We identified those with CKD based on eGFR and UACR and those registered with a CKD diagnosis code. Two limitations of the study are possible lack of data completeness and the reliance of a single time point to report CKD.Results: A total of 2,157 patients were identified with CKD with an age-standardised prevalence of 3.01%. Only 75 patients were registered with a diagnosis code for CKD. Approximately 80% of patients were classified with CKD stages 1-2.Conclusion: This is the first study reporting CKD in Greenland. We found a lower prevalence of CKD than reported by other studies, and a low number of patients correctly diagnosed with CKD. We call for increased awareness and diagnosis coding of CKD in Greenland.

Is the Pattern Changing? Atrial Fibrillation and Screening with Holter Electrocardiograms among Ischemic Stroke Patients in Greenland from 2016 to 2021.

A standardized examination regime for ischemic stroke (IS) patients was implemented in Greenland in 2010. Prevalence of atrial fibrillation (AF) of 32% was found among discharged IS patients from 2011 to 2012, and our study aims to estimate the use of Holter ECGs for AF diagnostics and the current prevalence of AF among IS patients in Greenland. Patients discharged from Queen Ingrid's Hospital in Nuuk between 2016 and 2021 with an ICD-10 diagnosis of IS or stroke without specification were included. Data on Holter recordings, age, gender, medical treatment with rivaroxaban or warfarin, and ICD-10 and ICPC codes for AF were extracted for each patient. The overall incidence of IS from 2016 to 2021 was 133/100,000 and unchanged since 2012. Sixty-eight of the study's IS patients (14.5%) had AF, and 46% of IS patients with Holter data accessible had a recording according to international recommendations. Our results indicate that fewer IS patients in Greenland have AF than previously. However, the insufficient use of Holter as a diagnostic tool may explain part of the drop, as well as improved preventive treatment with rivaroxaban among AF patients in Greenland. Regardless, IS remains common, and a focus on diagnostics and preventable risk factors should be maintained.

High burden of symptoms reported among patients diagnosed with chronic obstructive pulmonary disease (COPD) in Greenland after introducing the COPD Assessment Test in clinical practice.

The aim was to test the internal consistency of the Greenlandic version of the COPD Assessment Test (CAT) questionnaire and to estimate the symptom burden in patients with chronic obstructive pulmonary disease (COPD) in Greenland using the CAT questionnaire. A Greenlandic version of the CAT questionnaire was developed including forward translation, reconciliation, backwards translation, and pilot test. Afterwards, a cross-sectional study of patients with COPD was conducted. The internal consistency assessed by the Cronbach α coefficient was 0.823 for the Greenlandic version of the questionnaire (n = 103). The CAT was negatively correlated to spirometry values and current smoking. In the cross-sectional study (n = 250), 81.1% of the patients experienced a high symptom burden (≥10). The main CAT score was 17 (range 0-38). The CAT was used in 9 out of 17 towns in Greenland. The Greenlandic version of the CAT questionnaire demonstrated a good internal consistency. We observed a high burden of symptoms associated with reduced lung function and active smoking status among patient diagnosed with COPD in Greenland. The questionnaire can be used in clinical practice for assessment of symptom burden in patients with COPD in Greenland and may help to increase focus on symptom control and quality of care.

Signs of non-alcoholic fatty liver disease in indigenous Arctic populations - a systematic review.

INTRODUCTION: The increasing prevalence of obesity and type 2 diabetes mellitus has become a global healthcare concern spreading to indigenous Arctic populations. As non-alcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome, it has become a leading cause of chronic liver disease. However, data are sparse on the prevalence of NAFLD in indigenous Arctic populations who may have a different risk profile for diabetes complications. METHODS: We conducted a systematic review to estimate the prevalence of NAFLD or signs of NAFLD in indigenous Arctic people inhabiting Greenland, Alaska, Canadian territories and Eastern Russia. Also, we wanted to discuss how Arctic research in metabolic disease such as NAFLD may move forward. RESULTS: Through the pre-specified search of Ovid MEDLINE and Embase, 3,070 unique references were identified and six studies including 5,487 persons qualified for data extraction. The prevalence of NAFLD or signs of NAFLD varied between 21% and 65%. The risk of bias was considerable particularly due to the inclusion of small and heterogeneous studies. CONCLUSION: Only limited published research exists on NAFLD in indigenous Arctic populations. This review reports that the prevalence of NAFLD or signs of NAFLD in the indigenous Arctic populations residing in Arctic Regions may be similar to the global level, emphasising the need for further health research in indigenous Arctic populations.

Low Prevalence of Chronic Obstructive Pulmonary Disease in Greenland-A Call for Increased Focus on the Importance of Diagnosis Coding.

The aim of this study was to estimate the prevalence of patients diagnosed with chronic obstructive pulmonary disease (COPD) according to age, gender, and residence in Greenland and to investigate the associated quality of care. The study was performed as an observational cross-sectional study using data on patients diagnosed with COPD, extracted from the electronical medical record (EMR) in Greenland. The total prevalence of patients aged 20-79 years diagnosed with COPD in Greenland in 2022 was 2.2%. The prevalence was significantly higher in the capital Nuuk compared to the remaining parts of Greenland (2.4% vs. 2.0%, respectively). Significantly more women than men were diagnosed with COPD, but the lung function of men was found to be significantly reduced/impaired compared to women. The prevalence of patients aged 40 years or above was 3.8%. The quality of care was significantly higher among patients living in Nuuk compared to the remaining parts of Greenland for eight out of ten quality indicators. The prevalence of COPD in Greenland is lower than in other comparable populations and might be underestimated. Continued focus on early detection of new cases and initiatives to improve and expand monitoring of quality-of-care measurements, including both additional clinical and patient reported outcomes, are recommended.

Low prevalence of diagnosed asthma in Greenland - a call for increased focus on diagnosing.

The aim of this study was to estimate prevalence of patients with asthma in Greenland according to age, gender and residence and to investigate the associated quality of care. The study was performed as a cross-sectional study with data extracted from the Greenlandic electronical medical record. A total of 870 patients aged 12 years or above were diagnosed with asthma at the end of 2022, corresponding to a prevalence of 1.9%. In 2020, the total prevalence was 0.2%. The prevalence of patients aged 12 years or above with asthma was highest among patients in Nuuk (3.3%) compared with patients in the remaining parts of Greenland (1.1%). More women than men were diagnosed with asthma, and the prevalence increased with age from 20 to 59 years. The prevalence of current smokers was high among the asthma population. The quality of care was significantly higher among patients living in Nuuk for all process indicators compared with patients from the remaining parts of Greenland. The prevalence of asthma in Greenland is low compared to other comparable populations and might be underestimated. Initiatives supporting increased focus on diagnosing asthma are thus warranted.

The effect of diabetes and the diabetogenic TBC1D4 p.Arg684ter variant on kidney function in Inuit in Greenland.

The aim of this study was to examine the effect of diabetes and the diabetogenic TBC1D4 variant on kidney function in Greenland in a population-based setting. Health survey data and TBC1D4 genotypes from 5,336 Greenlanders were used to estimate odds ratios (ORs) of albuminuria (>30 mg/g creatinine) and chronic kidney disease (CKD, eGFR <60 ml/min/1.73m2), comparing individuals with and without diabetes, including the effect of TBC1D4 variant. Of the 3,909 participants with complete data, 9.3% had diabetes. Albuminuria was found in 27.6% and 9.5% and CKD was found in 10.8% and 6.3% among those with and without diabetes, respectively. Diabetes was cross-sectionally associated with an increased risk of albuminuria (OR (95% CI) = 2.37 (1.69,3.33); p < 0.001) and the TBC1D4 variant protected against albuminuria (OR (95% CI) = 0.44 (0.22,0.90); p = 0.02) in a multivariable model. Neither diabetes nor the TBC1D4 variant significantly associated with CKD. The presence/absence of diabetes did not predict changes in eGFR and UACR in longitudinal analyses. Diabetes conferred an increased risk of albuminuria, and the TBC1D4 variant was associated with a decreased risk of albuminuria, but neither was associated with CKD. The potential renoprotective association of the TBC1D4 variant on albuminuria calls for further studies.

Dyslipidemia and the preventive potential in the Greenlandic population.

Background: Low-density lipoprotein cholesterol (LDL-C) is a well-established risk factor for development of cardiovascular diseases. Based on available clinical data, we aimed to investigate the plasma lipid profile in the Greenlandic population, the proportion on cholesterol-lowering treatment and the adherence to local indications for cholesterol-lowering therapy. Methods: This is an observational cross-sectional study of the adult (≥21 years) Greenlandic population with focus on clinically determined lipid levels from 2017 to early 2022. We investigated levels of dyslipidemia and assessed cholesterol-lowering medication usage in individuals with an indication according to current Greenlandic guidelines, which include a) LDL-C >5 mmol/l, b) diabetes, c) diagnosed atherosclerotic disease and 4) a SCORE2 >7.5%. Results: In the adult Greenlandic population of 40,565 individuals a lipid profile was available in 13,895 with a mean LDL-C of 3.0 mmol/L and 976 (7%) had a LDL-C >5 mmol/l. One or more indications for cholesterol-lowering medication was present in 3988 individuals and a total of 5464 adult Greenlanders either fulfilled local criteria for statin therapy or received a statin (some without current indication) and among these, 2232 (41%) individuals received no statin. Conclusion: These findings indicate that clinically significant dyslipidemia is common in the adult Greenlandic population and that the cardiovascular preventive potential of cholesterol-lowering therapy is currently underutilized.

Prevalence and clinical features of heart failure in Greenland.

Heart Failure (HF) constitutes a significant burden for healthcare around the world. In Greenland, risk factors like smoking, diabetes, and obesity are prevalent. Yet, the prevalence of HF remains unexplored. This register-based cross-sectional study uses data from the national medical record in Greenland to estimate the age- and gender-specific prevalence of HF and to describe the characteristics of patients with HF in Greenland. A total of 507 patients (26% women) with a mean age of 65 years were included based on a diagnosis of HF. The overall prevalence was 1.1% and higher among men compared to women (1.6% vs. 0.6%, p < 0.05). The highest prevalence was among men above 84 years (11.1%). More than half (53%) had a body mass index above 30 kg/m2 and 43% were current daily smokers. The proportion diagnosed with ischaemic heart disease (IHD) was 33%. The overall prevalence of HF in Greenland is consistent with that in other high-income countries, yet high among men in some age groups, compared to Danish men. Almost half the patients were obese and/or smokers. A low prevalence of IHD was observed indicating that other factors may play a role in developing HF among Greenlanders.

A novel splice-affecting HNF1A variant with large population impact on diabetes in Greenland.

Background: The genetic disease architecture of Inuit includes a large number of common high-impact variants. Identification of such variants contributes to our understanding of the genetic aetiology of diseases and improves global equity in genomic personalised medicine. We aimed to identify and characterise novel variants in genes associated with Maturity Onset Diabetes of the Young (MODY) in the Greenlandic population. Methods: Using combined data from Greenlandic population cohorts of 4497 individuals, including 448 whole genome sequenced individuals, we screened 14 known MODY genes for previously identified and novel variants. We functionally characterised an identified novel variant and assessed its association with diabetes prevalence and cardiometabolic traits and population impact. Findings: We identified a novel variant in the known MODY gene HNF1A with an allele frequency of 1.9% in the Greenlandic Inuit and absent elsewhere. Functional assays indicate that it prevents normal splicing of the gene. The variant caused lower 30-min insulin (ß = -232 pmol/L, ßSD = -0.695, P = 4.43 × 10-4) and higher 30-min glucose (ß = 1.20 mmol/L, ßSD = 0.441, P = 0.0271) during an oral glucose tolerance test. Furthermore, the variant was associated with type 2 diabetes (OR 4.35, P = 7.24 × 10-6) and HbA1c (ß = 0.113 HbA1c%, ßSD = 0.205, P = 7.84 × 10-3). The variant explained 2.5% of diabetes variance in Greenland. Interpretation: The reported variant has the largest population impact of any previously reported variant within a MODY gene. Together with the recessive TBC1D4 variant, we show that close to 1 in 5 cases of diabetes (18%) in Greenland are associated with high-impact genetic variants compared to 1-3% in large populations. Funding: Novo Nordisk Foundation, Independent Research Fund Denmark, and Karen Elise Jensen's Foundation.

The Prevalence of Inflammatory Bowel Disease in Greenland.

BACKGROUND: Inflammatory bowel disease (IBD) is sparsely investigated in Arctic populations. The aim of this study was to estimate the prevalence of ulcerative colitis (UC) and Crohn's disease (CD) in Greenland. METHODS: Cross-sectional nationwide data on demography, anthropometry, biochemistry, and pharmacotherapy were extracted from the electronic medical records in Greenland. Diagnoses of UC and CD were based on International Classification of Diseases-Tenth Revision and International Classification of Primary Care-Second Edition coding and treatment with mesalazine. Data from Statistics Greenland were used for prevalence calculations. RESULTS: In total, 254 patients in Greenland experienced IBD, with 214 cases of UC and 40 cases of CD. The overall IBD prevalence was 0.45%, distributed as 0.38% with UC and 0.07% with CD. The IBD prevalence was similar across the 5 regions of Greenland. However, a higher prevalence was observed in the region main towns with the largest populations (0.53%) compared with the small towns along the coastline (0.29%). UC patients were prescribed mesalazine treatment with a frequency of 78%. Furthermore, 10% of all IBD patients received treatment with nonspecific immunomodulators and 7% received biologics. CONCLUSIONS: This study estimates the prevalence and uncovers characteristics of IBD in Greenland. Although CD may be underdiagnosed or less prevalent, the overall prevalence of IBD in Greenland parallels Scandinavian countries and North America. These results boost the knowledge on autoimmune diseases in arctic populations and may guide clinicians in their management of IBD in Greenland. Furthermore, the results may encourage research in IBD across the Arctic regions.

The burden of inflammatory bowel disease has never been investigated in Greenland. This nationwide, cross-sectional, register-based study estimates the prevalence of ulcerative colitis and Crohn's disease in Greenland and reports that the overall prevalence of inflammatory bowel disease in Greenland parallels Western countries.

Prevalence of patients using antihypertensive medication in Greenland, and an assessment of the importance of diagnosis for the associated quality of care - a cross-sectional study.

This study aimed to estimate the age- and sex specific prevalence of patients using antihypertensive medication in Greenland, and compared the quality of care between patients with and without a diagnosis for hypertension. The study was a cross-sectional study comparing patients using antihypertensive medication in 2020 (6,629 patients) and 2021 (7,008 patients), respectively. For data from 2021, patients with a medical diagnosis code were identified. Data was obtained from the Greenlandic electronic medical record. The population of Greenland was used as background population. Quality of care was evaluated based on suggested indicators by international guidelines and goals from Steno Diabetes Centre Greenland. The prevalence of patients aged ≥20 years using antihypertensive medication had increased from 16.7% in 2020 to 17.5% in 2021. The prevalence increased by age and was higher among women compared to men. In 2021, the prevalence of patients aged ≥20 years with a medical diagnosis code for hypertension was 7.9%. The use of antihypertensive medication in Greenland is common. The associated quality of care was low. However, process indicators were significantly improved when patients had a medical diagnosis code. Future focus must be on initiating initiatives ensuring that more patients are registered with a medical diagnosis code.

Prevalence of Patients Receiving Urate-Lowering Medicine in Greenland and Denmark: A Cross-Sectional Case-Control Study.

This study estimates the age- and sex-specific prevalence of patients receiving urate-lowering therapy (ULT) in Greenland and compares the results with estimates in Denmark. Characteristics of patients receiving ULT in Greenland were compared to age- and sex-matched controls. The study was designed as a cross-sectional case−control study based on nationwide data from medical and population registers in Greenland and Denmark. The prevalence of patients receiving ULT was significantly lower in Greenland (0.55%) compared to Denmark (1.40%) (p < 0.001). In both countries, the prevalence increased with age and was higher among men compared to women. In Greenland, patients receiving ULT were more often overweight, and more frequently received blood glucose-, lipid-, and blood pressure-lowering medicine including diuretics compared to age- and sex-matched controls. The prevalence of patients receiving ULT was significantly lower in Greenland compared to Denmark. Common life-style related risk factors for hyperuricemia and gout were observed frequently among ULT-treated patients compared to controls. Along with an increasing prevalence of lifestyle-related diseases in Greenland, the prevalence of patients receiving ULT may increase in the years to come. More focus on detection and management of hyperuricemia and gout in Greenland is warranted to improve quality of health care.

Prevalence of Chronic Obstructive Pulmonary Disease and Chronic Bronchitis Among Predominantly Smoking Workers in the Seafood Industry in Greenland.

Introduction: For decades, the prevalence of smoking has been high in Greenland. Even so, the prevalence of chronic obstructive pulmonary disease (COPD), a smoking-related disease, remains largely unexplored. This cross-sectional study aimed to estimate the prevalence of COPD and chronic bronchitis (CB) among Inuit workers in the seafood industry in Greenland. Methods: A total of 355 participants, 254 males and 101 females, met the inclusion criteria. Participants had a mean age of 38 years (standard deviation 13.5; range 17-68 years). COPD was diagnosed based on post-bronchodilator ratio between forced expiratory volume within one second and forced vital capacity (FEV1/FVC) below the lower limit of normal (LLN) according to the Global Lung Function Initiative. Participants completed a questionnaire aiming to diagnose CB. Results: The overall prevalence was 9.9% for COPD; 7.4% for CB. Participants were predominantly smokers; 73.2% active smokers, 91.8% active or former smokers. The prevalence of COPD was high, especially among those under 40 years of age. Both COPD and CB were associated with smoking status. Discussion: This study among Greenlandic seafood workers found that smoking was a risk factor for COPD and CB among Greenlanders of Inuit origin. The high prevalence of COPD and the high prevalence of smoking underlines the importance of further initiatives to reduce smoking in Greenland.

Thyroid autoimmunity in Greenlandic Inuit.

Objective: This study aimed to provide the first data on the occurrence of thyroid autoimmunity among Inuit in Greenland, a distinct ethnic group who is not iodine deficient. Design: This study is a population-based cross-sectional study. Methods: Data were collected in Nuuk in West Greenland and in Ammassalik district in East Greenland. Information on lifestyle, diet and diseases was obtained using questionnaires. Thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) and thyroid-stimulating hormone (TSH) were measured in serum. Iodine and creatinine were measured in spot urine samples. Results: The participation rate was 95% with 434 Inuit participants; 75% were smokers. Iodine excretion was 169 µg/24 h in urban West Greenland, 224 µg/24 h in the main town and 228 µg/24 h in settlements in rural East Greenland. TPOAb, TgAb or either of these was measured in the serum from 3.7, 5.9 and 8.3% of participants, respectively. TPOAb or TgAb was found in 9.3% of Inuit women and 7.5% of men and more frequently, in East Greenland Inuit with the higher iodine excretion (P = 0.02). There was some evidence suggesting that thyroid autoimmunity was more frequent among non-smokers (12.5%) compared to smokers (7.0%). Harbouring a thyroid autoantibody was most frequent in participants with TSH above 3.6 mIU/L (P < 0.001). Conclusion: Thyroid autoantibodies were rare among Greenland Inuit. While iodine nutrition was associated with autoimmunity similarly to other ethnic groups, the influence of sex and smoking was limited. This could suggest genetic component in Inuit, but the impact of cold, selenium and persistent organic pollutants needs to be elucidated.

The prevalence of patients treated for osteoporosis in Greenland is low compared to Denmark.

The study is a register-based cross-sectional study aiming to estimate the prevalence of treated osteoporosis in Greenland compared to Denmark and provide a description of the patients with osteoporosis in Greenland. In addition, the study estimates the incidence of hip fractures in Greenland from 2018 to 2020 among people aged 65 years or older. The overall prevalence of patients prescribed medication for osteoporosis among those aged 18 years or older was 0.56% in Greenland and 2.36% in Denmark (p < 0.001). Among those aged 50 years or older, the prevalence was 1.28% and 4.71% in Greenland and Denmark, respectively (p < 0.001). The prevalence increased to 3.41% and 11.18% among patients aged 80 years or older in Greenland and Denmark, respectively. The incidence of hip fractures in Greenland was 6.55 per 1,000 inhabitants in 2020 compared to 5.65 per 1,000 inhabitants in Denmark (NS). In conclusion, the prevalence of treated osteoporosis in Greenland was less than one in four of that of Denmark. The incidence of hip fractures was similar in Greenland than in Denmark. Hence, our findings suggest that a marked number of subjects with osteoporosis in Greenland go untreated.