201
|
Perini W, Agyemang C, Snijder MB, Peters RJG, Kunst AE. Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study. Scand J Public Health 2017; 46:204-213. [PMID: 28699411 PMCID: PMC5871022 DOI: 10.1177/1403494817718906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD). OBJECTIVE The aim of this study was to determine whether the socio-economic gradient of estimated CVD risk differs between ethnic groups. METHODS Using the Healthy Life in an Urban Setting study, we obtained data on SES and CVD risk factors among participants from six ethnic backgrounds residing in Amsterdam. SES was measured using educational level and occupational level. CVD risk was estimated based on the occurrence of CVD risk factors using the Dutch version of the systematic coronary risk evaluation algorithm. Ethnic disparities in socio-economic gradients for estimated CVD risk were determined using the relative index of inequality (RII). RESULTS Among Dutch-origin men, the RII for estimated CVD risk according to educational level was 6.15% (95% confidence interval [CI] 4.35-7.96%), indicating that those at the bottom of the educational hierarchy had a 6.15% higher estimated CVD risk relative than those at the top. Among Dutch-origin women, the RII was 4.49% (CI 2.45-6.52%). The RII was lower among ethnic minority groups, ranging from 0.83% to 3.13% among men and -0.29% to 5.12% among women, indicating weaker associations among these groups. Results were similar based on occupational level. CONCLUSIONS Ethnic background needs to be considered in associations between SES and disease. The predictive value of SES varies between ethnic groups and may be quite poor for some groups.
Collapse
|
202
|
Brathwaite R, Smeeth L, Addo J, Kunst AE, Peters RJG, Snijder MB, Derks EM, Agyemang C. Ethnic differences in current smoking and former smoking in the Netherlands and the contribution of socioeconomic factors: a cross-sectional analysis of the HELIUS study. BMJ Open 2017; 7:e016041. [PMID: 28698339 PMCID: PMC5541454 DOI: 10.1136/bmjopen-2017-016041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Data exploring how much of the ethnic differences in smoking prevalence and former smoking are explained by socioeconomic status (SES) are lacking. We therefore assessed ethnic differences in smoking prevalence and former smoking and the contribution of both educational level and occupational-related SES to the observed ethnic differences in smoking behaviour. METHODS Data of 22 929 participants (aged 18-70 years) from the multiethnic cross-sectional Healthy Life in an Urban Setting study in the Netherlands were analysed. Poisson regression models with a robust variance were used to estimate prevalence ratios. RESULTS Compared with the Dutch, after adjustment for age and marital status, smoking prevalence was higher in men of Turkish (prevalence ratio 1.69, 95% CI 1.54 to 1.86), African Surinamese (1.55, 95% CI 1.41 to 1.69) and South-Asian Surinamese origin (1.53, 95% CI 1.40 to 1.68), whereas among women, smoking prevalence was higher in Turkish, similar in African Surinamese but lower in all other ethnic origin groups. All ethnic minority groups, except Ghanaians, had a significantly lower smoking cessation prevalence than the Dutch. Socioeconomic gradients in smoking (higher prevalence among those lower educated and with lower level employment) were observed in all groups except Ghanaian women (a higher prevalence was observed in the higher educated). Ethnic differences in smoking prevalence and former smoking are largely, but not completely, explained by socioeconomic factors. CONCLUSIONS Our findings imply that antismoking policies designed to target smoking within the lower socioeconomic groups of ethnic minority populations may substantially reduce ethnic inequalities in smoking particularly among men and that certain groups may benefit from targeted smoking cessation interventions.
Collapse
|
203
|
Appiah LT, Sarfo FS, Agyemang C, Tweneboah HO, Appiah NABA, Bedu-Addo G, Opare-Sem O. Current trends in admissions and outcomes of cardiac diseases in Ghana. Clin Cardiol 2017; 40:783-788. [PMID: 28692760 DOI: 10.1002/clc.22753] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular diseases (CVDs) pose a major burden in Africa, but data on temporal trends in disease burden are lacking. We assessed trends in CVD admissions and outcomes in central Ghana using a retrospective analysis of data from January 2004 to December 2015 among patients admitted to the medical wards of a tertiary medical center in Kumasi, Ghana. Rates of admissions and mortality were expressed as CVD admissions and deaths divided by the total number of medical admissions and deaths, respectively. Case fatality rates per specific cardiac disease diagnosis were also computed. Over the period, there were 4226 CVD admissions, with a male-to-female ratio of 1.1 to 1. There was a progressive increase in percentage of CVD admissions from 4.6% to 8.2%, representing an 78% increase, between 2004 and 2014. Of the 2170 CVD cases whose data were available, the top 3 causes of CVD admissions were heart failure (HF; 88.3%), ischemic heart disease (IHD; 7.2%), and dysrhythmias (1.9%). Of all HF admissions, 52% were associated with hypertension. IHD prevalence rose by 250% between 2005 and 2015. There were 976 deaths (23%), with an increase in percentage of hospital deaths that were cardiovascular in nature from 3.6% to 7.3% between 2004 and 2014, representing a 102% increase. Cardiac disease admissions and mortality have increased progressively over the past decade, with HF as the most common cause of admission. Once rare, IHD is emerging as a significant contributor to the CVD burden in sub-Saharan Africa.
Collapse
|
204
|
Galbete C, Nicolaou M, Meeks KA, de-Graft Aikins A, Addo J, Amoah SK, Smeeth L, Owusu-Dabo E, Klipstein-Grobusch K, Bahendeka S, Agyemang C, Mockenhaupt FP, Beune EJ, Stronks K, Schulze MB, Danquah I. Food consumption, nutrient intake, and dietary patterns in Ghanaian migrants in Europe and their compatriots in Ghana. Food Nutr Res 2017; 61:1341809. [PMID: 28747862 PMCID: PMC5510194 DOI: 10.1080/16546628.2017.1341809] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
Background: West African immigrants in Europe are disproportionally affected by metabolic conditions compared to European host populations. Nutrition transition through urbanisation and migration may contribute to this observations, but remains to be characterised. Objective: We aimed to describe the dietary behaviour and its socio-demographic factors among Ghanaian migrants in Europe and their compatriots living different Ghanaian settings. Methods: The multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study was conducted among Ghanaian adults in rural and urban Ghana, and Europe. Dietary patterns were identified by principal component analysis. Results: Contributions of macronutrient to the daily energy intake was different across the three study sites. Three dietary patterns were identified. Adherence to the ‘mixed’ pattern was associated with female sex, higher education, and European residency. The ‘rice, pasta, meat, and fish’ pattern was associated with male sex, younger age, higher education, and urban Ghanaian environment. Adherence to the ‘roots, tubers, and plantain’ pattern was mainly related to rural Ghanaian residency. Conclusion: We observed differences in food preferences across study sites: in rural Ghana, diet concentrated on starchy foods; in urban Ghana, nutrition was dominated by animal-based products; and in Europe, diet appeared to be highly diverse.
Collapse
|
205
|
Gyamfi J, Butler M, Williams SK, Agyemang C, Gyamfi L, Seixas A, Zinsou GM, Bangalore S, Shah NR, Ogedegbe G. Blood pressure control and mortality in US- and foreign-born blacks in New York City. J Clin Hypertens (Greenwich) 2017; 19:956-964. [DOI: 10.1111/jch.13045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/21/2017] [Accepted: 04/30/2017] [Indexed: 11/28/2022]
|
206
|
Ravenell J, Shimbo D, Booth JN, Sarpong DF, Agyemang C, Beatty Moody DL, Abdalla M, Spruill TM, Shallcross AJ, Bress AP, Muntner P, Ogedegbe G. Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study. Circulation 2017; 135:2470-2480. [PMID: 28428231 PMCID: PMC5711518 DOI: 10.1161/circulationaha.116.027051] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. METHODS We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression- and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. RESULTS Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. CONCLUSIONS On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.
Collapse
|
207
|
Brathwaite R, Addo J, Kunst AE, Agyemang C, Owusu-Dabo E, de-Graft Aikins A, Beune E, Meeks K, Klipstein-Grobusch K, Bahendeka S, Mockenhaupt FP, Amoah S, Galbete C, Schulze MB, Danquah I, Smeeth L. Smoking prevalence differs by location of residence among Ghanaians in Africa and Europe: The RODAM study. PLoS One 2017; 12:e0177291. [PMID: 28475620 PMCID: PMC5419606 DOI: 10.1371/journal.pone.0177291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 04/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although the prevalence of smoking is low in Ghana, little is known about the effect of migration on smoking. Comparing Ghanaians living in their country of origin to those living in Europe offers an opportunity to investigate smoking by location of residence and the associations between smoking behaviours and migration-related factors. METHODS Data on a relatively homogenous group of Ghanaians living in London (n = 949), Amsterdam (n = 1400), Berlin (n = 543), rural Ghana (n = 973) and urban Ghana (n = 1400) from the cross-sectional RODAM (Research on Obesity & Diabetes in African Migrants) study were used. Age-standardized prevalence rates of smoking by location of residence and factors associated with smoking among Ghanaian men were estimated using prevalence ratios (PR: 95% CIs). RESULTS Current smoking was non-existent among women in rural and urban Ghana and London but was 3.2% and 3.3% in women in Amsterdam and Berlin, respectively. Smoking prevalence was higher in men in Europe (7.8%) than in both rural and urban Ghana (4.8%): PR 1.91: 95% CI 1.27, 2.88, adjusted for age, marital status, education and employment. Factors associated with a higher prevalence of smoking among Ghanaian men included European residence, being divorced or widowed, living alone, Islam religion, infrequent attendance at religious services, assimilation (cultural orientation), and low education. CONCLUSION Ghanaians living in Europe are more likely to smoke than their counterparts in Ghana, suggesting convergence to European populations, although prevalence rates are still far below those in the host populations.
Collapse
|
208
|
Meeks KAC, Stronks K, Adeyemo A, Addo J, Bahendeka S, Beune E, Owusu-Dabo E, Danquah I, Galbete C, Henneman P, Klipstein-Grobusch K, Mockenhaupt FP, Osei K, Schulze MB, Spranger J, Smeeth L, Agyemang C. Peripheral insulin resistance rather than beta cell dysfunction accounts for geographical differences in impaired fasting blood glucose among sub-Saharan African individuals: findings from the RODAM study. Diabetologia 2017; 60:854-864. [PMID: 28144712 PMCID: PMC6518094 DOI: 10.1007/s00125-017-4216-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/09/2017] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess the extent to which insulin resistance and beta cell dysfunction account for differences in impaired fasting blood glucose (IFBG) levels in sub-Saharan African individuals living in different locations in Europe and Africa. We also aimed to identify determinants associated with insulin resistance and beta cell dysfunction among this population. METHODS Data from the cross-sectional multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study were analysed. Participants included Ghanaian individuals without diabetes, aged 18-96 years old, who were residing in Amsterdam (n = 1337), Berlin (n = 502), London (n = 961), urban Ghana (n = 1309) and rural Ghana (n = 970). Glucose and insulin were measured in fasting venous blood samples. Anthropometrics were assessed during a physical examination. Questionnaires were used to assess demographics, physical activity, smoking status, alcohol consumption and energy intake. Insulin resistance and beta cell function were determined using homeostatic modelling (HOMA-IR and HOMA-B, respectively). Logistic regression analysis was used to study the contribution of HOMA-IR and inverse HOMA-B (beta cell dysfunction) to geographical differences in IFBG (fasting glucose 5.6-6.9 mmol/l). Multivariate linear regression analysis was used to identify determinants associated with HOMA-IR and inverse HOMA-B. RESULTS IFBG was more common in individuals residing in urban Ghana (OR 1.41 [95% CI 1.08, 1.84]), Amsterdam (OR 3.44 [95% CI 2.69, 4.39]) and London (OR 1.58 [95% CI 1.20 2.08), but similar in individuals living in Berlin (OR 1.00 [95% CI 0.70, 1.45]), compared with those in rural Ghana (reference population). The attributable risk of IFBG per 1 SD increase in HOMA-IR was 69.3% and in inverse HOMA-B was 11.1%. After adjustment for HOMA-IR, the odds for IFBG reduced to 0.96 (95% CI 0.72, 1.27), 2.52 (95%CI 1.94, 3.26) and 1.02 (95% CI 0.78, 1.38) for individuals in Urban Ghana, Amsterdam and London compared with rural Ghana, respectively. In contrast, adjustment for inverse HOMA-B had very minor impact on the ORs of IFBG. In multivariate analyses, BMI (β = 0.17 [95% CI 0.11, 0.24]) and waist circumference (β = 0.29 [95%CI 0.22, 0.36]) were most strongly associated with higher HOMA-IR, whereas inverse HOMA-B was most strongly associated with age (β = 0.20 [95% CI 0.16, 0.23]) and excess alcohol consumption (β = 0.25 [95% CI 0.07, 0.43]). CONCLUSIONS/INTERPRETATION Our findings suggest that insulin resistance, rather than beta cell dysfunction, is more important in accounting for the geographical differences in IFBG among sub-Saharan African individuals. We also show that BMI and waist circumference are important factors in insulin resistance in this population.
Collapse
|
209
|
Nyaaba GN, Stronks K, de-Graft Aikins A, Kengne AP, Agyemang C. Tracing Africa's progress towards implementing the Non-Communicable Diseases Global action plan 2013-2020: a synthesis of WHO country profile reports. BMC Public Health 2017; 17:297. [PMID: 28381252 PMCID: PMC5382491 DOI: 10.1186/s12889-017-4199-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/23/2017] [Indexed: 11/13/2022] Open
Abstract
Background Half of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013–2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa’s progress towards WHO policy recommendations for reducing the NCD burden. Methods Data from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports. Results More than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive. Conclusion Our findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4199-6) contains supplementary material, which is available to authorized users.
Collapse
|
210
|
Melo HN, Stoots SJM, Pool MA, Carvalho VO, Almeida LOC, Aragão MLDC, Agyemang C, Cipolotti R. Physical activity level and performance in the six-minute walk test of children and adolescents with sickle cell anemia. Rev Bras Hematol Hemoter 2017; 39:133-139. [PMID: 28577650 PMCID: PMC5457483 DOI: 10.1016/j.bjhh.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To establish determinants of maximum walking distance in the 6-minute walk test of children and adolescents with sickle cell anemia, and to compare the performance in this test with physical activity level between patients and healthy controls. METHODS A cross-sectional study was performed in which the participants answered the Physical Activity Questionnaire for Older Children and Adolescents, and completed the 6-minute walk test. MAIN RESULTS Fifty-seven patients and 58 controls were studied. By univariate analysis of the patients, age (p<0.0001) and indirect bilirubin (p=0.008) were associated with maximum walking distance in the 6-minute walk test. In multivariate analysis, age was positively associated (p<0.0001; beta: 0.75), while body mass index was inversely associated with distance walked (p=0.047; beta: -0.32). This yields the following equation: maximum distance walked=487.7 (age×18.3)-(12×body mass index) meters. Patients reported a lower physical activity level however there was no significant difference in the distance walked in six minutes between patients (500.6±88.7m) and controls (536.3±94m). CONCLUSION The determinants for the 6-minute walk test in children and adolescents with sickle cell anemia were age and body mass index. There was no significant difference in the 6-minute walk test but patients with sickle cell anemia had a lower physical activity level compared to healthy controls.
Collapse
|
211
|
Cole HV, Owusu-Dabo E, Iwelunmor J, Newsome V, Meeks K, Agyemang C, Jean-Louis G. Sleep duration is associated with increased risk for cardiovascular outcomes: a pilot study in a sample of community dwelling adults in Ghana. Sleep Med 2017; 34:118-125. [PMID: 28522079 DOI: 10.1016/j.sleep.2017.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/08/2017] [Accepted: 03/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Associations between sleep duration and cardiovascular disease (CVD) risk factors have been demonstrated in past studies. However, previous studies have not investigated these relationships using objective sleep measures in sub-Saharan Africa. Our objective was to investigate the association between sleep duration and cardiovascular risk factors in a sample of community-dwelling Ghanaian adults. METHODS We used wrist actigraphy along with a seven-day sleep diary to measure sleep duration, wake after sleep onset, sleep latency, and sleep quality. Participants were randomly selected from among those participating in the RODAM study in rural and urban Ghana. Outcome measurements included 10-year risk of CVD events, prevalent CVD, and metabolic syndrome. Additional participant characteristics were assessed using a structured questionnaire. Linear and logistic regression analyses were used to assess the relationships between sleep measures and CVD risk. RESULTS A total of 263 participants from rural and urban Ghana participated. Total sleep time was positively associated with a 10-year CVD risk; this association remained after adjusting for age, sex, urban vs rural location, socio-economic status, physical activity, and sleep disturbance (β = 0.990, p = 0.015). Short sleep, defined as sleeping less than seven hours per night on average, was negatively associated with a 10-year CVD risk, and this relationship remained in the fully adjusted model (β = -2.100, p = 0.011). Sleep duration was not associated with prevalence of CVD or metabolic syndrome. CONCLUSION Using actigraphy to measure sleep duration among a population of community-dwelling adults in sub-Saharan Africa is feasible. We found a positive association between sleep and CVD risk. No association was found between sleep duration and prevalent CVD or metabolic syndrome. The implications and new directions relating to these findings are stated.
Collapse
|
212
|
Addo J, Agyemang C, de-Graft Aikins A, Beune E, Schulze MB, Danquah I, Galbete C, Nicolaou M, Meeks K, Klipstein-Grobusch K, Bahendaka S, Mockenhaupt FP, Owusu-Dabo E, Kunst A, Stronks K, Smeeth L. Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study. J Epidemiol Community Health 2017; 71:633-639. [PMID: 28348205 PMCID: PMC5485755 DOI: 10.1136/jech-2016-208322] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/15/2017] [Accepted: 02/13/2017] [Indexed: 11/21/2022]
Abstract
Background The prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana. Methods Data were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25–70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe. Results A total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations. Conclusions The association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations.
Collapse
|
213
|
Snijder MB, Agyemang C, Peters RJ, Stronks K, Ujcic-Voortman JK, van Valkengoed IGM. Case Finding and Medical Treatment of Type 2 Diabetes among Different Ethnic Minority Groups: The HELIUS Study. J Diabetes Res 2017; 2017:9896849. [PMID: 28154830 PMCID: PMC5244015 DOI: 10.1155/2017/9896849] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/13/2016] [Indexed: 12/21/2022] Open
Abstract
Aims. Prevention of diabetes complications depends on the level of case finding and successful treatment of diabetes, which may differ between ethnicities. Therefore, we studied the prevalence by age, awareness, treatment, and control of type 2 diabetes, among a multiethnic population. Methods. We included 4,541 Dutch, 3,032 South-Asian Surinamese, 4,109 African Surinamese, 2,323 Ghanaian, 3,591 Turkish, and 3,887 Moroccan participants (aged 18-70 y) from the HELIUS study. The prevalence of diabetes was analysed by sex, ethnicity, and 10-year age groups. Ethnic differences in the prevalence, awareness, treatment, and control of diabetes were studied by logistic regression. Results. From the age of 31-40 years and older, the prevalence of diabetes was 3 to 12 times higher among ethnic minority groups than that among the Dutch host population. Awareness and medical treatment of diabetes were 2 to 5 times higher among ethnic minorities than that among Dutch. Among those medically treated, only 37-53% had HbA1c levels on target (≤7.0%); only Dutch men had HbA1c levels on target more often (67%). Conclusions. Our results suggest that the age limit for case finding among ethnic minority groups should be lower than that for the general population. Importantly, despite higher awareness and treatment among ethnic minorities, glycemic control was low, suggesting a need for increased efforts to improve the effectiveness of treatment in these groups.
Collapse
|
214
|
Schmengler H, Ikram UZ, Snijder MB, Kunst AE, Agyemang C. Association of perceived ethnic discrimination with general and abdominal obesity in ethnic minority groups: the HELIUS study. J Epidemiol Community Health 2016; 71:453-460. [PMID: 27965316 DOI: 10.1136/jech-2016-207875] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/01/2016] [Accepted: 11/25/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Discrimination is associated with obesity, but this may differ according to the type of obesity and ethnic group. This study examines the association of perceived ethnic discrimination (PED) with general and abdominal obesity in 5 ethnic minority groups. METHODS We used cross-sectional data from the HELIUS study, collected from 2011 to 2015. The study sample included 2297 Ghanaians, 4110 African Surinamese, 3021 South-Asian Surinamese, 3562 Turks and 3868 Moroccans aged 18-70 years residing in Amsterdam, the Netherlands. Body mass index (BMI) was used as a measure for general obesity, and waist circumference (WC) for abdominal obesity. PED was measured using the Everyday Discrimination Scale. We used linear regression models adjusted for sociodemographics, psychosocial stressors and health behaviours. In additional analysis, we used standardised variables to compare the strength of the associations. RESULTS In adjusted models, PED was significantly, positively associated with BMI in the South-Asian Surinamese (β coefficient 0.338; 95% CI 0.106 to 0.570), African Surinamese (0.394; 0.171 to 0.618) and Turks (0.269; 0.027 to 0.510). For WC, a similar pattern was seen: positive associations in the South-Asian Surinamese (0.759; 0.166 to 1.353), African Surinamese (0.833; 0.278 to 1.388) and Turks (0.870; 0.299 to 1.440). When stratified by sex, we found positive associations in Surinamese women, Turkish men and Moroccan men. The strength of the associations with BMI and WC was comparable in the groups. Among the Ghanaians, no significant associations were observed. CONCLUSIONS Ethnic and sex variations are observed in the association of PED with both general and abdominal obesity. Further research on psychosocial buffers and underlying biological mechanisms might help in understanding these variations.
Collapse
|
215
|
Agyemang C. Lonely and bored stiff: challenging phase for ethnic minority and migrant health in Europe. Eur J Public Health 2016; 26:898-899. [DOI: 10.1093/eurpub/ckw112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
216
|
Owolabi M, Olowoyo P, Miranda JJ, Akinyemi R, Feng W, Yaria J, Makanjuola T, Yaya S, Kaczorowski J, Thabane L, Van Olmen J, Mathur P, Chow C, Kengne A, Saulson R, Thrift AG, Joshi R, Bloomfield GS, Gebregziabher M, Parker G, Agyemang C, Modesti PA, Norris S, Ogunjimi L, Farombi T, Melikam ES, Uvere E, Salako B, Ovbiagele B. Gaps in Hypertension Guidelines in Low- and Middle-Income Versus High-Income Countries: A Systematic Review. Hypertension 2016; 68:1328-1337. [PMID: 27698059 PMCID: PMC5159303 DOI: 10.1161/hypertensionaha.116.08290] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
217
|
Commodore-Mensah Y, Ukonu N, Obisesan O, Aboagye JK, Agyemang C, Reilly CM, Dunbar SB, Okosun IS. Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey. J Am Heart Assoc 2016; 5:JAHA.116.004059. [PMID: 27815269 PMCID: PMC5210341 DOI: 10.1161/jaha.116.004059] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. METHODS AND RESULTS Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10-1.29), diabetic (OR, 1.43; 95% CI, 1.17-1.73), and hypertensive (OR, 1.18; 95% CI, 1.05-1.32) than those residing in the United States for <10 years. CONCLUSIONS In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.
Collapse
|
218
|
Miranda R, Meeks K, Snijder MB, van den Born BJ, Fransen M, Peters RJG, Stronks K, Agyemang C. Health literacy and hypertension outcomes in a large multi-ethnic population: The HELIUS study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
219
|
Kristiansen M, Byberg S, Agyemang C, Norredam M. Dementia burden among migrants in Denmark compared with Danish-born: a register-based cohort study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
220
|
Boateng D, Agyemang C, Beune EJAJ, Smeeth L, Schulze M, Addo J, Aikins A, Galbete C, Agyei-Baffour P, Kengne AP, Grobbee DE, Stronks K, Klipstein-Grobusch K. Migration and cardiovascular disease risk among Ghanaian populations in Europe: The RODAM study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw170.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
221
|
Agyemang C, van de Vorst IE, Bots ML, Koek HL, Seixas A, Norredam M, Ikram U, Stronks K, Vaartjes I. Ethnic variations in prognosis of patients with dementia: A prospective nationwide study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
222
|
Agyemang C, Meeks K, Beune E, Owusu-Dabo E, Mockenhaupt FP, Addo J, de Graft Aikins A, Bahendeka S, Danquah I, Schulze MB, Spranger J, Burr T, Agyei-Baffour P, Amoah SK, Galbete C, Henneman P, Klipstein-Grobusch K, Nicolaou M, Adeyemo A, van Straalen J, Smeeth L, Stronks K. Obesity and type 2 diabetes in sub-Saharan Africans - Is the burden in today's Africa similar to African migrants in Europe? The RODAM study. BMC Med 2016; 14:166. [PMID: 27769239 PMCID: PMC5075171 DOI: 10.1186/s12916-016-0709-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. METHODS A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. RESULTS In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04-13.57; women, 33.9 %; PR: 4.11, 3.13-5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98-37.84; women, 54.2 %; PR: 6.63, 5.04-8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73-5.40; women, 9.2 %; PR: 1.81, 1.25-2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50-7.98; women, 10.2 %; PR: 2.21, 1.30-3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. CONCLUSION Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
Collapse
|
223
|
Agyemang C, Beune E, Meeks K, Addo J, Aikins ADG, Bahendeka S, Danquah I, Mockenhaupt FP, Schulze MB, Klipstein-Grobusch K, Smeeth L, Stronks K. Innovative ways of studying the effect of migration on obesity and diabetes beyond the common designs: lessons from the RODAM study. Ann N Y Acad Sci 2016; 1391:54-70. [PMID: 27706830 DOI: 10.1111/nyas.13204] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes and obesity are major global public health problems, with migrant populations in high-income countries being particularly affected. Type 2 diabetes and obesity are also major threats in low- and middle-income countries, from which most migrant populations originate. Transitioning of societies and the resulting changes in lifestyles are thought to be major driving forces, but the key specific factors within this broad category still need to be determined. Migrant studies provide a unique opportunity to understand the potential underlying causes of these conditions, but current research is mainly geared toward analyzing the differences between migrants and the host populations in the countries of settlement. For better understanding, there is a need to extend migrant health research across national boundaries. This review discusses innovative ways of studying the effect of migration on type 2 diabetes and obesity beyond the common designs and the relevance of extending migrant health studies across national boundaries in the current era of increasing global migration. Specifically, we describe the burden and different methods for conducting migrant studies. We use the Research on Obesity and Diabetes among African Migrants (RODAM) study as a case study, discussing the methods, some results, and lessons learned, including challenges and an essential recipe for success that may guide future migrant health research.
Collapse
|
224
|
Spruill TM, Shallcross AJ, Ogedegbe G, Chaplin WF, Butler M, Palfrey A, Shimbo D, Muntner P, Sims M, Sarpong DF, Agyemang C, Ravenell J. Psychosocial Correlates of Nocturnal Blood Pressure Dipping in African Americans: The Jackson Heart Study. Am J Hypertens 2016; 29:904-12. [PMID: 26869251 DOI: 10.1093/ajh/hpw008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/09/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND African Americans exhibit a lower degree of nocturnal blood pressure (BP) dipping compared with Whites, but the reasons for reduced BP dipping in this group are not fully understood. The aim of this study was to identify psychosocial factors associated with BP dipping in a population-based cohort of African Americans. METHODS This cross-sectional study included 668 Jackson Heart Study (JHS) participants with valid 24-hour ambulatory BP data and complete data on psychosocial factors of interest including stress, negative emotions, and psychosocial resources (e.g., perceived support). The association of each psychosocial factor with BP dipping percentage and nondipping status (defined as <10% BP dipping) was assessed using linear and Poisson regression models, respectively, with progressive adjustment for demographic, socioeconomic, biomedical, and behavioral factors. RESULTS The prevalence of nondipping was 64%. Higher depressive symptoms, higher hostility, and lower perceived social support were associated with a lower BP dipping percentage in unadjusted models and after adjustment for age, sex, body mass index, and mean 24-hour systolic BP (P < 0.05). Only perceived support was associated with BP dipping percentage in fully adjusted models. Also, after full multivariable adjustment, the prevalence ratio for nondipping BP associated with 1 SD (7.1 unit) increase in perceived support was 0.93 (95% CI: 0.88-0.99). No other psychosocial factors were associated with nondipping status. CONCLUSIONS Lower perceived support was associated with reduced BP dipping in this study. The role of social support as a potentially modifiable determinant of nocturnal BP dipping warrants further investigation.
Collapse
|
225
|
Liu CT, Raghavan S, Maruthur N, Kabagambe EK, Hong J, Ng MCY, Hivert MF, Lu Y, An P, Bentley AR, Drolet AM, Gaulton KJ, Guo X, Armstrong LL, Irvin MR, Li M, Lipovich L, Rybin DV, Taylor KD, Agyemang C, Palmer ND, Cade BE, Chen WM, Dauriz M, Delaney JAC, Edwards TL, Evans DS, Evans MK, Lange LA, Leong A, Liu J, Liu Y, Nayak U, Patel SR, Porneala BC, Rasmussen-Torvik LJ, Snijder MB, Stallings SC, Tanaka T, Yanek LR, Zhao W, Becker DM, Bielak LF, Biggs ML, Bottinger EP, Bowden DW, Chen G, Correa A, Couper DJ, Crawford DC, Cushman M, Eicher JD, Fornage M, Franceschini N, Fu YP, Goodarzi MO, Gottesman O, Hara K, Harris TB, Jensen RA, Johnson AD, Jhun MA, Karter AJ, Keller MF, Kho AN, Kizer JR, Krauss RM, Langefeld CD, Li X, Liang J, Liu S, Lowe WL, Mosley TH, North KE, Pacheco JA, Peyser PA, Patrick AL, Rice KM, Selvin E, Sims M, Smith JA, Tajuddin SM, Vaidya D, Wren MP, Yao J, Zhu X, Ziegler JT, Zmuda JM, Zonderman AB, Zwinderman AH, Adeyemo A, Boerwinkle E, Ferrucci L, Hayes MG, Kardia SLR, Miljkovic I, Pankow JS, Rotimi CN, Sale MM, Wagenknecht LE, Arnett DK, Chen YDI, Nalls MA, Province MA, Kao WHL, Siscovick DS, Psaty BM, Wilson JG, Loos RJF, Dupuis J, Rich SS, Florez JC, Rotter JI, Morris AP, Meigs JB. Trans-ethnic Meta-analysis and Functional Annotation Illuminates the Genetic Architecture of Fasting Glucose and Insulin. Am J Hum Genet 2016; 99:56-75. [PMID: 27321945 PMCID: PMC5005440 DOI: 10.1016/j.ajhg.2016.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/02/2016] [Indexed: 12/11/2022] Open
Abstract
Knowledge of the genetic basis of the type 2 diabetes (T2D)-related quantitative traits fasting glucose (FG) and insulin (FI) in African ancestry (AA) individuals has been limited. In non-diabetic subjects of AA (n = 20,209) and European ancestry (EA; n = 57,292), we performed trans-ethnic (AA+EA) fine-mapping of 54 established EA FG or FI loci with detailed functional annotation, assessed their relevance in AA individuals, and sought previously undescribed loci through trans-ethnic (AA+EA) meta-analysis. We narrowed credible sets of variants driving association signals for 22/54 EA-associated loci; 18/22 credible sets overlapped with active islet-specific enhancers or transcription factor (TF) binding sites, and 21/22 contained at least one TF motif. Of the 54 EA-associated loci, 23 were shared between EA and AA. Replication with an additional 10,096 AA individuals identified two previously undescribed FI loci, chrX FAM133A (rs213676) and chr5 PELO (rs6450057). Trans-ethnic analyses with regulatory annotation illuminate the genetic architecture of glycemic traits and suggest gene regulation as a target to advance precision medicine for T2D. Our approach to utilize state-of-the-art functional annotation and implement trans-ethnic association analysis for discovery and fine-mapping offers a framework for further follow-up and characterization of GWAS signals of complex trait loci.
Collapse
|
226
|
Oti SO, van de Vijver S, Gomez GB, Agyemang C, Egondi T, Kyobutungi C, Stronks K. Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya. Bull World Health Organ 2016; 94:501-9. [PMID: 27429489 PMCID: PMC4933135 DOI: 10.2471/blt.15.156513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/21/2015] [Accepted: 02/04/2016] [Indexed: 01/16/2023] Open
Abstract
Objective To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya. Methods The intervention in 2012–2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention. We also estimated the costs associated with implementation, using a top-down costing approach. Findings The intervention reached 60% of the target population (4049/6780 people), at a cost of 17 United States dollars (US$) per person screened and provided access to treatment for 68% (660/976) of people referred, at a cost of US$ 123 per person with hypertension who attended the clinic. Of the 660 people who attended the clinic, 27% (178) were retained in care, at a cost of US$ 194 per person retained; and of those patients, 33% (58/178) achieved blood pressure control. The total intervention cost per patient with blood pressure controlled was US$ 3205. Conclusion With moderate implementation costs, it was possible to achieve hypertension awareness and treatment levels comparable to those in high-income settings. However, retention in care and blood pressure control were challenges in this slum setting. For patients, the costs and lack of time or forgetfulness were barriers to retention in care.
Collapse
|
227
|
Bijker R, Agyemang C. The influence of early-life conditions on cardiovascular disease later in life among ethnic minority populations: a systematic review. Intern Emerg Med 2016; 11:341-53. [PMID: 26141120 DOI: 10.1007/s11739-015-1272-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/10/2015] [Indexed: 11/25/2022]
Abstract
Ethnic minority groups are disproportionately affected by cardiovascular diseases (CVDs). The reasons for the high prevalence of CVD in ethnic minority groups are not fully understood. Recently, the importance of early-life developmental factors and their impact on CVDs in adulthood is increasingly being recognised, but little is known about this among ethnic minority groups. Therefore, the current paper aimed to fill this knowledge gap by reviewing the available literature to assess the influence of early-life conditions on CVDs and its risk factors in ethnic minority populations residing in Western countries. A systematic search was performed in PubMed and EMBASE between 1989 and 2014. In total, 1418 studies were identified of which 19 met the inclusion criteria. Six studies investigated the relationship between early-life anthropometrics and CVD risk factors of which all except one found significant associations between the assessed anthropometric measures and CVD risk factors. Seven studies evaluated the influence of childhood socio-economic status (SES) on CVD and risk factors of which five found significant associations between childhood SES measures and CVD risk factors. Five studies investigated the relationship between other early-life conditions including early-life nutrition, physical development, and childhood psychosocial conditions, and CVD risk factors. Four of these studies found significant associations between the assessed childhood conditions and CVD risk factors. This review reinforces the importance of early-life conditions on adult CVD in ethnic minority groups. Improvement of early-life conditions among ethnic minority groups may contribute to reducing CVD risk in these populations.
Collapse
|
228
|
Meeks KAC, Freitas-Da-Silva D, Adeyemo A, Beune EJAJ, Modesti PA, Stronks K, Zafarmand MH, Agyemang C. Disparities in type 2 diabetes prevalence among ethnic minority groups resident in Europe: a systematic review and meta-analysis. Intern Emerg Med 2016; 11:327-40. [PMID: 26370238 DOI: 10.1007/s11739-015-1302-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/20/2015] [Indexed: 01/20/2023]
Abstract
Many ethnic minorities in Europe have a higher type 2 diabetes (T2D) prevalence than their host European populations. The risk size differs between ethnic groups, but the extent of the differences in the various ethnic minority groups has not yet been systematically quantified. We conducted a meta-analysis of published data on T2D in various ethnic minority populations resident in Europe compared to their host European populations. We systematically searched MEDLINE (using PUBMED) and EMBASE for papers on T2D prevalence in ethnic minorities in Europe published between 1994 and 2014. The ethnic minority groups were classified into five population groups by geographical origin: South Asian (SA), Sub-Saharan African (SSA), Middle Eastern and North African (MENA), South and Central American (SCA), and Western Pacific (WP). Pooled odds ratios with corresponding 95 % confidence interval (CI) were calculated using Review Manager 5.3. Twenty articles were included in the analysis. Compared with the host populations, SA origin populations had the highest odds for T2D (3.7, 95 % CI 2.7-5.1), followed by MENA (2.7, 95 % CI 1.8-3.9), SSA (2.6, 95 % CI 2.0-3.5), WP (2.3, 95 % CI 1.2-4.1), and lastly SCA (1.3, 95 % CI 1.1-1.6). Odds ratios were in all ethnic minority populations higher for women than for men except for SCA. Among SA subgroups, compared with Europeans, Bangladeshi had the highest odds ratio of 6.2 (95 % CI 3.9-9.8), followed by Pakistani (5.4, 95 % CI 3.2-9.3) and Indians (4.1, 95 % CI 3.0-5.7). The risk of T2D among ethnic minority groups living in Europe compared to Europeans varies by geographical origin of the group: three to five times higher among SA, two to four times higher among MENA, and two to three times higher among SSA origin. Future research and policy initiatives on T2D among ethnic minority groups should take the interethnic differences into account.
Collapse
|
229
|
van de Vijver S, Oti SO, Gomez GB, Agyemang C, Egondi T, Moll van Charante E, Brewster LM, Hankins C, Tanovic Z, Ezeh A, Kyobutungi C, Stronks K. Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: the SCALE-UP study. Glob Health Action 2016; 9:30922. [PMID: 27019347 PMCID: PMC4808680 DOI: 10.3402/gha.v9.30922] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/25/2016] [Accepted: 02/27/2016] [Indexed: 11/14/2022] Open
Abstract
Background A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and other CVD risk factors in a slum setting in Nairobi, Kenya. Design Prospective intervention study includes awareness campaigns, household visits for screening, and referral and treatment of people with hypertension. The primary outcome was overall change in mean systolic blood pressure (SBP), while secondary outcomes were changes in awareness of hypertension and other CVD risk factors. We evaluated the intervention's impact through consecutive cross-sectional surveys at baseline and after 18 months, comparing outcomes of intervention and control group, through a difference-in-difference method. Results We screened 1,531 and 1,233 participants in the intervention and control sites. We observed a significant reduction in mean SBP when comparing before and after measurements in both intervention and control groups, −2.75 mmHg (95% CI −4.33 to −1.18, p=0.001) and −1.67 mmHg (95% CI −3.17 to −0.17, p=0.029), respectively. Among people with hypertension at baseline, SBP was reduced by −14.82 mmHg (95% CI −18.04 to −11.61, p<0.001) in the intervention and −14.05 (95% CI −17.71 to −10.38, p<0.001) at the control site. However, comparing these two groups, we found no difference in changes in mean SBP or hypertension prevalence. Conclusions We found significant declines in SBP over time in both intervention and control groups. However, we found no additional effect of a community-based intervention involving awareness campaigns, screening, referral, and treatment. Possible explanations include the beneficial effect of baseline measurements in the control group on behaviour and related BP levels, and the limited success of treatment and suboptimal adherence in the intervention group.
Collapse
|
230
|
Agyemang C, Snijder MB, Adjei DN, van den Born BJH, Modesti PA, Peters RJ, Stronks K, Vogt L. Ethnic Disparities in CKD in the Netherlands: The Healthy Life in an Urban Setting (HELIUS) Study. Am J Kidney Dis 2016; 67:391-9. [DOI: 10.1053/j.ajkd.2015.07.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/14/2015] [Indexed: 11/11/2022]
|
231
|
Commodore-Mensah Y, Hill M, Allen J, Cooper LA, Blumenthal R, Agyemang C, Himmelfarb CD. Sex Differences in Cardiovascular Disease Risk of Ghanaian- and Nigerian-Born West African Immigrants in the United States: The Afro-Cardiac Study. J Am Heart Assoc 2016; 5:e002385. [PMID: 26896477 PMCID: PMC4802474 DOI: 10.1161/jaha.115.002385] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of African immigrants in the United States grew 40-fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States. METHODS AND RESULTS This cross-sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35-74 years in the Baltimore-Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m(2)) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033-0.29) and 0.25 (95% CI 0.09-0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83-0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%. CONCLUSIONS The prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.
Collapse
|
232
|
Anujuo K, Stronks K, Snijder MB, Jean-Louis G, van den Born BJ, Peters RJ, Agyemang C. Relationship between sleep duration and arterial stiffness in a multi-ethnic population: The HELIUS study. Chronobiol Int 2016; 33:543-52. [PMID: 27058653 PMCID: PMC5357559 DOI: 10.3109/07420528.2016.1158721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We examined the relationship between sleep duration and arterial stiffness among a multi-ethnic cohort, and whether the associations differed among ethnic minority groups in the Netherlands. Data were derived from 10 994 participants (aged 18-71 years) of the Healthy Life in an Urban Setting (HELIUS) study. Self-reported sleep duration was categorized into: short (<7 h/night), healthy (7-8 h/night) and long (≥9 h/night). Arterial stiffness was assessed by duplicate pulse-wave velocity (PWV in m/s) measurements using the Arteriograph system. The association of sleep duration with PWV was analysed using linear regression (β) with 95% confidence interval (CI). Results showed that neither short nor long sleep was related to PWV in all ethnic groups, except for long sleep in Dutch men which was associated with higher PWV (indicating stiffer arteries) after adjustment for potential confounders (β = 0.67, 95%CI, 0.23-1.11). Our study showed no convincing evidence that sleep duration was related to arterial stiffness among various ethnic groups. The link between sleep duration and cardiovascular outcomes does not seem to operate through arterial stiffness. Further research is needed to consolidate these findings.
Collapse
|
233
|
van de Vijver S, Oti S, Oduor C, Ezeh A, Lange J, Agyemang C, Kyobutungi C. Challenges of health programmes in slums. Lancet 2015; 386:2114-2116. [PMID: 26452707 DOI: 10.1016/s0140-6736(15)00385-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
234
|
Meeks KAC, Stronks K, Beune EJAJ, Adeyemo A, Henneman P, Mannens MMAM, Nicolaou M, Peters RJG, Rotimi CN, Snijder MB, Agyemang C. Prevalence of type 2 diabetes and its association with measures of body composition among African residents in the Netherlands--The HELIUS study. Diabetes Res Clin Pract 2015; 110:137-46. [PMID: 26432411 DOI: 10.1016/j.diabres.2015.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/29/2015] [Accepted: 09/12/2015] [Indexed: 02/05/2023]
Abstract
AIMS To compare type 2 diabetes prevalence among three ethnic groups resident in the Netherlands: Ghanaians, African Surinamese and Dutch origin. Secondly, to determine the contribution of measures of body composition to ethnic differences in type 2 diabetes. METHODS Baseline data from Ghanaian (n=1873), African Surinamese (n=2189) and Dutch (n=2151) origin participants of the HELIUS study (aged 18-70 years) were analyzed. Type 2 diabetes was determined according to the WHO criteria. Logistic regression tested ethnic differences in type 2 diabetes and the contribution of body fat percentage and waist-to-hip ratio. RESULTS Among men, type 2 diabetes prevalence was higher in Ghanaians (14.9%) than in African Surinamese (10.4%) and Dutch (5.0%). Among women, type 2 diabetes prevalence in Ghanaian (11.1%) was higher than in Dutch (2.3%), but similar to African Surinamese (11.5%). After adjusting for age, body fat percentage and waist-to-hip ratio, the odds ratios for having type 2 diabetes were 1.55 (95% CI: 1.12-2.15) for Ghanaian men compared with African Surinamese and 4.19 (95% CI: 2.86-6.12) compared with Dutch. Among women these odds ratios were 0.94 (95% CI: 0.70-1.26) and 4.78 (95% CI: 2.82-8.11). CONCLUSIONS The higher prevalence of type 2 diabetes among Ghanaian compared with African Surinamese men suggests a need to distinguish between African descent populations when assessing their type 2 diabetes risk. The higher odds for type 2 diabetes among Ghanaians cannot be attributed to differences in body composition. Further research on the contribution of lifestyle factors as well as genetic and epigenetic factors is needed to identify the reasons for the observed disparities.
Collapse
|
235
|
Snijder MB, Stronks K, Agyemang C, Busschers WB, Peters RJ, van den Born BJH. Response to Letter to the Editor. Int J Cardiol 2015; 198:56-7. [PMID: 26151714 DOI: 10.1016/j.ijcard.2015.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
|
236
|
Meeks K, Freitas-Da-Silva D, Adeyemo A, Beune E, Modesti P, Stronks K, Zafarmand M, Agyemang C. Disparities in type 2 diabetes among ethnic minority groups resident in Europe - a meta-analysis. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
237
|
Agyemang C, Snijder MB, Adjei DN, van den Born BJH, Modesti P, Peters RJG, Stronks K, Vogt L. Ethnic Disparities in Chronic Kidney Disease in the Netherlands. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
238
|
Fernald F, van den Born BJH, Snijder MB, Brewste LM, Peters RJ, Agyemang C. Hypertension management among diabetics in a multi-ethnic population: The HELIUS study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
239
|
Agyemang C, Beune E, Stronks K, Bahendeka S. Research on Obesity and Type 2 Diabetes among African Migrants: the RODAM study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
240
|
van Oeffelen AAM, Rittersma S, Vaartjes I, Stronks K, Bots ML, Agyemang C. Are There Ethnic Inequalities in Revascularisation Procedure Rate after an ST-Elevation Myocardial Infarction? PLoS One 2015; 10:e0136415. [PMID: 26368504 PMCID: PMC4569548 DOI: 10.1371/journal.pone.0136415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
Background Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisation rate after occurrence of an ST-elevation myocardial infarction (STEMI) between first generation ethnic minority groups (henceforth, migrants) and ethnic Dutch. Methods All STEMI events between 2006 and 2011 were identified in a subset of the Achmea Health Database, which records medical care to persons insured at the Achmea health insurance company, a major health insurance company in the central part of the Netherlands. Ethnic Dutch and migrants from Suriname (Hindustani Surinamese and non-Hindustani Surinamese), Morocco, and Turkey were included (n = 1,765). Multivariable Cox proportional hazards regression analyses were used to identify ethnic inequalities in revascularisation rate (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)) after a STEMI event. Results On average, 73.2% of STEMI events were followed by a revascularisation procedure. After adjustment for confounders (age, sex, degree of urbanization) no significant differences in revascularisation rate were found between the ethnic Dutch population and Hindustani Surinamese (HR: 1.04; 0.85–1.27), non-Hindustani Surinamese (HR: 0.98; 0.63–1.51), Moroccan (HR: 0.94; 0.77–1.14), and Turkish migrants (HR: 1.04; 0.88–1.24). Additional adjustment for comorbidity and neighborhood income did not change our findings. Conclusion Our study suggests no ethnic inequalities in revascularisation rate after a STEMI event. This finding is in agreement with the universally accessible health care system in the Netherlands.
Collapse
|
241
|
Commodore-Mensah Y, Himmelfarb CD, Agyemang C, Sumner AE. Cardiometabolic Health in African Immigrants to the United States: A Call to Re-examine Research on African-descent populations. Ethn Dis 2015; 25:373-80. [PMID: 26675140 DOI: 10.18865/ed.25.3.373] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the 20th century, Africans in Sub-Saharan Africa had lower rates of cardiometabolic disease than Africans who migrated. However, in the 21st century, beyond infectious diseases, the triple epidemics of obesity, diabetes and hypertension have taken hold in Africa. Therefore, Africans are acquiring these chronic diseases at different rates and different intensity prior to migration. To ensure optimal care and health outcomes, the United States practice of grouping all African-descent populations into the "Black/African American" category without regard to country of origin masks socioeconomic and cultural differences and needs re-evaluation. Overall, research on African-descent populations would benefit from a shift from a racial to an ethnic perspective. To demonstrate the value of disaggregating data on African-descent populations, the epidemiologic transition, social, economic, and health characteristics of African immigrants are presented.
Collapse
|
242
|
Adjei DN, Agyemang C, Dasah JB, Kuranchie P, Amoah AGB. The effect of electronic reminders on risk management among diabetic patients in low resourced settings. J Diabetes Complications 2015; 29:818-21. [PMID: 26025699 DOI: 10.1016/j.jdiacomp.2015.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/23/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Information technology has potential to improve health care delivery particularly among individuals with chronic diseases such as diabetes in low and middle-income countries (LMIC). Research on the usefulness of information technology to manage persons living with chronic diseases is scarce in LMIC. We sought to evaluate the effect of an electronic reminder system on cardiovascular risk factors (blood pressure, heart rate, and fasting plasma glucose) and adherence to clinical appointments among persons living with diabetes. RESEARCH DESIGN AND METHODS A randomized controlled design was used to recruit 200 diabetic patients (intervention n=100, control n=100) from the National Diabetes Management Research Centre, Accra. All patients received usual diabetes care. The intervention group was given electronic reminders for their clinical appointments and their physicians were prompted with abnormal laboratory results for six months. RESULTS Baseline characteristics were largely similar for both groups. At six months follow up, the mean reductions of all the cardiovascular risk factors in the intervention group were significantly greater than in the control group: -1.7 kg/m(2) versus -1.1 kg/m(2)(p=0.002) for BMI; -4.7 mmHg versus -2.8 mmHg (p=0.002) for SBP; -5.3 mmH versus -3.1 mmHg (p=0.001) for DBP; -1.7 bpm versus -0.1 bpm (p=0.001) for heart rate and -2.3 mmol/L versus -1.6 mmol/L (p=0.001) for fasting plasma glucose, respectively. Adherence to appointment schedules was also significantly higher in the intervention group compared with the control group (97.8% versus 89.4%, p=0.010). CONCLUSIONS Locally developed electronic initiatives such as this resulted in improved cardiovascular risk factors and effective compliance to clinical practices and improved quality of care for persons living with diabetes.
Collapse
|
243
|
Byberg S, Agyemang C, Zwisler AD, Krasnik A, Norredam M. Cardiovascular disease incidence and survival: Are migrants always worse off? Eur J Epidemiol 2015; 31:667-77. [PMID: 25968173 DOI: 10.1007/s10654-015-0024-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
Studies on cardiovascular disease (CVD) incidence and survival show varying results between different ethnic groups. Our aim was to add a new dimension by exploring the role of migrant status in combination with ethnic background on incidence of-and survival from-CVD and more specifically acute myocardial infarction (AMI) and stroke. We conducted a historically prospective cohort study comprising all newly-arrived migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114,331), matched 1:6 to Danish-born by age and sex. CVD incidence was retrieved from the National Patient Registry and differences in incidence were assessed by Poisson regression and stratified by sex. Survival differences were assessed by Cox regression using all-cause and cause-specific mortality as outcome. Male refugees had significantly lower incidence of CVD (RR = 0.89; 95 % CI 0.85-0.93) and stroke (IRR = 0.62; 95 % CI 0.56-0.69) compared to Danish-born, but significantly higher incidence of AMI (IRR = 1.12; 95 % CI 1.02-1.24). Female refugees had similar rates of CVD and AMI, but significantly lower incidence of stroke (RR = 0.76; 95 % CI 0.67-0.85). Both male and female family-reunified immigrants had significantly lower incidence of CVD, AMI and stroke. All-cause and cause-specific survival after CVD, AMI and stroke was similar or significantly better for migrants compared to Danish-born, regardless of type of migrant (refugee vs. family-reunified) or country of origin. Refugees are disadvantaged in terms of some types of cardiovascular disease compared to Danish-born. Family-reunified migrants on the other hand had lower rates of CVD. All migrants had better survival than Danish-born indicating that migrants may not always be disadvantaged in health.
Collapse
|
244
|
Snijder MB, Stronks K, Agyemang C, Busschers WB, Peters RJ, van den Born BJH. Ethnic differences in arterial stiffness the Helius study. Int J Cardiol 2015; 191:28-33. [PMID: 25965592 DOI: 10.1016/j.ijcard.2015.04.234] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/16/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Well-known ethnic differences in cardiovascular risk exist, which may be explained by ethnic differences in arterial stiffness. Our aim was to assess ethnic differences in arterial stiffness, to explore whether these differences are accounted for by conventional cardiovascular risk factors, and study whether they differ across age. METHODS Cross-sectional data of 1797 Dutch, 1846 South-Asian Surinamese, 1840 African Surinamese, and 1673 Ghanaian participants of the observational HELIUS study (aged 18-70 years) were used. Arterial stiffness was assessed by duplicate pulse wave velocity (PWV) measurements using the Arteriograph system. RESULTS Linear regression showed that South-Asian Surinamese had higher PWVs as compared with Dutch (age-adjusted mean difference (95% CI) was 0.55 (0.39-0.70) m/s in men and 0.82 (0.63-1.01) m/s in women). These differences were largely, but not completely, explained by conventional risk factors (particularly age and MAP). These ethnic differences were not found at young age (<35 years). African Surinamese and Ghanaians had higher PWVs as compared with Dutch across the entire age range (ranging from 0.22 (0.06-0.39) m/s in African Surinamese men to 1.07 (0.89-1.26) m/s in Ghanaian women), but these differences disappeared or reversed after adjustment for risk factors. CONCLUSIONS PWV levels paralleled the well-known ethnic differences in cardiovascular risk. After adjustment for cardiovascular risk factors, however, these ethnic differences in PWV largely disappear. Together with the absence of ethnic differences in PWV at young age, our results support the hypothesis that higher PWV in South-Asian and African ethnic groups develops due to higher exposure to cardiovascular risk factors.
Collapse
|
245
|
Afrifa-Anane E, Agyemang C, Codjoe SNA, Ogedegbe G, de-Graft Aikins A. The association of physical activity, body mass index and the blood pressure levels among urban poor youth in Accra, Ghana. BMC Public Health 2015; 15:269. [PMID: 25881047 PMCID: PMC4376361 DOI: 10.1186/s12889-015-1546-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background Globally, there is an increasing prevalence of high blood pressure (HBP) among adults and youth. However, the mechanisms of how the risk factors (physical inactivity and obesity) relate with blood pressure (BP) are not well known especially among the urban poor youth in low and middle income countries. Meanwhile childhood and adolescent physical inactivity and obesity, particularly in conditions of poverty, predispose individuals to cardiovascular diseases (CVDs) in later life. The aim of this study was to assess the BP levels and to examine its associations with physical activity (PA) and body mass index (BMI) amongst urban poor youth in Accra, Ghana. Methods We studied 201 youth aged 15–24 years in three urban poor communities in Accra, Ghana. Height, weight and BP were measured in all subjects. PA levels were assessed using the Edulink Urban Health and Poverty project questionnaire. Multiple linear regression analysis was used to determine the factors influencing BP levels. Results The proportion of pre-hypertension and hypertension among the youth was 32.3% and 4%, respectively. The rates of pre-hypertension (42.0 vs. 24.8) and hypertension (6.8 vs. 1.8) were higher in males than in females. More than three-quarters (84.1%) of the youth were not physically active. Females were more physically inactive compared to the males (94.7% vs. 70.5%). The average BMI was 22.8 kg/m2. For overweight (17.7 vs. 6.8) and obesity (13.3 vs. 2.3), females had higher rates than males. BMI was positively related to systolic BP, and significantly associated with systolic BP (β = 1.4, p < 0.000 and β = 0.8, p < 0.000; respectively for male and female youth) compared to diastolic BP. Youth with low PA had raised BP. Conclusion The positive association of BMI and BP in the study communities suggests the need for health measures to tackle their increase and related public health consequences. Further studies on BP and other risk factors among the youth of rural populations and other developing countries will be important to stall the rising prevalence and implications for adult morbidity and mortality.
Collapse
|
246
|
van de Vijver S, Oti S, Moll van Charante E, Allender S, Foster C, Lange J, Oldenburg B, Kyobutungi C, Agyemang C. Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands. Global Health 2015; 11:11. [PMID: 25890177 PMCID: PMC4363048 DOI: 10.1186/s12992-015-0095-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 02/16/2015] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources. We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic. Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings. The involvement and support of African communities’ infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers’ perspective and health effects in the target population, similar to the study design for Nairobi.
Collapse
|
247
|
Agyemang C, Kieft S, Snijder MB, Beune EJ, van den Born BJ, Brewster LM, Ujcic-Voortman JJ, Bindraban N, van Montfrans G, Peters RJ, Stronks K. Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: the HELIUS study. Int J Cardiol 2015; 183:180-9. [PMID: 25679990 DOI: 10.1016/j.ijcard.2015.01.061] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/24/2014] [Accepted: 01/25/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Hypertension is a major problem among European ethnic minority groups. We assessed the current situation of hypertension prevalence and its management among a multi-ethnic population in Amsterdam, The Netherlands. METHODS Data from the HELIUS study were used including 12,974 participants (1871 Ghanaian, 2184 African Surinamese, 2278 South-Asian Surinamese, 2277 Turkish, 2222 Moroccan and 2142 Dutch origin people), aged 18-70 years. Comparisons among groups were made using proportions and age-adjusted prevalence ratios (PRs). RESULTS Hypertension prevalence ranged from 24% and 16% in Moroccan men and women to 52% and 62% in Ghanaian men and women. Except for Moroccan women, age-adjusted PR of hypertension was higher in all the ethnic minority groups than in Dutch. Among hypertensives, ethnic minority groups generally had higher levels of hypertension awareness and BP lowering treatment than Dutch. Moreover, prevalence rates for the prescription of more than one BP lowering drug were generally higher in African and South-Asian origin groups compared with Dutch origin people. By contrast, BP control levels were lower in all the ethnic groups than in Dutch, with control rates being significantly lower in Ghanaian men (26%, PR=0.49; 95% CI, 0.37-0.66) and women (45%, PR=0.64; 0.52-0.77), African-Surinamese men (30%, PR=0.61; 0.46-0.81) and women (45%, PR=0.72; 0.51-0.77), and South-Asian Surinamese men (43%, PR=0.77; 0.61-0.97) and women (47%, PR=0.76; 0.63-0.92) compared with Dutch men (53%) and women (61%). CONCLUSION Our findings indicate poor BP control in ethnic minority groups despite the high treatment levels. More work is needed to unravel the potential factors contributing to the poor control in order to improve BP control in ethnic minority groups, particularly among African and South-Asian origin groups.
Collapse
|
248
|
Odusola AO, Nelissen H, Hendriks M, Schultsz C, Wit F, Bolarinwa OA, Akande T, Agyemang C, Ogedegbe G, Agbede K, Adenusi P, Osibogun A, Stronks K, Haafkens J. How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.57021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
249
|
Odusola AO, Hendriks M, Schultsz C, Bolarinwa OA, Akande T, Osibogun A, Agyemang C, Ogedegbe G, Agbede K, Adenusi P, Lange J, van Weert H, Stronks K, Haafkens JA. Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study. BMC Health Serv Res 2014; 14:624. [PMID: 25491509 PMCID: PMC4267751 DOI: 10.1186/s12913-014-0624-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 11/19/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors. METHODS We conducted a qualitative interview study with 40 insured hypertensive patients who had received hypertension care for > 1 year in a rural primary care hospital in Kwara state, Nigeria. Supported by MAXQDA software, interview transcripts were inductively coded. Codes were then grouped into concepts and thematic categories, leading to matrices for inhibitors and facilitators of treatment adherence. RESULTS Important patient-identified facilitators of medication adherence included: affordability of care (through health insurance); trust in orthodox "western" medicines; trust in Doctor; dreaded dangers of hypertension; and use of prayer to support efficacy of pills. Inhibitors of medication adherence included: inconvenient clinic operating hours; long waiting times; under-dispensing of prescriptions; side-effects of pills; faith motivated changes of medication regimen; herbal supplementation/substitution of pills; and ignorance that regular use is needed. Local practices and norms were identified as important inhibitors to the uptake of healthier behaviors (e.g. use of salt for food preservation; negative cultural images associated with decreased body size and physical activity). Important factors facilitating such behaviors were the awareness that salt substitutes and products for composing healthier meals were cheaply available at local markets and that exercise could be integrated in people's daily activities (e.g. farming, yam pounding, and household chores). CONCLUSIONS With a better understanding of patient perceived inhibitors and facilitators of adherence to hypertension treatment, this study provides information for patient education and health system level interventions that can be designed to improve compliance. TRIAL REGISTRATION ISRCTN47894401 .
Collapse
|
250
|
Goosen S, Middelkoop B, Stronks K, Agyemang C, Kunst AE. High diabetes risk among asylum seekers in The Netherlands. Diabet Med 2014; 31:1532-41. [PMID: 24860962 DOI: 10.1111/dme.12510] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/05/2014] [Accepted: 05/21/2014] [Indexed: 02/03/2023]
Abstract
AIMS To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. METHODS We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. RESULTS The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardized prevalence ratios were found for asylum seekers from Somalia, Sudan and Sri Lanka. The standardized prevalence ratio was higher in asylum seekers aged ≥ 30 years. Incidence rates were higher compared with the reference population for all length-of-stay intervals. CONCLUSIONS Asylum seekers from the majority of countries of origin were at higher risk of diabetes compared with the general population in the Netherlands. Asylum seekers from Somalia were particularly at risk. This emerging public health issue requires attention from policy-makers and care providers.
Collapse
|