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Agyemang C, van Oeffelen AAM, Norredam M, Kappelle LJ, Klijn CJM, Bots ML, Stronks K, Vaartjes I. Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands. Stroke 2014; 45:3236-42. [PMID: 25270628 DOI: 10.1161/strokeaha.114.006462] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. METHODS A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch). RESULTS Compared with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0.16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence of ischemic stroke and intracerebral hemorrhage compared with ethnic Dutch. CONCLUSIONS Our findings suggest that Surinamese have an increased risk, whereas Moroccans have a reduced risk for all the various stroke subtypes. Among other ethnic minorities, the risk seems to depend on the stroke subtype and sex. These findings underscore the need to identify the root causes of these ethnic differences to assist primary and secondary prevention efforts.
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Affiliation(s)
- Charles Agyemang
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Aloysia A M van Oeffelen
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Marie Norredam
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - L Jaap Kappelle
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Catharina J M Klijn
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Michiel L Bots
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Karien Stronks
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Ilonca Vaartjes
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
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252
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Norredam M, Hansen OH, Petersen JH, Kunst AE, Kristiansen M, Krasnik A, Agyemang C. Remigration of migrants with severe disease: myth or reality?--a register-based cohort study. Eur J Public Health 2014; 25:84-9. [PMID: 25201902 DOI: 10.1093/eurpub/cku138] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND 'Remigration bias' is often referred to when explaining low mortality outcomes among migrants compared with local-born. The hypothesis suggests that severely ill migrants tend to return to their country of origin, but it has hitherto not been tested in a large-scale epidemiological study. Consequently, we studied whether migrants with severe disease were more likely to emigrate compared with migrants without severe disease. METHODS A historic prospective cohort study was conducted based on all adult refugees and family reunification immigrants (n = 114,331) who obtained residence permission in Denmark between 1 January 1993 and 31 December 2010. Migrants with severe disease were identified through the Danish National Patient Register. Emigrations during follow-up (1 January 1993 to 31 December 2011) were identified using the Danish Civil Registration System. Hazard ratios were calculated for emigration among migrants with different levels of disease severity, adjusting for sex, age and income. RESULTS Results showed progressively fewer emigrations with increasing disease severity. Migrants with low (HR = 0.92; 95% CI: 0.80-1.06), moderate (HR = 0.84; 95% CI: 0.67-1.06) and high (HR = 0.70; 95% CI: 0.55-0.90) disease severity had fewer emigrations to 'country of origin' compared with migrants without disease. For emigration to 'any country', results likewise showed fewer emigrations among migrants with low (HR = 0.86; 95% CI: 0.78-0.95), moderate (HR = 0.73; 95% CI: 0.62-0.87) and high (HR = 0.64; 95% CI: 0.53-0.76) disease severity. This tendency was also observed by nationality and migrant status. On the disease-specific level, no uniform tendencies in emigration patterns were identified. CONCLUSION The results do not generally support the hypothesis of 'remigration bias' but rather suggest the opposite. Accordingly, remigration bias does not appear to explain lower mortality of migrants.
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Affiliation(s)
- Marie Norredam
- 1 Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark 2 Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark
| | - Oluf Hoejbjerg Hansen
- 3 Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- 3 Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anton E Kunst
- 4 Department of Public Health, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands
| | - Maria Kristiansen
- 1 Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark
| | - Allan Krasnik
- 1 Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark
| | - Charles Agyemang
- 4 Department of Public Health, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands
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Anujuo K, Stronks K, Snijder MB, Jean-Louis G, Ogedegbe G, Agyemang C. Ethnic differences in self-reported sleep duration in the Netherlands – the HELIUS study. Sleep Med 2014; 15:1115-21. [DOI: 10.1016/j.sleep.2014.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/11/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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Agyemang C, van Oeffelen AA, Norredam M, Kappelle LJ, Klijn CJ, Bots ML, Stronks K, Vaartjes I. Socioeconomic Inequalities in Stroke Incidence Among Migrant Groups. Stroke 2014; 45:2397-403. [DOI: 10.1161/strokeaha.114.005505] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charles Agyemang
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Aloysia A. van Oeffelen
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Marie Norredam
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - L. Jaap Kappelle
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Catharina J.M. Klijn
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Michiel L. Bots
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Karien Stronks
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Ilonca Vaartjes
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
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255
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Agyei B, Nicolaou M, Boateng L, Dijkshoorn H, van den Born BJ, Agyemang C. Relationship between psychosocial stress and hypertension among Ghanaians in Amsterdam, the Netherlands--the GHAIA study. BMC Public Health 2014; 14:692. [PMID: 25001592 PMCID: PMC4099212 DOI: 10.1186/1471-2458-14-692] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Background Hypertension is highly prevalent among recent sub-Saharan African (SSA) migrants in western countries and some tend to associate their hypertension to psychosocial stress. However data on the relationship between hypertension and psychosocial stress among SSA migrants are rare. We assessed the relationship between psychosocial stress and hypertension among the largest SSA migrant population (Ghanaians) in Amsterdam, the Netherlands. Methods Data were obtained from structured interviews along with medical examination among 212 participants from a cross-sectional study: the GHAIA study in 2010 in Amsterdam. Blood pressure was measured with a validated Oscillometric automated digital blood pressure device. Psychosocial stress was assessed by questionnaires on perceived discrimination, depressive symptoms and financial problems. Binary logistic regression was used to study associations between psychosocial stress and hypertension. Results The overall prevalence of hypertension was 54.7%. About two thirds of the study population experienced a moderate (31%) or high (36%) level of discrimination. 20.0% of the participants had mild depressive symptoms, whilst 9% had moderate depressive symptoms. The prevalence of financial stress was 34.8%. The psychosocial stresses we assessed were not significantly associated with hypertension: adjusted odds ratios comparing those with low levels and those with high levels were 0.99 (95% CI, 0.47–2.08) for perceived discrimination, 0.81 (95% CI, 0.26–2.49) for depressive symptoms and 0.71 (95% CI, 0.37–1.36) for financial stress, respectively. Conclusion We did not find evidence for the association between psychosocial stress and hypertension among recent SSA migrants. More efforts are needed to unravel other potential factors that may underlie the high prevalence of hypertension among these populations.
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Affiliation(s)
| | | | | | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands.
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van Oeffelen AAM, Agyemang C, Stronks K, Bots ML, Vaartjes I. Prognosis after a first hospitalisation for acute myocardial infarction and congestive heart failure by country of birth. Heart 2014; 100:1436-43. [PMID: 24914061 DOI: 10.1136/heartjnl-2013-305444] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate differences in 28-day and 5-year mortality and 5-year readmission after a first hospitalisation for acute myocardial infarction (AMI) and congestive heart failure (CHF) between first generation ethnic minority groups (henceforth, migrants) and the ethnic Dutch population. METHODS Nationwide prospective cohorts of first hospitalised AMI (N=213 630) and CHF patients (N=189 069) between 1998 and 2010 were built. Differences in 28-day and 5-year mortality and in 5-year AMI/CHF readmission between migrants (Surinamese, Moroccan, Turkish, Antillean, Indonesian, Chinese and South Asian) and the ethnic Dutch population were investigated using Cox proportional hazard regression models. RESULTS After the first AMI hospitalisation, mortality and AMI/CHF readmission were higher in the majority of migrant groups compared with ethnic Dutch. For example, HRs (adjusted for age, sex, marital status, degree of urbanisation and year of event) with 95% CIs among Surinamese (mainly of African or South-Asian origin) were 1.16 (1.02 to 1.32) for 28-day mortality, 1.44 (1.30 to 1.60) for 5-year mortality, 1.33 (1.08 to 1.63) for AMI readmission and 2.09 (1.82 to 2.40) for CHF readmission. After a first CHF hospitalisation, mortality rates among migrants were more diverse, with lower 28-day mortality among Moroccan and Turkish migrants and higher 5-year mortality among Surinamese, Chinese and South Asians. Readmission after CHF was often higher among migrant groups. CONCLUSIONS Prognosis after a first AMI hospitalisation was worse among most migrant groups compared with the ethnic Dutch population. Ethnic inequalities in prognosis after a first CHF hospitalisation were more diverse. Efforts should be made to disentangle the underlying factors of the results.
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Affiliation(s)
- A A M van Oeffelen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Agyemang
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K Stronks
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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257
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Norredam M, Agyemang C, Hoejbjerg Hansen OK, Petersen JH, Byberg S, Krasnik A, Kunst AE. Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the 'healthy migrant effect' hypothesis. Trop Med Int Health 2014; 19:958-67. [PMID: 24889930 DOI: 10.1111/tmi.12340] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. METHODS We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. RESULTS Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. CONCLUSION Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included.
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Affiliation(s)
- Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Disease, University Hospital Copenhagen, Hvidovre, Denmark
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258
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Modesti PA, Agostoni P, Agyemang C, Basu S, Benetos A, Cappuccio FP, Ceriello A, Del Prato S, Kalyesubula R, O’Brien E, Kilama MO, Perlini S, Picano E, Reboldi G, Remuzzi G, Stuckler D, Twagirumukiza M, Van Bortel LM, Watfa G, Zhao D, Parati G. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings. J Hypertens 2014; 32:951-60. [PMID: 24577410 PMCID: PMC3979828 DOI: 10.1097/hjh.0000000000000125] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 02/06/2023]
Abstract
The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.
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Affiliation(s)
- Pietro A. Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Florence
| | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanjay Basu
- University of California, San Francisco, California, USA
| | - Athanase Benetos
- INSERM UMR S1116, Université de Lorraine, Vandoeuvre-les-Nancy, Nancy, France
| | - Francesco P. Cappuccio
- University of Warwick, Warwick Medical School, and University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Antonio Ceriello
- Institut d’Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Stefano Del Prato
- Section of Metabolic Diseases and Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche ‘Mario Negri’, Bergamo, Italy
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
| | - Marc Twagirumukiza
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Luc M. Van Bortel
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | | | - Dong Zhao
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Gianfranco Parati
- Department of Health Sciences, University of Milano-Bicocca
- Department of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Agyemang C, Beune E, Meeks K, Owusu-Dabo E, Agyei-Baffour P, Aikins ADG, Dodoo F, Smeeth L, Addo J, Mockenhaupt FP, Amoah SK, Schulze MB, Danquah I, Spranger J, Nicolaou M, Klipstein-Grobusch K, Burr T, Henneman P, Mannens MM, van Straalen JP, Bahendeka S, Zwinderman AH, Kunst AE, Stronks K. Rationale and cross-sectional study design of the Research on Obesity and type 2 Diabetes among African Migrants: the RODAM study. BMJ Open 2014; 4:e004877. [PMID: 24657884 PMCID: PMC3963103 DOI: 10.1136/bmjopen-2014-004877] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Obesity and type 2 diabetes (T2D) are highly prevalent among African migrants compared with European descent populations. The underlying reasons still remain a puzzle. Gene-environmental interaction is now seen as a potential plausible factor contributing to the high prevalence of obesity and T2D, but has not yet been investigated. The overall aim of the Research on Obesity and Diabetes among African Migrants (RODAM) project is to understand the reasons for the high prevalence of obesity and T2D among sub-Saharan Africans in diaspora by (1) studying the complex interplay between environment (eg, lifestyle), healthcare, biochemical and (epi)genetic factors, and their relative contributions to the high prevalence of obesity and T2D; (2) to identify specific risk factors within these broad categories to guide intervention programmes and (3) to provide a basic knowledge for improving diagnosis and treatment. METHODS AND ANALYSIS RODAM is a multicentre cross-sectional study among homogenous sub-Saharan African participants (ie, Ghanaians) aged >25 years living in rural and urban Ghana, the Netherlands, Germany and the UK (http://rod-am.eu/). Standardised data on the main outcomes, genetic and non-genetic factors are collected in all locations. The aim is to recruit 6250 individuals comprising five subgroups of 1250 individuals from each site. In Ghana, Kumasi and Obuasi (urban stratum) and villages in the Ashanti region (rural stratum) are served as recruitment sites. In Europe, Ghanaian migrants are selected through the municipality or Ghanaian organisations registers. ETHICS AND DISSEMINATION Ethical approval has been obtained in all sites. This paper gives an overview of the rationale, conceptual framework and methods of the study. The differences across locations will allow us to gain insight into genetic and non-genetic factors contributing to the occurrence of obesity and T2D and will inform targeted intervention and prevention programmes, and provide the basis for improving diagnosis and treatment in these populations and beyond.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Beune
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Karlijn Meeks
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Ellis Owusu-Dabo
- Faculty of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Agyei-Baffour
- Faculty of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ama de-Graft Aikins
- The Regional Institute for Population Studies: University of Ghana, Legon, Ghana
| | - Francis Dodoo
- The Regional Institute for Population Studies: University of Ghana, Legon, Ghana
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Stephen K Amoah
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbruecke, Nuthetal, Germany
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbruecke, Nuthetal, Germany
| | - Joachim Spranger
- Department of Endocrinology, Diabetes and Nutrition, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tom Burr
- Source BioScience, Nottingham, UK
| | - Peter Henneman
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marcel M Mannens
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jan P van Straalen
- Department of Clinical Chemistry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Silver Bahendeka
- International Diabetes Federation, Africa Region, Kampala, Uganda
| | - A H Zwinderman
- Department of Clinical Epidemiology, Bioinformatics, and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Pool MS, Otupiri E, Owusu-Dabo E, de Jonge A, Agyemang C. Physical violence during pregnancy and pregnancy outcomes in Ghana. BMC Pregnancy Childbirth 2014; 14:71. [PMID: 24528555 PMCID: PMC3931479 DOI: 10.1186/1471-2393-14-71] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 02/11/2014] [Indexed: 11/11/2022] Open
Abstract
Background In pregnancy, violence can have serious health consequences that could affect both mother and child. In Ghana there are limited data on this subject. We sought to assess the relationship between physical violence during pregnancy and pregnancy outcomes (early pregnancy loss, perinatal mortality and neonatal mortality) in Ghana. Method The 2008 Ghana Demographic and Health Survey data were used. For the domestic violence module, 2563 women were approached of whom 2442 women completed the module. After excluding missing values and applying the weight factor, 1745 women remained. Logistic regression analysis was performed to assess the relationship between physical violence in pregnancy and adverse pregnancy outcomes with adjustments for potential confounders. Results About five percent of the women experienced violence during their pregnancy. Physical violence in pregnancy was positively associated with perinatal mortality and neonatal mortality, but not with early pregnancy loss. The differences remained largely unchanged after adjustment for age, parity, education level, wealth status, marital status and place of residence: adjusted odds ratios were 2.32; 95% CI: 1.34-4.01 for perinatal mortality, 1.86; 95% CI: 1.05-3.30 for neonatal mortality and 1.16; 95% CI: 0.60-2.24 for early pregnancy loss. Conclusion Our findings suggest that violence during pregnancy is related to adverse pregnancy outcomes in Ghana. Major efforts are needed to tackle violence during pregnancy. This can be achieved through measures that are directed towards the right target groups. Measures should include education, empowerment and improving socio-economic status of women.
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Affiliation(s)
| | | | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Gurgel RQ, Cipolotti R, Meeuwes M, Souza de Carvalho TF, Ferrão TO, Peters M, Agyemang C. Response to low bone mineral areal density in patients with sickle cell anaemia (SCA) and short stature should be interpreted with caution. Trop Med Int Health 2014; 19:E1-E2. [PMID: 24405582 DOI: 10.1111/tmi.12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R Q Gurgel
- Department of Medicine and Post Graduate Nucleus of Medicine, Federal University of Sergipe, Aracaju-SE, Brazil
| | - R Cipolotti
- Department of Medicine and Post Graduate Nucleus of Medicine, Federal University of Sergipe, Aracaju-SE, Brazil
| | - M Meeuwes
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T F Souza de Carvalho
- Department of Medicine and Post Graduate Nucleus of Medicine, Federal University of Sergipe, Aracaju-SE, Brazil
| | - T O Ferrão
- Department of Medicine and Post Graduate Nucleus of Medicine, Federal University of Sergipe, Aracaju-SE, Brazil
| | - M Peters
- Department of Pediatric Hematology, Emma Children's Hospital AMC, Academic Medical Center, Amsterdam, The Netherlands
| | - C Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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262
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van Oeffelen AAM, Agyemang C, Stronks K, Bots ML, Vaartjes I. Incidence of first acute myocardial infarction over time specific for age, sex, and country of birth. Neth J Med 2014; 72:20-27. [PMID: 24457435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To study the age- and sex-specific incidence rates of first acute myocardial infarction (AMI) among first-generation ethnic minority groups (henceforth, migrant groups) and the Dutch majority population in the Netherlands during two time periods (2000-2004 and 2005-2010). METHODS Through linkage of Dutch nationwide registers, first AMI events in the Dutch majority population and the major migrant groups living in the Netherlands were identified from 2000-2004 and 2005-2010. Absolute incidence rates were calculated within each age-sex-period-country of birth group. RESULTS Regardless of ethnic background, AMI incidence rates were higher in men than in women and increased with age. Incidence significantly declined over time among the Dutch majority population (men: -26.8%, women: -26.7%), and among most migrant groups under study. It was only in Moroccan migrants that AMI incidence significantly increased over time (men: 25.2%, women: 41.7%). Trends differed between age categories, but did not show a consistent pattern. The higher AMI incidence in Surinamese men and women and Turkish and Indonesian men compared with the Dutch majority population persisted over time, but decreased with age and became absent after 70 years of age. Moroccans had a significantly lower incidence compared with the Dutch majority population during 2000-2004, which disappeared during 2005-2010. CONCLUSION Primary preventive strategies should focus on Surinamese men and women and Turkish and Indonesian men below 70 years of age. Future research is necessary to unravel the factors that provoke the increasing AMI incidence over time among Moroccans.
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Affiliation(s)
- A A M van Oeffelen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
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Oti SO, van de Vijver SJM, Kyobutungi C, Gomez GB, Agyemang C, Moll van Charante EP, Brewster LM, Hendriks ME, Schultsz C, Ettarh R, Ezeh A, Lange J. A community-based intervention for primary prevention of cardiovascular diseases in the slums of Nairobi: the SCALE UP study protocol for a prospective quasi-experimental community-based trial. Trials 2013; 14:409. [PMID: 24289751 PMCID: PMC4220814 DOI: 10.1186/1745-6215-14-409] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of cardiovascular disease is rising in sub-Saharan Africa with hypertension being the main risk factor. However, context-specific evidence on effective interventions for primary prevention of cardiovascular diseases in resource-poor settings is limited. This study aims to evaluate the feasibility and cost-effectiveness of one such intervention--the "Sustainable model for cardiovascular health by adjusting lifestyle and treatment with economic perspective in settings of urban poverty". METHODS/DESIGN DESIGN A prospective quasi-experimental community-based intervention study. SETTING Two slum settlements (Korogocho and Viwandani) in Nairobi, Kenya. STUDY POPULATION Adults aged 35 years and above in the two communities. INTERVENTION The intervention community (Korogocho) will be exposed to an intervention package for primary prevention of cardiovascular disease that comprises awareness campaigns, household screening for cardiovascular diseases risk factors, and referral and treatment of people with high cardiovascular diseases risk at a primary health clinic. The control community (Viwandani) will continue accessing the usual standard of care for primary prevention of cardiovascular diseases in Kenya. DATA Demographic and socioeconomic data; anthropometric and clinical measurements including blood pressure. Population-based data will be collected at the baseline and endline--12 months after implementing the intervention. These data will be collected from a random sample of 1,610 adults aged 35 years and above in the intervention and control sites at both baseline and endline. Additionally, operational (including cost) and clinic-based data will be collected on an ongoing basis. MAIN OUTCOMES (1) A positive difference in the change in the proportion of the intervention versus control study populations that are at moderate or high risk of cardiovascular disease; (2) a difference in the change in mean systolic blood pressure in the intervention versus control study populations; (3) the net cost of the complete intervention package per disability-adjusted life year gained. ANALYSIS Primary outcomes comparing pre- and post-, and operational data will be analyzed descriptively and "impact" of the intervention will be calculated using double-difference methods. We will also conduct a cost-effectiveness analysis of the intervention using World Health Organization guidelines. DISCUSSION The outcomes of the study will be disseminated to local policy makers and health planners. TRIAL REGISTRATION Current controlled trials ISRCTN84424579.
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Affiliation(s)
- Samuel O Oti
- African Population and Health Research Center, PO Box 10787–00100, Nairobi, Kenya
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Steven JM van de Vijver
- African Population and Health Research Center, PO Box 10787–00100, Nairobi, Kenya
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Catherine Kyobutungi
- African Population and Health Research Center, PO Box 10787–00100, Nairobi, Kenya
| | - Gabriela B Gomez
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Eric P Moll van Charante
- Department of Family Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Lizzy M Brewster
- Department of Internal and Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Marleen E Hendriks
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Remare Ettarh
- African Population and Health Research Center, PO Box 10787–00100, Nairobi, Kenya
| | - Alex Ezeh
- African Population and Health Research Center, PO Box 10787–00100, Nairobi, Kenya
| | - Joep Lange
- Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands
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Agyemang C, van Oeffelen AAM, Bots ML, Stronks K, Vaartjes I. Socioeconomic inequalities in acute myocardial infarction incidence in migrant groups: has the epidemic arrived? analysis of nation-wide data. Heart 2013; 100:239-46. [PMID: 24241713 DOI: 10.1136/heartjnl-2013-304721] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We assessed socioeconomic inequalities in relation to acute myocardial infarction (AMI) incidence among major ethnic groups in The Netherlands. METHODS A nationwide register-based cohort study was conducted (n=2 591 170) between 1 January 1998 and 31 December 2007 among ethnic Dutch and migrant groups from Suriname, Netherlands Antilles, Indonesia, Morocco and Turkey. Standardised household disposable income was used as a proxy for socioeconomic position. Cox proportional hazard models were used to estimate the socioeconomic inequalities in AMI incidence. RESULTS Among ethnic Dutch, the AMI incidence was higher in the low-income group than in the high-income group: adjusted HRs were 2.05 (95% CI 2.00 to 2.10) for men and 2.33 (95% CI 2.23 to 2.43) for women. Importantly, similar socioeconomic inequalities in AMI incidence were also observed in all minority groups, with the low socioeconomic group having a higher AMI incidence than the high socioeconomic group: adjusted HR ranging from 2.07 (95% CI 1.26 to 3.40) in Moroccans to 2.73 (95% CI 1.55 to 4.80) in Antilleans in men; and from 2.17 (95% CI 1.74 to 2.71) in Indonesians to 3.88 (95% CI 2.36 to 6.38) in Turks in women. CONCLUSIONS Our findings demonstrate socioeconomic inequalities in AMI incidence in migrant groups and suggest a convergence towards the Dutch general population. If the AMI incidence rates of the low socioeconomic group could be reduced to the level of the high socioeconomic group, this would represent a major public health improvement for all ethnic groups.
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Affiliation(s)
- C Agyemang
- Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands
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van Middendorp D, ten Asbroek A, Bio FY, Edusei A, Meijjer L, Newton S, Agyemang C. Rural and urban differences in blood pressure and pregnancy-induced hypertension among pregnant women in Ghana. Global Health 2013; 9:59. [PMID: 24228792 PMCID: PMC3922859 DOI: 10.1186/1744-8603-9-59] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/05/2013] [Indexed: 02/03/2023] Open
Abstract
Background Globally, about 350.000 women die every year from pregnancy related causes and more than half of these deaths occur in sub-Saharan Africa (SSA). Approximately 12% of the maternal deaths are associated with hypertensive disorders in pregnancy such as pregnancy induced hypertension (PIH). However, very little is known about PIH and associated determinants in many SSA countries such as Ghana. We therefore sought to assess rural and urban differences in blood pressure (BP) and PIH among pregnant women in Ghana. Methods We conducted a cross-sectional study among 967 rural (677) and urban (290) pregnant women with a gestational age of more than 20 weeks. PIH was defined as a systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg. Results Women in urban Ghana had a higher mean systolic and diastolic BP than women in rural Ghana (105/66 mmHg versus 102/61 mmHg, p < 0.001 for both systolic and diastolic BP). The prevalence of PIH was also higher in urban Ghana (3.1%) than in rural Ghana (0.4%) (p = 0.014). The urban and rural difference in mean diastolic blood pressure persisted even after adjustments for the study characteristics in a linear regression model. In both rural and urban Ghana, BMI, heart rate and a family history of hypertension were independently associated with BP. Conclusion Our findings suggest higher mean BP levels and PIH in urban Ghana than in rural Ghana. BMI was independently related to high BP. Left unchecked, the increasing prevalence of overweight and obesity in Ghana will exacerbate PIH levels in Ghana.
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Affiliation(s)
| | | | | | | | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands PO Box 22660, Amsterdam, The Netherlands.
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van de Vijver S, Oti S, Tervaert TC, Hankins C, Kyobutungi C, Gomez GB, Brewster L, Agyemang C, Lange J. Introducing a model of cardiovascular prevention in Nairobi's slums by integrating a public health and private-sector approach: the SCALE-UP study. Glob Health Action 2013; 6:22510. [PMID: 24149078 PMCID: PMC3805842 DOI: 10.3402/gha.v6i0.22510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/10/2013] [Accepted: 09/30/2013] [Indexed: 12/23/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is a leading cause of death in sub-Saharan Africa (SSA), with annual deaths expected to increase to 2 million by 2030. Currently, most national health systems in SSA are not adequately prepared for this epidemic. This is especially so in slum settlements where access to formal healthcare and resources is limited. Objective To develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches. Study design Two non-profit organizations that conduct public health research, Amsterdam Institute for Global Health and Development (AIGHD) and African Population and Health Research Center (APHRC), collaborated with private-sector Boston Consulting Group (BCG) to develop a service delivery package for CVD prevention in slum settings. A theoretic model was designed based on the integration of public and private sector approaches with the focus on costs and feasibility. Results The final model includes components that aim to improve community awareness, a home-based screening service, patient and provider incentives to seek and deliver treatment specifically for hypertension, and adherence support. The expected outcomes projected by this model could prove potentially cost effective and affordable (1 USD/person/year). The model is currently being implemented in a Nairobi slum and is closely followed by key stakeholders in Kenya including the Ministry of Health, the World Health Organization (WHO), and leading non-governmental organizations (NGOs). Conclusion Through the collaboration of public health and private sectors, a theoretically cost-effective model was developed for the prevention of CVD and is currently being implemented in the slums of Nairobi. If results are in line with the theoretical projections and first impressions on the ground, scale-up of the service delivery package could be planned in other poor urban areas in Kenya by relevant policymakers and NGOs.
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Affiliation(s)
- Steven van de Vijver
- Health Challenges and Systems, African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;
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Meeuwes M, Souza de Carvalho TF, Cipolotti R, Gurgel RQ, Ferrão TO, Peters M, Agyemang C. Bone mineral density, growth, pubertal development and other parameters in Brazilian children and young adults with sickle cell anaemia. Trop Med Int Health 2013; 18:1539-46. [DOI: 10.1111/tmi.12211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Meeuwes
- Department of Public Health; Academic Medical Centre, University of Amsterdam; Amsterdam The Netherlands
| | - T. F. Souza de Carvalho
- Department of Medicine and Post Graduate Nucleus of Medicine; Federal University of Sergipe; Aracaju Brazil
| | - R. Cipolotti
- Department of Medicine and Post Graduate Nucleus of Medicine; Federal University of Sergipe; Aracaju Brazil
| | - R. Q. Gurgel
- Department of Medicine and Post Graduate Nucleus of Medicine; Federal University of Sergipe; Aracaju Brazil
| | - T. O. Ferrão
- Department of Medicine and Post Graduate Nucleus of Medicine; Federal University of Sergipe; Aracaju Brazil
| | - M. Peters
- Department of Pediatric Hematology; Emma Children's Hospital, AMC; Amsterdam The Netherlands
| | - C. Agyemang
- Department of Public Health; Academic Medical Centre, University of Amsterdam; Amsterdam The Netherlands
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van de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I, Kyobutungi C. Status report on hypertension in Africa--consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD's. Pan Afr Med J 2013; 16:38. [PMID: 24570798 PMCID: PMC3932118 DOI: 10.11604/pamj.2013.16.38.3100] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/24/2013] [Indexed: 12/18/2022] Open
Abstract
Hypertension has always been regarded as a disease of affluence but this has changed drastically in the last two decades with average blood pressures now higher in Africa than in Europe and USA and the prevalence increasing among poor sections of society. We have conducted a literature search on PubMed on a broad range of topics regarding hypertension in Africa, including data collection from related documents from World Health Organization and other relevant organizations that are available in this field. We have shared the initial results and drafts with international specialists in the context of hypertension in Africa and incorporated their feedback. Hypertension is the number one risk factor for CVD in Africa. Consequently, cardiovascular disease (CVD) has taken over as number one cause of death in Africa and the total numbers will further increase in the next decades reflecting on the growing urbanization and related lifestyle changes. The new epidemic of hypertension and CVD is not only an important public health problem, but it will also have a big economic impact as a significant proportion of the productive population becomes chronically ill or die, leaving their families in poverty. It is essential to develop and share best practices for affordable and effective community-based programs in screening and treatment of hypertension. In order to prevent and control hypertension in the population, Africa needs policies developed and implemented through a multi-sectoral approach involving the Ministries of Health and other sectors including education, agriculture, transport, finance among others.
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Affiliation(s)
- Steven van de Vijver
- APHRC, African Population and Health Research Center, Nairobi, Kenya ; AIGHD, Amsterdam Institute for Global Health and Development, The Netherlands
| | - Hilda Akinyi
- APHRC, African Population and Health Research Center, Nairobi, Kenya
| | - Samuel Oti
- APHRC, African Population and Health Research Center, Nairobi, Kenya ; AIGHD, Amsterdam Institute for Global Health and Development, The Netherlands
| | - Ademola Olajide
- Department of Health, Nutrition and Population, African Union Commission, Addis Ababa, Ethiopia
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, the Netherlands
| | - Isabella Aboderin
- APHRC, African Population and Health Research Center, Nairobi, Kenya
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Anujuo K, Snijder MB, Stronks K, Agyemang C. Sleep patterns and sleep problems in a multi-ethnic population in Amsterdam, The Netherlands. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Norredam M, Hoejbjerg Hansen O, Holm Pedersen J, Byberg S, Krasnik A, Agyemang C, Kunst AE. Exploring disease trajectories according to migrant status – does the ‘healthy migrant effect’ last? Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Agyemang C, van Oeffelen AAM, Bots ML, Stronks K, Vaartjes I. Socioeconomic inequalities in acute myocardial infarction incidence in migrant groups: Has the epidemic arrived? Analysis of nation-wide data. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oti SO, van de Vijver SJM, Agyemang C, Kyobutungi C. The magnitude of diabetes and its association with obesity in the slums of Nairobi, Kenya: results from a cross-sectional survey. Trop Med Int Health 2013; 18:1520-30. [PMID: 24118454 DOI: 10.1111/tmi.12200] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the prevalence, awareness, treatment and control of diabetes and to examine the relationship of obesity with raised blood glucose in the slums of Nairobi, Kenya. METHODS We used data from a cross-sectional population-based survey, conducted in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged ≥18 years living in two slums - Korogocho and Viwandani - in Nairobi. RESULTS The prevalence (weighted by sampling and response rates) of diabetes was 4.8% (95%CI 4.0-5.7) in women and 4.0% (95%CI 3.3-4.7) in men. Less than a quarter of those found to have diabetes were aware of their condition among which just over half of men and three-quarters of women reported being on any treatment in the 12 months preceding the survey. Overall, fewer than 5% of all people with diabetes had their blood sugar under control. Obesity and overweight were significantly associated with increased odds (1.7, 95%CI 1.1-2.6) of raised blood glucose only among women while adjusting for important covariates. CONCLUSION The prevalence of diabetes in this impoverished population is moderately high, while the levels of awareness, treatment and control are quite low. In this population, obesity is an important risk factor for raised blood glucose particularly among women. Prevention and control strategies that target modifiable risk factors for diabetes and increase access to treatment and control in such disadvantaged settings are urgently needed.
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Affiliation(s)
- Samuel O Oti
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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van Oeffelen AAM, Vaartjes I, Stronks K, Bots ML, Agyemang C. Sex disparities in acute myocardial infarction incidence: Do ethnic minority groups differ from the majority population? Eur J Prev Cardiol 2013; 22:180-8. [DOI: 10.1177/2047487313503618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aloysia AM van Oeffelen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Michiel L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
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van Oeffelen AAM, Vaartjes I, Stronks K, Bots ML, Agyemang C. Incidence of acute myocardial infarction in first and second generation minority groups: does the second generation converge towards the majority population? Int J Cardiol 2013; 168:5422-9. [PMID: 24035066 DOI: 10.1016/j.ijcard.2013.08.046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 05/30/2013] [Accepted: 08/18/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Differences in acute myocardial infarction (AMI) incidence between ethnic minority and migrant groups (henceforth, minority groups) and the majority population have been reported. Health differences may converge towards the majority population over generations. We assessed whether AMI incidence differences between minority groups living in the Netherlands and the Dutch majority population exist, and whether the incidence converges towards the majority population over generations. METHODS A nationwide register-based cohort study was conducted from 1997 to 2007. Using Cox Proportional Hazard Models AMI incidence differences between minorities and the majority population were estimated. When possible, analyses were stratified by generation. RESULTS AMI incidence differences between minorities and the majority population depended on the country of origin, and often varied between minorities originating from the same geographical region. For example, among North African and Mediterranean minorities, incidence was higher in Turkish (Hazard Ratio (HR): 1.34; 95% Confidence Interval (95% CI): 1.28-1.41), but lower in Moroccans (HR: 0.46; 95% CI: 0.40-0.52) compared with the majority population. Most minorities had a similar or lower incidence than the majority population, which remained similar or converged towards the incidence of the majority population over generations. In contrast, among minorities from the former Dutch colonies (Suriname, Indonesia, Netherlands Antilles) beneficial intergenerational changes were observed. CONCLUSIONS Health care professionals and policy makers should be aware of substantial AMI incidence differences between minority groups and the majority population, and the often unbeneficial change over generations. Future research should be cautious when clustering minority groups based on geographical region of the country of origin.
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Affiliation(s)
- A A M van Oeffelen
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands.
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Frederiksen HW, Kamper-Jørgensen Z, Agyemang C, Krasnik A, Norredam M. Health-reception of newly arrived documented migrants in Europe--why, whom, what and how? Eur J Public Health 2013; 23:725-6. [PMID: 23933957 DOI: 10.1093/eurpub/ckt110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hanne W Frederiksen
- Department of Nursing, University College Capital, Hilleroed, Denmark, Research Centre for Migration, Ethnicity and Health (MESU), Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark and Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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van Oeffelen A, Agyemang C, Koopman C, Stronks K, Bots M, Vaartjes I. Downward trends in acute myocardial infarction incidence: how do migrants fare with the majority population? Results from a nationwide study. Eur J Prev Cardiol 2013; 21:1493-500. [PMID: 23928569 DOI: 10.1177/2047487313500156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS In previous decades, a steep decline in acute myocardial infarction (AMI) incidence occurred in Western countries. We assessed whether this decline was also present in migrant groups living in the Netherlands. METHODS AND RESULTS Nationwide registers were linked between 1998 and 2007. Poisson regression analyses were used to calculate the biannual percentage change in AMI incidence within major non-Western migrant groups, and the differences in these changes with the Dutch majority population. Within the Dutch majority population, AMI incidence significantly declined in men (-12%) and women (-9.5%). Incidence also declined among most migrant groups under study, ranging from -12 to -4.0% in men, and from -16 to -9.5% in women. Only in Turkish women and Moroccan men the AMI incidence remained stable over time (-0.3 and 2.8%, respectively). There were no statistically significant trend differences between the Dutch majority population and the migrant groups under study. The higher AMI incidence in Turkish men and Surinamese men and women, and the lower AMI incidence in Moroccan men persisted over time. CONCLUSIONS There was a declining AMI incidence rate within the Dutch majority population as well as within most of the major migrant groups living in the Netherlands, except in Turkish women and Moroccan men. Trend patterns among migrant groups did not significantly differ from the Dutch majority population. To reduce ethnic inequalities, primary preventive strategies should be targeted at those migrant groups with a persisting higher incidence.
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Affiliation(s)
- Aam van Oeffelen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Agyemang
- Department of Public Health, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - C Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K Stronks
- Department of Public Health, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Ml Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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277
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Ogedegbe G, Spruill TM, Sarpong DF, Agyemang C, Chaplin W, Pastva A, Martins D, Ravenell J, Pickering TG. Correlates of isolated nocturnal hypertension and target organ damage in a population-based cohort of African Americans: the Jackson Heart Study. Am J Hypertens 2013; 26:1011-6. [PMID: 23676475 DOI: 10.1093/ajh/hpt064] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND African Americans have higher rates of nocturnal hypertension and less nocturnal blood pressure (BP) dipping compared with whites. Although nocturnal hypertension is associated with increased cardiovascular morbidity and mortality, its clinical significance among those with normal daytime BP is unclear. This paper reports the prevalence and correlates of isolated nocturnal hypertension (INH) in a population-based cohort of African Americans enrolled in the Jackson Heart Study (JHS). METHODS The study sample included 425 untreated, normotensive and hypertensive JHS participants who underwent 24-hour ambulatory BP monitoring (ABPM), echocardiography, and 24-hour urine collection. Multiple logistic regression and 1-way analysis of variance models were used to test the hypothesis that those with INH have worse target organ damage reflected by greater left ventricular (LV) mass and proteinuria compared with normotensive participants. RESULTS Based on 24-hour ABP profiles, 19.1% of participants had INH. In age and sex-adjusted models, participants with INH had greater LV mass compared with those who were normotensive (P = 0.02), as well as about 3 times the odds of LV hypertrophy and proteinuria (Ps < 0.10). However, multivariable adjustment reduced the magnitude and statistical significance of each of these differences. CONCLUSIONS INH was associated with increased LV mass compared with normo tension in a population-based cohort of African Americans enrolled in the JHS. There were trends toward a greater likelihood of LV hyper trophy and proteinuria among participants with INH vs. those who were normotensive. The clinical significance of the noted target organ damage should be explored in this population.
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Affiliation(s)
- Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA.
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278
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Nicolaou M, Kunst AE, Busschers WB, van Valkengoed IG, Dijkshoorn H, Boateng L, Brewster LM, Snijder MB, Stronks K, Agyemang C. Differences in Body Fat Distribution Play a Role in the Lower Levels of Elevated Fasting Glucose amongst Ghanaian Migrant Women Compared to Men. PLoS One 2013; 8:e66516. [PMID: 23840498 PMCID: PMC3686715 DOI: 10.1371/journal.pone.0066516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 05/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite higher levels of obesity, West African migrant women appear to have lower rates of type 2 diabetes than their male counterparts. We investigated the role of body fat distribution in these differences. METHODS Cross-sectional study of Ghanaian migrants (97 men, 115 women) aged 18-60 years in Amsterdam, the Netherlands. Weight, height, waist and hip circumferences were measured. Logistic regression was used to explore the association of BMI, waist and hip measurements with elevated fasting glucose (glucose≥5.6 mmol/L). Linear regression was used to study the association of the same parameters with fasting glucose. RESULTS Mean BMI, waist and hip circumferences were higher in women than men while the prevalence of elevated fasting glucose was higher in men than in women, 33% versus 19%. With adjustment for age only, men were non-significantly more likely than women to have an elevated fasting glucose, odds ratio (OR) 1.81, 95% CI: 0.95, 3.46. With correction for BMI, the higher odds among men increased and were statistically significant (OR 2.84, 95% CI: 1.32, 6.10), but with consideration of body fat distribution (by adding both hip and waist in the analysis) differences were no longer significant (OR 1.56 95% CI: 0.66, 3.68). Analysis with fasting glucose as continuous outcome measure showed somewhat similar results. CONCLUSION Compared to men, the lower rates of elevated fasting glucose observed among Ghanaian women may be partly due to a more favorable body fat distribution, characterized by both hip and waist measurements.
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Affiliation(s)
- Mary Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim B. Busschers
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G. van Valkengoed
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Henriette Dijkshoorn
- Department of Epidemiology, Documentation and Health Promotion, Municipal Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Linda Boateng
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lizzy M. Brewster
- Departments of Internal and Vascular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke B. Snijder
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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279
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Bos M, Agyemang C. Prevalence and complications of diabetes mellitus in Northern Africa, a systematic review. BMC Public Health 2013; 13:387. [PMID: 23617762 PMCID: PMC3646695 DOI: 10.1186/1471-2458-13-387] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/15/2013] [Indexed: 12/13/2022] Open
Abstract
Background Diabetes is increasingly becoming a major chronic disease burden all over the world. This requires a shift in healthcare priorities and up-to-date data on the epidemiology and impact of diabetes in all regions of the world to help plan and prioritize health programs. We systematically reviewed the literature on diabetes prevalence and its complications in the UN sub region of Northern Africa including Morocco, Algeria, Tunisia, Libya, Egypt, Sudan, South Sudan and Western Sahara. Methods A systematic literature review of papers published on diabetes prevalence and complications in North Africa from January 1990 to July 2012. Literature searches were conducted using electronic databases. Results Diabetes prevalence ranged from 2.6% in rural Sudan to 20.0% in urban Egypt. Diabetes prevalence was significantly higher in urban areas than in rural areas. Undiagnosed diabetes is common in Northern Africa with a prevalence ranging from 18% to 75%. The prevalence of chronic diabetes complications ranged from 8.1% to 41.5% for retinopathy, 21% to 22% for albuminuria, 6.7% to 46.3% for nephropathy and 21.9% to 60% for neuropathy. Conclusions Diabetes is an important and common health problem in Northern Africa. Variations in prevalence of diabetes between individual countries are observed. Chronic complications of diabetes are common. Urgent measures are needed to prevent diabetes and its related complications in Northern Africa.
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Affiliation(s)
- Manouk Bos
- Academic Medical Centre, University of Amsterdam, PO Box 22660, Amsterdam, The Netherlands
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280
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Rafnsson SB, Bhopal RS, Agyemang C, Fagot-Campagna A, Harding S, Hammar N, Hedlund E, Juel K, Primatesta P, Rosato M, Rey G, Wild SH, Mackenbach JP, Stirbu I, Kunst AE. Sizable variations in circulatory disease mortality by region and country of birth in six European countries. Eur J Public Health 2013; 23:594-605. [DOI: 10.1093/eurpub/ckt023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van de Vijver S, Oti S, Addo J, de Graft-Aikins A, Agyemang C. Review of community-based interventions for prevention of cardiovascular diseases in low- and middle-income countries. Ethn Health 2013; 17:651-676. [PMID: 23297746 DOI: 10.1080/13557858.2012.754409] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND An increasing burden of cardiovascular disease (CVD) is occurring in low- and middle-income countries (LMICs) as a result of urbanisation and globalisation. Low rates of awareness and treatment of risk factors worsen the prognosis in these settings. Prevention of CVD is proven to be cost effective and should be the main intervention. Insight into prevention programmes in LMIC is important in addressing the rising levels of these diseases. OBJECTIVE To evaluate the effectiveness of the community-based interventions for CVD prevention programmes in LMIC. DESIGN A literature review with searches in the databases of PubMed, EMBASE, CINAHL, LILACS, African Index Medicus and Google Scholar between 1990 and May 2012. RESULTS Twenty-six studies involving population-based and high-risk interventions have been included in this review. The content of the population intervention was mainly health promotion through media and health education, and the high-risk approach focused often on education of patients, training of health care providers and implementing treatment guidelines. A few studies had a single intervention on exercising or salt reduction. Most studies showed a significant reduction of cardiovascular risk ranging from lifestyle changes on diet, smoking and alcohol to biomedical outcomes like blood pressure, glucose levels or weight. Some studies showed improved management of risk factors like increased control of hypertension or adherence to medication. CONCLUSION There have been effective community-based programmes aimed at reducing cardiovascular risk factors in LMIC but these have generally been limited to the urban poor. Health education with a focus on diet and salt, training of health care providers and implementing treatment guidelines form key elements in successful programmes.
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Affiliation(s)
- Steven van de Vijver
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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283
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Oosterberg EH, Devillé WLJM, Brewster LM, Agyemang C, van den Muijsenbergh METC. [Chronic disease in ethnic minorities: tools for patient-centred care in diabetes, hypertension and COPD]. Ned Tijdschr Geneeskd 2013; 157:A5669. [PMID: 23594868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the Netherlands, chronic diseases, such as diabetes mellitus and cardiovascular disease, are more common and have a poorer prognosis in patients of Surinamese, Turkish and Moroccan origin. Surinamese develop cardiovascular diseases more often and at an earlier age; it is recommended that their cardiovascular risk profile be checked at an earlier stage. Standard treatment of diabetes mellitus is less effective among ethnic minorities. Patient information that is in line with the educational level and cultural values of the patient leads to better glucose levels. Focus group research among ethnic minorities shows that lifestyle changes which conflict with their own cultural beliefs or lack support in their social environment are often not adopted. Ethnic differences in the efficacy and toxicity of drugs are mainly caused by genetically determined variations in the activity of drug metabolizing enzymes.
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284
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de Munter JSL, Agyemang C, Brewster LM, Stronks K, van Valkengoed IGM. The association of leisure-time physical activity and active commuting with measures of socioeconomic position in a multiethnic population living in the Netherlands: results from the cross-sectional SUNSET study. BMC Public Health 2012; 12:815. [PMID: 22998730 PMCID: PMC3490879 DOI: 10.1186/1471-2458-12-815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In most European origin populations measures of socioeconomic position are positively associated with leisure time physical activity (LTPA), this is unclear for active commuting. In addition, these associations have scarcely been studied in ethnic minority groups, who often have a high cardiovascular disease risk. Because of the expected public health potential, we assessed the relationship of active commuting and LTPA with measures of socioeconomic position across two large ethnic minority groups in the Netherlands as compared to the European-Dutch population. METHODS We included South Asian-Surinamese (n = 370), African-Surinamese (n = 689), and European-Dutch (n = 567) from the cross-sectional population-based SUNSET study (2001-2003). Active commuting and LTPA were assessed by the SQUASH physical activity questionnaire and calculated in square-root-transformed metabolic equivalents of task-hours/week (SQRTMET). Socioeconomic position was indicated by level of education (low/high) and occupational class (low/high). We used age-adjusted linear regression models to assess the association between physical activity and socioeconomic position. RESULTS Compared to the European-Dutch men, South Asian-Surinamese men engaged in lower levels of commuting activity and LTPA, and South Asian-Surinamese women engaged in lower levels of LTPA than their European-Dutch counterparts. Differences between the African Surinamese and the European-Dutch were small. We observed a positive gradient in active commuting activity for education in European-Dutch men (beta high education was 0.93, 95%CI: 0.45-1.40 SQRTMET higher versus low education), in South Asian-Surinamese men (beta: 0.56, 0.19-0.92), but not in African-Surinamese men (-0.06, -0.45-0.33, p for ethnicity-interaction = 0.002). In women we observed a positive gradient in active commuting activity and occupational class in European-Dutch women, and less strongly in South Asian-Surinamese and African-Surinamese women (p for ethnicity-interaction = 0.02). For LTPA and socioeconomic position, we observed no statistically significant interaction by ethnicity. CONCLUSIONS The positive gradient for socioeconomic position observed in European-Dutch was less strong, in particular for active commuting, among the South Asian-Surinamese and the African-Surinamese. This indicates that the typical focus on physical activity interventions in lower socioeconomic groups could work for European-Dutch populations, but this strategy may not be entirely applicable in the ethnic minority groups.
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Affiliation(s)
- Jeroen SL de Munter
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lizzy M Brewster
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene GM van Valkengoed
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Agyemang C, van Valkengoed IG, van den Born BJ, Bhopal R, Stronks K. Heterogeneity in sex differences in the metabolic syndrome in Dutch white, Surinamese African and South Asian populations. Diabet Med 2012; 29:1159-64. [PMID: 22356260 DOI: 10.1111/j.1464-5491.2012.03616.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To determine whether sex differences in the prevalence of the metabolic syndrome and its components differ among different ethnic groups. METHODS A random sample of non-institutionalized adults aged 35-60 years in Amsterdam, the Netherlands (white Dutch men n = 242, women n = 244; African-Surinamese men n = 193, women n = 399, Hindustani-Surinamese men n = 149, women n = 186). The metabolic syndrome was defined according to the International Diabetes Federation criteria. RESULTS In all ethnic groups, the prevalence of central obesity and reduced HDL cholesterol were higher in women than in men, but the prevalence of elevated blood pressure, fasting glucose and triglycerides were lower in women than in men. However, the magnitude of the differences varied. The sex differences in the prevalence of central obesity and reduced HDL cholesterol were particularly larger in ethnic minority groups, especially in African-Surinamese than in white Dutch. After adjustment for education, smoking, alcohol intake and physical activity, the prevalence of the metabolic syndrome was lower in white Dutch women than in white Dutch men (adjusted prevalence ratio 0.70, 95% CI 0.52-0.94). By contrast, the prevalence of the metabolic syndrome was higher in African-Surinamese women than in African-Surinamese men (adjusted prevalence ratio 1.56, 95% CI 1.12-2.18). Among Hindustani-Surinamese, men and women had a similar prevalence of the metabolic syndrome (adjusted prevalence ratio 1.00, 95% CI 0.76-1.31). CONCLUSIONS Our findings suggest different patterns in sex differences in the metabolic syndrome among the ethnic groups. The relatively high prevalence of central obesity in African-Surinamese women may underlie their higher prevalence of the metabolic syndrome. Strategies to improve metabolic profiles among African-Surinamese and white Dutch people need to take sex differences into account.
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Affiliation(s)
- C Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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286
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de-Graft Aikins A, Arhinful DK, Pitchforth E, Ogedegbe G, Allotey P, Agyemang C. Establishing and sustaining research partnerships in Africa: a case study of the UK-Africa Academic Partnership on Chronic Disease. Global Health 2012; 8:29. [PMID: 22897937 PMCID: PMC3475042 DOI: 10.1186/1744-8603-8-29] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 06/13/2012] [Indexed: 11/20/2022] Open
Abstract
This paper examines the challenges and opportunities in establishing and sustaining north-south research partnerships in Africa through a case study of the UK-Africa Academic Partnership on Chronic Disease. Established in 2006 with seed funding from the British Academy, the partnership aimed to bring together multidisciplinary chronic disease researchers based in the UK and Africa to collaborate on research, inform policymaking, train and support postgraduates and create a platform for research dissemination. We review the partnership's achievements and challenges, applying established criteria for developing successful partnerships. During the funded period we achieved major success in creating a platform for research dissemination through international meetings and publications. Other goals, such as engaging in collaborative research and training postgraduates, were not as successfully realised. Enabling factors included trust and respect between core working group members, a shared commitment to achieving partnership goals, and the collective ability to develop creative strategies to overcome funding challenges. Barriers included limited funding, administrative support, and framework for monitoring and evaluating some goals. Chronic disease research partnerships in low-income regions operate within health research, practice, funding and policy environments that prioritise infectious diseases and other pressing public health and developmental challenges. Their long-term sustainability will therefore depend on integrated funding systems that provide a crucial capacity building bridge. Beyond the specific challenges of chronic disease research, we identify social capital, measurable goals, administrative support, creativity and innovation and funding as five key ingredients that are essential for sustaining research partnerships.
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Affiliation(s)
- Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Daniel K Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Emma Pitchforth
- LSE Health, London School of Economics and Political Science, London, UK
- RAND Europe, Cambridge, UK
| | - Gbenga Ogedegbe
- School of Medicine, New York University, New York City, NY, USA
| | - Pascale Allotey
- School of Medical and Health Sciences, Monash University Sunway Campus, Bandar Sunway, Malaysia
| | - Charles Agyemang
- Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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287
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de Munter JSL, Agyemang C, van Valkengoed IGM, Bhopal R, Zaninotto P, Nazroo J, Kunst AE, Stronks K. Cross national study of leisure-time physical activity in Dutch and English populations with ethnic group comparisons. Eur J Public Health 2012; 23:440-6. [PMID: 22809760 DOI: 10.1093/eurpub/cks088] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Variations between countries in leisure-time physical activity (LTPA) can be used to test the convergence thesis, which expects that ethnic minority groups change towards the LTPA levels of the native population of host countries. The aim of this study was to test whether similar differences in LTPA between the native populations of England and the Netherlands are also observed among the Indian and African descent groups living in these countries. METHODS We used English and Dutch population-based health surveys that included participants aged 35-60 years of European (n(english) = 14,723, n(dutch) = 567), Indian (n(english) = 1264, n(dutch) = 370) and African-Caribbean (n(english) = 1112, n(dutch) = 689) descent. Levels of LTPA (30-minute walking, any reported cycling, gardening, dancing and playing sports) were estimated with age-sex-standardized prevalence rates. Comparisons among groups were made using adjusted Prevalence Ratios (PRs). RESULTS Within both countries and compared with the European group, Indian and African groups had lower levels of gardening and cycling, whereas the African groups had higher levels of dancing. Between countries, among the European groups, the Netherlands showed higher prevalence of cycling than England, PR = 2.26 (95% CI: 2.06-2.48), and this was 2.85 (1.94-4.19) among Indian descent, and 2.77 (2.05-3.73) among African descent. For playing sports, this was PR = 1.30 (1.23-1.38), 1.43 (1.24-1.66) and 1.22 (1.10-1.34), whereas for gardening this was PR = 0.71 (0.65-0.78), 0.65 (0.52-0.81) and 0.75 (0.62-0.90), respectively. Walking and dancing showed inconsistent differences between the countries and ethnic groups. CONCLUSION This cross-national comparison supports the expectation that LTPA of Indian and African descent groups converge towards the national levels of England and the Netherlands respectively.
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Affiliation(s)
- Jeroen S L de Munter
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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288
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Agyemang C, Nicolaou M, Boateng L, Dijkshoorn H, van de Born BJ, Stronks K. Prevalence, awareness, treatment, and control of hypertension among Ghanaian population in Amsterdam, The Netherlands: the GHAIA study. Eur J Prev Cardiol 2012; 20:938-46. [PMID: 22679251 DOI: 10.1177/2047487312451540] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Migration from sub-Saharan Africa to industrialized countries has increased tremendously over the last few decades, yet very little is known about the health status of sub-Saharan African populations living in industrialized communities. The aim of this study was to assess prevalence, levels of awareness, treatment, and control of hypertension among the largest sub-Saharan African group (Ghanaians) living in the Netherlands. METHODS Cross-sectional study of Ghanaian adults aged 18-60 years in Amsterdam, the Netherlands. RESULTS The overall prevalence of hypertension was 55%. Of these, about half were aware of their condition, 45% were receiving antihypertensive medication, and 15% were controlled (blood pressure <140/90 mmHg). The prevalence rates of hypertension, awareness, and treatment were similar among males and females. However, males had a lower blood pressure control rate than females. Among all hypertensives, 22% of females had their blood pressure controlled compared with 5.8% in males: adjusted prevalence ratio (APR) 3.94 (95% CI 1.05-14.79). Among those receiving treatment for their hypertension, 48% of females were controlled compared with only 13% of males: APR 4.08 (95% CI 1.20-13.87). CONCLUSION Hypertension is a major problem among this recently migrated sub-Saharan African population. Furthermore, hypertension control rate is very low particularly in males. Urgent measures are needed to halt the increasing prevalence of hypertension and to improve hypertension control among these populations.
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289
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Addo J, Agyemang C, Smeeth L, de-Graft Aikins A, Edusei AK, Ogedegbe O. A review of population-based studies on hypertension in Ghana. Ghana Med J 2012; 46:4-11. [PMID: 23661811 PMCID: PMC3645150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Hypertension is becoming a common health problem worldwide with increasing life expectancy and increasing prevalence of risk factors. Epidemiological data on hypertension in Ghana is necessary to guide policy and develop effective interventions. METHODS A review of population-based studies on hypertension in Ghana was conducted by a search of the PUBMED database, supplemented by a manual search of bibliographies of the identified articles and through the Ghana Medical Journal. A single reviewer extracted data using standard data collection forms. RESULTS Eleven studies published on hypertension with surveys conducted between 1973 and 2009 were identified. The prevalence of hypertension was higher in urban than rural areas in studies that covered both types of area and increased with increasing age (prevalence ranging from 19.3% in rural to 54.6% in urban areas). Factors associated with high blood pressure included increasing body mass index, increased salt consumption, family history of hypertension and excessive alcohol intake. The levels of hypertension detection, treatment and control were generally low (control rates ranged from 1.7% to 12.7%). CONCLUSION An increased burden of hypertension should be expected in Ghana as life expectancy increases and with rapid urbanisation. Without adequate detection and control, this will translate into a higher incidence of stroke and other adverse health outcomes for which hypertension is an established risk factor. Prevention and control of hypertension in Ghana is thus imperative and any delays in instituting preventive measures would most likely pose a greater challenge on the already overburdened health system.
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Affiliation(s)
- J Addo
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
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290
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de-Graft Aikins A, Addo J, Ofei F, Bosu W, Agyemang C. Ghana's burden of chronic non-communicable diseases: future directions in research, practice and policy. Ghana Med J 2012; 46:1-3. [PMID: 23661810 PMCID: PMC3645141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
The prevalence of major chronic non-communicable diseases and their risk factors has increased over time and contributes significantly to the Ghana's disease burden. Conditions like hypertension, stroke and diabetes affect young and old, urban and rural, and wealthy and poor communities. The high cost of care drives the poor further into poverty. Lay awareness and knowledge are limited, health systems (biomedical, ethnomedical and complementary) are weak, and there are no chronic disease policies. These factors contribute to increasing risk, morbidity and mortality. As a result chronic diseases constitute a public health and a developmental problem that should be of urgent concern not only for the Ministry of Health, but also for the Government of Ghana. New directions in research, practice and policy are urgently needed. They should be supported by active partnerships between researchers, policymakers, industry, patient groups, civil society, government and development partners.
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Affiliation(s)
- A de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
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291
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de Graft Aikins A, Anum A, Agyemang C, Addo J, Ogedegbe O. Lay representations of chronic diseases in Ghana: implications for primary prevention. Ghana Med J 2012; 46:59-68. [PMID: 23661819 PMCID: PMC3645147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Ghana's health system is ill-equipped to tackle the country's double burden of infectious and chronic diseases. The current focus is on empowering lay communities to adopt healthy practices to prevent chronic diseases. Understanding how individuals make sense of health, illness and chronic illnesses is an important first step to developing practical interventions. METHODS Six focus group discussions with lay people (N= 51) in Accra, Nkoranza and Kintampo to explore: (1) knowledge of prevalent chronic diseases in Ghana; (2) chronic disease causal theories; and (3) chronic disease treatment. RESULTS Nineteen conditions were listed cumulatively. Diabetes and hypertension were listed by all groups. Rural groups included HIV/AIDS on their list as well as diseases with alleged spiritual roots, in particular epilepsy and sickle cell disease. Multiple causal theories were presented for diabetes and hypertension; cancers were attributed to toxic foods; asthma attributed to environmental pollution. Biomedical care was preferred by the majority. Lay representations were drawn from multiple sources: medical professionals and chronically ill individuals were the most legitimate knowledge sources. CONCLUSION This study provides insights on how lay representations of common chronic diseases and their major risk factors provide public health specialists with the conceptual tools to develop primary prevention strategies. The first challenge will be to train health experts to provide accurate information in practical language that lay people can understand and apply to their daily lives. A second challenge will be to develop sustainable behaviour-change interventions. Best practices from other African countries can inform interventions in Ghana.
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Affiliation(s)
- A de Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana.
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292
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Agyemang C, Attah-Adjepong G, Owusu-Dabo E, De-Graft Aikins A, Addo J, Edusei AK, Nkum BC, Ogedegbe G. Stroke in Ashanti region of Ghana. Ghana Med J 2012; 46:12-17. [PMID: 23661812 PMCID: PMC3645146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To determine the morbidity and mortality in adult in-patients with stroke admitted to the Komfo Anokye Teaching Hospital (KATH). METHODS A retrospective study of in-patients with stroke admitted to the KATH, from January 2006 to december 2007 was undertaken. Data from admission and discharge registers were analysed to determine stroke morbidity and mortality. RESULTS Stroke constituted 9.1% of total medical adult admissions and 13.2% of all medical adult deaths within the period under review. The mean age of stroke patients was 63.7 (95% ci=62.8, 64.57) years. Males were younger than females. The overall male to female ratio was 1:0.96, and the age-adjusted risk of death from stroke was slightly lower for females than males (relative risk= 0.88; 95% ci=0.79, 1.02, p=0.08). The stroke case fatality rate was 5.7% at 24 hours, 32.7% at 7 days, and 43.2% at 28 days. CONCLUSION Stroke constitutes a significant cause of morbidity and mortality in Ghana. Major efforts are needed in the prevention and treatment of stroke. Population-based health education programs and appropriate public health policy need to be developed. This will require a multidisciplinary approach of key players with a strong political commitment. There is also a clear need for further studies on this topic including, for example, an assessment of care and quality of life after discharge from hospital. The outcomes of these studies will provide important information for the prevention efforts.
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Affiliation(s)
- C Agyemang
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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293
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Johnman C, Blakely T, Bansal N, Agyemang C, Ward H. Linkage of data in the study of ethnic inequalities and inequities in health outcomes in Scotland, New Zealand and The Netherlands: insights for global study of ethnicity and health. Public Health 2012; 126:245-247. [PMID: 22414606 DOI: 10.1016/j.puhe.2012.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reducing inequalities in health is a global priority. An essential tool in achieving this reduction is the ability to provide valid measurements of inequalities, which are comparable over time and ultimately across countries and continents. With valid data a true understanding of inequalities can be ascertained, which can begin to inform effective legislation and policy. In this workshop, the speakers described in three different countries, Scotland, New Zealand and The Netherlands, how record linkage has been used to link ethnic status to health and health care measures and so to determine ethnic inequalities in health with the ultimate aim of reducing these inequalities.
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Affiliation(s)
- C Johnman
- Institute of Health and Wellbeing, University of Glasgow, Scotland, United Kingdom.
| | - T Blakely
- University of Otago, PO Box 7343, Wellington, New Zealand.
| | - N Bansal
- Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
| | - C Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - H Ward
- Information and Statistics Division, Edinburgh, Scotland, United Kingdom.
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294
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van Valkengoed IGM, Agyemang C, Krediet RT, Stronks K. Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study. BMC Nephrol 2012; 13:26. [PMID: 22564356 PMCID: PMC3492102 DOI: 10.1186/1471-2369-13-26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ratio (WHtR), and ACR differed between subjects of Hindustani-Surinamese, African-Surinamese and Dutch origin. METHODS In total, 334 Hindustani-Surinamese (~South Asian), 589 African-Surinamese (~African), and 493 Dutch (~European) men and women, aged 35-60 years, randomly selected from the municipal register of Amsterdam, participated in an interview and physical examination.We calculated the WHtR by dividing the waist circumference by height and the log ACR (logACR, log mg/mmol) by log-transforming the albumin concentration by the creatinine concentration in urine. The association between WHtR and logACR was studied in the total population and stratified by ethnicity. We also tested for interaction. RESULTS In the total population, a higher WHtR was associated with a higher logACR, after adjustment for sex, age, and smoking, body mass index and the presence of type 2 diabetes or hypertension. Among the Hindustani-Surinamese, the adjusted association between WHtR and logACR appeared somewhat stronger than among the other ethnic groups: for every 0.1 increase in the WHtR, the log-ACR increased by 0.522 (0.096-0.949) log mg/mmol among the Hindustani-Surinamese, by 0.334 (0.047-0.622) among the African-Surinamese and by 0.356 (-0.010-0.721) among the Dutch. However, the interaction was not statistically significant. CONCLUSIONS WHtR was associated with a higher ACR among populations of Hindustani-Surinamese, African-Surinamese and Dutch origin. Our study seems to support global use of WHtR in relation to ACR across ethnic groups. However, although not significant, the association appeared slightly stronger among the Hindustani-Surinamese than among the other ethnic groups. If confirmed, this could have implications for use of the WHtR across ethnic groups.
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Affiliation(s)
- Irene G M van Valkengoed
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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295
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Abstract
Barriers to blood pressure control exist at the patient, physician, and system levels. We review the current evidence for interventions that target patient- and physician-related barriers, such as patient education, home blood pressure monitoring, and computerized decision-support systems for physicians, and we emphasize the need for more studies that address the effectiveness of these interventions in African American patients.
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Affiliation(s)
- Taiye Odedosu
- Bellevue Adult Primary Care Practice, Bellevue Hospital Center, New York, NY, USA
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296
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Agyemang C, Kunst AE, Bhopal R, Zaninotto P, Nazroo J, Unwin N, van Valkengoed I, Redekop WK, Stronks K. A cross-national comparative study of metabolic syndrome among non-diabetic Dutch and English ethnic groups. Eur J Public Health 2012; 23:447-52. [PMID: 22542542 DOI: 10.1093/eurpub/cks041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence suggests a higher prevalence of type 2 diabetes (T2D) in The Netherlands than in England, although generalized obesity prevalence is substantially lower in The Netherlands. Metabolic syndrome (MS) is more strongly associated with the risk of progression to T2D than generalized obesity. Therefore examining MS may help to better understand the differences in T2D between the two countries. We assessed whether the Dutch and English differences in T2D prevalence reflect similar differences in MS in Whites, South-Asian Indians and African-Caribbeans living in these two countries. METHODS Secondary analyses of population-based studies of 3010 participants aged 35-60 years. Metabolic syndrome was defined according to the International Diabetes Federation criteria. Prevalence ratios (PRs) were estimated using regression models. RESULTS In general, the Dutch ethnic groups had a higher prevalence of MS than their English counterparts. Adjusted PRs were 1.37[95% confidence interval (CI)1.03-1.82] and 1.52 (1.06-2.19) in White-Dutch men and women compared to White-English men and women; 2.20 (1.14-4.26) and 1.46 (0.96-2.24) in Dutch-African-Caribbean men and women compared to English-African-Caribbean men and women and 0.97 (0.74-1.27) and 1.42 (1.00-2.03) in Dutch-Indian men and women compared with their English-Indian peers, respectively. Similar patterns were also observed for some MS components, e.g. raised fasting glucose in men and central obesity in women. CONCLUSION The comparatively high prevalence of MS among Dutch ethnic groups may contribute to their high prevalence of T2D. The high levels of some MS components, e.g. raised fasting glucose in men and central obesity in women add to the high prevalence of MS in Dutch ethnic groups.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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297
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Boateng L, Nicolaou M, Dijkshoorn H, Stronks K, Agyemang C. An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam. BMC Health Serv Res 2012; 12:75. [PMID: 22443162 PMCID: PMC3348030 DOI: 10.1186/1472-6963-12-75] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/24/2012] [Indexed: 11/18/2022] Open
Abstract
Background Sub-Saharan African populations are growing in many European countries. Data on the health of these populations are rare. Additionally, many sub-Saharan African migrants are confronted with issues of low socio-economic status, acculturation and language difficulties, which may hamper their access to health care. Despite the identification of some of those barriers, little is known about the enabling factors. Knowledge about the enablers and barriers in access to healthcare experienced is important in addressing their health needs and promoting healthcare access. This study aimed to investigate the enabling factors as well as barriers in access to the Dutch healthcare system among the largest sub-Saharan African migrant group (Ghanaians) living in Amsterdam, the Netherlands. Methods Six focus groups were conducted from November 2009 to February 2010. A semi-structured interview guideline was used. Discussions were conducted in English or Twi (Ghanaian dialect), recorded and transcribed verbatim. Analysis was based on the Andersen model of healthcare utilisation using MAXQDA software. Results Knowledge and perceived quality of the health system, awareness of diseases, family and community support, community initiatives and availability of social support were the main enablers to the healthcare system. Difficulties with the Dutch language and mistrust in health care providers were major barriers in access to healthcare. Conclusions Access to healthcare is facilitated mainly by knowledge of and the perceived efficiency and quality of the Dutch healthcare system. However, poor Dutch language proficiency and mistrust in health care providers appear to be important barriers in accessing healthcare. The enablers and barriers identified by this study provide useful information for promoting healthcare access among this and similar Sub-Saharan African communities.
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Affiliation(s)
- Linda Boateng
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands.
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298
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Munter JSLD, Agyemang C, Stronks K, Valkengoed IGMV. Association of physical activity, smoking, and alcohol intake with CVD-related hospital discharge in people of European, South Asian, or African descent. Eur J Prev Cardiol 2012; 20:80-8. [DOI: 10.1177/2047487311434232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Charles Agyemang
- Academic Medical Center, University of Amsterdam, The Netherlands
| | - Karien Stronks
- Academic Medical Center, University of Amsterdam, The Netherlands
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299
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Agyemang C, Humphry RW, Bhopal R. Divergence with age in blood pressure in African-Caribbean and white populations in England: implications for screening for hypertension. Am J Hypertens 2012; 25:89-96. [PMID: 21881618 DOI: 10.1038/ajh.2011.160] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We assessed when blood pressure (BP) and hypertension begin to rise in African-Caribbeans compared to the white population; and whether the change relates to body mass index (BMI). METHODS Secondary analysis of the cross-sectional Health Surveys for England among 22,723 participants (21,344 whites and 1,379 African-Caribbeans) adults aged ≥18 years. RESULTS The cubic spline graphs showed a crossover (African-Caribbean greater than whites) at 30-40 years in BP. Age-specific mean BP and hypertension prevalence data showed at 20-29 years African-Caribbean men were advantaged but not thereafter. There was little difference in BMI in men. African-Caribbean women had lower systolic BP (but higher prevalence of hypertension) at 20-29 years but higher BP and prevalence of hypertension thereafter. African-Caribbean women had higher BMI than white women. Regression showed an age and ethnicity interaction for systolic (0.076 mm Hg greater increase per year, P = 0.054) and diastolic BP (0.068 mm Hg greater increase per year (P = 0.009) and hypertension (OR equals 1.02, P = 0.004) in African-Caribbean men, and diastolic BP in African-Caribbean women (0.057 mm Hg greater increase per year, P = 0.017). Crossover was 28, 44, and 28 years for systolic BP, diastolic BP and hypertension in men, respectively; and 40 years for diastolic BP in women. CONCLUSIONS Clinicians should be extra vigilant about screening African-Caribbean patients from the age of 30 years. Detailed study is needed to understand the still mysterious mechanisms for this crossover.
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300
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de-Graft Aikins A, Pitchforth E, Allotey P, Ogedegbe G, Agyemang C. Culture, ethnicity and chronic conditions: reframing concepts and methods for research, interventions and policy in low- and middle-income countries. Ethn Health 2012; 17:551-561. [PMID: 23534503 DOI: 10.1080/13557858.2012.782209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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