Diabetes Management Among Arab Americans Who Sought Care at a Large Metropolitan Hospital System in Michigan

Cardiovascular disease in Arab Americans: A literature review of prevalence, risk factors, and directions for future research

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Recent evidence suggests Arab Americans, individuals with ancestry from Arabic-speaking countries, have an elevated risk for CVD compared to other ethnicities in the US. However, research focusing specifically on CVD in this population is limited. This literature review synthesizes studies investigating CVD prevalence, risk factors, and outcomes in Arab Americans. Multiple studies found higher rates of coronary heart disease, cerebrovascular disease, and hypertension compared to non-Hispanic White participants. The prevalence of type 2 diabetes, a major CVD risk factor, was also markedly higher, ranging from 16 % to 41 % in Arab Americans based on objective measures. Possible explanations include high rates of vitamin D deficiency, genetic factors, and poor diabetes control. Other metabolic factors like dyslipidemia and obesity did not consistently differ from general population estimates. Psychosocial factors may further increase CVD risk, including acculturative stress, discrimination, low health literacy, and barriers to healthcare access. Smoking, especially waterpipe use, was more prevalent in Arab American men. Though heterogenous, Arab Americans overall appear to have elevated CVD risk, warranting tailored screening and management. Culturally appropriate educational initiatives on CVD prevention are greatly needed. Future directions include better characterizing CVD prevalence across Arab American subgroups, delineating genetic and environmental factors underlying increased diabetes susceptibility, and testing culturally tailored interventions to mitigate CVD risks. In summary, this review highlights concerning CVD disparities in Arab Americans and underscores the need for group-specific research and preventive strategies.

Health information technology use among foreign-born adults of Middle Eastern and North African decent in the United States

Health information technology (HIT) use among foreign-born adults of Middle Eastern and North African (MENA) descent living in America is an understudied population. They are currently categorized as "White" in the United States (US) on federal forms. The purpose was to uncover the prevalence of HIT use among MENA immigrants compared to US- and foreign-born White adults before and after adjusting for other factors. The 2011-2018 National Health Interview Survey data (n = 161,613; ages 18 + years) was analyzed. HIT uses evaluated were searching for health information, filling prescriptions, scheduling appointments, and communicating with healthcare providers via email (last 12 months). Crude and multivariable logistic regression models were used to estimate the odds of each HIT use, any HIT use, and all HIT uses before and after adjustment. The most common HIT use was looking up health information, with 46.4% of foreign-born adults of MENA, 47.8% of foreign-born White, and 51.2% of US-born White adults reporting its use (p = .0079). Foreign-born adults of MENA descent had lower odds (OR = 0.64; 95%CI = 0.56-0.74) of reporting any HIT use, but no difference in reporting all HIT uses compared to US-born White adults in adjusted models. This is the first study to explore HIT use among Americans of MENA descent. Patterns of HIT use among adults of MENA descent differ from White adults. Results contribute to growing body of literature showing the health of Americans of MENA descent differs from White Americans. A separate racial/ethnic identifier is needed to better capture HIT uses among populations of MENA descent.

Improving the Collection of National Health Data: the Case for the Middle Eastern and North African Checkbox for Communities in the USA

INTRODUCTION

The Office of Management and Budget (OMB) is reviewing current minimum standards for collecting race/ethnicity data on federal forms. This review is extremely important for Middle Eastern and North African (MENA) Americans, who have been overlooked and unable to receive federal funding for their communities for decades. MENA individuals are defined as "White," which is particularly concerning given that research continues to identify that their health and lived experiences differ from Whites. From January to April 2023, the OMB requested public comments on a separate MENA checkbox. The purpose of this research was to describe public comments regarding the addition of the MENA checkbox on the US Census and other federal forms.

METHODS

A public comment period outlining changes to the collection of race/ethnicity data on the US Census and other federal forms opened in January 2023. Public comments were reviewed to determine whether MENA was mentioned, whether comments supported a MENA checkbox, and whether comments mentioned acceptance for health-related reasons.

RESULTS

There were 6700 comments reviewed. Most (73.88%) mentioned adding a MENA checkbox. Of those, 99.31% accepted adding the checkbox. Among the comments that accepted adding a MENA checkbox, 29.09% mentioned health, 44.75% mentioned linguistic/language services, and 44.75% mentioned education-related reasons.

CONCLUSIONS

Overall, the comments reviewed demonstrated strong acceptance of the addition of a MENA checkbox on federal forms. These findings are encouraging, yet further review is needed to contribute to the OMB's final decision on whether to add the checkbox and uncover the health of this population.

The Burden of and Factors Associated with Age-Related Eye Diseases in Arab American Adults

To estimate the age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration among the Arab American community, a notably understudied minority that is aggregated under whites. The Arab American Eye Study is a multicenter retrospective chart review involving 10 years of electronic medical records (1/1/2010 through 1/1/2020). The study sample included 1390 Arab Americans and 4950 whites 45 years of age and older, totaling 6340 subjects. Arab Americans were identified using an Arab American name algorithm. Subjects with race variables other than white or Arab American or those under age 45 were excluded from the study. Age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration were determined. Odds ratios with 95% confidence intervals were used to examine the association between race/ethnicity and eye diseases. Of the 6340 participants (4950 whites and 1390 Arab Americans), males comprised 46.3% and the median age group was 55-64 years. Arab Americans displayed higher age- and sex-adjusted proportions of cataracts (45.4% versus 40.7%), dry age-related macular degeneration (10% versus 8.9%), glaucoma (8% vs 6%), and diabetic retinopathy (11.7% versus 4.2%). Fully adjusted logistic regression revealed that Arab Americans were 19% more likely to have cataracts (OR 1.19; 95% CI 1.05, 1.35) and 272% more likely to have diabetic retinopathy (OR 2.72; 95% CI 2.17; 3.41). Results from the Arab American Eye Study suggest that the burden of cataract and diabetic retinopathy is significantly higher among Arab Americans in comparison to whites.

Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review

Background

Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.

Methods

PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.

Results

Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.

Conclusion

Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.

Health Assessment of the Arab American Community in Southwest Chicago

Chicago is among the top five metropolitan areas in the United States where Arab Americans reside; however, we have little available data on their perceptions of personal or community health. We collected 200 community health surveys in collaboration with a community-based organization that serves mainly Arabs in Chicago's southwest suburbs. The survey evaluated perceived community and personal health. In a mostly female, married, and low-income sample, participants identified cancers, diabetes, and high blood pressure/cholesterol as the top three health problems, while alcohol abuse, drug abuse, and overweight/obesity as the top three risky behaviors within the community. Gender differences, age differences, and educational level differences were found on certain determinants of health regarding the health of the community, perceived health problems, and risky behaviors. Our data validates previous findings from the literature highlighting cancer, diabetes, and high blood pressure as health priorities among Arabs, but offers new insights into unidentified issues within the Arab American community in Southwest Chicago such as alcohol, drug abuse, and child neglect/abuse. Furthermore, our findings warrant the need for classifying Arabs as a separate minority population facing health disparities.