Suspected Undiagnosed ADRD Among Middle Eastern and North African Americans

Cognitive Difficulty in Middle Eastern and North African Adults Living in the United States Compared With Other Racial and Ethnic Categories, 2017-2021

Objectives. To estimate the odds of having cognitive difficulties among Middle Eastern and North African (MENA) American adults and compare these odds with those of White, Black, Hispanic/Latino, Asian, American Indian or Alaska Native (AI/AN), and Native Hawaiian/Other Pacific Islander adults nationally and in the 4 states with the largest MENA populations (California, New York, Michigan, and Texas) after adjusting for sociodemographic factors. Methods. We analyzed 2017-2021 American Community Survey data (aged ≥ 45 years; n = 7 284 988), comparing presence of cognitive difficulties by race/ethnicity. Results. MENA adults had greater odds of reporting cognitive difficulties than did White (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.42, 1.56), Black (OR = 1.20; 95% CI = 1.14, 1.26), Hispanic (OR = 1.46; 95% CI = 1.39, 1.53), Asian (OR = 1.31; 95% CI = 1.25, 1.38), and AI/AN (OR = 1.07; 95% CI = 1.01, 1.14) adults. In all 4 states, odds of having cognitive difficulties were higher among MENA than Asian adults. Other racial/ethnic comparisons differed by state. Conclusions. A separate checkbox for MENA Americans approved by the Office of Management and Budget is important so health outcomes can be studied in more detail and funds can be allocated for research and resources at state and national levels. (Am J Public Health. 2024;114(11):1265-1274. https://doi.org/10.2105/AJPH.2024.307803).

Health Information Technology Use among Foreign-Born Adults of Middle Eastern and North African Descent in the United States

Health information technology (HIT) use among foreign-born adults of Middle Eastern and North African (MENA) descent is understudied. MENA Americans are currently categorized as "White" in the United States (US) on federal forms. Our 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 covariates. The 2011-2018 National Health Interview Survey data (n = 161,613; ages 18 + years) were 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 (searching for health information, filling prescriptions, scheduling appointments, and/or communicating with healthcare providers via email), and overall use of any HIT before and after adjustment. The most common HIT use was looking up health information (46.4% foreign-born MENA, 47.8% foreign-born White, 51.2% US-born White; 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. This is the first study to explore HIT use among MENA Americans. Results contribute to growing body of literature showing the health of MENA Americans differs from White Americans. A separate racial/ethnic identifier is needed to better capture HIT uses among populations of MENA descent.

Maternal and Perinatal Health Disparities Among Middle Eastern and North African Women and Children in the United States

INTRODUCTION

Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White).

METHODS

We analyzed 2000-2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women.

RESULTS

Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18-45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38-0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16-2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19-2.66) compared to US-born White children in adjusted models.

DISCUSSION

MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts.

Suitability of Middle Eastern and North African immigrant minimal reporting category for Arab immigrant health research in the national health interview survey

Studies of Middle Eastern immigrants using national data, with and without African immigrants, have provided important discoveries on the health of this group. However, they do not directly measure health among Arab immigrants. It is yet to be determined whether using a Middle Eastern and North African (MENA) classification can represent the health needs of Arab immigrants. The objective of this study was to assess if MENA immigrant health reflects the same patterns found in previous research focusing on Arab immigrant health. We used multiple years of data from the National Health Interview Survey in alignment with each former study methodology to compare our findings with four previous research studies. The independent variable was region of birth among non-Hispanic Whites. The dependent variables were chronic diseases, women's preventive health behaviors, men's preventive health behaviors, and cigarette smoking. Logistic regression was conducted to determine the odds of each outcome for MENA immigrants compared to US-born Whites. Then, adjusted 95% confidence intervals representing the more inclusive MENA immigrant categorization were compared to previous studies among Arab immigrants. Chronic conditions, women's and men's preventive health behaviors and cigarette smoking did not differ whether the MENA or Arab definition was used. However, statistically significant differences were observed between MENA and Arab immigrants regarding bachelor's degree or higher, not employed and years in the US. The MENA category reflects the Arab immigrant experience, even though it includes a wider set of origins, some of which are not Arab. Including a MENA identifier on future data collections will both represent Arab Americans, as well as identify this population as distinct from Whites to better represent and track health disparities.

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.