Elevated blood pressure among Southeast Asian refugee children in Minnesota

Describing Racial Disparity in Hypertension Control in a Large Minnesota Outpatient Practice

Introduction

This analysis is a part of ongoing quality improvement efforts aiming at improving hypertension control among various racial minority groups seen in a large outpatient practice with a special focus on two war refugee populations, the Hmong and the Somali populations.

Method

Deidentified medical records were reviewed for adult hypertensive patients who had an outpatient encounter with a hypertension diagnosis during the years 2015 through 2019. The study outcome was the rate of uncontrolled hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, and stratified by race, age, and gender.

Results

There were 752,504 patient records representing 259,824 unique patients (mean age 61 ± 13 years) with 49.1% women, 82.1% white 8.3% African American, 4% Asian, 1.6% Hispanic, Somali 0.6%, and 0.2% Hmong. Hmong men had the highest rate of uncontrolled HTN (33.6%) followed by African American (31.3%) then Somali (29.2%). Among women, African Americans had the highest rate (28.6%) followed by Hmong (28.5%) then Somali (25.7%). In all races except Somali, the rate of uncontrolled hypertension was highest in the 18-29 age group, decreased progressively over the next several decades, then increased again in the ≥70 age group.

Conclusion

Hmong, African American, and Somali groups have the highest rates of uncontrolled hypertension. Efforts to address hypertension management need to be tailored to the specific characteristics of each racial group and to target young adults.

Assessment of ideal cardiovascular health metrics in refugees, East of Iran

Background

In 2013, there was an estimation of greater than 4.5 million Afghan refugees who had migrated to the least developed countries. Over one million are legally registered in Iran. We assessed the heart health status as described by the American Heart Association (AHA) in the Afghan refugee populace.

Methods

This cross-sectional survey was carried out on 1,634 Afghan refugees, including 746 males (45.7%) and 888 females (54.3%), selected through a convenience sampling method in 2016. The American Heart Association's seven cardiovascular health metrics were evaluated to specify the status of heart health in Afghan refugees. Differences with age and sex were analyzed using the χ² test.

Results

Only one (0.1%) participant met the ideal for all seven cardiovascular health metrics. No significant differences were found between women and men in meeting the ideal criteria for more than five cardiovascular health metrics. As age increased, the proportion of refugees who met the ideal for more than five cardiovascular health metrics declined.

Conclusions

Refugees were not meeting the ideal cardiovascular health for some of the assessed metrics. Intervention to improve and monitor heart health in Afghan refugees is needed.

Review of Hmong-Related Health Problems: A Quick Guide for Healthcare Providers

The people of Hmong descent are one of the largest resettled communities in the United States (US). The Central Valley of California is well known to be the home to the largest Hmong population in the US. However, despite the presence of such a large Hmong community in the Central Valley, our knowledge of their cultural perceptions of medicine is limited. Based on local Central Valley health providers’ experiences and observations, the Hmong people have a number of health-related challenges that differ from those of the general population, and this should be considered when dealing with their healthcare needs. In this report, we present a quick guide about the Hmong community and their health-related issues. We hope this will help clinicians and researchers better understand the Hmong community, which in turn would help provide a better quality of healthcare to the Hmong people and stimulate intellectual curiosity among healthcare providers towards this unique Asian ethnicity.

Cardiovascular diseases and their risk factors among Syrian refugees in Turkey

BACKGROUND

Information on the world distribution of cardiovascular disease and its risk factors in refugees/migrants is not available at the same rate for all countries or for different ethnic and socioeconomic groups. Today, Syria's humanitarian catastrophe has become a public health concern, which cannot be ignored.

METHODS

A search was conducted across PubMed and Google Scholar for papers on cardiovascular diseases among refugees/migrants worldwide with a focus on Syrian in Turkey.

RESULTS

The total number of papers identified through the database searches and from reference lists was 486. Of these, 62 were found to be relevant after further screening. A further 42 papers were considered not eligible after full-text, language and data assessments, resulting in a final 20 papers included in the qualitative analysis. These studies discussed several major themes: cardiovascular diseases and their risk factors among refugees/migrants, the effects of changing living conditions on refugees/migrants, the effects of psychological and socioeconomic factors, and the prevention and treatment of cardiovascular diseases in refugees/migrants. The risk of cardiovascular disease varied by country of origin, country of destination, and duration of residence. The findings suggest that cardiovascular diseases and their risk factors are increased for Syrian refugees in Turkey.

CONCLUSION

Raising awareness, prevention, early detection, and good management as well as monitoring and reporting of risk factors are the key components to controlling cardiovascular diseases in refugees. Further studies and greater acquisition of survey data are urgently needed.

Ethnic-group socioeconomic status as an indicator of community-level disadvantage: A study of overweight/obesity in Asian American adolescents

Asian American children and adolescents are an under-investigated subpopulation in obesity research. Informed by a wide socioeconomic diversity among Asian American ethnic groups, this study explored ethnic-group socioeconomic status (SES) as an indicator of community-level disadvantage that may influence overweight/obesity in Asian American adolescents. We hypothesized that ethnic-group SES was inversely associated with overweight/obesity in Asian American adolescents. Multiple logistic regression models were fitted using a sample of 1525 Asian American adolescents ages 12-17 from pooled 2007-2012 California Health Interview Survey (CHIS) data. Age, gender, nativity, individual-level SES (income and education), and two lifestyle variables (fast food consumption and physical activity) were controlled for. We found that adolescents in high- or middle-level SES ethnic groups were far less likely to be overweight/obese than those in low-SES ethnic groups. Further, these relationships were more pronounced for foreign-born adolescents but not significant for U.S.-born adolescents. Ethnic-group SES may be a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans and, potentially, other populations with high proportions of immigrants of diverse socioeconomic and ethnic backgrounds.

Overweight, elevated blood pressure, acanthosis nigricans and adherence to recommended dietary and physical activity guidelines among Hmong and white middle school students

This cross-sectional study was conducted among low-income middle-school students (N = 426) in rural northern California to compare rates of overweight, elevated blood pressure and acanthosis nigricans (AN) between Hmong and white students. Associations among rates of overweight, elevated blood pressure, AN, and scores for adherence to recommended dietary guidelines were also examined. Fifty-two percent (52%) of white students were overweight/obese compared to 38% of Hmong students. Higher fruit consumption was associated with a lower BMI among white, but not Hmong students. Whereas 7% of white students were classified as pre-hypertensive/hypertensive, the rate for Hmong students was 17%. Additionally, at 13 versus 2%, six-fold more Hmong students had an elevated blood pressure with a normal BMI compared to white students, respectively. Ethnicity was also an independent predictive factor for AN. Hmong students appear to be at higher risk for both hypertension and AN than white students irrespective of BMI.

A Longitudinal Study of Overweight, Elevated Blood Pressure, and Acanthosis Nigricans Among Low-Income Middle School Students

This longitudinal study examined the rates of overweight, elevated blood pressure, acanthosis nigricans, and their associated factors in third through fifth grade students over 4 years. Participants consisted of 279 students who participated in health screenings in 2002 and 2006. Hispanic students had significantly higher rates of overweight and acanthosis nigricans compared to White students. There was a sharp increase in elevated blood pressure from 2002 to 2006 among obese children. While 20% of the matched obese students were above the 90th percentile in 2002, 82% of the same students were above the 90th percentile in 2006. After controlling for sex, ethnicity, and grade, preadolescent obesity in 2002 continued to be a significant factor associated with elevated blood pressure and acanthosis nigricans in 2006. These findings demonstrate that prevention and treatment of obesity during preadolescence is critical for the prevention of elevated high blood pressure in early adolescence.

High prevalence of gouty arthritis among the Hmong population in Minnesota

OBJECTIVE

The prevalence of gout is on the rise worldwide, especially among newly industrialized populations. We evaluated the prevalence of gout in the recently established Hmong of Minneapolis/St. Paul (MSP) compared with that in non-Hmong populations.

METHODS

The prevalence of self-reported gout in the Hmong population was estimated from 2 cross-sectional community surveys and compared with national data extrapolated from the Third National Health and Nutrition Examination Survey. The prevalence of physician-diagnosed gout in Hmong and non-Hmong MSP residents was separately estimated from the diagnosis codes of 11 MSP primary care clinics.

RESULTS

The prevalence of self-reported gout among MSP Hmong was 2-fold higher than in the general US population (6.5% versus 2.9%; P < 0.001). Although women of both groups reported gout at a rate of 1.9%, Hmong men were significantly more likely than their non-Hmong counterparts to report gout (11.5% versus 4.1%; P < 0.001). Similar results were observed when investigating physician-diagnosed gout in MSP (2.8% Hmong versus 1.5% non-Hmong; P < 0.001). No difference was observed between the women of the 2 groups (0.8% versus 0.7%; P = 0.833), whereas Hmong men were more than twice as likely to be diagnosed with gout compared with their non-Hmong counterparts (6.1% versus 2.5%; P < 0.001). Among Hmong men, advancing age was associated with a considerably higher likelihood of being diagnosed with gout.

CONCLUSION

A significant association is observed between Hmong ethnicity and gout, both self-reported and physician diagnosed. This unique population may provide an opportunity to further our understanding of the pathophysiology of gout.

Adiposity and height of adult Hmong refugees: relationship with war-related early malnutrition and later migration

This study investigated whether historical proxies for poor nutrition early in life were associated with differences in body composition and height among adult Hmong refugees. Life history and anthropometric data were collected from a sample of 279 Hmong aged 18-51 years who were born in Laos or Thailand and resettled in French Guiana or the United States following the Second Indochina War. Overall, 30.5% were born in a war zone in Laos, while 38.8% were displaced as infants; these individuals were presumed to have experienced malnutrition in the perinatal and infant periods, respectively. Resettlement in urban areas in the US was utilized as a proxy for greater exposure to excessive energy balance, compared with Hmong who resettled in rural areas in French Guiana. In multiple linear regression models, being displaced in infancy was negatively associated with height after controlling for confounders, while being born in a war zone was associated with higher adiposity and centralized body fat distribution. Resettlement in the US was associated with a higher centralization of subcutaneous fat, but not overall adiposity. These findings may be of interest to the study of the developmental origins of obesity, in a population that has undergone early malnutrition followed by migration and rapid nutritional transition.

Our lives were healthier before: focus groups with African American, American Indian, Hispanic/Latino, and Hmong people with diabetes

Focus groups were conducted to explore health-related beliefs and experiences of African American, Hispanic/Latino, American Indian, and Hmong people with diabetes and engage community members in improving diabetes care and education for these populations. Eighty participants attended 12 focus groups, 3 per population. Major themes were loss of health attributed to modern American lifestyles, lack of confidence in the medical system, and the importance of spirituality. Participants recommended improvements in the areas of health care, diabetes education, social support, and community action. Their recommendations emphasize the importance of respectful, knowledgeable health care providers; culturally responsive diabetes education for people with diabetes and their families; and broad-based community action. These recommendations align with current public health priorities and medical knowledge. It is proposed that healthy traditions from diverse populations can be leveraged to improve the health of all people with diabetes.

Hypertension screening and cardiovascular risk profiling in Vietnam

The purpose of the present descriptive study was to determine the risks associated with hypertension in Vietnamese communities around Ho Chi Minh City, Vietnam. The 357 volunteers for this health promotion screening consisted of 125 men and 232 women, 19-85 years of age. Participants completed surveys on their cardiovascular health history, health practices and hypertension knowledge. Nearly one-third of the sample was found to have systolic blood pressure (SBP) above 139 mmHg and/or diastolic blood pressure (DBP) above 89 mmHg. Fifteen participants had either SBP over 180 mmHg or DBP over 108 mmHg, nine of these 15 participants were taking antihypertensive drugs and 76 were taking other cardiac medications. The majority (98%) cooked with salt and 75% added salt when eating. Drinking alcohol (21%) and smoking (23%) were more common in male participants. Knowledge of cardiovascular risks was very low, indicating a need for community health promotion activities with educational campaigns and further screenings.

Cancer in the Minnesota Hmong population

BACKGROUND

The Hmong are an isolated, agrarian people who settled in the mountainous regions of what today are Vietnam, Cambodia, and Laos. After the Vietnam War, many Hmong were relocated to the U.S. Minnesota has the second largest population (after California) of Hmong individuals. The objective of this study was to examine cancer incidence in this population, because it may indicate areas for targeted surveillance and intervention.

METHODS

The Minnesota Cancer Surveillance System database was screened for Hmong surnames, and proportional incidence ratios (PIRs) were calculated for the period 1988-1999.

RESULTS

Compared with all Minnesotans, the Hmong population had increased PIRs for nasopharyngeal cancer (PIR, 39.39; 95% confidence interval [95% CI], 21.01-66.86), gastric cancer (PIR, 8.70; 95% CI, 5.39-13.25), hepatic cancer (PIR, 8.08; 95% CI, 3.88-14.71), and cervical cancer (PIR, 3.72; 95% CI, 2.04-6.20) and had decreased PIRs for prostate cancer, breast cancer, Hodgkin disease, and melanoma.

CONCLUSIONS

The current observations have implications for cancer control interventions. In particular, an increased incidence of cervical cancer might be addressed in part by targeting culturally sensitive screening programs in the Hmong population.

A descriptive study of hypertension in Vietnamese Americans

This study focused on the extent of hypertension (HTN) and risk factors in 201 Vietnamese in a Gulf Coast community. Blood pressure and pulse were measured by a Welch-Allyn Vital Signs Monitor (Model AD-9000, Armstrong Medical, Lincolnshire, IL). The survey tool consisted of demographic information, health status, medications, dietary habits, smoking and alcohol use, education, family configuration, family health history, and 12 true or false items on HTN knowledge. Participants believed that HTN was inherited, presented symptoms, was caused by stress and lack of daily exercise, and had no cure. Of the factors correlated with high blood pressure, the most significant item was the total knowledge score. Nearly 44% of the participants in this sample were hypertensive. Other significant correlation findings included smoking r = .45, p < .05) and exercise r = .15, p < .05) were related to high blood pressure. Cultural sensitivity was found to be critical in the data collection process. This study demonstrates a profound need for health education related to cardiovascular disease, smoking, and alcohol use in Vietnamese Americans.

A debunking of the myth of healthy Asian Americans and Pacific Islanders

PURPOSE

To present evidence that the model of healthy Asian Americans and Pacific Islanders (AAPIs) stereotype is a myth.

SEARCH METHOD

The authors retrieved literature from the National Library of Medicine's compact disk databases (Cancerlit, CINAHL, Health, and MEDLINE), and examined pertinent federal government publications supplemented by the authors' knowledge of other published materials.

IMPORTANT FINDINGS

This review paper presents three reasons why AAPIs are underserved: (1) the population growth rate has been unusually rapid and recent; (2) data regarding the health status of AAPIs are inadequate; and (3) the myth that AAPIs are model minority populations in terms of their health status was promulgated.

MAJOR CONCLUSIONS

The conclusions are as follows: (1) AAPIs are heterogenous with respect to demographic factors and health risk factors; (2) because the current databases on the health status of AAPIs include small sample sizes, both the quantity and quality of these data need to be improved with respect to appropriate gender and ethnic group representation; (3) Risk factor and mortality data for AAPIs suggest that the burden of certain preventable diseases, namely, tuberculosis, hepatitis-B, liver cancer, and lung cancer may be higher than those of any other racial and ethnic population. The model healthy AAPI stereotype is a myth.

Blood pressure in youth from four ethnic groups: the Pasadena Prevention Project

To explore the racial differences in blood pressure levels in American youth, and to extend current data to include youth of Asian, black, Hispanic, and non-Hispanic white descent, we recorded blood pressures among ninth graders during the spring of the years 1985 to 1989 in a suburb of Los Angeles. Trained observers, following a standardized protocol, obtained blood pressure measurements from 4577 students (39% black, 30% Hispanic, 21% white, 10% Asian; 50% female) with a mean age of 15 years. With the use of age- and sex-specific 90th percentiles reported in 1987 by the Second Task Force on Blood Pressure Control in Children to define elevated blood pressure, the prevalence of elevated systolic blood pressure (SBP) was 8.1% (diastolic blood pressure (DBP), 9.3%) among female subjects and 16.0% (DBP, 18.5%) among male subjects. Comparisons of the prevalence of elevated blood pressure among ethnic-racial groups within sexes were statistically significant only for Asian girls (SBP, 13.1%; DBP, 14.0%) relative to other female subjects (SBP, 7.6%, p < 0.005; DBP, 8.8%, p < 0.01); these differences persisted after adjustment for body height and body mass index. A similar trend for Asian boys was apparent only for DBP (23.0% vs 18.0%, p = 0.065). Results for group means were comparable: average SBP and DBP were higher for Asian girls than for other ethnic groups. In addition, boys in this sample may have higher blood pressure than boys from other areas of the country. These results suggest that Asians in California may be at greater risk of having early development of hypertension.

The effects of violence on health and adjustment of Southeast Asian refugee children: an integrative review

Public health nurses have historically been on the front line in meeting the needs of refugees in their practice communities. Little nursing research has been focused on the needs of refugees, however. The purpose of this integrative literature review was to clarify research focused on the needs of one refugee group, southeast Asian. The integrating factors reviewed were the instruments used, sampling procedures, statistical methods, and clarification of independent and dependent variables. Power analyses were computed on three of the studies to critique further the appropriateness of sample size. Findings indicate that premigration experiences, especially violence, play an important role in health status and adaptation after settling in the United States. Since health problems are often manifested in cultural ways different from Western norms, public health nurses would benefit from continued research clarifying the needs of individuals from other cultures.