Blood pressure and serum cholesterol among male Ethiopian immigrants compared to other Israelis

The Cardiometabolic Health of African Immigrants in High-Income Countries: A Systematic Review

In recent decades, the number of African immigrants in high-income countries (HICs) has increased significantly. However, the cardiometabolic health of this population remains poorly examined. Thus, we conducted a systematic review to examine the prevalence of cardiometabolic risk factors among sub-Saharan African immigrants residing in HICs. Studies were identified through searches in electronic databases including PubMed, Embase, CINAHL, Cochrane, Scopus, and Web of Science up to July 2021. Data on the prevalence of cardiometabolic risk factors were extracted and synthesized in a narrative format, and a meta-analysis of pooled proportions was also conducted. Of 8655 unique records, 35 articles that reported data on the specific African countries of origin of African immigrants were included in the review. We observed heterogeneity in the burden of cardiometabolic risk factors by African country of origin and HIC. The most prevalent risk factors were hypertension (27%, range: 6-55%), overweight/obesity (59%, range: 13-91%), and dyslipidemia (29%, range: 11-77.2%). The pooled prevalence of diabetes was 11% (range: 5-17%), and 7% (range: 0.7-14.8%) for smoking. Few studies examined kidney disease, hyperlipidemia, and diagnosed cardiometabolic disease. Policy changes and effective interventions are needed to improve the cardiometabolic health of African immigrants, improve care access and utilization, and advance health equity.

Prevalence of Blood Pressure, Blood Glucose and Serum Lipids Abnormalities Among Ethiopian Immigrants: A Community-Based Cross-Sectional Study

The main objective of this study was to investigate the prevalence of hypertension, glucose and blood lipid abnormalities among a community of Ethiopian immigrants in Minnesota. This cross-sectional study used data from the parish nursing program 2007-2012. A total of 673 encounters were included in this study. Various dependent variables including systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (BG), and serum lipids were examined. High blood pressure was defined as a mean SBP equal to or higher than 140 mm/Hg and/or DBP equal to or higher than 90 mmHg. Elevated fasting glucose defined as levels equal to or higher than 126 mg/dL. High level of total cholesterol (TC), total triglyceride (TG), low-density lipoprotein (LDL) cholesterol, and low high-density lipoprotein (HDL) cholesterol were defined as ≥240, ≥200, ≥160 and ≤40 mg/dL, respectively. General linear regression models were used to investigate the relationship of participants' age and gender, to the continuously distributed response variables, which included systolic and DBP, BG, TC, TG, LDL cholesterol and HDL cholesterol. This is a nonrandom sample of adult Ethiopian church members who were invited to participate in a parish nurse cardiovascular disease (CVD) risk factor screening program. Participants in this sample were 43 % male and 57 % female. The overall prevalence of hypertension was 30.1 % with a cut off mark of 140/90 mm/Hg. The prevalence of hypertension was 33 and 24 % among men than among women, respectively (p < 0.01). Of all participants, 12 % had BG level of equal to or higher than 126 mg/dL. Low levels of HDL were reported in 30 % of the participants (<40 mg/dL). A higher prevalence of high LDL level (20 %) was observed among women compared to those found in men (16 %). High TC levels (>240 mg/dL) were observed in 15 % of the women and 10 % of the men (p = 0.2). Higher SBP and DBP were significantly higher in male participants than their female counterparts (p < 0.05) and in contrast, women showed a significantly higher TC (p < 0.01) and LDL (0.05) and HDL (p < 0.001). Female participants also had higher BG than male participants but the difference was not statistically significant (p > 0.05). This opportunity sample suggests high prevalence of CVD risk factors in a community of Ethiopian-American adults, and a pressing need for more comprehensive and systematic assessment of chronic disease health needs in this growing community.

Diabetes among Ethiopian Immigrants to Israel: Exploring the Effects of Migration and Ethnicity on Diabetes Risk

Objective

Diabetes prevalence among ethnic minorities and immigrants often differs from the majority indigenous population. We compared diabetes prevalence, incidence and risk among Ethiopian and non-Ethiopian Jews. Within these main groups, we controlled for the effect of migration on diabetes risk by comparing the subgroups of Ethiopian and former Soviet Union (FSU) immigrants, and compared both with Israeli-born non-Ethiopian Jews.

Methods

The study cohort included adult Ethiopian (n = 8,398) and age-matched non-Ethiopian Jews (n = 15,977) and subgroups: Ethiopian immigrants (n = 7,994), FSU immigrants (n = 1,541) and Israeli-born non-Ethiopian Jews (n = 10,828). Diabetes prevalence, annual incidence, and hazard ratios (HRs) adjusted for sex and metabolic syndrome (MetS)-components, were determined in three age groups (<50yrs, 50-59yrs, and ≥60yrs). Comparisons of body mass index (BMI) at diabetes incidence were made.

Results

Younger (<50yrs) Ethiopians had higher prevalence rates, 3.6% (95%CI: 3.1–4.1) and annual incidence, 0.9% (95%CI: 0.8–1.0) than non-Ethiopians, 2.7% (95%CI: 2.3–3.0) and 0.5% (95%CI: 0.4–0.6), respectively. These differences were particularly pronounced among Ethiopian women. Diabetes risk among Ethiopians was higher and adjustment for MetS-components was important only for BMI, which further increased hazard ratio (HR) estimates associated with Ethiopian ethnicity from 1.81 (95% CI:1.50–2.17) to 2.31 (95% CI:1.91–2.79). The same differences were seen when comparing Ethiopian to FSU immigrants. BMI before incident diabetes was lower among younger Ethiopian immigrants than younger FSU immigrants and Israeli-born.

Conclusions

Ethiopian ethnicity is associated with increased diabetes risk, which is age and BMI dependent. Young Ethiopians<50yrs, particularly women, had the greatest increase in risk. Lower BMI cut-offs should be defined to reflect diabetes risk among Ethiopians.

The prevalence of diabetes, hypertension and obesity among immigrants from East Africa and the former Soviet Union: a retrospective comparative 30-year cohort study

Background

Previous studies have reported an increasing prevalence of metabolic abnormalities in immigrants who moved from low-cardiovascular-risk regions to Western countries, but little is known about time trends following immigration.

Methods

A retrospective cohort study of immigrants from Ethiopia in east Africa (EAI), the former Soviet Union (FSUI) and native-born Israelis (NBI) over a 35-year period. EAI were divided into three groups by date of immigration. Associations between ethnicity, age, sex and metabolic risk factors were assessed using logistic regression models.

Results

The study included 58,901 individuals (20,768 EAI, 20,507 FSUI, and 17,626 NBI). The multivariate odds ratios (OR) for diabetes were 2.4 (95 % CI 2.1–2.6), 2.1 (95 % CI 1.9–2.2) and 1.5 (95 % CI 1.3–1.7), respectively, for the three waves of EAI immigrations (P < 0.001 for trend) and 1.1 (95 % CI 0.9–1.2) for FSUI. For hypertension, the corresponding ORs were 1.8 (95 % CI 1.6–1.9), 1.4 (95 % CI 1.3–1.5), and 1.1 (95 % CI 0.9–1.2), respectively (P < 0.001) for EAI, and 2.1 (95 % CI 1.9–2.2) for FSUI. For obesity the ORs were −0.5 (95 % CI 0.4–0.6), 0.5 (95 % CI 0.4–0.6), and 0.3 (95 % CI 0.2–0.3), respectively (P < 0.001) for EAI, and 1.2 (95 % CI 1.1–1.3) for FSUI. The prevalence of diabetes in NBI with a BMI of 30 was identical to a BMI of 23.4 for EAI and 28.9 for FSUI.

Conclusions

The prevalence of diabetes and hypertension was higher in EAI and increased over the years, despite a lower prevalence of obesity. It exceeded the prevalence rates in NBI.

Metabolic changes in immigrants from Africa to a Western country: time-lag effects of 20 years since immigration

BACKGROUND

An increase in the prevalence of type 2 diabetes mellitus occurs in immigrants from developing regions to Western countries. However, the dynamics of these transitions in relation to the duration of residence in the new environment are not clearly defined.

METHODS

Data concerning cardiovascular risk factors were retrospectively extracted from medical charts of 736 Ethiopian immigrants and 575 randomly-chosen, age and sex matched non-Ethiopian subjects ("reference group"). Ethiopian immigrants were designated "established" (≥ 20 years of residence), "intermediate" (10-15 years of residence), or "recent" (<10 years of residence).

RESULTS

Compared to non-Ethiopians, the age- and sex-adjusted odds ratio (OR) for diabetes was 1.00 (95%CI: 0.66-1.49) for established, 0.55 (95%CI: 0.29-1.03) for intermediate, and 0.15 (95%CI: 0.04-0.50) for recent immigrants (P < 0.001). The corresponding OR for hypertension was 0.94 (95%CI: 0.68-1.31), 0.42 (95%CI: 0.26-0.69), and 0.14 (95%CI: 0.06-0.30) for the established, intermediate, and recent immigrants respectively (P < 0.001). In contrast to the gradual increase in prevalence of diabetes and hypertension, the Ethiopian immigrants maintained their lower body mass index (BMI) (28.7 ± 5 vs 25.5 ± 5 kg/m(2) respectively, P < 0.001) and serum low-density-lipoprotein cholesterol (129 ± 36 vs 118 ± 34 mg/dL, P < 0.001) compared to the non-Ethiopians even after 20 years of residence in Israel.

CONCLUSIONS

The prevalence of diabetes and hypertension among the immigrants increased to about half that of the local population within 15 years and became equal to that of the local population after a time-lag of 20 years. These metabolic derangements occurred despite maintaining desirable BMI levels, reinforcing the need for re-defining optimal BMI ranges in relation to the ethnic origin.

Migration and differences in dietary habits-a cross sectional study of Finnish twins in Sweden

OBJECTIVE

To compare dietary habits between Finnish twin migrants to Sweden and their co-twins always living in Finland, and to analyse how migration influenced food consumption patterns in the migrants.

SUBJECTS/METHODS

Same-sexed twin pairs born in Finland below 75 years of age, with at least one twin migrating to Sweden (n=1083 pairs). Dietary habits were assessed by a food frequency questionnaire included in a comprehensive mailed questionnaire (response rate 71%). For 76 male twin pairs, information was also collected by a dietary history interview inquiring the habitual diet during the previous year.

RESULTS

Migrant twins in Sweden had a lower intake of typical Finnish foods like dark bread and berries, and an increased consumption of fresh fruit compared with co-twins living in Finland. The migrants consumed less potatoes and more rice and pasta. Sweet pastries were consumed less often by the migrants and they also tended to more often cut out visible fat of meat and on the other hand add salt to dishes. Among men the migrants had a lower alcohol intake than their co-twins living in Finland.

CONCLUSIONS

Migration from Finland to Sweden is associated with differences in the food pattern that reflect population differences in eating habits between the two countries. The differences include a reduced consumption of typical Finnish foods like dark bread and berries and are of bidirectional nature from the point of view of cardiovascular health.

Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review

OBJECTIVE

A number of studies have documented that acculturation to western society is related to an increase in blood pressure (BP). Although there is evidence that higher socioeconomic status appears related to better cardiovascular health, increasing acculturation to western society appears related to worse cardiovascular health. The purpose of this meta-analysis was to investigate the association between acculturation and BP.

METHODS

Literature searches yielded 125 relevant research manuscripts, which were coded by teams of two independent raters. This study was conducted in 2003 and 2004, and research databases such as MEDLINE and PsychINFO were searched through 2004. Measures of association (effect sizes) were extracted for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. Random effects models were used to analyze the resulting data.

RESULTS

The overall effect sizes associated with acculturation were 0.28 for SBP and 0.30 for DBP, with increasing acculturation to western society related to higher BP. More acculturated individuals had an average of 4 mm Hg higher BP than less acculturated individuals, which is similar to the effect sizes of known risk factors for high BP such as diet and physical activity. The effects of acculturation on BP appear to be universal, with similar effect sizes found across all regions of the world. Change in BP due to acculturation was not related to body mass index (BMI) or cholesterol but was related to length of residence in the new culture, with the largest effect sizes seen on initial entry and then decreasing rapidly within the first few years. Sudden cultural changes, such as migration from rural to urban settings, resulted in the largest effect sizes, which finding supports the hypothesis that the stress of cultural change is important role in the acculturation effect.

CONCLUSIONS

Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some non-Western cultural values and practices are health protective.

Evaluation of Concentric Left Ventricular Geometry in Humans

There might be limitations in identifying concentric left ventricular (LV) geometry by ratio of diastolic posterior wall thickness (WT p ) to cavity radius, defined as relative wall thickness (RWT p ). This study has been designed to evaluate age effects on RWT p . WT p , mean of septal thickness and WT p (WT m ), and cavity radius were cross-sectionally evaluated in 766 1- to 85-year-old, normotensive, nonobese subjects and 331 hypertensive Italians (used as a test series). RWT p ≥0.43 defined “traditional” concentric LV geometry. The ratios WT m /radius (RWT m ) and RWT p increased by 0.005 and 0.006 per year of age in the age stratum up to 17 years and by 0.002 in the older age stratum (18 years or older; all P <0.0001). Thus, RWT m and RWT p were normalized to average age in both age strata (10 and 46 years) by age-specific regression coefficients. The 90th and 95th percentiles of age-normalized RWT p or RWT m were 0.40 and 0.42 or 0.41 and 0.43, respectively, in adults and 0.36 and 0.39 or 0.36 and 0.38, respectively in young subjects. In hypertensive subjects, traditional RWT p cutoff identified 74 subjects (22%) with concentric LV geometry; by 95th or 90th normal percentiles, normalized RWT m identified 112 (34%), or 149 (45%) subjects with concentric LV geometry, and normalized RWT p 29% and 39%, respectively (all P <0.0001 versus unadjusted RWT p ). Thus, prevalence of concentric LV geometry increases with age-normalized RWT. Accordingly, we suggest that concentric LV hypertrophy be defined by coexistence of high LV mass with age-normalized RWT m >0.41 or RWT p >0.40. Further studies are required to establish prognostic implications of our findings.

Migration and mortality: a 20 year follow up of Finnish twin pairs with migrant co-twins in Sweden

STUDY OBJECTIVE

Finland has a higher mortality overall and for major causes of death than Sweden, primarily in men. The objective of this study was to analyse mortality in migrants from Finland to Sweden.

DESIGN

A longitudinal study based on the Finnish Twin Cohort Study. Information about migration from Finland to Sweden, duration of stay in Sweden for the migrants, and deaths 1976-1995 was obtained from national registers. Observed numbers of deaths in migrants were compared with expected numbers based on the age standardised mortality experience of the Finnish Twin Cohort. First deaths in migrants and non-migrants of migrant discordant pairs were compared controlling for genetic and early childhood factors.

PARTICIPANTS

Twin pairs of the Finnish Twin Cohort Study where at least one twin had migrated to Sweden (1542 twin pairs).

MAIN RESULTS

Among men, migrants from Finland to Sweden showed an overall similar mortality compared with all subjects of the Finnish Twin Cohort (SMR 1.1; 95% CI 0.9 to 1.4). Mortality from non-violent causes was increased for migrants with at most 20 years in Sweden (SMR 1.9; 95% CI 1.2 to 2.6) and decreased in those with a longer stay (SMR 0.7; 95% CI 0.4 to 0.9). Similar results were obtained concerning first deaths in twin pairs discordant for migration. Among women, migrants had an increased mortality overall (SMR 1.4; 95% CI 1.0 to 1.8), from cardiovascular disease (SMR 1.7; 95% CI 1.0 to 2.7), and from violent causes (SMR 2.5; 95% CI 1.2 to 4.6) compared with all women of the Finnish Twin Cohort. In analyses of migrant discordant pairs only first deaths from cardiovascular disease tended to be more common in the migrants than in non-migrant co-twins.

CONCLUSIONS

Migrants from Finland to Sweden seem to have an overall mortality comparable to that prevailing in Finland suggesting no strong influence on mortality by the migration. Duration of stay seems to be associated with mortality in the migrants, at least in men, with a lower mortality after several years in Sweden.

Geographical differences in the incidence of acute myocardial infarction in Sweden. Analyses of possible causes using two parallel case-control studies

OBJECTIVES

To analyse differences in myocardial infarction incidence between two Swedish counties and to evaluate the importance of major risk factors for the observed differences.

DESIGN

The incidence of first myocardial infarction was studied using information from registers. For a number of risk factors of myocardial infarction, the prevalence as well as the relative risk was estimated from population controls of case-control studies in the two areas.

SUBJECTS

Men and women aged 45-64 years in Stockholm and Västernorrland County 1993-94.

MAIN OUTCOME MEASURES

Relative risks (RRs) and impact fractions were used to evaluate the importance of differences in risk factor prevalence for differences in myocardial infarction incidence between the two areas.

RESULTS

The incidence of first myocardial infarction was higher in Västernorrland than in Stockholm amongst both men (RR = 1.23; 95% CI = 1.08-1.40) and women (RR = 1.41; 95% CI = 1.11-1.79). Obesity and increased levels of blood serum lipids were more prevalent in Västernorrland than in Stockholm amongst men with impact fractions of 6 and 9-11%, respectively. Amongst women, corresponding differences were not seen, but job strain and shift work tended to be more common in the more northern area. Current smoking was more frequent in Stockholm, particularly for women.

CONCLUSIONS

The incidence of first myocardial infarction was higher in Västernorrland than in Stockholm in both genders. A higher prevalence of obesity and elevated blood serum lipids may explain, in part, this excess incidence amongst men, but amongst women the causes of the higher incidence in the more northern area remain largely unclear.