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Konlan KD, Lee H, Afaya A. Prevalence and risk factors of hypertension among adolescents living in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1431-1442. [PMID: 37272549 DOI: 10.1080/09603123.2023.2218280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
This study assessed the prevalence of and risk factors for hypertension among adolescents in two selected districts in Ghana. The data were analyzed using SPSS version 24. Multivariate logistic regression analyses were conducted to determine the risk factors of hypertension among adolescents. The overall prevalence of high blood pressure (BP) was 11.6%. The non-modifiable risk factors that predicted high BP were district of residence (Adjusted odds ratio [AOR] = 0.328, 95% confidence interval [CI] = 0.328-0.203), age (AOR = 1.540, 95%CI = 1.240-1.913), relationship status (AOR = 1.960 95%CI = 1.059-3.628) and possessing a phone (AOR = 0.538, 95%CI = 0.325-0.890). The modifiable risk factors that predicted high BP were high BMI, not checking BP regularly, and not having an awareness of salt intake. In accordance with these results, prevention programs must focus on adolescent knowledge, lifestyle practices, and attitudes toward control measures. It is important to incorporate health education in school curricula to promote a healthy lifestyle and limit the risks associated with high BP.
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Affiliation(s)
- Kennedy Diema Konlan
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Agani Afaya
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Gona CM, Palan-Lopez R, Wood L, Gotora RS, Gona PN. African Immigrant Health: The Health Promotion Beliefs of Zimbabwean Immigrants in the United States. J Immigr Minor Health 2022; 24:1261-1268. [PMID: 34855044 DOI: 10.1007/s10903-021-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
To examine the health beliefs that can influence engagement in cardiovascular disease (CVD) risk reduction health promotion activities among Zimbabwe-born immigrants in the US. Focus group interviews with 37 New England-based Zimbabwean immigrants in the US conducted between January and April 2019. Focus groups were led by study investigators who were members of the Zimbabwean community. Interviews were audio-recorded and transcribed. Data were analyzed using framework analysis. Five themes emerged: (1) negative attitudes toward ill health, (2) mistrust toward western medicine, (3) stigma and taboo toward ill health, (4) a negative change in eating habits and (5) negative attitudes toward physical exercise. The participants' attitudes and beliefs may interfere with their engagement in health promotion activities aimed at reducing the burden of CVD risk in this population. Understanding these beliefs paves the way for development of culturally congruent health promotion interventions in Zimbabwean and other African immigrant populations.
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Affiliation(s)
- Clara M Gona
- School of Nursing, MGH Institute of Health Professions, Charlestown Navy Yard, 36 First Avenue, Boston, MA, 02129, USA.
| | - Ruth Palan-Lopez
- School of Nursing, MGH Institute of Health Professions, Charlestown Navy Yard, 36 First Avenue, Boston, MA, 02129, USA
| | - Lisa Wood
- Connell School of Nursing, Boston College, Boston, MA, USA
| | | | - Philimon N Gona
- College of Nursing and Health Sciences, UMASS Boston, Boston, MA, USA
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Ramos SR, Fraser M, Araya F, Kim HY, Parrilla JAS, Sy KM, Nagpal RT, Camacho-Rivera M, Boutjdir M. Community-engaged Intervention Mapping for CVD-prevention in Black and Latinx Sexual Minority Men with HIV in New York City: Protocol for A Web-based Mixed Method Study. JMIR Res Protoc 2022; 11:e41602. [PMID: 36130735 PMCID: PMC9597416 DOI: 10.2196/41602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Approximately every 37 seconds, someone in the United States dies of cardiovascular disease (CVD). It has emerged as an important contributor to morbidity among persons with HIV. Black and Latinx sexual minority men are at higher risk of both HIV and CVD when compared to heterosexual, nonethnic or minority men. Persons with HIV have a 1.5 to 2-times risk of having CVD than do HIV-negative persons. Data suggest that by the year 2030, an estimated 78% of persons with HIV will have CVD. The relationship between HIV and CVD in marginalized populations is not well understood because overall awareness of HIV and CVD as comorbid conditions is low, which further heightens risk. This has created a critically pressing issue affecting underrepresented ethnic and racial populations with HIV and requires immediate efforts to mitigate risk. Objective The purpose of this formative, mixed methods study is to use a community-engaged approach to map a behavioral intervention for CVD prevention in Black and Latinx sexual minority men with HIV in New York City. Methods Literature reviews focused on behavioral prevention studies using intervention mapping. In Aim 1, we will use qualitative interviews with HIV program managers and community members to understand facilitators and barriers to CVD prevention, chronic illnesses of concern, and early design elements needed for a web-based CVD prevention intervention. In Aim 2, we will conduct qualitative interviews and administer cross-sectional validated surveys with 30 Black and Latinx sexual minority men with HIV. We will assess illness perceptions of chronic conditions, such as HIV, hypertension, and diabetes. A total of 40 participants (program managers and community members) for Aims 1 and 2 will be enrolled to participate. To develop the protocol, we will follow steps 1 through 3 (needs assessment, change objectives, implementation strategy) of intervention mapping, using mixed methods. Results The study was approved by New York University Institutional Review Board in February 2021 (IRB-FY2021-4772) and also by the Yale University Institutional Review Board in June 2022 (#2000031577). We anticipate completing data collection on or before December 2022. Early analyses suggested concerns about illnesses outside of HIV and associated comorbid conditions, such as COVID-19 and monkeypox. Additionally, we noted a strong interest in using a web-based platform for CVD prevention education. Conclusions Web-based, behavioral, CVD prevention interventions may be promising modalities to closing the cardiovascular health disparities gap in Black and Latinx sexual minority men with HIV by extending the reach of prevention interventions using community-informed approaches and technological modalities that have been underused in this population. International Registered Report Identifier (IRRID) RR1-10.2196/41602
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Affiliation(s)
- S Raquel Ramos
- School of Public Health, Social and Behavioral Sciences, School of Nursing, Yale University, 400 West Campus Drive, Orange, US
| | | | - Faven Araya
- Arthur Ashe Institute for Urban Health, Brooklyn, US
| | | | | | - Kalla Maxine Sy
- School of Public Health, Social and Behavioral Sciences, Yale University, New Haven, US
| | | | | | - Mohamed Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, US.,Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, US.,Department of Medicine, NYU School of Medicine, New York, US
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Ude AO. Experiences of stress among West Africa-born immigrant women with hypertension in Washington DC area. Public Health Nurs 2022; 39:1017-1026. [PMID: 35152489 DOI: 10.1111/phn.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a study that explored hypertension (HTN) stress and coping experiences of West-Africa-born immigrant (WABI) women in Washington DC Metropolitan area of the United States. DESIGN AND SAMPLE This qualitative study conducted from December 2017 to May 2018 involved WABI women (n = 15) in Washington Metropolitan area that self-reported diagnosis of HTN. The transactional model of stress and coping (TMSC) provided the conceptual framework. Data collection was through semi-structured one-on-one interviews. Data analysis was done through manual open-hand coding of themes. RESULTS Three themes emerged from the analysis: Perceived Stressors, Sources of Stress, and Coping Measures. Participants perceived that their HTN diagnosis contributed to their stress; reported other financial, school, work, trauma, household and marriage-related stressors, and coping measures that include faith-based and other recreational leisure activities. CONCLUSION Participants mentioned stressors related to lack of support with domestic house chores and described various religious practices as coping strategies. These findings provide additional insights relevant to several ongoing public health nursing conversations on acute and chronic stress management in different parts of the globe. Public health nurses need to utilize these findings when assessing stressors and considering safe coping measures that appeal to WABI women experiencing HTN or chronic illness.
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Affiliation(s)
- Assumpta Onyinye Ude
- National Institutes of Health Clinical Center Nursing Department, Bethesda, Maryland, USA
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Ogungbe O, Turkson-Ocran RA, Nkimbeng M, Cudjoe J, Miller HN, Baptiste D, Himmelfarb CD, Davidson P, Cooper LA, Commodore-Mensah Y. Social determinants of hypertension and diabetes among African immigrants: the African immigrants health study. ETHNICITY & HEALTH 2022; 27:1345-1357. [PMID: 33550838 DOI: 10.1080/13557858.2021.1879026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the association between social determinants of health, hypertension, and diabetes among African immigrants. METHODS The African Immigrant Health Study was a cross-sectional study of the health of African immigrants in the Baltimore-Washington Metropolitan Area. The outcomes of interest were self-reported diagnoses of hypertension and diabetes. Logistic regression was used to examine the relationship between educational status, employment, income, social support, health insurance, and self-reported diagnoses of hypertension and diabetes, adjusting for age, sex, and length of stay in the U.S. RESULTS A total of 465 participants with mean (±SD) age 47 (±11.5) years were included. Sixty percent were women, 64% had a college degree or higher, 83% were employed, 67% had health insurance, and 70% were married/cohabitating. Over half (60%) of the participants had lived in the United States for ≥ 10 years, and 84% were overweight/obese. The overall prevalence of hypertension and diabetes was 32% and 13%, respectively. The odds of diabetes was higher (aOR: 5.00, 95% CI: 2.13, 11.11) among those who were unemployed than among those who were employed, and the odds of hypertension was higher among those who had health insurance (aOR:1.73, 95% CI: 1.00, 3.00) than among those who did not. CONCLUSIONS Among African immigrants, those who were unemployed had a higher likelihood of a self-reported diagnosis of diabetes than those who were employed. Also, people who had health insurance were more likely to self-report a diagnosis of hypertension. Additional studies are needed to further understand the influence of social determinants of health on hypertension and diabetes to develop health policies and interventions to improve the cardiovascular health of African immigrants.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lisa A Cooper
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Osokpo OH, Lewis LM, Ikeaba U, Chittams J, Barg FK, Riegel BJ. Self-Care of African Immigrant Adults with Chronic Illness. Clin Nurs Res 2022; 31:413-425. [PMID: 34726102 PMCID: PMC8951348 DOI: 10.1177/10547738211056168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.
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Affiliation(s)
- Onome H. Osokpo
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Lisa M. Lewis
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Uchechukwu Ikeaba
- West Chester University of Pennsylvania, 25 University Avenue, West Chester, PA 19383
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Frances K. Barg
- University of Pennsylvania Perelman School of Medicine, 915 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Barbara J. Riegel
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Obichi CC, Dee V. Acculturation, Cultural Beliefs, and Cardiovascular Disease Risk Levels Among Nigerian, Ghanaian and Cameroonian Immigrants in the United States. J Immigr Minor Health 2022; 24:1154-1160. [PMID: 34997444 DOI: 10.1007/s10903-021-01321-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States (U.S.). Immigrant groups from sub-Saharan Africa in the U.S. have higher CVD risk than their African American counterparts. This study examines associations of sociodemographic factors (age, sex, education, & income) to acculturation, cultural beliefs, and CVD risk levels (CVDRL) among Nigerian, Ghanaian, and Cameroonian immigrants (NGCI) in the U.S. A correlational cross-sectional design was used. Data from a convenience sample (n = 178) of NGCI were analyzed using correlations, regressions, and path analysis. Acculturation had a statistically significant influence on cultural beliefs (β = 0.16, P < .05). Age, sex, and education were the strongest predictors of CVDRL among the NGCI sample. High acculturation among NGCI in the U.S. have been associated with more health-promoting cultural beliefs. It is important that NGCI who may have difficulties understanding the culture of the U.S. healthcare system receive quality care.
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Affiliation(s)
| | - Vivien Dee
- School of Nursing, Azusa Pacific University, 901 E. Alosta Ave., Azusa, CA, 91702, USA
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Adeloye D, Ige-Elegbede JO, Ezejimofor M, Owolabi EO, Ezeigwe N, Omoyele C, Mpazanje RG, Dewan MT, Agogo E, Gadanya MA, Alemu W, Harhay MO, Auta A, Adebiyi AO. Estimating the prevalence of overweight and obesity in Nigeria in 2020: a systematic review and meta-analysis. Ann Med 2021; 53:495-507. [PMID: 33783281 PMCID: PMC8018557 DOI: 10.1080/07853890.2021.1897665] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Targeted public health response to obesity in Nigeria is relatively low due to limited epidemiologic understanding. We aimed to estimate nationwide and sub-national prevalence of overweight and obesity in the adult Nigerian population. METHODS MEDLINE, EMBASE, Global Health, and Africa Journals Online were systematically searched for relevant epidemiologic studies in Nigeria published on or after 01 January 1990. We assessed quality of studies and conducted a random-effects meta-analysis on extracted crude prevalence rates. Using a meta-regression model, we estimated the number of overweight and obese persons in Nigeria in the year 2020. RESULTS From 35 studies (n = 52,816), the pooled crude prevalence rates of overweight and obesity in Nigeria were 25.0% (95% confidence interval, CI: 20.4-29.6) and 14.3% (95% CI: 12.0-15.5), respectively. The prevalence in women was higher compared to men at 25.5% (95% CI: 17.1-34.0) versus 25.2% (95% CI: 18.0-32.4) for overweight, and 19.8% (95% CI: 3.9-25.6) versus 12.9% (95% CI: 9.1-16.7) for obesity, respectively. The pooled mean body mass index (BMI) and waist circumference were 25.6 kg/m2 and 86.5 cm, respectively. We estimated that there were 21 million and 12 million overweight and obese persons in the Nigerian population aged 15 years or more in 2020, accounting for an age-adjusted prevalence of 20.3% and 11.6%, respectively. The prevalence rates of overweight and obesity were consistently higher among urban dwellers (27.2% and 14.4%) compared to rural dwellers (16.4% and 12.1%). CONCLUSIONS Our findings suggest a high prevalence of overweight and obesity in Nigeria. This is marked in urban Nigeria and among women, which may in part be due to widespread sedentary lifestyles and a surge in processed food outlets, largely reflective of a trend across many African settings.KEY MESSAGESAbout 12 million persons in Nigeria were estimated to be obese in 2020, with prevalence considerably higher among women. Nutritional and epidemiological transitions driven by demographic changes, rising income, urbanization, unhealthy lifestyles, and consumption of highly processed diets appear to be driving an obesity epidemic in the country.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Janet O. Ige-Elegbede
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Martinsixtus Ezejimofor
- Division of Health Sciences, University of Warwick, Coventry, UK
- Clinical Standard Unit, British Association of Dermatologists (BAD), London, UK
| | - Eyitayo O. Owolabi
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | | | | | - Rex G. Mpazanje
- Nigeria Country Office, World Health Organization, Abuja, Nigeria
| | - Mary T. Dewan
- Nigeria Country Office, World Health Organization, Abuja, Nigeria
| | | | - Muktar A. Gadanya
- Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | | | - Michael O. Harhay
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
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Michgelsen J, Boateng D, Meeks KA, Beune E, Addo J, Bahendeka S, Stronks K, Agyemang C. Association between Practising Religion and Cardiovascular Disease Risk among Ghanaian Non-Migrants and Migrants in Europe: The RODAM Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052451. [PMID: 33801505 PMCID: PMC7967581 DOI: 10.3390/ijerph18052451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Sub-Saharan African migrants residing in high-income countries are more affected by cardiovascular diseases (CVDs) and associated risk factors than host populations for unclear reasons. The aim was to explore the associations of religion and religious affiliations with CVD risk among Ghanaian non-migrants and migrants in Europe. (2) Methods: The 10-year CVD risk was estimated using pooled cohort equations for 3004 participants from the cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) study. Logistic regression analyses were conducted to assess associations between religion and elevated CVD risk (score ≥ 7.5) with adjustment for covariates. (3) Results: Religious men in Europe had a lower 10-year CVD risk compared with non-religious men (adjusted OR 0.51; 95% confidence interval 0.30–0.85), specifically men affiliated with Seventh-Day Adventism (0.24; 0.11–0.53) followed by other affiliations (0.32; 0.11–0.94) and Roman Catholicism (0.42; 0.21–0.86). The opposite was found in Ghana, with religious women having higher odds for elevated 10-year CVD risk (1.53; 1.02–2.30) compared with their non-religious counterparts, specifically women affiliated with Reformed Christianity (1.73; 1.03–2.90) and other denominations (2.81; 1.20–6.54). Associations were not significant for men in Ghana and women in Europe. Adjustments for social support, stress, and health behaviors did not meaningfully alter the associations. (4) Conclusions: Christian religious Ghanaian men living in Europe seem to have lower CVD risk compared with their non-religious counterparts, while Christian religious women in Ghana appear to have increased CVD risk. Further unravelling the contributing factors and the differences between sex and environmental settings is needed.
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Affiliation(s)
- Jessica Michgelsen
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands; (K.A.C.M.); (E.B.); (K.S.); (C.A.)
- Correspondence: ; Tel.: +316-43-42-89-03
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands;
| | - Karlijn A.C. Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands; (K.A.C.M.); (E.B.); (K.S.); (C.A.)
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-5635, USA
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands; (K.A.C.M.); (E.B.); (K.S.); (C.A.)
| | - Juliet Addo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | | | - Karien Stronks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands; (K.A.C.M.); (E.B.); (K.S.); (C.A.)
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands; (K.A.C.M.); (E.B.); (K.S.); (C.A.)
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Gona CM, Lupafya TH, Zhou-Chidavaenzi N, Mafundikwa E, Gona PN. The Health Status of Zimbabwean Immigrants in the US: A Needs Assessment. Clin Nurs Res 2021; 30:969-976. [PMID: 33588578 DOI: 10.1177/1054773821995496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many Zimbabwean immigrants have settled in the US in the past 20 years. These immigrants originate from a country highly burdened with HIV and other non-communicable diseases. The health needs of these immigrants are not known. To determine the prevalence of health conditions, and healthcare utilization of Zimbabwean immigrants. A cross-sectional study of 98 Zimbabwean immigrants recruited at religious festivals, completed questionnaires and had blood pressure and weight measurements taken. Three quarters (74.4%) were overweight/obese, 34.7% had hypertension, 79.6% were health insured, 87% had regular PCPs. In the year prior 78.7% had seen a provider, and 25% had utilized the ER for care. Despite regular visits to providers participants, Zimbabwean immigrants utilized the ER more frequently than other populations and had high prevalence of preventable cardiovascular disease risk factors. Providers need to partner with this population to come up culturally appropriate prevention and management interventions.
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Affiliation(s)
- Clara M Gona
- MGH Institute of Health Professions, Boston, USA
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11
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Doamekpor LA, Gleason JL, Opara I, Amutah-Onukagha NN. Nativity and Cardiovascular Dysregulation: Evidence from the 2001-2016 National Health and Nutrition Examination Survey. J Racial Ethn Health Disparities 2021; 8:136-146. [PMID: 32410072 PMCID: PMC8324316 DOI: 10.1007/s40615-020-00765-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/14/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine nativity-based differences in 3 cardiovascular biomarkers commonly used to assess cardiovascular dysregulation. METHODS Data was pooled from the 2001-2016 National Health and Nutrition Examination Survey to compare biomarker risk scores for the US-born (n = 4693) and foreign-born (n = 2968) Black adults. We used multivariable-adjusted logistic regression to assess the association between nativity and cardiovascular biomarkers, controlling for gender, age, health behaviors, and socioeconomic status. RESULTS In the full model, a foreign-born health advantage was not observed in all 3 cardiovascular biomarkers. In fact, foreign-born Blacks were almost twice as likely to have high mean diastolic blood pressure compared with the US-born individuals (OR = 1.82; 95% CI = 1.15, 2.88) and had an increased risk of high 60-s pulse. Foreign-born individuals living in the USA for less than 5 years were 62% less likely to have high mean systolic blood pressure than individuals living in the USA for 20 years or more. CONCLUSIONS The foreign-born health advantage among Blacks was not observed in the cardiovascular biomarkers under study, suggesting that the commonly cited Healthy Immigrant Effect may need to be reassessed.
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Affiliation(s)
| | - Jessica L Gleason
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Ijeoma Opara
- Stony Brook University School of Social Welfare, Stony Brook, NY, 11794, USA
| | - Ndidiamaka N Amutah-Onukagha
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, 136 Harrison Avenue, Boston, MA, 02111, USA
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Angaw DA, Ali R, Tadele A, Shumet S. The prevalence of cardiovascular disease in Ethiopia: a systematic review and meta-analysis of institutional and community-based studies. BMC Cardiovasc Disord 2021; 21:37. [PMID: 33461482 PMCID: PMC7814574 DOI: 10.1186/s12872-020-01828-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background Worldwide cardiovascular disease is the major cause of disability and premature death. This is due to the ascending trend of consuming an unhealthy diet and obesity which increases the risk of hypertension and type 2 diabetes mellitus. Thus this study aimed to determine the pooled prevalence of the cardiovascular disease in Ethiopia.
Methods Medline, Scopus, and Google Scholar search engines were accessed using medical subject heading (MeSH) terms for studies based in Ethiopia, from 2000 to 2018. However, studies done among a specific group of the population were excluded from the study. Data were extracted by one reviewer and then checked independently by a second reviewer. Studies were qualitatively synthesis in terms of design, quality, study population, outcomes, and result. Sub-group analysis and sensitivity tests were conducted to identify potential influences on the prevalence estimates. Quantitative results were pooled in a statistical meta-analysis using STATA version 14 software. Result Nine eligible cross-sectional studies were included in the analysis. The prevalence ranges from 1 to 20%. The pooled prevalence of cardiovascular disease (CVD) was 5% (95% CI: 3–8%). The prevalence was higher in the population who visits hospitals, 8% (95% CI: 4–12%) compared to the general population, 2% (95% CI: 1–5%). There was no significant difference in the overall prevalence of CVD between males and females. Conclusion The prevalence of cardiovascular disease was high. A higher prevalence of CVD was found among patients who visited health institutions than the general population and no observed significant sex difference in the prevalence
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Affiliation(s)
- Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Rahma Ali
- Department of Population and Family Health, Faculty of Public, Jimma University, Jimma, Ethiopia
| | - Afework Tadele
- Department of Population and Family Health, Faculty of Public, Jimma University, Jimma, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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13
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Stress Measured by Allostatic Load Varies by Reason for Immigration, Age at Immigration, and Number of Children: The Africans in America Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124533. [PMID: 32599711 PMCID: PMC7345091 DOI: 10.3390/ijerph17124533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022]
Abstract
Stress leads to physiologic dysfunction and cardiometabolic disease. Allostatic load score (ALS) measures stress-induced cardiovascular, metabolic, and inflammatory biomarkers. We estimated the odds of high ALS by reason for and age at immigration, duration of American residence, number of children, and socioeconomic status in 193 African immigrants (male: 65%, age 41 ± 10 y (mean ± Standard Deviation (SD)), range 22–65 y). ALS was calculated with High-ALS defined as ALS ≥ 3.0 and Low-ALS defined as ALS < 3.0. Oral glucose tolerance tests (OGTT) were performed, the cardiovascular disease (CVD) risk estimated, and TNF-α, an inflammatory cytokine, measured. Logistic regression was used to estimate odds of High-ALS. In the High- and Low-ALS groups, ALS were 4.0 ± 1.2 vs. 1.3 ± 0.7, diabetes prevalence: 14% vs. 4%, CVD risk: 23% vs. 8%, TNF-α levels: 15 ± 9 vs. 11 ± 6 pg/mL, respectively (all p ≤ 0.01). Immigrants were more likely to be in the High-ALS group if their reason for immigration was work or asylum/refugee (OR 2.18, p = 0.013), their age at immigration was ≥30 y (OR 3.28, p < 0.001), their duration of residence in United States was ≥10 y (OR 3.16, p = 0.001), or their number of children was ≥3 (OR 2.67, p = 0.019). Education, income, health insurance, marital status, and gender did not affect High-ALS odds. Factors adversely influencing allostatic load and cardiometabolic health in African immigrants were age at and reason for immigration, duration of residence in America, and number of children.
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Turkson‐Ocran RN, Nmezi NA, Botchway MO, Szanton SL, Golden SH, Cooper LA, Commodore‐Mensah Y. Comparison of Cardiovascular Disease Risk Factors Among African Immigrants and African Americans: An Analysis of the 2010 to 2016 National Health Interview Surveys. J Am Heart Assoc 2020; 9:e013220. [PMID: 32070204 PMCID: PMC7335539 DOI: 10.1161/jaha.119.013220] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
Background Racial/ethnic minorities, especially non-Hispanic blacks, in the United States are at higher risk of developing cardiovascular disease. However, less is known about the prevalence of cardiovascular disease risk factors among ethnic sub-populations of blacks such as African immigrants residing in the United States. This study's objective was to compare the prevalence of cardiovascular disease risk factors among African immigrants and African Americans in the United States. Methods and Results We performed a cross-sectional analysis of the 2010 to 2016 National Health Interview Surveys and included adults who were black and African-born (African immigrants) and black and US-born (African Americans). We compared the age-standardized prevalence of hypertension, diabetes mellitus, overweight/obesity, hypercholesterolemia, physical inactivity, and current smoking by sex between African immigrants and African Americans using the 2010 census data as the standard. We included 29 094 participants (1345 African immigrants and 27 749 African Americans). In comparison with African Americans, African immigrants were more likely to be younger, educated, and employed but were less likely to be insured (P<0.05). African immigrants, regardless of sex, had lower age-standardized hypertension (22% versus 32%), diabetes mellitus (7% versus 10%), overweight/obesity (61% versus 70%), high cholesterol (4% versus 5%), and current smoking (4% versus 19%) prevalence than African Americans. Conclusions The age-standardized prevalence of cardiovascular disease risk factors was generally lower in African immigrants than African Americans, although both populations are highly heterogeneous. Data on blacks in the United States. should be disaggregated by ethnicity and country of origin to inform public health strategies to reduce health disparities.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins University School of Nursing and Bloomberg School of Public HealthBaltimoreMD
| | - Sherita Hill Golden
- Johns Hopkins University School of Medicine and Bloomberg School of Public HealthBaltimoreMD
| | - Lisa A. Cooper
- Johns Hopkins University School of MedicineSchool of Nursing, and Bloomberg School of Public HealthBaltimoreMD
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15
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Commodore-Mensah Y, Turkson-Ocran RA, Nmezi NA, Nkimbeng M, Cudjoe J, Mensah DS, York S, Mossburg S, Patel N, Adu E, Cortez J, Mbaka-Mouyeme F, Mwinnyaa G, Dennison Himmelfarb C, Cooper LA. Commentary: Engaging African Immigrants in Research Experiences and Lessons from the Field. Ethn Dis 2019; 29:617-622. [PMID: 31641329 PMCID: PMC6802169 DOI: 10.18865/ed.29.4.617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Global migration from Africa to more economically developed regions such as the United States, Europe, the Middle East, and Australia has reached unprecedented rates in the past five decades. The size of the African immigrant population in the United States has roughly doubled every decade since 1970. However, research has not kept up with the growing size of this vulnerable population. Data from African immigrants have not traditionally been reported separately from Blacks/African Americans. There is growing interest in increasing the participation of African immigrants in research to understand their unique health needs and the full spectrum of factors impacting their health, ranging from racial, social, environmental, and behavioral factors, to individual biological and genetic factors which may also inform health challenges. This line of inquiry may also inform our understanding of health disparities among their African American counterparts. However, little is known about effective community engagement and recruitment strategies that may increase the participation of this population in research studies. The purpose of this commentary is to: 1) describe lessons learned from our experiences engaging African immigrants in research in the Baltimore, Washington, DC, and Atlanta metropolitan areas; 2) discuss strategies for successful recruitment; and 3) consider future directions of research and opportunities to translate research findings into health policy for this population.
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Affiliation(s)
| | | | - Nwakaego A. Nmezi
- University of Florida, Department of Counseling Psychology, Gainesville, FL
| | | | | | | | | | | | | | - Eunice Adu
- Johns Hopkins School of Nursing, Baltimore, MD
| | | | | | | | | | - Lisa A. Cooper
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Public Health, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
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16
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Horlyck-Romanovsky MF, Fuster M, Echeverria SE, Wyka K, Leung MM, Sumner AE, Huang TTK. Black Immigrants from Africa and the Caribbean Have Similar Rates of Diabetes but Africans Are Less Obese: the New York City Community Health Survey 2009-2013. J Racial Ethn Health Disparities 2019; 6:635-645. [PMID: 30725381 DOI: 10.1007/s40615-019-00562-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was designed to determine (a) whether the prevalence and odds of either obesity or diabetes differed in foreign-born black Africans and Caribbeans living in New York City (NYC) and (b) whether time in the United States (US) affected odds of either outcome. METHODS Data were obtained from NYC Community Health Survey 2009-13 for 380 African-born blacks and 2689 Caribbean-born blacks. Weighted logistic regression estimated odds of obesity and diabetes, adjusting for age, sex, education, income, marital status, children < 18, BMI (diabetes models only), and time in the US. RESULTS Obesity prevalence in Africans (60.2%, male; age, 46.0 ± 13.5 years, (mean ± SD); BMI, 27.3 ± 5.6 kg/m2) was 16.7 and 30.2% in Caribbeans (39.3%, male; age, 49.7 ± 14.7 years; BMI, 28.0 ± 5.8 kg/m2). Prevalence of diabetes was 10.5% in Africans and 14.7% in Caribbeans. Africans had lower adjusted odds of obesity (aOR = 0.60 (95% CI, 0.40-0.90); P = 0.015), but there was no difference in diabetes odds between groups. Obesity odds were higher in African (aOR = 2.35 (95% CI, 1.16-4.78); P = 0.018) and Caribbean women (aOR = 2.20 (95% CI, 1.63-2.98); P < 0.001) than their male counterparts. Odds of diabetes did not differ between sexes in either group. Time in the US did not affect odds of either obesity or diabetes. CONCLUSIONS Africans living in NYC are less obese than Caribbeans, but odds of diabetes do not differ. Time in the US does not affect odds of either obesity or diabetes. Hence, BMI and diabetes risk profiles in blacks differ by region of origin and combining foreign-born blacks into one group masks important differences.
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Affiliation(s)
- Margrethe F Horlyck-Romanovsky
- Graduate School of Public Health and Health Policy, Center for Systems and Community Design, City University of New York, New York, NY, USA.
- Graduate School of Public Health and Health Policy, Department of Community Health and Social Science, City University of New York, New York, NY, USA.
| | - Melissa Fuster
- Brooklyn College, Department of Health and Nutrition Sciences, City University of New York, Brooklyn, NY, USA
| | - Sandra E Echeverria
- Graduate School of Public Health and Health Policy, Department of Community Health and Social Science, City University of New York, New York, NY, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, Center for Systems and Community Design, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, Department of Epidemiology and Biostatistics, City University of New York, New York, NY, USA
| | - May May Leung
- Hunter College, Nutrition Program, City University of New York, New York, NY, USA
| | - Anne E Sumner
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA
- National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Terry T-K Huang
- Graduate School of Public Health and Health Policy, Center for Systems and Community Design, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, Department of Community Health and Social Science, City University of New York, New York, NY, USA
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17
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Agyemang C, van den Born BJ. Non-communicable diseases in migrants: an expert review. J Travel Med 2019; 26:5139836. [PMID: 30346574 DOI: 10.1093/jtm/tay107] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-communicable diseases (NCDs) remain a major challenge in the 21st century. High-income countries (HICs) populations are ethnically and culturally diverse due to international migration. Evidence suggests that NCDs rates differ between migrants and the host populations in HICs. This paper presents a review of NCDs burden among migrant groups in HICs in Europe, North America and Australia with a major focus on cardiovascular diseases (CVDs), cancer and diabetes. METHODS We performed a narrative review consisting of scholarly papers published between 1960 until 2018. RESULTS CVD risk differs by country of origin, country of destination and duration of residence. For example, stroke is more common in sub-Sahara African and South-Asian migrants, but lower in North African and Chinese migrants. Chinese migrants, however, have a higher risk of haemorrhagic stroke despite the lower rate of overall stroke. Coronary heart disease (CHD) is more common in South-Asian migrants, but less common in sub-Saharan and north African migrants although the lower risk of CHD in these population is waning. Diabetes risk is higher in all migrants and migrants seem to develop diabetes at an earlier age than the host populations. Migrants in general have lower rates of overall cancer morbidity and mortality than the host populations in Europe. However, migrants have a higher infectious disease-related cancers than the host populations in Europe. In North America, the picture is more complex. Data from cross-national comparisons indicate that migration-related lifestyle changes associated with the lifestyle of the host population in the country of settlement may influence NCDs risk among migrants in a very significant way. CONCLUSION With exception of diabetes, which is consistently higher in all migrant groups than in the host populations, the burden of NCDs among migrants seems to depend on the migrant group, country of settlement and NCD type. This suggests that more work is needed to disentangle the key migration-related lifestyle changes and contextual factors that may be driving the differential risk of NCDs among migrants in order to assist prevention and clinical management of NCDs in these populations.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, AZ Amsterdam, the Netherlands
| | - Bert-Jan van den Born
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, AZ Amsterdam, the Netherlands.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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18
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The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study. J Immigr Minor Health 2019; 20:1137-1146. [PMID: 28852948 DOI: 10.1007/s10903-017-0644-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD risk.
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Boateng D, Agyemang C, Beune E, Meeks K, Smeeth L, Schulze M, Addo J, de-Graft Aikins A, Galbete C, Bahendeka S, Danquah I, Agyei-Baffour P, Owusu-Dabo E, Mockenhaupt FP, Spranger J, Kengne AP, Grobbee DE, Stronks K, Klipstein-Grobusch K. Migration and Cardiovascular Disease Risk Among Ghanaian Populations in Europe: The RODAM Study (Research on Obesity and Diabetes Among African Migrants). Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.004013. [PMID: 29150534 DOI: 10.1161/circoutcomes.117.004013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND For migrant populations from sub-Saharan Africa, adverse cardiovascular disease (CVD) risk factors have been observed to be higher than found in their home country-based counterparts or among the host populations in high-income countries. Differences in absolute overall CVD risk, however, remain largely unexplained. We, therefore, predicted the differences in 10-year CVD risk among sub-Saharan African migrants (Ghanaians) living in 3 European cities and Ghana. METHODS AND RESULTS For 3864 subjects aged 40 to 70 years from the multicenter RODAM study (Research on Obesity and Diabetes Among African Migrants) conducted among Ghanaian adults residing in rural and urban Ghana and 3 European cities (Amsterdam, Berlin, and London), 10-year risk of CVD was estimated using the Pooled Cohort Equations with estimates ≥7.5% defining high CVD risk. Logistic regressions were used to determine the association of migration on CVD risk. The proportion with CVD risk ≥7.5% among Ghanaian men was 34.7% in rural Ghana, 45.4% in urban Ghana, 53.9% in Amsterdam, 61.0% in Berlin, and 52.2% in London. Compared with rural Ghana, CVD risk was significantly increased for Ghanaian men living in Berlin (adjusted odds ratio, 2.80; 95% confidence interval, 1.76-4.45) and Amsterdam (1.88; 1.25-2.84). Increased risk observed for men was largely not seen for women. CVD risk increased with longer stay in Europe. CONCLUSIONS Knowledge about predictors of increased CVD risk among sub-Saharan African migrants in Europe and nonmigrants in urban centers will inform and support targeted health care and interventions to these populations.
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Affiliation(s)
- Daniel Boateng
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.).
| | - Charles Agyemang
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Erik Beune
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Karlijn Meeks
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Liam Smeeth
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Matthias Schulze
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Juliet Addo
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Ama de-Graft Aikins
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Cecilia Galbete
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Silver Bahendeka
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Ina Danquah
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Peter Agyei-Baffour
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Ellis Owusu-Dabo
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Frank P Mockenhaupt
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Joachim Spranger
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Andre P Kengne
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Diederick E Grobbee
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Karien Stronks
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
| | - Kerstin Klipstein-Grobusch
- From Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (D.B., D.E.G., K.K.-G.); School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (D.B., P.A.B., E.O.-D.); Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, The Netherlands (C.A., E.B., K.M., K.S.); Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom (L.S., J.A.); Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.S., C.G., I.D.); Regional Institute for Population Studies, University of Ghana, Legon, Ghana (A.d.-G.A.); Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala (S.B.); Kumasi Centre for Collaborative Research, Kwame NKrumah University of Science and Technology, Ghana (E.O.-D.); Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany (F.P.M.); Charite Center for Cardiovascular Research, Berlin, Germany (J.S.); Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (A.P.K.); and Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (K.K.-G.)
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Commodore-Mensah Y, Selvin E, Aboagye J, Turkson-Ocran RA, Li X, Himmelfarb CD, Ahima RS, Cooper LA. Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010-2016 National Health Interview Survey. BMC Public Health 2018; 18:773. [PMID: 29925352 PMCID: PMC6011357 DOI: 10.1186/s12889-018-5683-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ethnic minority populations in the United States (US) are disproportionately affected by cardiovascular disease (CVD) risk factors, including hypertension, overweight/obesity, and diabetes. The size and diversity of ethnic minority immigrant populations in the US have increased substantially over the past three decades. However, most studies on immigrants in the US are limited to Asians and Hispanics; only a few have examined the prevalence of CVD risk factors across diverse immigrant populations. The prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes was examined and contrasted among a socioeconomically diverse sample of immigrants. It was hypothesized that considerable variability would exist in the prevalence of hypertension, overweight and diabetes. METHODS A cross-sectional analysis of the 2010-2016 National Health Interview Survey (NHIS) was conducted among 41,717 immigrants born in Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia and Southeast Asia. The outcomes were the prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes. RESULTS The highest multivariable adjusted prevalence of diagnosed hypertension was observed in Russian (24.2%) and Southeast Asian immigrants (23.5%). Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent had the highest prevalence of overweight/obesity (71.5 and 73.4%, respectively) and diagnosed diabetes (9.6 and 10.1%, respectively). Compared to European immigrants, immigrants from Mexico/Central America/Caribbean and the Indian subcontinent respectively had higher prevalence of overweight/obesity (Prevalence Ratio (PR): 1.19[95% CI, 1.13-1.24]) and (PR: 1.22[95% CI, 1.14-1.29]), and diabetes (PR: 1.70[95% CI, 1.42-2.03]) and (PR: 1.78[95% CI, 1.36-2.32]). African immigrants and Middle Eastern immigrants had a higher prevalence of diabetes (PR: 1.41[95% CI, 1.01-1.96]) and PR: 1.57(95% CI: 1.09-2.25), respectively, than European immigrants -without a corresponding higher prevalence of overweight/obesity. CONCLUSIONS Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent bore the highest burden of overweight/obesity and diabetes while those from Southeast Asia and Russia bore the highest burden of hypertension.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Department of Community-Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD 21205 USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287 USA
| | - Jonathan Aboagye
- School of Medicine, Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205 USA
| | | | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Cheryl Dennison Himmelfarb
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Rexford S. Ahima
- Department of Community-Public Health, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287 USA
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287 USA
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite #2-500, Baltimore, MD 21287 USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St, Suite 2-500, Baltimore, MD 21287 USA
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21
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African Americans, African Immigrants, and Afro-Caribbeans Differ in Social Determinants of Hypertension and Diabetes: Evidence from the National Health Interview Survey. J Racial Ethn Health Disparities 2017; 5:995-1002. [PMID: 29234990 DOI: 10.1007/s40615-017-0446-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023]
Abstract
In the United States (U.S.), Blacks have higher morbidity and mortality from cardiovascular disease (CVD) than other racial groups. The Black racial group includes African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans (ACs); however, little research examines how social determinants differentially influence CVD risk factors in each ethnic subgroup. We analyzed the 2010-2014 National Health Interview Survey, a cross-sectional, nationally representative survey of non-institutionalized civilians. We included 40,838 Blacks: 36,881 AAs, 1660 AIs, and 2297 ACs. Age- and sex-adjusted hypertension prevalence was 37, 22, and 21% in AAs, ACs, and AIs, respectively. Age- and sex-adjusted diabetes prevalence was 12, 10, and 7% in AAs, ACs, and AIs, respectively. In the multivariable logistic regression analyses, social determinants of hypertension and diabetes differed by ethnicity. Higher income was associated with lower odds of hypertension in AAs (aOR 0.86, 95% CI 0.77-0.96) and ACs (aOR 0.55, 95% CI 0.37-0.83). In AAs, those with some college education (aOR 0.79, 95% CI 0.68-0.92) and college graduates (aOR 0.62, 95% CI 0.53-0.73) had lower odds of hypertension than those with < high school education. In AIs, having health insurance was associated with higher odds of hypertension (aOR 1.59, 95% CI 1.04-2.42) and diabetes (aOR 3.22, 95% CI 1.29-8.04) diagnoses. We observed that the social determinants associated with hypertension and diabetes differed by ethnicity. Socioeconomic factors of health insurance and income were associated with a disparate prevalence of hypertension by ethnic group. Future research among Blacks should stratify by ethnicity to adequately address the contributors to health disparities.
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Commodore-Mensah Y, Ukonu N, Obisesan O, Aboagye JK, Agyemang C, Reilly CM, Dunbar SB, Okosun IS. Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey. J Am Heart Assoc 2016; 5:JAHA.116.004059. [PMID: 27815269 PMCID: PMC5210341 DOI: 10.1161/jaha.116.004059] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. METHODS AND RESULTS Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10-1.29), diabetic (OR, 1.43; 95% CI, 1.17-1.73), and hypertensive (OR, 1.18; 95% CI, 1.05-1.32) than those residing in the United States for <10 years. CONCLUSIONS In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.
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Affiliation(s)
| | - Nwakaego Ukonu
- Counseling Psychology, Department of Psychology, University of Florida, Gainesville, FL
| | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Carolyn M Reilly
- Nell Hodgson Woodruff, School of Nursing Emory University, Atlanta, GA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff, School of Nursing Emory University, Atlanta, GA
| | - Ike S Okosun
- Department of Epidemiology & Biostatistics, School of Public Health Georgia State University, Atlanta, GA
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23
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Agyemang C, Beune E, Meeks K, Addo J, Aikins ADG, Bahendeka S, Danquah I, Mockenhaupt FP, Schulze MB, Klipstein-Grobusch K, Smeeth L, Stronks K. Innovative ways of studying the effect of migration on obesity and diabetes beyond the common designs: lessons from the RODAM study. Ann N Y Acad Sci 2016; 1391:54-70. [PMID: 27706830 DOI: 10.1111/nyas.13204] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes and obesity are major global public health problems, with migrant populations in high-income countries being particularly affected. Type 2 diabetes and obesity are also major threats in low- and middle-income countries, from which most migrant populations originate. Transitioning of societies and the resulting changes in lifestyles are thought to be major driving forces, but the key specific factors within this broad category still need to be determined. Migrant studies provide a unique opportunity to understand the potential underlying causes of these conditions, but current research is mainly geared toward analyzing the differences between migrants and the host populations in the countries of settlement. For better understanding, there is a need to extend migrant health research across national boundaries. This review discusses innovative ways of studying the effect of migration on type 2 diabetes and obesity beyond the common designs and the relevance of extending migrant health studies across national boundaries in the current era of increasing global migration. Specifically, we describe the burden and different methods for conducting migrant studies. We use the Research on Obesity and Diabetes among African Migrants (RODAM) study as a case study, discussing the methods, some results, and lessons learned, including challenges and an essential recipe for success that may guide future migrant health research.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Karlijn Meeks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Juliet Addo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | | | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Smith CE, Coltell O, Sorlí JV, Estruch R, Martínez-González MÁ, Salas-Salvadó J, Fitó M, Arós F, Dashti HS, Lai CQ, Miró L, Serra-Majem L, Gómez-Gracia E, Fiol M, Ros E, Aslibekyan S, Hidalgo B, Neuhouser ML, Di C, Tucker KL, Arnett DK, Ordovás JM, Corella D. Associations of the MCM6-rs3754686 proxy for milk intake in Mediterranean and American populations with cardiovascular biomarkers, disease and mortality: Mendelian randomization. Sci Rep 2016; 6:33188. [PMID: 27624874 PMCID: PMC5021998 DOI: 10.1038/srep33188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 08/23/2016] [Indexed: 12/13/2022] Open
Abstract
Controversy persists on the association between dairy products, especially milk, and cardiovascular diseases (CVD). Genetic proxies may improve dairy intake estimations, and clarify diet-disease relationships through Mendelian randomization. We meta-analytically (n ≤ 20,089) evaluated associations between a lactase persistence (LP) SNP, the minichromosome maintenance complex component 6 (MCM6)-rs3754686C>T (nonpersistence>persistence), dairy intake, and CVD biomarkers in American (Hispanics, African-American and Whites) and Mediterranean populations. Moreover, we analyzed longitudinal associations with milk, CVD and mortality in PREDIMED), a randomized Mediterranean diet (MedDiet) intervention trial (n = 7185). The MCM6-rs3754686/MCM6-rs309180 (as proxy), LP-allele (T) was strongly associated with higher milk intake, but inconsistently associated with glucose and lipids, and not associated with CVD or total mortality in the whole population. Heterogeneity analyses suggested some sex-specific associations. The T-allele was associated with higher CVD and mortality risk in women but not in men (P-sex interaction:0.005 and 0.032, respectively), mainly in the MedDiet group. However, milk intake was not associated with CVD biomarkers, CVD or mortality either generally or in sub-groups. Although MCM6-rs3754686 is a good milk intake proxy in these populations, attributing its associations with CVD and mortality in Mediterranean women to milk is unwarranted, as other factors limiting the assumption of causality in Mendelian randomization may exist.
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Affiliation(s)
- Caren E. Smith
- Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Oscar Coltell
- Department of Computer Languages and Systems, School of Technology and Experimental Sciences. University Jaume I, Castellón, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose V. Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
| | - Ramón Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Miguel Ángel Martínez-González
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra-Navarra Institute for Health Research (IdisNa), Pamplona, Navarra, Spain
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, University Rovira i Virgili, Reus, Spain
| | - Montserrat Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Epidemiology Unit, Municipal Institut for Medical Research (IMIM), Barcelona, Spain
| | - Fernando Arós
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Txagorritxu, Vitoria, Spain
| | - Hassan S. Dashti
- Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Chao Q. Lai
- Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Leticia Miró
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Family Medicine, Research Unit. Distrito Sanitario Atención Primaria Sevilla, Spain
| | - Lluís Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Enrique Gómez-Gracia
- Department of Epidemiology, School of Medicine, University of Malaga, Malaga, Spain
| | - Miquel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Palma Institute of Health Research (IdISPa). Hospital Son Espases. Palma de Mallorca, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Stella Aslibekyan
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Bertha Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | | | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Katherine L. Tucker
- Department of Clinical Laboratory & Nutritional Sciences, University of Massachusetts Lowell, Massachusetts, USA
| | - Donna K. Arnett
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - José M. Ordovás
- Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
- Department of Epidemiology and Population Genetics, Centro Nacional Investigación Cardiovasculares (CNIC), Madrid, Spain
- Instituto Madrileño de Estudios Avanzados en Alimentación, Madrid, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
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Expanding the Role of Nurses to Improve Hypertension Care and Control
Globally. Ann Glob Health 2016; 82:243-53. [DOI: 10.1016/j.aogh.2016.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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