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Agyemang C, van der Linden EL, Chilunga F, van den Born BJH. International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe. J Am Heart Assoc 2024; 13:e030228. [PMID: 38686900 DOI: 10.1161/jaha.123.030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 05/02/2024]
Abstract
Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Eva L van der Linden
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Felix Chilunga
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
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Wändell P, Crump C, Li X, Stattin NS, Carlsson AC, Sundquist J, Sundquist K. Hypertension in Pregnancy Among Immigrant and Swedish Women: A Cohort Study of All Pregnant Women in Sweden. J Am Heart Assoc 2024; 13:e031125. [PMID: 38366326 PMCID: PMC10944082 DOI: 10.1161/jaha.123.031125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Little is known about risks of hypertensive disorders of pregnancy in both first- and second-generation immigrant women in Europe and other Western countries; such knowledge may help elucidate the influence of genetic versus social factors on such risks. We aimed to study both first- and second-generation immigrant women for the presence of all types of hypertension (preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia) during pregnancy. METHODS AND RESULTS A cohort study was conducted using data derived from the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% CIs while adjusting for sociodemographic factors and comorbidities. The first-generation study included a total of 1 084 212 deliveries and 68 311 hypertension cases, and the second-generation study included 989 986 deliveries and 67 505 hypertension cases. The fully adjusted HR (with 99% CI) for hypertension in pregnancy among first-generation immigrant women was 0.69 (0.66-0.72), and among second-generation immigrant women, it was 0.88 (0.86-0.91), compared with Swedish-born women with 2 Swedish-born parents. Women born in Finland or with parent(s) from Finland had higher risks, with fully adjusted HRs (99% CIs) of 1.30 (1.18-1.43) and 1.12 (1.07-1.17), respectively. CONCLUSIONS Both first- and second-generation immigrant women had overall lower risks of hypertension in pregnancy compared with other Swedish women. However, the risk reduction was less pronounced in second-generation compared with first-generation immigrant women, suggesting that environmental factors in Sweden may have an important influence on risk of hypertension during pregnancy.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
| | - Casey Crump
- Department of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas Health Science CenterHoustonTX
| | - Xinjun Li
- Center for Primary Health Care ResearchLund UniversityMalmöSweden
| | - Nouha Saleh Stattin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Academic Primary Health Care CentreStockholmSweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Academic Primary Health Care CentreStockholmSweden
| | - Jan Sundquist
- Department of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas Health Science CenterHoustonTX
- Center for Primary Health Care ResearchLund UniversityMalmöSweden
- Center for Community‐Based Healthcare Research and Education, Department of Functional PathologySchool of Medicine, Shimane UniversityMatsueJapan
| | - Kristina Sundquist
- Department of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas Health Science CenterHoustonTX
- Center for Primary Health Care ResearchLund UniversityMalmöSweden
- Center for Community‐Based Healthcare Research and Education, Department of Functional PathologySchool of Medicine, Shimane UniversityMatsueJapan
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The Morphology of Coronary Artery Disease in South Asians versus White Caucasians and its Implications. Can J Cardiol 2022; 38:1570-1579. [PMID: 35568268 DOI: 10.1016/j.cjca.2022.05.005] [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: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes relative to White Caucasians (WCs) following invasive revascularization procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and discuss their potential impact on the development of coronary disease, acute coronary syndrome and revascularization outcomes. SAs have a more diffuse pattern with multi-vessel involvement compared to WCs. However, less is known about other morphological characteristics such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher non-calcified plaque composition, elevated thrombosis and inflammatory markers likely contribute to the disease pattern. While the current evidence on the role of coronary vessel size remains inconsistent, smaller coronary diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularization outcomes. In conclusion, SAs have a unique CAD risk profile comprised of traditional and novel risk factors. Our findings highlight the need for additional awareness of healthcare professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
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Bolijn R, Sieben CHAM, Kunst AE, Blom M, Tan HL, van Valkengoed IGM. Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands. Int J Cardiol 2021; 343:156-161. [PMID: 34509532 DOI: 10.1016/j.ijcard.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Insight into the occurrence of out-of-hospital cardiac arrest (OHCA) within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women, but relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied. We investigated sex differences in OHCA incidence, overall and across these subgroups. METHODS We performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01-01-2009 (n = 1,688,285) with prospectively collected EMS-attended OHCA cases (n = 5676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups. RESULTS The age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31-0.35). These sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30-0.35) and ethnic groups (HR range: 0.19-0.40), except among Moroccans (HR 0.89, 95% CI 0.51-1.57). CONCLUSION Women have a substantial, yet lower OHCA incidence rate than men. The magnitude of these sex differences did not vary across social strata.
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Affiliation(s)
- Renee Bolijn
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Cenne H A M Sieben
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marieke Blom
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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Ben Zekry S, Sreedharan S, Han D, Sellers S, Ahmadi AA, Blanke P, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Shin S, Choi JH, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Leipsic J, Chang HJ. Comparison of coronary atherosclerotic plaque progression in East Asians and Caucasians by serial coronary computed tomographic angiography: A PARADIGM substudy. J Cardiovasc Comput Tomogr 2021; 16:222-229. [PMID: 34736879 DOI: 10.1016/j.jcct.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate potential differences in plaque progression (PP) between in East Asians and Caucasians as well as to determine clinical predictors of PP in East Asians. BACKGROUND Studies have demonstrated differences in cardiovascular risk factors as well as plaque burden and progression across different ethnic groups. METHODS The study comprised 955 East Asians (age 60.4 ± 9.3 years, 50.9% males) and 279 Caucasians (age 60.4 ± 8.6 years, 74.5% males) who underwent two serial coronary computed tomography angiography (CCTA) studies over a period of at least 24 months. Patients were enrolled and analyzed from the PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging) registry. After propensity-score matching, plaque composition and progression were compared between East Asian and Caucasian patients. Within East Asians, the plaque progression group (defined as plaque volume at follow-up CCTA minus plaque volume at baseline CCTA> 0) was compared to the no PP group to determine clinical predictors for PP in East Asians. RESULTS In the matched cohort, baseline volumes of total plaque as well as all plaque subtypes were comparable. There was a trend towards increased annualized plaque progression among East Asians compared to Caucasians (18.3 ± 24.7 mm3/year vs 16.6 mm3/year, p = 0.054). Among East Asians, 736 (77%) had PP. East Asians with PP had more clinical risk factors and higher plaque burden at baseline (normalized total plaque volume of144.9 ± 233.3 mm3 vs 36.6 ± 84.2 mm3 for PP and no PP, respectively, p < 0.001). Multivariate logistic regression analysis showed that baseline normalized plaque volume (OR: 1.10, CI: 1.10-1.30, p < 0.001), age (OR: 1.02, CI: 1.00-1.04, p = 0.023) and body mass index (OR: 2.24, CI: 1.01-1.13, p = 0.024) were all predictors of PP in East Asians. Clinical events, driven mainly by percutaneous coronary intervention, were higher among the PP group with a total of 124 (16.8%) events compared to 22 (10.0%) in the no PP group (p = 0.014). CONCLUSION East Asians and Caucasians had comparable plaque composition and progression. Among East Asians, the PP group had a higher baseline plaque burden which was associated with greater PP and increased clinical events.
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Affiliation(s)
- Sagit Ben Zekry
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Subhashaan Sreedharan
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephanie Sellers
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Amir A Ahmadi
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada; Icahn School of Medicine at Mt. Sinai Hospital, New York, NY, USA
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Bundang, South Korea
| | | | - Erica Maffei
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, South Korea
| | | | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mt. Sinai Hospital, New York, NY, USA; Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
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Armengol GD, Hayfron-Benjamin CF, van den Born BJH, Galenkamp H, Agyemang C. Microvascular and macrovascular complications in type 2 diabetes in a multi-ethnic population based in Amsterdam. The HELIUS study. Prim Care Diabetes 2021; 15:528-534. [PMID: 33676869 DOI: 10.1016/j.pcd.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess ethnic differences in diabetes-related microvascular and macrovascular complication rates in a multi-ethnic population in the Netherlands. STUDY, DESIGN AND SETTING Data from the HELIUS study comprising of 165 Dutch, 591 South-Asian Surinamese, 494 African Surinamese, 272 Ghanaian, 368 Turkish, and 444 Moroccan participants with diabetes were analyzed. Logistic regression was used to assess ethnic differences in microvascular (nephropathy) and macrovascular (coronary heart disease (CHD), peripheral artery disease (PAD) and stroke) complications, with adjustments for age, sex, education, and the conventional risk factors. RESULTS In an age-sex adjusted model, ethnic minorities had higher odds of nephropathy than Dutch except for Ghanaians and African Surinamese. The difference remained statistically significant in South-Asian Surinamese (odds ratio: 2.29; 95% CI, 1.09-4.80), but not in the Turkish (1.01; 0.43-2.38) and Moroccan (1.56; 0.68-3.53) participants. The odds of CHD was higher in all ethnic minorities than in Dutch, with the odds ratios ranging from 2.73 (1.09-6.84) in Ghanaians to 6.65 (2.77-15.90) in Turkish in the fully-adjusted model. There were no ethnic differences in the odds of PAD and stroke. CONCLUSIONS The findings suggest ethnic inequalities in macrovascular and microvascular complications in diabetes, with nephropathy and CHD being the most common complications affecting ethnic minorities.
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Affiliation(s)
- Gina Domínguez Armengol
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles F Hayfron-Benjamin
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Physiology, University of Ghana Medical School, Ghana.
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Cardiovascular health care and health literacy among immigrants in Europe: a review of challenges and opportunities during the COVID-19 pandemic. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2020; 30:1285-1291. [PMID: 33134037 PMCID: PMC7592128 DOI: 10.1007/s10389-020-01405-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
Objectives Europe is a destination for many migrants, a group whose proportion of the overall population will increase over the next decades. The cardiovascular (CV) risk distribution and outcomes, as well as health literacy, are likely to differ from the host population. Challenges related to migrant health status, cardiovascular risk distribution and health literacy are compounded by the ongoing coronavirus disease 2019 (COVID-2019) crisis. Methods We performed a narrative review of available evidence on migrant CV and health literacy in Europe. Results Health literacy is lower in migrants but can be improved through targeted interventions. In some subgroups of migrants, rates of cardiovascular disease (CVD) risk factors, most importantly hypertension and diabetes, are higher. On the other hand, there is strong evidence for a so-called healthy migrant effect, describing lower rates of CV risk distribution and mortality in a different subset of migrants. During the COVID-19 pandemic, CV risk factors, as well as health literacy, are key elements in optimally managing public health responses in the ongoing pandemic. Conclusions Migrants are both an opportunity and a challenge for public health in Europe. Research aimed at better understanding the healthy migrant effect is necessary. Implementing the beneficial behaviors of migrants could improve outcomes in the whole population. Specific interventions to screen for risk factors, manage chronic disease and increase health literacy could improve health care for migrants. This pandemic is a challenge for the whole population, but active inclusion of immigrants in established health care systems could help improve the long-term health outcomes of migrants in Europe.
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Ihdayhid AR, Goeller M, Dey D, Nerlekar N, Yap G, Thakur U, Adams D, Cameron J, Seneviratne S, Achenbach S, Ko B. Comparison of Coronary Atherosclerotic Plaque Burden and Composition as Assessed on Coronary Computed Tomography Angiography in East Asian and European-Origin Caucasians. Am J Cardiol 2019; 124:1012-1019. [PMID: 31351575 DOI: 10.1016/j.amjcard.2019.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/24/2022]
Abstract
Recent evidence suggests plaque morphology evaluated on coronary computed tomography angiography has prognostic implications. East Asians have a lower prevalence of myocardial infarction and cardiovascular mortality compared with European-origin Caucasians. We aimed to compare coronary atherosclerotic burden and plaque composition in a matched cohort of Caucasian and East Asians patients with stable chest pain who underwent computed tomography angiography. Two-hundred symptomatic patients (age 58.8 ± 7.9, male 51%) were matched for age, gender, body mass index, and diabetes (100 each ethnic group). A blinded core-laboratory quantified calcified and noncalcified plaque (NCP) volume and burden. Components of NCP were differentiated by plaque hounsfield unit (HU) thresholds which defined high-risk necrotic core (-30 to 30HU), fibrofatty plaque (31 to 130HU); and low-risk fibrous plaque (131 to 350HU). Composition of NCP components was derived as (NCP component volume/total NCP volume) × 100%. Segment Involvement Score, percent diameter and area stenosis were comparable in both groups. Similarly, there was no difference in the volume and burden of total, calcified and NCP. Compared with Caucasians, East Asians demonstrated lower composition of plaque attenuation corresponding to necrotic core (3.5 vs 5.1%; p = 0.004) and fibrofatty plaque (29.6 vs 37.3%; p = 0.005), and higher fibrous plaque (65.7 vs 57.6%; p = 0.004). On multivariable analysis East Asian ethnicity was independently associated with lower composition of high-risk plaque after adjustment for risk factors and scan parameters. These findings were consistent in a propensity-matched sensitivity-analysis. In conclusion, based on this matched cohort, East Asian ethnicity is associated with significantly less composition of high-risk NCP (necrotic core and fibrofatty plaque) and a higher composition of low-risk fibrous plaque compared with Caucasians; which may confer a lower risk of cardiovascular events.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Markus Goeller
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Grace Yap
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Daniel Adams
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Stephan Achenbach
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
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Bodewes AJ, Agyemang C, Kunst AE. All-cause mortality among three generations of Moluccans in the Netherlands. Eur J Public Health 2019; 29:463-467. [PMID: 30544210 DOI: 10.1093/eurpub/cky255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mortality variations have been reported for ethnic minority groups compared with their host populations. It is uncertain how this mortality variations change over time as younger generations become older and mix with the host population. This study aimed to examine all-cause mortality among three generations of Moluccans in the Netherlands, and to compare Moluccans with a mixed and non-mixed ethnic background. METHODS We used data from the death and municipality registry for the years 2000 through 2013, including all registered Dutch inhabitants. A list of Moluccan surnames was used to select the Moluccan population. Mortality differences were calculated by Poisson regression, controlling for sex, age and district socio-economic status. RESULTS High all-cause mortality rates were observed in all generations of Moluccans although the extent of the differences between Moluccans and the Dutch were smaller in second (1.15, 1.07-1.23) and third generation (1.14, 1.00-1.29) compared with the first generation (1.55, 1.49-1.60). Higher all-cause mortality is also reflected in the higher mortality from most causes of death except neoplasms and external causes. Both mixed and non-mixed Moluccans showed high all-cause mortality among the first (child) and second generation compared with the Dutch. CONCLUSION Our findings show a higher all-cause mortality in three generations of Moluccans compared with the Dutch. The results show that mortality inequalities may persist, though in an attenuated form, over generations among ethnic minorities.
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Affiliation(s)
- Adee J Bodewes
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
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Rye E, Lee A, Mukhtar H, Narayan A, Robert Denniss A, Chow C, Kovoor P, Sivagangabalan G. ST-elevation myocardial infarction in a migrant population: a registry-based study of patient treatment and outcomes. Intern Med J 2019; 49:502-512. [PMID: 30152033 DOI: 10.1111/imj.14084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Internationally, a growing number of studies has identified race-related disparities in the presentation, treatment and outcomes of patients with ST-elevation myocardial infarction (STEMI). With a large migrant population, Australia presents a unique microcosm in which to study the impact of migrant status and ethnicity in STEMI patients. AIM To investigate if first-generation migrants differed in presentation, treatment or outcomes following STEMI compared with the Australian-born population. METHODS We conducted a retrospective observational study using data from a clinician-initiated registry. The study involved 2154 patients who presented to 12 hospitals between 2004 and 2012. Our main outcome measures included time to reperfusion, 30-day mortality and complications. RESULTS Migrants (n = 1035, 48.8%) were more likely to be older (61 vs 58 years, P < 0.001), diabetic (29.3 vs 21.5%, P < 0.001) and have a prolonged symptom to door time (102 vs 91 min, P = 0.04). Despite lower rates of previous known ischaemic heart disease (22.5 vs 26.6%, P = 0.03), migrants had more diffuse disease (triple vessel or left main (3VD/LM): 29.8 vs 22.0%, P < 0.001) and higher troponin values (3.77 vs 3.22 μg/L, P = 0.01). We found no significant differences in hospital treatment times, intervention types or rates. Multivariate regression identified age, diabetes, female gender and multi-vessel disease as predictors of complications and death at 30 days. CONCLUSIONS Migrants had longer pre-hospital delays and exhibited different cardiovascular risk profiles than Australian-born patients but received comparable treatment in the acute hospital setting. Higher rates of diabetes and multi-vessel coronary artery disease were seen among migrant patients, indicating a relatively higher risk population.
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Affiliation(s)
- Eleanor Rye
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Andrea Lee
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Hadia Mukhtar
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Arun Narayan
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - A Robert Denniss
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Clara Chow
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gopal Sivagangabalan
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
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11
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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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12
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Bart van der Worp H, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2018; 252:207-274. [PMID: 27664503 DOI: 10.1016/j.atherosclerosis.2016.05.037] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societie: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societie: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societie: European Society of Cardiology (ESC)
| | | | - Josep Redon
- Societie: European Society of Hypertension (ESH)
| | | | - Naveed Sattar
- Societie: European Association for the Study of Diabetes (EASD)
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13
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Deen L, Buddeke J, Vaartjes I, Bots ML, Norredam M, Agyemang C. Ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands: a register-based cohort study. BMJ Open 2018; 8:e021509. [PMID: 30121599 PMCID: PMC6104747 DOI: 10.1136/bmjopen-2018-021509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However, evidence on ethnic differences in CVD among women with breast cancer is sparse. We assessed ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands. METHODS A nationwide register-based cohort study comprising all women with a first admission for breast cancer (n=127 714) between 1996 and 2010 in the Netherlands was conducted. Differences in CVD admission, CVD mortality and overall CVD event, which comprised a CVD admission and/or CVD mortality, between the largest ethnic minority groups (Surinamese, Moroccan, Turkish, Antillean and Indonesian) and the Dutch general population (henceforth, Dutch) were investigated using Cox proportional hazard models. RESULTS The incidence of cardiovascular outcomes varied by the ethnic group. The incidence of an overall cardiovascular event was significantly higher for women with breast cancer from Suriname (HR 1.46; 95% CI 1.29 to 1.64) and Turkey (HR 1.25; 95% CI 1.03 to 1.51), compared with Dutch women with breast cancer. In contrast, Indonesian women with breast cancer had a significantly lower risk (HR 0.88; 95% CI 0.81 to 0.96) of a cardiovascular event compared with Dutch women with breast cancer. The risk of a cardiovascular event did not differ between Moroccan and Dutch women with breast cancer, whereas for Antillean women the risk was not significantly higher. CONCLUSIONS Our findings suggest that Surinamese and Turkish women with breast cancer are disadvantaged in terms of cardiovascular outcomes compared with Dutch women with breast cancer. More work is needed to unravel the potential factors contributing to these differences.
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Affiliation(s)
- Laura Deen
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Josefien Buddeke
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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14
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Fedeli U, Cestari L, Ferroni E, Avossa F, Saugo M, Modesti PA. Ethnic inequalities in acute myocardial infarction hospitalization rates among young and middle-aged adults in Northern Italy: high risk for South Asians. Intern Emerg Med 2018; 13:177-182. [PMID: 28176186 DOI: 10.1007/s11739-017-1631-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/02/2017] [Indexed: 12/25/2022]
Abstract
The knowledge of ethnic-specific health needs is now essential to design effective health services and population-based prevention strategies. However, data on migrant populations living in Southern Europe are limited. The study is designed to investigate ethnic inequalities in hospitalization for acute myocardial infarction (AMI) in the Veneto region (Italy). Hospital admissions for AMI in Veneto for the whole resident population aged 20-59 years during 2008-2013 were studied. Age and gender-specific AMI hospitalization rates for immigrant groups (classified by country of origin according to the United Nations geoscheme) and Italians were calculated. The indirect standardization method was used to estimate standardized hospitalization ratios (SHR) for each immigrant group, with rates of Italian residents as a reference. Overall, 8200 AMI events were retrieved, 648 among immigrants. The highest risk of AMI is seen in South Asians males (SHR 4.2, 95% CI 3.6-4.9) and females (SHR 2.5, 95% CI 1.4-4.5). AMI rates in South Asian males sharply increase in the 30-39 years age class. Other immigrant subgroups (Eastern Europe, North Africa, Sub-Saharan Africa, other Asian countries, Central-South America, high-income countries) displayed age- and gender-adjusted hospitalization rates similar to the native population. Present findings stress the urgent need for implementation of ethnic-specific health policies in Italy. The awareness about the high cardiovascular risk in subjects from South Asia must be increased among general practitioners and immigrant communities.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua, PD, Italy.
| | - Laura Cestari
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua, PD, Italy
| | - Eliana Ferroni
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua, PD, Italy
| | - Francesco Avossa
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua, PD, Italy
| | - Mario Saugo
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua, PD, Italy
| | - Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Modesti PA, Fedeli U. Coronary Heart Disease Among Non-Western Immigrants in Europe. UPDATES IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2018. [DOI: 10.1007/978-3-319-93148-7_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Diverging patterns of cardiovascular diseases across immigrant groups in Northern Italy. Int J Cardiol 2017; 254:362-367. [PMID: 29246427 DOI: 10.1016/j.ijcard.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/15/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Only fragmentary data are available on the burden of non-communicable diseases among immigrants in Europe, mostly limited to mortality by cause. Aim of the study is to investigate the prevalence of cardiovascular diseases across different immigrant groups in the Veneto Region (North-Eastern Italy). METHODS The resident population aged 20-59 was classified according to country of citizenship. The Adjusted Clinical Groups System was adopted to identify selected cardiovascular conditions by linkage of Hospital Discharge Records, Emergency Room visits, Chronic disease registry for copayment exemptions, the Home care database, and drugs reimbursed by the Regional Health Service. Age standardized prevalence rates were compared across population groups, and rate ratios (RR) with 95% confidence intervals (CI) were computed taking the Italian population as reference. RESULTS The prevalence of diabetes was higher across all immigrant groups compared to Italians. Specific risk patterns could be identified associated to different ethnicities: South Asian immigrants were at very high risk of diabetes, dyslipidemia, and ischemic heart disease (males RR 2.3, CI 1.9-2.8; females RR 2.0, CI 1.2-3.5). Immigrants from Africa were affected by high rates of hypertension, cerebrovascular diseases, and heart failure, with a more pronounced unfavorable profile among females (hypertension RR 3.0, CI 2.6-3.3; cerebrovascular diseases RR 1.7, CI 1.1-2.7). CONCLUSIONS Wide differences in the prevalence of cardiovascular diseases could be detected across immigrant groups. These findings represent a first step towards systematic chronic disease surveillance by ethnicity, a fundamental tool for shaping culturally-tailored prevention strategies.
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17
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Risk of disability pension in first and second generation immigrants: the role of age and region of birth in a prospective population-based study from Sweden. BMC Public Health 2017; 17:931. [PMID: 29202827 PMCID: PMC5716008 DOI: 10.1186/s12889-017-4944-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In several countries, immigrants have higher disability pension (DP) rates than natives. Reasons for this are poorly understood. The aim of this study was to investigate if the risk of diagnosis-specific DP differed in first, second, and second/intermediate generation immigrants compared to natives, in general and across regions of birth, and stratified by age. METHODS A population-based prospective cohort study of all 3,507,055 individuals aged 19-50 years and living in Sweden in 2004 with a 6-year follow-up period. Hazard ratios (HR) and 95% confidence intervals (CI) for mental and somatic DP were estimated by Cox regression for first, second, and second/intermediate generation immigrants compared to natives, across regions of birth and stratified by age. RESULTS After multivariate adjustment, HRs for both mental and somatic DP were higher at follow-up in the first generation compared to natives: mental HR 1.17 (CI 1.12-1.22) and somatic 1.15 (1.09-1.22) for individuals <35 years; 1.74 (1.69-1.79) and 1.70 (1.66-1.74) ≥35 years (median), respectively. Immigrants born in Europe outside EU25, and countries outside Europe had particularly elevated HRs. Also in the second generation, HRs were higher in mental 1.29 (1.21-1.37) and somatic DP: 1.30 (1.19-1.42) in those <35 years; and 1.18 (1.10-1.27); and 1.10 (1.03-1.17) for those ≥35 years, respectively. Among second generation immigrants there were no strong differences in HRs between regions of birth. CONCLUSIONS Compared to natives, the risk of DP was higher in first and second generation immigrants. Higher estimates were seen for immigrants from Europe outside EU25 and from the rest of the world in the first generation. No considerable differences in estimates regarding mental or somatic DP diagnoses were found.
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18
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Adams DB, Narayan O, Munnur RK, Cameron JD, Wong DTL, Talman AH, Harper RW, Seneviratne SK, Meredith IT, Ko BS. Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography. Int J Cardiovasc Imaging 2016; 33:241-249. [PMID: 27672064 DOI: 10.1007/s10554-016-0982-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/19/2016] [Indexed: 01/09/2023]
Abstract
Epidemiological studies observed a higher prevalence of coronary atherosclerosis in South Asians when compared to Caucasians, but quantitative computed tomography differences in aggregate plaque volume (APV) and epicardial fat volume (EFV) between South Asians, Southeast or East Asians (SEEAs) and Caucasians remain unknown. We aimed to compare APV and EFV quantified on computed-tomographic-coronary-angiography (CTCA) between South Asian, SEEA and Caucasian populations residing in Australia. Age, gender and body-mass-index matched subjects from three ethnic groups who underwent clinically indicated 320-detector CTCA were retrospectively analysed. Percentage APV in the first 5 cm of the left anterior descending artery (LAD) and EFV were quantified using dedicated software (Vital Images, USA). One-hundred-and-fifty subjects (average age = 57.7 years, 56 % male, n = 50 in each ethnic group) were analysed. Mean LAD percentage APV was highest in South Asians (44.5 ± 8.4 % vs. 37.5 ± 6.5 % in SEEAs and 39.5 ± 6.4 % in Caucasians, P = 0.00001). South Asian ethnicity predicted LAD APV above traditional risk factors on multivariate analysis (P = 0.000002). EFV was significantly higher in both South Asians (103.2 ± 41.7 cm3 vs. 85.8 ± 39.4 cm3, P = 0.035) and SEEAs (110.8 ± 36.9 cm3 vs. 85.8 ± 39.4 cm3, P = 0.001) when compared with Caucasians. In this cohort LAD percentage APV and EFV, as quantified on CTCA, differs between South Asians, SEEA and Caucasian populations, with higher LAD APV observed in South Asians and lower EFV in Caucasians. Atherosclerotic volume in LAD was best predicted by South Asian ethnicity above traditional risk factors and EFV. Further research is required to establish whether APV and EFV quantification can improve cardiac risk prediction in the South Asian population.
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Affiliation(s)
- Daniel B Adams
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Om Narayan
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Ravi Kiran Munnur
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - James D Cameron
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Dennis T L Wong
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Andrew H Talman
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Richard W Harper
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Sujith K Seneviratne
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Ian T Meredith
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia
| | - Brian S Ko
- Department of Medicine Monash Medical Centre (MMC), Monash Cardiovascular Research Centre, MonashHEART, Monash Health and Monash University, Melbourne, Australia.
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315-2381. [PMID: 27222591 PMCID: PMC4986030 DOI: 10.1093/eurheartj/ehw106] [Citation(s) in RCA: 4367] [Impact Index Per Article: 545.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Corresponding authors: Massimo F. Piepoli, Heart Failure Unit, Cardiology Department, Polichirurgico Hospital G. Da Saliceto, Cantone Del Cristo, 29121 Piacenza, Emilia Romagna, Italy, Tel: +39 0523 30 32 17, Fax: +39 0523 30 32 20, E-mail: ,
| | - Arno W. Hoes
- Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands, Tel: +31 88 756 8193, Fax: +31 88 756 8099, E-mail:
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GYH, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23:NP1-NP96. [PMID: 27353126 DOI: 10.1177/2047487316653709] [Citation(s) in RCA: 567] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societies: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societies: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Naveed Sattar
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leslie Cho
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Miles Fisher
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lars Rydén
- Societies: European Society of Cardiology (ESC)
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Sohail QZ, Chu A, Rezai MR, Donovan LR, Ko DT, Tu JV. The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Alves L, Azevedo A, Barros H, Vollenweider P, Waeber G, Marques-Vidal P. Prevalence and management of cardiovascular risk factors in Portuguese living in Portugal and Portuguese who migrated to Switzerland. BMC Public Health 2015; 15:307. [PMID: 25879907 PMCID: PMC4392627 DOI: 10.1186/s12889-015-1659-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information regarding the health status of migrants compared to subjects who remain in the country of origin is scarce. We compared the levels and management of the main cardiovascular risk factors between Portuguese living in Porto (Portugal) and Portuguese migrants living in Lausanne (Switzerland). METHODS Cross-sectional studies conducted in Porto (EPIPorto, 1999 to 2003, n = 1150) and Lausanne (CoLaus, 2003 to 2006, n = 388) among subjects aged 35-65 years. Educational level, medical history and time since migration were collected using structured questionnaires. Body mass index, blood pressure, cholesterol and glucose levels were measured using standardized procedures. RESULTS Portuguese living in Lausanne were younger, more frequently male and had lower education than Portuguese living in Porto. After multivariate adjustment using Poisson regression, no differences were found between Portuguese living in Porto or in Lausanne: prevalence rate ratio (PRR) and (95% confidence interval) for Portuguese living in Lausanne relative to Portuguese living in Porto: 0.92 (0.71 - 1.18) for current smoking; 0.78 (0.59 - 1.04) for obesity; 0.81 (0.62 - 1.05) for abdominal obesity; 0.82 (0.64 - 1.06) for hypertension; 0.88 (0.75 - 1.04) for hypercholesterolemia and 0.92 (0.49 - 1.73) for diabetes. Treatment and control rates for hypercholesterolemia were higher among Portuguese living in Lausanne: PRR = 1.91 (1.15 - 3.19) and 3.98 (1.59 - 9.99) for treatment and control, respectively. Conversely, no differences were found regarding hypertension treatment and control rates: PRR = 0.98 (0.66 - 1.46) and 0.97 (0.49 - 1.91), respectively, and for treatment rates of diabetes: PRR = 1.51 (0.70 - 3.25). CONCLUSIONS Portuguese living in Lausanne, Switzerland, present a similar cardiovascular risk profile but tend to be better managed regarding hypercholesterolemia than Portuguese living in Porto, Portugal.
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Affiliation(s)
- Luís Alves
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
- St. André de Canidelo Family Health Unit, Vila Nova de Gaia, Portugal.
| | - Ana Azevedo
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
| | - Henrique Barros
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, CHUV and Faculty of biology and medicine, Lausanne, Switzerland.
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, CHUV and Faculty of biology and medicine, Lausanne, Switzerland.
| | - Pedro Marques-Vidal
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopole 2, Route de la Corniche 10, CH, 1010, Lausanne, Switzerland.
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van der Wal JM, Bodewes AJ, Agyemang CO, Kunst AE. Higher self-reported prevalence of hypertension among Moluccan-Dutch than among the general population of The Netherlands: results from a cross-sectional survey. BMC Public Health 2014; 14:1273. [PMID: 25511556 PMCID: PMC4301884 DOI: 10.1186/1471-2458-14-1273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/11/2014] [Indexed: 11/26/2022] Open
Abstract
Background Several studies in the Netherlands revealed ethnic disparities in hypertension prevalence, but none have focused on the Moluccan-Dutch, a migrant group from Indonesia that settled in the Netherlands in 1951. The Moluccan-Dutch are considered to be fairly well integrated in Dutch society. The aim of this study was to compare hypertension prevalence among the Moluccan-Dutch to the native Dutch and to explore the contribution of known risk factors. Methods A health interview survey was conducted from August 2012 till March 2013 among nineteen Moluccan neighborhoods, resulting in the inclusion of 708 participants. The primary outcome variable was self-reported prevalence of hypertension. Explanatory variables were BMI, exercise, smoking, alcohol intake and mental health status. Data on the control group was extracted from the Dutch National Health Survey 2011, using a similar questionnaire. Differences in risk factor exposure were explored using Chi-square tests and the contribution of risk factors, separately and combined, was explored using multivariate logistic regression analysis. Results Moluccan-Dutch showed higher odds for reporting hypertension when compared to native Dutch, after adjusting for age and level of education (OR = 1.38; 95% CI = 1.13-1.69) and additional risk factors (OR = 1.49; 95% CI = 1.19-1.88). A higher prevalence of hypertension was found in both Moluccan-Dutch men (26.4% vs. 16.7%; p < 0.001) and women (26.7% vs. 17.9%; p < 0.001), when compared to the control group. Not only middle-aged, but also young Moluccan-Dutch men showed higher prevalence of hypertension. Conclusion The Moluccan-Dutch may be at increased risk for reporting hypertension. These results suggest that long-term stay over several generations does not necessarily result in similar levels of hypertension prevalence as the host population.
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Affiliation(s)
- Junus M van der Wal
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Agyemang C, van Oeffelen AAM, Norredam M, Kappelle LJ, Klijn CJM, Bots ML, Stronks K, Vaartjes I. Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands. Stroke 2014; 45:3236-42. [PMID: 25270628 DOI: 10.1161/strokeaha.114.006462] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. METHODS A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch). RESULTS Compared with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0.16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence of ischemic stroke and intracerebral hemorrhage compared with ethnic Dutch. CONCLUSIONS Our findings suggest that Surinamese have an increased risk, whereas Moroccans have a reduced risk for all the various stroke subtypes. Among other ethnic minorities, the risk seems to depend on the stroke subtype and sex. These findings underscore the need to identify the root causes of these ethnic differences to assist primary and secondary prevention efforts.
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Affiliation(s)
- Charles Agyemang
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Aloysia A M van Oeffelen
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Marie Norredam
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - L Jaap Kappelle
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Catharina J M Klijn
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Michiel L Bots
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Karien Stronks
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
| | - Ilonca Vaartjes
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.)
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Anujuo K, Stronks K, Snijder MB, Jean-Louis G, Ogedegbe G, Agyemang C. Ethnic differences in self-reported sleep duration in the Netherlands – the HELIUS study. Sleep Med 2014; 15:1115-21. [DOI: 10.1016/j.sleep.2014.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/11/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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Dotsenko E, Salivonchyk D, Welcome OM, Dotsenko K, Salivonchyk S, Bobkov V, Nikulina N, Semeniago E, Nerobeeva S. Influence of hyperbaric oxygenation treatment (HBOT) on clinical outcomes (recurrent myocardial infarction and survival rate) during five-year monitoring period after acute myocardial infarction. Health (London) 2014. [DOI: 10.4236/health.2014.61008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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