Lipids and lipoproteins in new immigrant Ethiopian Jews in Israel

Cardiovascular Disease and hospital admissions in African immigrants and former Soviet Union immigrants: A retrospective cohort study

BACKGROUND

Previous studies reported low prevalence of cardiovascular disease (CVD) despite an increasing prevalence of metabolic abnormalities in immigrants who moved from low CVD-risk regions to Western countries. Nevertheless, little is known about hospital admissions due to CVD in immigrants.

METHODS

A retrospective cohort study of East Africa immigrants (EAI), Former Soviet Union immigrants (FSUI) and native-born Israelis (NBI) over 11-year period. Associations between ethnicity, age, sex, CVD, and hospital admission were assessed using logistic and Poisson regression models. Incidence density rates per person-years were calculated.

RESULTS

The age-adjusted prevalence rates of ischemic heart disease in EAI, FSUI and NBI, respectively, were 1.8%, 8.2%, and 5.8%, respectively (p < 0.001). The corresponding rates for stroke were 2.6%, 3.5%, and 2.5%, respectively. Multivariate odds ratios for all CVD were found to be significantly lower in EAI for both sexes. Hospitalizations rate due to CVD were 9, 17, and 6 per 1000 person-years in EAI, FSUI and NBI, respectively (p < 0.001). EAI were more likely to be hospitalized due to hypertensive disease, cerebral vascular diseases and heart disease, in comparison to NBI and FSUI. However, when controlling for CVD risk factors profile, EAI had similar admission rates to NBI. EAI were more likely to be hospitalized in internal medicine, geriatrics, and neurology departments, and less likely to be admitted to intensive care units or surgical department.

CONCLUSIONS

EAI had low rates of all types of CVD, and low risk of hospitalization after controlling for CVD risk factors profile.

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

Background

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

Methods

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

Results

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

Conclusions

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

STUDY OBJECTIVE

The aim was to determine the effect of migration from a non-industrialised to an industrialised society on age related changes in blood pressure and serum cholesterol.

DESIGN

The study was a comparison of major risk factors for cardiovascular disease in cross sectional surveys in two groups: Ethiopian immigrants and Israeli industrial employees.

SETTING

Ethiopian immigrants were examined at Army induction centres in Israel; industrial employees were examined in the course of a national Israeli study on occupational risk factors for cardiovascular disease.

PARTICIPANTS

Participants were a sample of 387 male Ethiopians, aged 20-49 years, examined in 1987, who had immigrated to Israel three to four years previously, and a sample of 2747 male Israeli industrial employees in the same age group examined in 1985-7.

MEASUREMENTS AND MAIN RESULTS

Among the Ethiopians there were no cases of overweight (Quetelet's index above 2.8) and only 6.7% were smokers, as compared with 20.7% overweight and 47.1% smokers among the other Israelis (p less than 0.001 for both variables). There were no significant differences in the prevalence of hypertension (11.6% and 13.0% for Ethiopians and other Israelis respectively). Hypercholesterolaemia (greater than 5.2 mmol/litre, 200 mg/dl) was much more prevalent among the other Israelis (42.0% v 9.6%, p less than 0.001). Blood pressures were similar and increased with age in both groups. However, in contrast to the other Israelis, average serum cholesterol among the Ethiopians was low and increased minimally with age. After regression adjustment for age and body mass index, blood pressures were higher among the Ethiopians, whereas serum cholesterol remained considerably higher among the other Israelis. Serum cholesterol was correlated with blood pressure in both groups.

CONCLUSIONS

Since Ethiopian immigrants have been found to have uniformly low blood pressures on arrival in Israel, these findings suggest that there is an age dependent effect on blood pressure resulting from migration which is not reflected in the serum cholesterol values.