Prevalence, control, and treatment of diabetes, hypertension, and high cholesterol in the Amish

Abstract

BackgroundThe burden of diabetes and cardiovascular risk is not uniform across the USA, with much of this disparity tracking differences in socioeconomic status, cultural practices and lifestyle. To further evaluate disparities in these disorders, we assessed the prevalence of diabetes, hypertension, and hypercholesterolemia in an Old Order Amish community that is characterized by distinctive sociocultural practices that include a very cohesive social structure and limited use of modern technologies and medications. We compared prevalence of these conditions with that of the overall US population.MethodWe performed a community-wide survey in 5377 Amish individuals aged 18 years and older from the Lancaster County, Pennsylvania, Amish settlement that included a basic physical examination and fasting blood draw during the period 2010–2018. We then compared the prevalence of diabetes, hypertension, and high cholesterol, defined using standard criteria, between the Amish and the European Caucasian subsample of the 2013–2014 US National Health and Nutrition Examination Survey (NHANES).ResultsPrevalence rates for diabetes, hypertension and hypercholesterolemia were 3.3%, 12.7%, and 26.2% in the Amish compared with 13.2%, 37.8% and 35.7% in NHANES (p<0.001 for all). Among individuals with these disorders, Amish were less likely to be aware that they were affected, and among those aware, were less likely to be treated with a medication for their disorder.ConclusionThere is substantially lower prevalence of diabetes, hypertension and hypercholesterolemia in the Amish compared with non-Amish Caucasians in the USA. Possible factors contributing to this disparity include higher physical activity levels in the Amish or other protective sociocultural factors, a greater understanding of which could inform risk reduction interventions for these chronic diseases.

Impact of parental relatedness on reproductive outcomes among the Old Order Amish of Lancaster County

“…This study was based on 6136 Amish individuals from Lancaster, PA over 18 years of age and who were recruited through prior community‐wide studies conducted over the past 20 years (He et al, 2020; Xu et al, 2017). Study subjects had previously filled out detailed surveys regarding their prior pregnancy and reproductive histories including number of pregnancies, number of children, birth date of each child, number of stillbirths, and number of miscarriages.…”

“…Through our long‐standing population health studies in the Lancaster Amish (He et al, 2020; Hsueh et al, 2000; Mitchell et al, 2008; Streeten et al, 2003), we retrospectively identified 1824 couple pairs in whom we had performed exome sequencing (ES) and obtained detailed information about pregnancy outcomes. In this study, we evaluate the impact of known highly penetrant recessive variants (Crowgey et al, 2019) on reproductive outcomes.…”

Sugar-sweetened beverage consumption and mortality of chronic kidney disease: results from the US National Health and Nutrition Examination Survey, 1999–2014

“…Diabetes was defined as self-reported diabetes (or reported use of anti-hyperglycemic medications), or glycol hemoglobin ≥6.5% or measuring fasting glucose ≥126 mg/dL [ 36 ]. Hypertension was defined as self-reported hypertension (or reported use of anti-hypertensive medications) or measured systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg [ 36 ]. High cholesterol was defined as the ratio of total cholesterol to HDL of >5.9 [ 37 ].…”

Relation Between Dietary Carotenoid Intake, Serum Concentration, and Mortality Risk of CKD Patients Among US Adults: National Health and Nutrition Examination Survey 2001–2014

“…Diabetes was defined that reported: (1) self-reported diabetes; (2) the use of anti-hyperglycemic agents; (3)measured fasting plasma glucose ≥ 126 mg/dL; (4) 2-h plasma glucose ≥ 200 mg/dL during a 75-g oral glucose tolerance test; (5) glycolhemoglobin ≥ 6.5% (27). And hypertension was defined as people who: (1) self-reported hypertension; (2) reported use of antihypertensive agents; (3) measured systolic blood pressure ≥ 140 mmHg; (4)diastolic blood pressure ≥ 90 mmHg (27). High cholesterol levels were defined as the total-to-HDL cholesterol ratio was more than 5.9 (27).…”

“…And hypertension was defined as people who: (1) self-reported hypertension; (2) reported use of antihypertensive agents; (3) measured systolic blood pressure ≥ 140 mmHg; (4)diastolic blood pressure ≥ 90 mmHg (27). High cholesterol levels were defined as the total-to-HDL cholesterol ratio was more than 5.9 (27). And participants were considered to have a history of cardiovascular disease if they reported ever being told they had any of the following conditions by a health care provider: congestive heart failure, coronary heart disease, angina pectoris, heart attack, or stroke (28).…”