Risk of Developing Diabetes Among Refugees and Immigrants: A Longitudinal Analysis

Abstract

To determine the difference in risk of developing diabetes for refugees, immigrants, and American-born participants living in the same communities, and to explore potential mediators of that difference. Retrospective longitudinal cohort from January 1, 2003 and December 31, 2013. Refugees aged ≥18 years were matched in a 1:3 ratio by age, gender, and date of care initiation to (1) Spanish-speaking non-refugee immigrants, and (2) English-speaking controls receiving care in the same community health center. We used proportional hazards regression to estimate the risk of incident diabetes. We tested whether differences in education or baseline obesity mediated diabetes risk using counterfactual mediation analysis. We included 3174 participants. Among refugee participants, the most common countries of origin were Somalia (17.8 %), Iraq (16.7 %) and Bhutan (8.8 %). Diabetes incidence rate was 1.94, 1.91, and 1.22 cases per 100 person-years follow-up for refugees, immigrants, and controls, respectively. In adjusted models, both refugee (HR 2.08 95 % CI 1.32-3.30) and immigrant (HR 1.51 95 % CI 1.01-2.24) statuses were associated with increased diabetes risk compared with controls. Risk between refugees and immigrants did not differ (adjusted HR for refugees 1.37 95 % CI 0.91-2.06). In mediation analyses, educational attainment mediated 36 % (p = 0.007) of the difference in diabetes risk between refugees/immigrants and controls. Baseline obesity did not mediate difference in diabetes risk (proportion mediated 1 %, p = 0.84). Refugees and immigrants had significantly increased risk for diabetes, partially mediated by education. Education-based lifestyle interventions may be a promising strategy to prevent diabetes for these vulnerable patients.

Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

“…Among the 16 publications looking at physical health outcomes among all resettled refugee populations, 9 articles specific refugee adults as the target population [7,[11][12][13][14][15][16][17][18], and 7 articles specified refugee children [9,[19][20][21][22][23][24]. Most articles did not specify countries of origin, but rather grouped refugee country of origin into geographic regions (e.g., Southeast Asia and Africa).…”

Diabetes in developing countries

“…These individuals face stress, changing living conditions, and imbalanced diets. To date, such groups have not been researched adequately, but some data suggest increased risk of diabetes and its coexistence with tuberculosis …”

Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016

“…Although the nutrition transition is well underway in LMIC settings, there remains a paucity of data documenting trends in nutritional status of marginalised populations in these contexts, particularly for pregnant refugee and migrant women. Most of the published data on these populations come from refugee and migrant populations resettled in high-income countries (21,22) . With a growing global need to address the health of refugees, displaced persons and migrant communities in both LMIC and high-income countries, we examine changes in nutritional status among pregnant women from the Thailand-Myanmar border: in the setting of a protracted refugee situation and among a large and growing migrant worker population from Myanmar.…”