AnnotatedBibliography:DiabetesandHypertension

Geltman,P.L.,Dookeran,N.M.,Battaglia,T.,&Cochran,J.(2010).Chronicdiseaseanditsriskfactors
amongrefugeesandasyleesinMassachusetts,20012005.PrevChronicDis,7(3),A51.

Thepurposeofthestudywastoexaminetheprevalenceofriskfactorsforanddiagnosesofchronic
diseasesamongrefugeesandasyleesresettledinMassachusetts.Theauthorsperformeda
retrospectivecrosssectionalstudyusingRefugeeHealthAssessmentProgram(RHAP)datafromhealth
screeningsofnewlyarrivingrefugeesandasylees.Thestudyalsodeterminedprevalenceof
obesity/overweight,hypertension,diabetes,anemia,andhistoryofcoronaryarterydisease(CAD).
Europe/CentralAsiaandAfricawerethetoptworegionsoforiginrepresenting4,289adultswho
completedhealthscreeningfromJanuary1,2001throughDecember31,2005.Resultsshowedthat
almostonefifthofthesamplewasobeseandmorethanonefourthwasoverweight.Thelargest
portionoftheseindividualswasfromEuropeandCentralAsia.Almostonefourthhadhypertension
diagnoseswithdocumentationhighestamongpeoplefromEuropeandCentralAsia.Refugeesand
asyleesfromEastandSoutheastAsiahadthelowestprevalenceofobesity/overweightandthelowest
prevalenceofhypertension.TheywerealsomorelikelythanothertohaveCAD.Atotalof157
diagnosesofCAD,153wereamongrefugeesratherthanasyleesand80%ofthesehadbeen
documentedinreportsfromoverseasmedicalexaminations.Amongthetotalof131diabetes
diagnoses,71wereamongrefugeesand49%oftheseweredocumentedinreportsofoverseasmedical
examinations.
Theregionaloriginofrefugeesandasyleeswasstronglyassociatedwithprevalenceofriskfactorsfor
chronicdiseasesexceptdiabetes.AlthoughratesofCADanddiabetesarelowinthesample,thestudy
foundahighprevalenceofriskfactorsforchronicdiseasesuchasobesity/overweightandhypertension.
PopulationsresettlingintheUnitedStatesshouldbescreenedforchronicdiseaseriskfactorsandbe
linkedtomoreresourcestoaddresstheirlongtermhealthcareneedsandtoreceiveculturally
appropriatecounselingandeducationforriskreduction.
HealthofresettledIraqirefugeesSanDiegoCounty,California,October2007September2009.
(2010).MMWRMorbMortalWklyRep,59(49),16141618.
ThestudyreviewedrefugeehealthscreeningdataofIraqirefugeesresettlinginSanDiegoCounty,
California,USAinFiscalYear2008and2009.Among4,923screenedrefugeesaged>1year,692(14.1%)
hadlatenttuberculosisinfection(LTBI),and751(24.5%)wereclassifiedasobese.Among2,704adult
refugees,410(15.2%)werehypertensive.Ofrefugeesaged40yearsthatwerescreenedfor
hyperlipidemia,89.9%haddyslipidemia.Fewhadevidenceofpathogenicintestinalparasitesonstool
examination.

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Theeditorialnoteaccompanyingthearticlecomparesthefindingswiththatofthegeneralpopulationin
Californiaandprovidesscreeningconsiderationsbasedonkeyhighlightsfromtheaforementioned
assessments.TheprevalenceofobesityofIraqirefugeesinCalifornianearlyequalsthatofCalifornia
residents(24.6%and24.8%respectively).Theeditorsaddthatinadifferent2009surveyofIraqi
refugeesinJordanandSyriafoundthat41%51%ofrefugeesaged18yearsreportedadiagnosisof
chronicillnesssuchashypertension,diabetes,orcardiovasculardiseases.LTBIinIraqirefugeesaged
65yearswascomparabletoratesinotherrefugeepopulations.
Theeditorsemphasizetheimportanceofevaluationforobesity,hypertension,anddyslipidemiaduring
medicalassessmentandscreeningfordiabetesandheartdiseaseamongthosewithriskfactors.Testing
forLTBIshouldbeencouragedandtreatmentofferedtothosewithpositivetestresults.Theeditors
alsorecommendthattheCentersforDiseaseControlandPrevention(CDC)andstatepublichealth
departmentsshouldcollaborateinimprovingdatacollectionfornewlyarrivingrefugeesregarding
infectiousandchronicdiseases.
Kinzie,J.D.,Riley,C.,McFarland,B.,Hayes,M.,Boehnlein,J.,Leung,P.,etal.(2008).Highprevalence
ratesofdiabetesandhypertensionamongrefugeepsychiatricpatients.JNervMentDis,
196(2),108112.

Thestudyentailedachartreviewaimedtounderstandprevalenceratesofdiabetesandhypertension
amongrefugeepsychiatricpatientsattheInterculturalPsychiatricProgram(IPP)attheOregonHealth
andScienceUniversity,focusingonVietnamese,Cambodian,Somali,andBosnianrefugeepsychiatric
patients.EachpatientsufferedmultipletraumasandwasinactivetreatmentinIPPbetween2004and
2006.Thestudyassessedvariationsinprevalenceofdiabetesandhypertensionbasedonobesity(as
determinedbybodymassindex(BMI)),age,andmaritalstatus.
Variablesincludingethnicgroup,gender,age,maritalstatus,yearsintheUnitedStates,andpsychiatric
diagnosis,madeusingDiagnosticStatisticalManualIV(DSMIV)criteria.Additionally,medical
diagnoses,medicationsandsmokingandalcoholhistorywerenoted.Ofthe459participants,64.2%had
aPTSDdiagnosisusuallyassociatedwithmajordepression;16.8%hadmajordepressionalone;and
11.4%hadsometypeofpsychosis.
CambodiansexperiencedthehighestrateoftraumafollowedbySomali,Bosnian,andlastlythe
Vietnameserefugees.Fortytwopercenthadhypertension,varyingfrom51%ofCambodiansto32%of
Somalis.Additionally,15.5%ofthegrouphasdiabetes,varyingfrom24%amongSomalisto13%among
Vietnamese.Prevalenceofhypertensionintheparticipantswashigherthancurrentreportedratesin
countriesfromwhichrefugeesoriginated.
Prevalenceofhypertensioncorrelatedtoleveloftraumabutthefindingsarenotstatisticallysignificant.
AgeandBMIweretheonlystatisticallysignificantfactorsassociatedwithhypertension(p<0.000)while
otherfactors,suchasmaritalstatus,trauma,gender,andethnicgroupdidnotreachstatistical

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significance.Diabeteswasassociatedwithtrauma(p<0.008),maritalstatus(p<0.018),andage(p<
0.04),butwhencontrollingforBMI,onlyBMIremainedstatisticallyassociatedwithdiabetes.
Thestudyshowedthatrefugeepsychiatricpatientshadhighprevalenceofhypertensionanddiabetes
comparedtotheU.S.population.Psychiatricpatientsmayhaveincreasedriskfactorsforcardiovascular
diseasesingeneral.Additionally,chronicdiseasesarerapidlyincreasingindevelopingcountriesand
therefore,refugeesarriveintheU.S.withanexistingriskthatmaybeexacerbatedbytrauma.
Therefore,theauthorsconcludedthatrefugeeswithpsychiatricdiagnosesshouldbeparticularly
screenedforchronicdiseases.
Wieland,M.L.,Morrison,T.B.,Cha,S.S.,Rahman,A.S.,&Chaudhry,R.(2011).DiabetesCareAmong
SomaliImmigrantsandRefugees.JCommunityHealth.
Thestudyexploresthequalityofdiabetescareamong81Somalipatientswithdiabetes,olderthan18
years,withanassignedprimarycareproviderinthePrimaryCareInternalMedicineandFamily
MedicineclinicsatMayoClinicRochesterinMidwestUnitedStates.Thesepatientrecordswere
abstractedfromApril1,2008toJune30,2008.Thequalityofdiabetescarewascomparedtopatients
thatwerenotidentifiedasSomaliintheelectronicmedicalrecords.
ThecriteriausedforcompliancewithdiabetesqualityindicatorwashemoglobinA1C<7%,LDL
cholesterol<100mg/dl,bloodpressure<130/80mmHg,adaptedfromtheAmericanDiabetes
Associationguidelinesthatwerecurrentduringthestudyinterval.Thecompletionofdiabetesrelated
testswasretrievedfromallsourcedatasystemsattheclinictoassesstherateofadherencewith
diabetesqualitymetricsforbothSomaliandnonSomalipatients.Healthseekingbehaviors(i.e.number
ofprimarycarevisits,andemergencydepartmentvisits)werealsoextractedfrompatientsmedical
records.
ResultsshowedthatSomalipatientswithdiabeteswerelesslikelytomeettheoptimalglycemiccontrol
thannonSomalipatients.RatesoflipidcontrolamongnonSomalipatientswerenotstatistically
differentthancontrolsaswasthecasewithachievementofoptimalbloodpressure.Therewasno
differenceinachievementofoptimalbloodpressure.Thenumberofprimarycarevisitsduringthe
studyintervalwasassociatedwithachievementofallthreediabetescarequalitygoals.Therewasno
associationbetweenemergencydepartmentvisitsandachievementofthequalitygoals.
Thestudydemonstrateddisparitiesinachievementofdiabetesmanagementqualitygoalsamong
SomalipatientsascomparedtononSomalipatients.Indiscussionoftheirfindings,theauthors
suggestedthatlowhealthliteracymaybeafactorthatleadstothisdisparitybecauseoflinguisticand
culturalbarriersinpatientproviderrelationships.Thepositiveassociationbetweenprimarycarevisits
andachievementofdiabetesgoalssuggeststhatprogramsshouldpromotepatientprovider
relationshipsandhealthcareliteracyindiabetescare.

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Yanni,E.A.,Naoum,M.,Odeh,N.,Han,P.,Coleman,M.,&Burke,H.(2012).TheHealthProfileand
ChronicDiseasesComorbiditiesofUSBoundIraqiRefugeesScreenedbytheInternational
OrganizationforMigrationinJordan:20072009.JImmigrMinorHealth.
TheobjectiveofthisstudywastodescribethehealthprofileofUnitedStatesboundIraqirefugees
screenedbyInternationalOrganizationforMigration(IOM)inJordanduringJune2007September
2009.Theauthorsreviewedandanalyzeddatafor18,990IraqirefugeesfromJune2007toSeptember
2009.InfectiousdiseasessuchasTB,syphilis,HIV,andleprosywereidentified.Atextsearchinexam
resultsandphysiciannoteswereusedtoclassifychronicnoninfectiousconditionssuchashypertension,
diabetesmellitus(DM),andobesity.Riskfactorssuchassmokingandobesitywerealsoidentified.
Resultsshowedthatof14,077USboundIraqirefugees15years,onewasdiagnosedwithactiveTB,
251hadlatentTBinfection(LTBI),14werediagnosedwithsyphilisandwerereceivingtreatment,and
5,095(26.8%)hadatleastonechroniccondition.Of13,299,15yearswithavailablebloodpressure
information,33%hadhypertension(140/90),including25%havingstageIand8%havingstageII
hypertension.Anadditional42%ofIraqirefugeeswereprehypertensive(120139/8089).Of267
children314yearsofagewithmeasurementofbloodpressure,12hadhypertension.
Ofthe18,990refugeesscreened,2.7%(n=514)werediagnosedwithDM,ofwhich11%hadtypeIand
89%hadtypeII.OfthosediagnosedwithDM,84%hadhypertensionand22%hadprehypertension.In
total,35%ofscreenedIraqirefugeeswithavailableinformationhadatleastoneofthreechronic
conditions:hypertension,DM,orobesity.
Overall,thestudyshowedthatthisparticulargroupofIraqirefugeeshadlowprevalenceofinfectious
diseasesandhighratesofchronicconditions.Thestudysfindingsillustratedthedramatictrendin
somerecentrefugeepopulationsawayfromacuteinfectiousdiseasestowardchronichealthconditions
suchashypertensionanddiabetes.Inadditionpatientswithprehypertensionmaylikelydevelop
hypertensionthanthosewithlowerbloodpressurelaterinresettlement.Theauthorsconcludedthat
largenumbersofIraqisresettlingintheUSmaybeatriskfordevelopingcardiovasculardiseases.

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