Diabetes among Ethiopian Immigrants to Israel: Exploring the Effects of Migration and Ethnicity on Diabetes Risk.

OBJECTIVE:Diabetes prevalence among ethnic minorities and immigrants often differs from the majority indigenous population. We compared diabetes prevalence, incidence and risk among Ethiopian and non-Ethiopian Jews. Within these main groups, we controlled for the effect of migration on diabetes risk by comparing the subgroups of Ethiopian and former Soviet Union (FSU) immigrants, and compared both with Israeli-born non-Ethiopian Jews. METHODS:The study cohort included adult Ethiopian (n = 8,398) and age-matched non-Ethiopian Jews (n = 15,977) and subgroups: Ethiopian immigrants (n = 7,994), FSU immigrants (n = 1,541) and Israeli-born non-Ethiopian Jews (n = 10,828). Diabetes prevalence, annual incidence, and hazard ratios (HRs) adjusted for sex and metabolic syndrome (MetS)-components, were determined in three age groups (<50yrs, 50-59yrs, and ≥60yrs). Comparisons of body mass index (BMI) at diabetes incidence were made. RESULTS:Younger (<50yrs) Ethiopians had higher prevalence rates, 3.6% (95%CI: 3.1-4.1) and annual incidence, 0.9% (95%CI: 0.8-1.0) than non-Ethiopians, 2.7% (95%CI: 2.3-3.0) and 0.5% (95%CI: 0.4-0.6), respectively. These differences were particularly pronounced among Ethiopian women. Diabetes risk among Ethiopians was higher and adjustment for MetS-components was important only for BMI, which further increased hazard ratio (HR) estimates associated with Ethiopian ethnicity from 1.81 (95% CI:1.50-2.17) to 2.31 (95% CI:1.91-2.79). The same differences were seen when comparing Ethiopian to FSU immigrants. BMI before incident diabetes was lower among younger Ethiopian immigrants than younger FSU immigrants and Israeli-born. CONCLUSIONS:Ethiopian ethnicity is associated with increased diabetes risk, which is age and BMI dependent. Young Ethiopians<50yrs, particularly women, had the greatest increase in risk. Lower BMI cut-offs should be defined to reflect diabetes risk among Ethiopians

Baseline characteristics of the study cohort.

<p>Baseline characteristics of the study cohort.</p

Adult Arabs have higher risk for diabetes mellitus than Jews in Israel

<div><p>Objective</p><p>Diabetes mellitus is an emerging epidemic in the Arab world. Although high diabetes prevalence is documented in Israeli Arabs, information from cohort studies is scant.</p><p>Methods</p><p>This is a population study, based on information derived between 2007–2011, from the electronic database of the largest health fund in Israel, among Arabs and Jews. Prevalence, 4-year-incidence and diabetes hazard ratios [HRs], adjusted for sex and the metabolic-syndrome [MetS]-components, were determined in 3 age groups (<50 years, 50–59 years, and ≥60 years).</p><p>Results</p><p>The study cohort included 17,044 Arabs (males: 49%, age: 39.4±17.3) and 16,012 Jews (males: 50%, age: 40.5 ±17.6). The overall age and sex-adjusted diabetes prevalence rates were much higher among Arabs 18.4% (95%CI: 17.6–19.1); and 10.3% (95%CI: 9.7–10.9) among Jews. Arab females had higher prevalence rates 20.0% (95%CI: 19–21) than Arab males 16.7% (95%CI: 15.7–17.8). Annual incidence rates were also significantly higher among Arabs 2.9% (95%CI: 2.7–3.1) than among Jews 1.7% (95%CI: 1.6–1.8). This held true across all age and sex subgroups. Adjustment for body mass index [BMI] attenuated HR estimates associated with Arab ethnicity across all age subgroups, mainly in the <50yrs age group from HR 2.04 (95%CI: 1.74–2.40) to 1.64 (95%CI: 1.40–1.92). BMI at incident diabetes among females was higher in Arabs than Jews. Males, however, did not differ by ethnicity.</p><p>Conclusion</p><p>Arabs, mainly female, have high incidence and prevalence of diabetes. This excess risk is only partially explained by the high prevalence of obesity. Effective culturally-congruent diabetes prevention and treatment and an effective engagement partnership with the Arab community are of paramount need.</p></div

Baseline characteristics of the study cohort.

<p>Baseline characteristics of the study cohort.</p

Standardized and age-specific prevalence and weighted cumulative 4-yr incidence per 100 persons of diabetes (95% confidence interval)^*.

<p>Standardized and age-specific prevalence and weighted cumulative 4-yr incidence per 100 persons of diabetes (95% confidence interval)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176661#t002fn002" target="_blank">*</a>}.</p

Standardized and age-specific prevalence and weighted average annual incidence per 100 persons of diabetes (95% confidence interval)^* over the period of 2008–11.

<p>Standardized and age-specific prevalence and weighted average annual incidence per 100 persons of diabetes (95% confidence interval)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0157354#t002fn002" target="_blank">*</a>} over the period of 2008–11.</p

Cox proportional hazard ratios (95% confidence interval) for incident diabetes by ethnicity, age, sex and components of the metabolic syndrome^*.

<p>Cox proportional hazard ratios (95% confidence interval) for incident diabetes by ethnicity, age, sex and components of the metabolic syndrome^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176661#t003fn001" target="_blank">*</a>}.</p

Cox proportional hazard ratios (95% confidence interval) for incident diabetes by ethnicity, age, sex and components of the metabolic syndrome^*.

<p>Cox proportional hazard ratios (95% confidence interval) for incident diabetes by ethnicity, age, sex and components of the metabolic syndrome^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0157354#t003fn001" target="_blank">*</a>}.</p

BMI among patients with incident diabetes and healthy controls by ethnicity and age^*.

<p>BMI among patients with <u>incident</u> diabetes and healthy controls by ethnicity and age^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176661#t004fn001" target="_blank">*</a>}.</p

Additional file 1 of Effect of temperature on Escherichia coli bloodstream infection in a nationwide population-based study of incidence and resistance

Additional file 1: Table S1. Characteristics of E. coli bloodstream infections by place of onset and by season