ORIGINAL PAPER

Prevalence of Blood Pressure, Blood Glucose and SerumLipids Abnormalities Among Ethiopian Immigrants:A Community-Based Cross-Sectional Study

Maryam Ghobadzadeh • Ellen W. Demerath •

Yisehak Tura

� Springer Science+Business Media New York 2014

Abstract The main objective of this study was to

investigate the prevalence of hypertension, glucose and

blood lipid abnormalities among a community of Ethiopian

immigrants in Minnesota. This cross-sectional study used

data from the parish nursing program 2007–2012. A total

of 673 encounters were included in this study. Various

dependent variables including systolic blood pressure

(SBP), diastolic blood pressure (DBP), blood glucose (BG),

and serum lipids were examined. High blood pressure was

defined as a mean SBP equal to or higher than 140 mm/Hg

and/or DBP equal to or higher than 90 mmHg. Elevated

fasting glucose defined as levels equal to or higher than

126 mg/dL. High level of total cholesterol (TC), total tri-

glyceride (TG), low-density lipoprotein (LDL) cholesterol,

and low high-density lipoprotein (HDL) cholesterol were

defined as C240, C200, C160 and B40 mg/dL, respec-

tively. General linear regression models were used to

investigate the relationship of participants’ age and gender,

to the continuously distributed response variables, which

included systolic and DBP, BG, TC, TG, LDL cholesterol

and HDL cholesterol. This is a nonrandom sample of adult

Ethiopian church members who were invited to participate

in a parish nurse cardiovascular disease (CVD) risk factor

screening program. Participants in this sample were 43 %

male and 57 % female. The overall prevalence of hyper-

tension was 30.1 % with a cut off mark of 140/90 mm/Hg.

The prevalence of hypertension was 33 and 24 % among

men than among women, respectively (p \ 0.01). Of all

participants, 12 % had BG level of equal to or higher than

126 mg/dL. Low levels of HDL were reported in 30 % of

the participants (\40 mg/dL). A higher prevalence of high

LDL level (20 %) was observed among women compared

to those found in men (16 %). High TC levels ([240 mg/

dL) were observed in 15 % of the women and 10 % of the

men (p = 0.2). Higher SBP and DBP were significantly

higher in male participants than their female counterparts

(p \ 0.05) and in contrast, women showed a significantly

higher TC (p \ 0.01) and LDL (0.05) and HDL

(p \ 0.001). Female participants also had higher BG than

male participants but the difference was not statistically

significant (p [ 0.05). This opportunity sample suggests

high prevalence of CVD risk factors in a community of

Ethiopian-American adults, and a pressing need for more

comprehensive and systematic assessment of chronic dis-

ease health needs in this growing community.

Keywords Blood pressure � Prevalence � Cardiovascular

risk factors � Ethnic groups

Background

Immigrants of African ethnicity represent one of the

fastest-growing immigrant groups in the United States.

According to Bureau of the Census [18] data, 13 % of the

general population of central Minnesota was from Africa.

Demographic trends indicate the number of Ethiopian

M. Ghobadzadeh (&)

School of Nursing, University of Minnesota, 5-140 Weaver-

Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455,

USA

e-mail: ghoba001@umn.edu

E. W. Demerath

Division of Epidemiology & Community Health, University of

Minnesota, 1300 2nd Street S, Suite 300, Minneapolis,

MN 55455, USA

Y. Tura

School of Nursing, Minnesota State University, Mankato,

MN, USA

123

J Immigrant Minority Health

DOI 10.1007/s10903-014-0051-6

immigrants will increase over time throughout the US and

Minnesota. Minneapolis-St. Paul happens to be home to

one of the largest populations of Ethiopian immigrants in

the US. According to the US Census American Community

Survey, 14,070 Ethiopians live in Minnesota [18, 19].

However, the health status of this diverse group remains

relatively understudied compared with many other immi-

grant populations. As immigrants become long-term resi-

dents, a particular focus on screening, prevention of non-

communicable chronic diseases, and treatment of these

conditions will become a public health priority and adopting

and implementing necessary interventions are recommended

to meet needs of this diverse group of people [20, 21].

This study is the description of recent trends in the prev-

alence of selected cardiovascular disease (CVD) risk factors

in a vulnerable understudied population with potentially high

rates of undiagnosed disease due to their recent immigration

to the US, lack of health insurance, and exposure to high

physical and emotional stress during their childhood and

adulthood period secondary to their immigration status.

Cardiovascular disease is a combination of hyperten-

sion, heart disease, and stroke and is the leading cause of

mortality and morbidity in the USA. [12]. Hypertension is

one of the most significant health problems for people of

African origin and has been shown to be strongly associ-

ated with other diseases such as diabetes mellitus and

hyperlipidemia [1, 14]. When left uncontrolled, hyperten-

sion causes serious conditions such as CVD and kidney

failure. Patients with hypertension tend not to seek medical

care until complications are already apparent and affect

their quality of life. One major emphasis of the primary

prevention of CVD since the early 1970s has focused on

early detection and treatment of hypertensive patients. The

literature indicates that timely screening of high blood

pressure is beneficial in terms of reducing the occurrence of

these outcomes and helps to reduce the chance of the

aforementioned complications [6]. Although nation-wide

programs for timely screening of hypertension have been

carried out in many places, community-based data

regarding the prevalence of hypertension and hypertension

subtypes among Ethiopian populations are scarce. In

Ethiopia, incomplete and irregular reporting of routine

health care has made it impossible to understand the risk

factor of non-communicable diseases. The prevalence of

high blood pressure in urban areas of Ethiopia was reported

to be comparable to the situation in the developed countries

and the risk of CVD morbidity and mortality associated

with elevated blood pressure may even be higher in Afri-

cans. A study carried out among residents of Addis Ababa

found prevalence of 31.5 and 28.9 % for hypertension

among men and women, respectively [16].

Although hypertension and diabetes are two indepen-

dent risk factors for developing coronary heart disease

(CHD), they often coexist and diabetic patients are twice as

likely to develop hypertension as general population [22].

Diabetes also leads to pathological changes including ath-

erosclerosis and subsequent chronic diseases. It was esti-

mated that 10.8 million Africans in Sub-Saharan Africa had

diabetes in 2006 and this figure is estimated to increase to

18.7 million by 2025 [9].

Some information on chronic disease risk factors among

Ethiopians has been made available from studies conducted

in Israel on Ethiopian immigrants. The studies in Israel

found a higher prevalence of diabetes among the Ethiopian

immigrants compared to the other Israelis. They also

reported a higher risk for development of diabetes and its

complications among population of Ethiopian immigrants

in comparison to the general population [5].

Elevated serum lipids are also a major, potentially risk

factor for cardiovascular chronic diseases in adults. How-

ever, elevated blood lipids are modifiable and can be

reduced by healthy lifestyle and timely medical interven-

tion. Thus, screening procedures that detect elevated lipid

levels appear justifiable as a public health care measure.

Furthermore, there is a myriad of evidence to support

screening for hypertension, blood sugar and lipid abnor-

malities in women. More women die each year due to

CVDs than from all types of cancers combined [10].

However, of those sudden cardiac deaths among women,

approximately two-thirds (64 %) have no previous symp-

toms [13].

To our knowledge, few studies have evaluated the

prevalence of serum lipids, blood sugar and blood pressure

abnormalities among African immigrants in the United

States. This work sets the foundation for future efforts of

prevention and control of chronic diseases among African

immigrants in the Twin Cities region.

Objective results from this study may also be used to

identify the health needs of the community members and

suggest possible intervention strategies to reduce risk fac-

tors for developing CHD.

The main objective of this analysis was to study the

prevalence of hypertension, glucose and blood lipid

abnormalities as well as mean levels of blood pressure,

serum glucose, and blood lipids among adults in an Ethi-

opian community using recently available data from a

Parish Nursing Program conducted 2007–2012 in Minne-

apolis, MN. Particular attention is given to sex and age

differences in the prevalence and levels of these risk fac-

tors, and to the extent of risk factor clustering.

Methods

The current study was based entirely on an existing com-

munity-based CVD risk factor screening and referral

J Immigrant Minority Health

123

program completed in three Ethiopian Orthodox Christian

Churches whose members are approximately 100 %

Amharic-speakers, and thus are likely to be fairly homo-

geneous in terms of cultural background and dietary habits.

The church attendees came from different regions of

Ethiopia, however. Individual-level information on region

of origin was not collected in the Parish Nurse risk factor

survey. The target population is Ethiopian immigrants

living in the Twin Cities metro area. Hundreds of Ethio-

pians are parishioners or attendees of the DSMA church

and other Ethiopian churches in the Twin Cities. At a given

Sunday service, over one hundred children, thirty to forty

teenagers, young parents, middle age and elderly Ethiopi-

ans attend the church. This allows the program to have

access to a wide range of Ethiopian families. Most mem-

bers of the community are first generation immigrants, and

they lack access to health care, face linguistic barriers, and

generally have limited knowledge in the critical areas of

health and wellness. As first generation immigrant com-

munity, members are often engaged in entry level jobs or

attend higher education for career development. Some are

considered middle income families. The gathering of the

community in one place allowed the program to easily

reach the community after services. The program has also

expanded its health screening services to two other Ethio-

pian churches in St. Paul, Minnesota that have the same

demographic, socio economic status and understanding of

health and wellness.

A series of annual cross-sectional surveys were con-

ducted in St. Paul and Minneapolis between 2007 and 2012.

The screening events were advertised in the church bulletin,

local Ethiopian radio (KFAI, Voices of Ethiopia) and flyers

which included information announced after services about

the direction for fasting prior to the tests. Participation in the

disease prevention programs was also encouraged by the

church’s leaders and priests. The parish nurse coordinator

organized screenings and health fairs, as well as provided

literature and health information to volunteers. The screen-

ing programs were carried out right after worship services.

Upon completion of the screening events, participants

were provided necessary education tailored to their risk

status as well as referral services for screening findings

needing immediate attention. Information on how to access

low cost health care services and clinics was also provided

to the participants.

Survey Data (2007–2012)

As stated above, study data came from a parish nursing

screening program for hypertension, hyperlipidemia, and

high blood sugar among people aged 18 or over supported

by the Minnesota Department of Health, Refugee Health

Program. Registered nurses working as volunteers collected

the clinical data. The data collection form included age,

gender, Systolic blood pressure (SBP), Diastolic blood

pressure (DBP), blood glucose (BG), total cholesterol (TC),

Triglyceride (TG), low density lipoprotein (LDL) and high

density lipoprotein (HDL). A database was developed for

quantitative analysis. To increase anonymity of the partici-

pants (a concern for the community), age was recorded in

three categories: 18–37, 38–57, and C58 year.

Blood Pressure Measurement

Sitting blood pressure was measured by nurses after wor-

ship services. Clients rested for 5–10 min before mea-

surement, one blood pressure reading was taken in right

arm. A second measurement was made in the opposite arm

if the first blood pressure reading was 10 mm/Hg higher or

20 mm/Hg lower than normal range (\120/80 mmHg) [3].

All reading measurements were recorded on the data

collection sheets. The average of all readings recorded for

each participant was calculated and used in the analysis.

Individuals were classified as hypertensive if their SBPs

were equal to or higher than 140 mmHg and/or DBPs equal to

or higher than 90 mmHg. If a person’s SBP ranges from 120 to

139 mmHg or DBP rises to a level of 80–89 mmHg, the

person is considered ‘‘pre-hypertensive’’. We further classi-

fied the severity of hypertension as pre-hypertension

(SBP C 120 mmHg and DBP C 80 mmHg), hypertensive

stage 1 (SBP 140-159 mmHg or DBP 90-99 mmHg), stage 2

(SBP C 160 or BP C 100 mmHg for DBP) according to the

blood pressure classifications set by the Seventh Report of the

Joint National Committee on Prevention, Detection, Evalua-

tion, and Treatment of High Blood Pressure (JNC 7) [3].

Blood Glucose Measurement

The level of blood sugar was measured in the fasting state.

Before the test, the participants fasted for 12–15 h. The

tests were performed with participants in a sitting position

at a constant temperature room. BG measurements were

measured from finger blood sample using FreeStyle Lite�

(Abbott Diabetes Care Inc), Accu-check or True track. The

participants were classified into three subgroups according

to the level of fasting BG: (1) B100 mg/dL, (2) 101–125

mg/dL, (3) 126–199 mg/dL, and (4) C200 mg/dL, as rec-

ommended by the American Diabetes Association (ADA),

with 100 mg/dL defined as the upper limit of normality for

fasting BG levels.

Serum Lipids Measurement

A handheld Professional Blood Testing Device (Cardi-

oChek� PA POC cholesterol testing system) was used to

measure the blood lipid levels. A drop of fresh capillary

J Immigrant Minority Health

123

blood (35-40 lL for Lipid Panel tests) was applied directly

to the test strip. The results were available within 2 min for

LDL, HDL, TG, and TC. Samples were collected after a

12-hour overnight fasting. Blood lipid levels were classi-

fied according to the Third Report of the National Cho-

lesterol Education Program Expert Panel [11]. TC

concentrations are classified into 3 categories: Desirable

(\200 mg/dL), borderline (200–239 mg/dL), and high

(Above 240 mg/dL). It has been suggested that HDL cho-

lesterol concentrations defined as ‘‘desirable’’ (40–59 mg/dL),

‘‘low’’ (\40 mg/dL), and ‘‘optimal ([60 mg/dL). LDL cho-

lesterol levels were classified as ‘‘optimal’’ (\100 mg/dL),

‘‘desirable’’ (100–129 mg/dL), ‘‘borderline’’ (130–159 mg/

dL), ‘‘high (160–189) and ‘‘very high’’ ([189 mg/dL). Ele-

vated TG levels were defined as ‘‘desirable’’ (\150 mg/dL),

borderline (150–199 mg/dL), high (200–499 mg/dL) and

very high ([500 mg/dL).

Risk Score Determination

The participants were classified into four groups as 0, 1, 2

and 3 based on the number of risk factors they had for

CHD: SBP C 140 mmHg or DBP C 90, glucose [ 100,

dyslipidemia: TC [ 200 or LDL [ 130 or HDL \ 40 or

TG [ 150. The participants with none of these above

cutoff points were coded as 0, and so forth, with maximum

being 3 (hypertension?, high BG?, high serum lipids?).

Statistical Analysis

Chi-square tests were used to assess sex differences in the

distribution of categorical variables (e.g., the prevalence of

different blood lipid, glucose, and blood pressure catego-

ries). General linear regression models were constructed to

examine the relationship of participants’ age and gender, to

the continuously distributed response variables, which

included systolic and DBP, BG, TC, TG, LDL cholesterol

and HDL cholesterol. In order to account for differences in

measurement conditions over repeated survey years, a

covariate term for year of data collection was also included

in the models. Gender is a dichotomous variable with

males coded as 0 and females as 1. We implemented SAS

Proc MI to impute the missing value based on gender and

age. We then used Proc MIANALYZE to provide param-

eter estimates, standard errors of the estimates, and p val-

ues for the association of gender and age group with the

cardiovascular risk factors using the imputed datasets.

Participants were divided into three age groups: 18–37,

38–57, and C58 years and age was entered as a categorical

variable in the regression models. In all analyses, statistical

significance was set at a = 0.05. Values are expressed as

mean ± SE and frequency ± [95 % confidence interval

(CI)]. The analyses were performed using SAS software,

version 9.3.

Results

Nurses recorded services provided for a total of 718 indi-

viduals from 2007 to 2012. A total 673 encounters were

included in the analyses, following the exclusion of 35

incomplete forms.

We examined the association of outcome variables by

survey year and found that prevalence and mean values for

the outcomes were relatively consistent across survey years

(data not shown). For this reason, and because the program

included some of the same individuals across multiple

survey years (but did not assign individual-level identifiers)

we chose to use only the 2012 data for the subsequent

analysis to avoid non-independence of the observations.

According to US Census Bureau, 51 % of all Ethiopian

living in Twin Cities was male and 49 % was female and

the mean age reported 30.2 for the males and 29.3 for the

females [18]. In 2012, the sample comprised 197 partici-

pants, 83 (43 %) men and 111(57 %) women. Over 80 %

of the study participants were older than 38 years of age

and more than 18 % were 58 years or older. The partici-

pants’ age were entered as a categorical variable in the

regression models.

Overall, only 31.6 % of the participants had blood pres-

sure values within normal ranges. A large number of those

surveyed had blood pressures that were within the pre-

hypertensive (SBP [ 130 mm Hg or DBP [ 80 mm Hg)

(38.3 %). Overall, prevalence of hypertension with a cut off

mark of 140/90 mm Hg was 30.1 %. The prevalence of

hypertension was significantly higher among men than

among women (33 and 24 % of all men and women

respectively, p = 0.01) (Table 1). The gender- and age-

specific mean BP, BG and serum lipids among participants

are shown in Table 2. Overall, the mean SBP was 127.7 ±

1.6 mmHg (124.4 ± 6.2 and 130.57 ± 4.8 for women and

men respectively) and the mean DBP was 78.36 ±

0.82 mmHg (80.8 mmHg ± 3.6 for men and 75.78 mm/

Hg ± 3.4 for women) (Table 2). SBP and DBP increased

with age in both men and women throughout the age groups

(p = 0.001). There was also a significant relationship

between gender and SBP (F = 5.07, p = 0.001), and the

association remained significant after age groups included as

a covariate (F = 15.5, p = 0.001).

The overall mean value for blood sugar was 109.4 ±

2.5 mg/100 ml. The fasting BG mean was higher in women

(113.7 ± 3.7 mg/100 ml vs. 104.7 ± 3 mg/100 ml). Of all

participants, 45 % had normal BG levels; 41.2 % were

considered as pre-diabetic (101–125 mg/dL) and 12 % had

BG level of equal to or higher than 126 mg/dL-199 (9 and

J Immigrant Minority Health

123

12 % of all men and women respectively, p = 0.7) and

only 1.8 % participants had BG level of equal to or higher

than 200 mg/dL. Neither the prevalence of elevated BG nor

mean fasting BG levels rose with age (p [ 0.05). A linear

regression was also performed and BG dependence on

gender and age was tested. Significant differences were not

observed between average fasting BG values and gender

after adjusting for age (F = 1.48, p = 0.2).

The mean serum cholesterol concentration was 168.5 ±

2.7 mg/dL. The mean TC was higher for women (171.9 ±

3.6 mg/dL) compared to male participants (162.39 ±

4.03 mg/dL). We found significant differences between

male and female participants in cholesterol levels

(p = 0.03) after adjusting for age. The mean LDL cho-

lesterol and TG concentration was 95 ± 5 and 130 ±

5.7 mg/dL, respectively.

Elevated TC and LDL were observed in 13.5 and

18.3 % of the sample, respectively. There were no differ-

ences in the prevalence of elevated TG between men

(22 %) and women (18 %) (p = 0.3).

High TC levels were observed in 15 % of the women

and 10 % of the men (p = 0.2). TC concentration was

significantly associated with gender and age as a cofactor

(F = 5.78, p = 0.03). Elevated levels of LDL were also

marginally associated with gender (F = 1.73, p = 0.05).

Women showed a higher prevalence of high LDL levels

(20 %) when compared with those found in men (16 %)

(Table 1).

The overall mean for HDL concentration was 48.93 ±

2.3 mg/dL. Reduced levels of HDL were observed in 30 %

of the participants (\40 mg/dL), and this percentage was

higher in men (37.4 %) than in women (20 %) (p \ 0.05).

A linear regression model that adjusted for age showed an

association between HDL and gender (F = 5.2, p = 0.006).

Table 3 shows the age-stratified prevalence of 0, 1, 2,

and 3 risk factor groups among men and women. Of all

female participants, 42 % had at least one risk factor for

CHD while the figure was 39 % for their male counter-

parts. Using the study criteria, 15 % of women and 22.5 %

of men had two risk factors. The criteria also showed that a

Table 1 Prevalence of elevated blood pressure, blood glucose and

serum lipids among participants by sex

Gender BPa BGb TCc TGd LDLe HDLf

Female 24 % 12 % 15 % 18 % 20 % 20 %

Male 33 % 9 % 10 % 22 % 16 % 37.4 %

P value 0.01 0.7 0.2 0.3 0.2 0.001

a Blood pressure cutoff point C140/80b Blood glucose cutoff point C126 mg/dLc Total cholesterol cutoff point C240 mg/dLd Total glyceride cutoff point C200 mg/dLe Low-density lipoprotein cutoff point C160 mg/dLf High-density lipoprotein cutoff point B40 mg/dL

Table 2 Mean (SD) of blood pressure, blood glucose and serum lipids among participants by sex and age

Age SBP DBP BG TC TG LDL HDL

Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE

Women (n = 111)

18–37 110 1.5 72 0.7 103 2.4 152 2.7 120 1.9 89 2.9 51.3 1.1

38–57 124.8 1.2 77 1.1 119 4.6 173 2.6 125 2.1 97 2.2 50 1.6

C58 126 1.1 74 1.7 106 2.5 183 1.3 139 2.9 128 2.3 43 1.2

Overall mean 124 6.2 75.78 3.4 113.7 3.7 171.9 3.6 128 2.3 98.22 3.4 52.87 1.5

Men (n = 80)

18–37 122 1.6 73 1.5 97.6 1.8 154 2.3 121 1.8 79 3 41 2.2

38–57 130 2.1 83 1.4 107 1.3 162 1.4 137.6 2.5 90 3.3 43 1.2

C58 135.5 6.5 82.5 2.6 104 3.2 171 1.5 131.5 1.2 94 1.4 50 2.1

Overall mean 130.57 4.8 80.8 3.6 104.7 3 162.39 4.03 135.47 7.8 90.54 3.01 44.27 2.1

p* 0.001 0.001 0.1 0.04 0.01 0.1 0.3

p** 0.02 0.002 0.2 0.01 0.04 0.05 0.001

p*** 0.001 0.001 0.2 0.03 0.07 0.3 0.006

p**** 0.1 0.001 0.1 0.1 0.7 0.2 0.001

SBP systolic blood pressure, DNP diastolic blood pressure, BP blood glucose, TC total cholesterol, TG total glyceride, LDL low-density

lipoprotein, HDL high-density lipoprotein

p * age effect

p ** sex effect

p *** sex effect after adjustment for age

p ****sex age interaction

J Immigrant Minority Health

123

higher of number of men who had three risk factors com-

pared to women (13 vs. 7 %) but this difference was not

statistically significant (See Fig. 1). As expected, the

number of risk factors increased strikingly with age in both

sexes (p \ 0.001).

Discussion

The impact of hypertension on cardiac function and its

economic consequences makes it a major public health

concern both in the US and in the world [4]. This study was

the first to-investigate the prevalence of blood pressure, BG

and serum lipid abnormalities in a group of adult Ethiopian

immigrants in the US. Overall, the prevalence rate of

hypertension in the study population was 30 %. Of all men

33 % were hypertensive while the figure was 24 % for their

female participants (p = 0.01). Higher SBP and DBP were

more common in male participants than their female

counterparts and in contrast, women tended to have higher

BG, TC and LDL, although the difference was marginally

significant for LDL and not significant for BG levels.

In the current study the overall prevalence of high blood

pressure was high among both male and female partici-

pants and indicates hypertension is a major public health

problem in this community. Awoke et al. [1] found similar

results in a study in Northwest Ethiopia on the prevalence

of hypertension in which the overall prevalence of hyper-

tension was reported as 28.3 % (n = 679). However, the

finding that higher blood pressure is more prevalent in men

than women in this study appears to be not in agreement

with [1] study in which the prevalence of hypertension was

slightly higher in women (30.3 %) than men (26.0 %).

Worldwide prevalence of hypertension also showed that

males had a slightly higher prevalence of hypertension than

females, but the statistical difference was not significant

except for the region of America and European countries

[7, 23]. Kinzie et al. [8] found a high prevalence of blood

pressure among Vietnamese, Cambodian, Somali, and

Bosnian refugees which was higher than US norms (45 %).

In all participants combined, 41.2 % had BG level of

higher than 101 mgdL but less than 126 mg/dL, a condi-

tion that is known as pre-diabetes. The overall diabetes

prevalence of 12 % in this group of (n = 197) Ethiopian

adults is higher than that found in other communities. In

the study by Kinzie et al. [8] the prevalence of diabetes

(fasting BG greater than 126 mg/dL) reported as to be

15.5 % which was also higher than the prevalence esti-

mated from most previous epidemiologic surveys of the US

population. Identification of those people who are pre-

diabetic and at risk of developing diabetes mellitus might

lead us to select an appropriate target group for interven-

tions targeted at preventing Type 2 diabetes [15].

The high prevalence of hypertension and high BG may be

explained by the fact that the participants are mostly

immigrants. Longitudinal studies on immigrants in Israel

found that African immigrants had more hypertension and a

higher prevalence of diabetes compared to the general

population [2]. Furthermore, the rates of diabetes and

hypertension are dramatically increasing in African coun-

tries including Ethiopia [1, 14]. Therefore this increase in

prevalence may merely reflect alterations in rates of diabetes

and hypertensive disorders in the country of origin [8].

Table 3 Frequency of risk

factors by age and gender

F frequency, P percent

p value for sex [0.05, p value

for age \0.001

Female Male

Age groups Age groups

Risk 1 (18–37) 2 (38–57) 3 C 58 Total Risk 1 (18–37) 2 (38–57) 3 (C58) Total

F P F P F P F P F P F P F P F P

0 20 71 12 21 7 26 39 35 0 7 37 10 20 3 19 20 25

1 8 29 27 49 12 44 47 42 1 8 42 17 35 6 33 31 39

2 0 0 13 23 4 15 17 15 2 1 5 13 27 4 22 18 22

3 0 0 4 7 4 15 8 7 3 0 0 8 18 3 16 11 14

25

39

22

14

35

43

15

7

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0 1 2 3PercentNumber of Risk Factors

Male Female

Fig. 1 Number of selected CVD risk factors by sex. p value for

gender effect [0.05, p value for age effect \0.001

J Immigrant Minority Health

123

We found that the overall prevalence of high TC and

LDL was 13.5 and 18.3 % among the participants and the

higher prevalence of both factors were observed among

women compared to those found in men. Little information

exists concerning the prevalence of serum lipid abnor-

malities among Ethiopian population. However, a study

conducted in 1993 by Swai et al. [14] in Tanzania, also

found that female participants had significantly higher

mean TC levels than male participants. CVD events are

commonly perceived as less serious threats to women than

men. Normally, premenopausal women are somewhat

protected from heart disease by estrogen. However, pre-

vious studies indicated that the female advantage is

decreased in women when other risk factors including high

blood sugar and hyperlipidemia presented. According to

the World Health Organization’s Global Burden Disease,

CVD is the leading cause of death among women and

accounted for approximately 32 % of death among women

in 2004 [24].

A study conducted by Tran [17] in Ethiopia reported a

high number of participants with one (40 and 35.4 % for

women and men respectively) or two (20.4 % of women

and 18.6 % of men) metabolic syndrome components. The

number of risk for CHD also increased significantly with

age in this study which used the same cutoff values. The

estimates are higher in the current study which may be due

to a smaller sample size. Tran [17] also used different

definitions to evaluate the risk prevalence among the par-

ticipants including Adult Treatment Panel III (ATP III) and

International Diabetes Federation (IDF) criteria. It is worth

mentioning that in the current study the evaluation of risk

prevalence based on the above mentioned standard criteria

was not possible due to the available data.

Although most of CVD risk factors are amenable to

change, not enough attention has been paid to identifica-

tion, screening and prevention of them in many under-

served communities. Health disparities, including

inadequate access to care, linguistic barriers and lack of

health insurance, certainly impact the availability of health

services for Ethiopian community. Consequently, despite

their risks and high rates of medical problems, they tend

not to seek professional help as much as they need. This is

concerning and necessitates interventions at the community

level that improve identification of problems and early

access to health services.

Several limitations should be considered when inter-

preting results of the present survey. The first limitation is

the non-random sampling design of the survey, which

suggests caution in interpretation of prevalence estimates

and the generalizability of the findings to all Ethiopian

immigrants. Further, due to the data deficiencies this study

could not investigate the impact of lifestyle and socio-

economic variables on the associations with blood

pressure, BG and serum lipid abnormalities. Body mass

index (BMI) and physical activity levels would be of par-

ticular importance to address in future surveys, as obesity

and sedentary behavior are upstream determinants of all of

the risk factors examined here. Therefore, larger studies

with more detailed information on demographic as well as

lifestyle characteristics including smoking status, BMI,

dietary habits and years living in the US will be needed to

help develop effective interventions and health promotion

programs among African immigrants. In the future, we also

hope to track individuals over time so that longitudinal

changes across all survey years can be assessed.

Acknowledgments We thank all the volunteers of the parish nurs-

ing program at the DSMA Parish Nursing Program (Debre Selam

Medhane Alem Ethiopian Orthodox Tewahedo Church) for their

excellent participation in collecting data and their incredibly valuable

role in educating and serving their community.

References

1. Awoke A, Awoke T, Alemu S, Megabiaw B. Prevalence and asso-

ciated factors of hypertension among adults in Gondar, Northwest

Ethiopia: a community based cross-sectional study. BMC Cardio-

vasc Disord. 2012;12:113. doi:10.1186/1471-2261-12-113.

2. Bursztyn M, Raz I. Blood pressure and insulin in Ethiopian

immigrants: longitudinal study. J Hum Hypertens. 1995;9(4):

245–8.

3. Chobanian AV, Barkis GL, Black HR, et al. Seventh report of the

Joint National Committee on prevention, detection, evaluation,

and treatment of high blood pressure. Hypertension. 2003;42:

1206–52.

4. Collins R, MacMahon S. Blood pressure, antihypertensive drug

treatment and the risks of stroke and of coronary heart disease. Br

Med Bull. 1994;50:272–98.

5. Green S, Etzion T, Jucha E. Blood pressure and serum cholesterol

among male Ethiopian immigrants compared to other Israelis.

J Epidemiol Commun Health. 1995;45:281–6.

6. Greenland P, Abrams J, Aurigemma GP, et al. Prevention Con-

ference V: beyond secondary prevention: Identifying the high-risk

patient for primary prevention: noninvasive tests of atherosclerotic

burden: Writing Group III. Circulation. 2000;101(1):e16–22.

7. Kearney P, Whelton M, Reynolds K, Muntner P, Whelton K, He

J. Global burden of hypertension: analysis of worldwide data.

Lancet. 2005;365(9455):217–23.

8. Kinzie JD, Riley C, McFarland B, Hayes M, Boehnlein J, Leung

P, et al. High prevalence rates of diabetes and hypertension

among refugee psychiatric patients. J Nerv Mental Dis.

2008;196(2):108–12.

9. Levitt NS. Diabetes in Africa: epidemiology, management and

healthcare challenges. Heart. 2008;94:1376–82.

10. Mosca L, et al. Evidence-based guidelines for cardiovascular

disease prevention in women: 2007 update. J Am Coll Cardiol.

2007;2007(49):1230–50.

11. National Cholesterol Education Program (NCEP). Expert Panel

on detection, evaluation, and treatment of high blood cholesterol

in adults (Adult Treatment Panel III) final report. Circulation.

2002;106:3143–421.

12. National Heart, Lung, and Blood Institute. Incidence and preva-

lence: 2006 chart book on cardiovascular and lung diseases.

Bethesda: National Institutes of Health; 2006.

J Immigrant Minority Health

123

13. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD,

Borden WB, et al. Heart disease and stroke statistics-2012 update:

a report from the American Heart Association. Circulation.

2012;125(1):e2–220.

14. Swai ES, Kapaga A, Kivaria F, Tinuga D, Joshua G, Sanka P.

Prevalence and distribution of peste des petits ruminants virus

antibodies in various districts of Tanzania. Vet Res Commun.

2009;33:927–36.

15. Tabak AG, Herder C, Rathmann W, Brunner E, Kivimaki M.

Prediabetes: a high-risk state for diabetes development. Lancet.

2012;379:2279–90.

16. Tesfaye F, Byass P, Wall S. Population based prevalence of high

blood pressure among adults in Addis Ababa: uncovering a silent

epidemic. BMC Cardiovasc Disord. 2009;9:39.

17. Tran A. Prevalence of metabolic syndrome among working adults

in Ethiopia. Int J Hypertens. 2011. doi:10.4061/2011/193719.

18. U.S. Census Bureau, American FactFinder 2010, viewed Feb 8,

2014.

19. U.S. Census Bureau, American FactFinder 2013, viewed Feb 8,

2014.

20. Vassan RS, Beiser A, Seshadri S, Larson MG, Kannel WB,

D’Agostino RB, Levy D. Residual lifetime risk for development

of hypertension in middle-aged men and women. The Framing-

ham Heart Study. JAMA. 2002;2002(287):1003–10.

21. Venter H, Gany F. African immigrant health. J Immigr Minor

Health. 2011;13(2):333–44.

22. Weber MA. When hypertension and diabetes coexist: strategies

for cardiorenal protection. Postgrad Med. 2000;108(5 Sup-

pl):12–8. doi:10.3810/pgm.10.2000.suppl8.46.

23. World Health Organization. World Health Day. High blood

pressure: Global and regional overview, 2013. http://www.searo.

who.int/entity/world_health_day/leaflet_burden_hbp_whd_2013.

pdf.

24. World Health Organization. Women and health. Today’s evi-

dence tomorrow agenda. Geneva, Switzerland; 2011. http://

whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf.

J Immigrant Minority Health

123