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Canadian Journal of Cardiology

The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review

      Abstract

      Background

      The increasing frequency of global migration to Canada and other high-income countries has highlighted the need for information on the risk of ischemic heart disease (IHD) and stroke among migrant populations.

      Methods

      Using the MEDLINE and EMBASE databases, we conducted an English-language literature review of articles published from 2000 to 2014 to study patterns in the incidence of IHD or stroke in migrant populations to high-income countries. Our search revealed 17 articles of interest. All studies stratified immigrants according to country or region of birth, except 2 from Canada and 1 from Denmark, in which all immigrant groups were analyzed together.

      Results

      The risk of IHD or stroke varied by country of origin, country of destination, and duration of residence. In our review we found that most migrant groups to Western Europe were at a similar or higher risk of IHD and stroke compared with the host population. Those at a higher risk included many Eastern European, Middle-Eastern, and South Asian immigrants. When duration of residence was considered, it appeared that in most migrants the risk of IHD worsened over time. In contrast, immigrants overall were at lower risk of myocardial infarction and stroke in Ontario compared with long-term residents of Canada.

      Conclusions

      The risks of IHD and stroke vary widely in immigrant populations in Western Europe. Detailed studies of immigrants to Canada according to country of birth and duration of residence should be undertaken to guide future cardiovascular health promotion initiatives.

      Résumé

      Introduction

      L’accroissement de la fréquence de la migration internationale vers le Canada et les autres pays à revenu élevé a fait ressortir le besoin d’information sur le risque de cardiopathie ischémique (CI) et d’accident vasculaire cérébral (AVC) chez les populations migrantes.

      Méthodes

      À partir des bases de données MEDLINE et EMBASE, nous avons mené une revue de la littérature de langue anglaise des articles publiés de 2000 à 2014 pour étudier les profils d’incidence de la CI ou de l’AVC des populations migrantes vers les pays à revenu élevé. Notre recherche a révélé 17 articles d’intérêt. Dans toutes les études, les immigrants étaient stratifiés selon le pays ou la région de naissance, à l’exception de 2 études du Canada et 1 du Danemark pour lesquelles tous les groupes d’immigrants étaient analysés ensemble.

      Résultats

      Le risque de CI ou d’AVC variait selon le pays d’origine, le pays de destination et la durée de résidence. Dans notre revue, nous avons observé que la plupart des groupes de migrants vers l’Europe occidentale étaient exposés à un risque similaire ou plus élevé de CI et d’AVC comparativement à la population hôte. Ceux exposés à un risque plus élevé comprenaient plusieurs immigrants de l’Europe orientale, du Moyen-Orient et de l’Asie du Sud. Lorsque la durée de résidence était considérée, il semblait que chez la plupart des migrants le risque de CI s’exacerbait avec le temps. En revanche, les immigrants étaient dans l’ensemble exposés à un risque plus faible d’infarctus du myocarde et d’AVC en Ontario comparativement aux résidents de longue durée du Canada.

      Conclusions

      Les risques de CI et d’AVC varient grandement entre les populations immigrantes en Europe occidentale. Des études approfondies sur les immigrants du Canada selon leur pays de naissance et la durée de résidence devraient être entreprises pour orienter les futures initiatives de promotion de la santé cardiovasculaire.
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      References

      1. International Organization for Migration. World Migration Report 2013. Available at: http://publications.iom.int/bookstore/free/WMR2013_EN.pdf. Accessed September 1, 2014.

      2. United Nations Department of Economic and Social Affairs and OECD. World Migration in Figures. Available at: http://www.oecd.org/els/mig/World-Migration-in-Figures.pdf. Accessed September 1, 2014.

        • Perez C.E.
        Health status and health behavior among immigrants.
        Health Rep. 2002; 13: S1-S12
        • Newbold K.B.
        Chronic conditions and the healthy immigrant effect: evidence from Canadian immigrants.
        J Ethn Migr Stud. 2006; 32: 765-784
        • Fennelly K.
        The “healthy migrant” effect.
        Minn Med. 2007; 90: 51-53
        • Wyatt S.B.
        • Williams D.R.
        • Calvin R.
        • et al.
        Racism and cardiovascular disease in African Americans.
        Am J Med Sci. 2003; 325: 315-331
      3. International Organization for Migration. International Migration, Health and Human Rights. Available at: http://www.ohchr.org/Documents/Issues/Migration/WHO_IOM_UNOHCHRPublication.pdf. Accessed September 1, 2014.

        • Sundquist J.
        Ethnicity, social class and health. A population- based study on the influence of social factors on self-reported illness in 223 Latin American refugees, 333 Finnish and 126 south European labour migrants and 841 Swedish controls.
        Soc Sci Med. 1995; 40: 777-787
        • Razum O.
        Commentary: of salmon and time travellers - Musing on the mystery of migrant mortality.
        Int J Epidemiol. 2006; 35: 919-921
        • Benfante R.
        Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review.
        Hum Biol. 1992; 64: 791-805
        • Landrine H.
        • Klonoff E.A.
        Culture change and ethnic-minority health behavior: an operant theory of acculturation.
        J Behav Med. 2004; 27: 527-555
        • Chiu M.
        • Austin P.C.
        • Manuel D.G.
        • Tu J.V.
        Cardiovascular risk factor profiles of recent immigrants vs long-term residents of Ontario: a multi-ethnic study.
        Can J Cardiol. 2012; 28: 20-26
        • Yusuf S.
        • Reddy S.
        • Ounpuu S.
        • Anand S.
        Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization.
        Circulation. 2001; 104: 2746-2753
      4. World Health Organization. Global Status Report on Noncommunicable Diseases 2010. Available at: http://www.who.int/nmh/publications/ncd_report2010/en/. Accessed September 1, 2014.

        • Gadd M.
        • Sundquist J.
        • Johansson S.E.
        • Wandell P.
        Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?.
        Eur J Cardiovasc Prev Rehabil. 2005; 12: 535-541
        • Yusuf S.
        • Reddy S.
        • Ounpuu S.
        • Anand S.
        Global burden of cardiovascular diseases: part ii: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies.
        Circulation. 2001; 104: 2855-2864
        • Balarajan R.
        Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales.
        BMJ. 1991; 302: 560-564
        • Stewart J.A.
        • Dundas R.
        • Howard R.S.
        • Rudd A.G.
        • Wolfe C.D.
        Ethnic differences in incidence of stroke: prospective study with stroke register.
        BMJ. 1999; 318: 967-971
        • Chaturvedi N.
        Ethnic differences in cardiovascular disease.
        Heart. 2003; 89: 681-686
        • Van Oeffelen A.A.
        • Vaartjes I.
        • Stronks K.
        • Bots M.L.
        • Agyemang C.
        Incidence of acute myocardial infarction in first and second generation minority groups: does the second generation converge towards the majority population?.
        Int J Cardiol. 2013; 168: 5422-5429
        • Agyemang C.
        • van Oeffelen A.A.
        • Bots M.L.
        • Stronks K.
        • Vaartjes I.
        Socioeconomic inequalities in acute myocardial infarction incidence in migrant groups: has the epidemic arrived? Analysis of nation-wide data.
        Heart. 2014; 100: 239-246
        • Agyemang C.
        • van Oeffelen A.A.
        • Norredam M.
        • et al.
        Socioeconomic inequalities in stroke incidence among migrant groups: analysis of nationwide data.
        Stroke. 2014; 45: 2397-2403
        • Van Oeffelen A.
        • Agyemang C.
        • Koopman C.
        • et al.
        Downward trends in acute myocardial infarction incidence: how do migrants fare with the majority population? Results from a nationwide study.
        Eur J Prev Cardiol. 2014; 21: 1493-1500
        • Gadd M.
        • Johansson S.E.
        • Sundquist J.
        • Wändell P.
        Morbidity in cardiovascular diseases in immigrants in Sweden.
        J Intern Med. 2003; 254: 236-243
        • Gadd M.
        • Johansson S.E.
        • Sundquist J.
        • Wändell P.
        The trend of cardiovascular disease in immigrants in Sweden.
        Eur J Epidemiol. 2005; 20: 755-760
        • Sundquist K.
        • Li X.
        Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study.
        J Intern Med. 2006; 259: 418-427
        • Hedlund E.
        • Lange A.
        • Hammar N.
        Acute myocardial infarction incidence in immigrants to Sweden. Country of birth, time since immigration, and time trends over 20 years.
        Eur J Epidemiol. 2007; 22: 493-503
        • Khan F.A.
        • Zia E.
        • Janzon L.
        • Engstrom G.
        Incidence of stroke and stroke subtypes in Malmo, Sweden, 1990-2000: marked differences between groups defined by birth country.
        Stroke. 2004; 35: 2054-2058
        • Hempler N.F.
        • Larsen F.B.
        • Nielsen S.S.
        • et al.
        A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role?.
        BMC Public Health. 2011; 11: 662
        • Norredam M.
        • Agyemang C.
        • Hoejbjerg Hansen O.K.
        • et al.
        Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the “healthy migrant effect” hypothesis.
        Trop Med Int Health. 2014; 19: 958-967
        • Connolly S.
        • Rosato M.
        • Kinnear H.
        • O’Reilly D.
        Variation in mortality by country of birth in Northern Ireland: a record linkage study.
        Health Place. 2011; 17: 801-806
        • Harding S.
        Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence.
        Epidemiology. 2003; 14: 287-292
        • Harding S.
        Mortality of migrants from the Caribbean to England and Wales: effect of duration of residence.
        Int J Epidemiol. 2004; 33: 382-386
        • Saposnik G.
        • Redelmeier D.A.
        • Lu H.
        • et al.
        Myocardial infarction associated with recency of immigration to Ontario.
        QJM. 2010; 103: 253-258
        • Saposnik G.
        • Redelmeier D.A.
        • Lu H.
        • et al.
        Risk of premature stroke in recent immigrants (PRESARIO): population-based matched cohort study.
        Neurology. 2010; 74: 451-457
        • Moon J.R.
        • Capistrant B.D.
        • Kawachi I.
        • et al.
        Stroke incidence in older US Hispanics: is foreign birth protective?.
        Stroke. 2012; 43: 1224-1229
        • Dassanayake J.
        • Gurrin L.
        • Payne W.R.
        • Sundararajan V.
        • Dharmage S.C.
        Cardiovascular disease risk in immigrants: what is the evidence and where are the gaps?.
        Asia Pac J Public Health. 2011; 23: 882-895
        • Agyemang C.
        • Bindraban N.
        • Mairuhu G.
        • et al.
        Prevalence, awareness, treatment, and control of hypertension among Black Surinamese, South Asian Surinamese and White Dutch in Amsterdam, The Netherlands: the SUNSET study.
        J Hypertens. 2005; 23: 1971-1977
        • Agyemang C.
        • Kunst A.E.
        • Bhopal R.
        • et al.
        Diabetes prevalence in populations of South Asian Indian and African origins: a comparison of England and the Netherlands.
        Epidemiology. 2011; 22: 563-567
        • Uitewaal P.J.
        • Manna D.R.
        • Bruijnzeels M.A.
        • Hoes A.W.
        • Thomas S.
        Prevalence of type 2 diabetes mellitus, other cardiovascular risk factors, and cardiovascular disease in Turkish and Moroccan immigrants in North West Europe: a systematic review.
        Prev Med. 2004; 39: 1068-1076
        • Alsheikh-Ali A.A.
        • Omar M.I.
        • Raal F.J.
        • et al.
        Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study.
        PLoS One. 2014; 9: e102830
        • Bainey K.R.
        • Jugdutt B.I.
        Increased burden of coronary artery disease in South-Asians living in North America. Need for an aggressive management algorithm.
        Atherosclerosis. 2009; 204: 1-10
        • Koulaouzidis G.
        • Nicoll R.
        • Charisopoulou D.
        • et al.
        Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors.
        Int J Cardiol. 2013; 167: 2472-2476
        • Agyemang C.
        • Addo J.
        • Bhopal R.
        • Aikins A.D.G.
        • Stronks K.
        Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review.
        Global Health. 2009; 5: 7
        • Ueshima H.
        • Sekikawa A.
        • Miura K.
        • et al.
        Cardiovascular disease and risk factors in Asia: a selected review.
        Circulation. 2008; 118: 2702-2709
        • Wild S.
        • McKeigue P.
        Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92.
        BMJ. 1997; 314: 705-710
        • Müller-Nordhorn J.
        • Binting S.
        • Roll S.
        • Willich S.N.
        An update on regional variation in cardiovascular mortality within Europe.
        Eur Heart J. 2008; 29: 1316-1326
        • Harding S.
        • Rosato M.
        • Teyhan A.
        Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups.
        Heart. 2008; 94: 463-470
        • Khan N.A.
        • Grubisic M.
        • Hemmelgarn B.
        • et al.
        Outcomes after acute myocardial infarction in South Asian, Chinese, and white patients.
        Circulation. 2010; 122: 1570-1577
        • Shah K.S.
        • Shah A.S.
        • Bhopal R.
        Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse.
        Eur J Prev Cardiol. 2014; 21: 619-638
        • Bansal N.
        • Fischbacher C.M.
        • Bhopal R.S.
        • Brown H.
        • Steiner M.F.
        • Capewell S.
        Myocardial infarction incidence and survival by ethnic group: Scottish Health and Ethnicity Linkage retrospective cohort study.
        BMJ Open. 2013; 3: e003415
        • Rana A.
        • de Souza R.J.
        • Kandasamy S.
        • Lear S.A.
        • Anand S.S.
        Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis.
        CMAJ Open. 2014; 2: E183-E191