Abstract
ObjectiveDiabetes 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.MethodsThe 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.ResultsYounger (<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.ConclusionsEthiopian 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.
Highlights
The emerging global epidemic of diabetes disproportionally affects indigenous and immigrant populations of non-European origin [1]
Diabetes risk among Ethiopians was higher and adjustment for metabolic syndrome (MetS)-components was important only for body mass index (BMI), which further increased hazard ratio (HR) estimates associated with Ethiopian ethnicity from 1.81 to 2.31
BMI before incident diabetes was lower among younger Ethiopian immigrants than younger former Soviet Union (FSU) immigrants and Israeli-born
Summary
The emerging global epidemic of diabetes disproportionally affects indigenous and immigrant populations of non-European origin [1]. Indigenous populations that preserve their traditional lifestyle are less affected; this is the case in rural Ethiopia where there is a diabetes prevalence of 1% [5,6]. A recent cross-sectional study showed that the increase in diabetes and hypertension prevalence among Ethiopian immigrants to Israel correlated with a longer period of residence in Israel [15]. Most of these observed trends were based on small cross-sectional studies, and were not adjusted for age, sex or diabetes risk factors. Cohort studies on diabetes incidence in recent immigrant populations to Israel have not been published
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