I van Valkengoed

Factors associated with hypertension awareness, treatment and control among ethnic groups in Amsterdam, the Netherlands: the SUNSET study.

We sought to determine factors associated with hypertension awareness, pharmacological treatment and control among ethnic groups in Amsterdam, The Netherlands. We analysed data on hypertensive subjects (Dutch n=130, Hindustani n=115 and African Surinamese n=225). After adjustments for important covariates, hypertension awareness was more common in Dutch people with abdominal obesity and family history of hypertension (FHH). Abdominal obesity was also associated with higher level of awareness in African Surinamese. Female sex, FHH and recent physician (general practitioner (GP)) visit were associated with higher level of awareness in both African and Hindustani Surinamese. Among the Dutch, hypertension treatment was more common in those with abdominal obesity, FHH and GP visit. Among Hindustanis, female sex, abdominal obesity and GP visit were positively associated with treatment of hypertension. Old age, female sex, FHH and GP visit were positively associated, whereas smoking was negatively associated with lower treatment in African Surinamese. High education and more physical activity were associated with better blood pressure (BP) control, whereas obesity was associated with poor BP control among the Dutch. Among African Surinamese, female sex and FHH were associated with better BP control, whereas abdominal obesity was associated with poor BP control. Only old age was associated with poor BP control in Hindustanis. In conclusion, our findings indicate that more attention is needed in promoting awareness and treatment among those with lower hypertension risk (i.e., normal body weight people and those without FHH), those without recent GP visits in all ethnic groups and African and Hindustani Surinamese men and smokers. More effort is also needed in hypertension control among Dutch people with low education, obesity and inadequate physical activity, African Surinamese men and those without FHH and old Hindustani people.

Risk of death after first admission for cardiovascular diseases by country of birth in The Netherlands: a nationwide record-linked retrospective cohort study

Objective: To examine differences in short- (28 days) and long-term (5 years) risk of death in patients hospitalised for the first time for various cardiovascular diseases (CVD) by country of birth and/or parental country of birth. Design: A nationwide prospective cohort of CVD patients. Settings: Entire Netherlands. Patients: 118 691 patients hospitalised for the first time for various CVDs were identified through the national hospital discharge, the Dutch population and the cause-of-death registers. Main outcome measures: Differences in short-term and long-term risk of death. Cox proportional hazard models were used to estimate the mortality hazard ratios. Results: After adjusting for age, compared with Dutch patients, Turkish, other non-Western and Western migrants had both a short- and long-term higher risk, while Suriname patients had only a long-term higher risk of total-mortality and combined-CVD mortality. These higher rates were driven mainly by an increased risk of short-term (hazard ratio 3.21; 95% CI 1.03 to 10.03) and long-term (2.29; 1.14 to 4.60) mortality following congestive heart failure (CHF) among Turkish; short-term (1.56; 1.10 to 2.20) and long-term (1.50; 1.11 to 2.01) mortality following cerebrovascular accident (CVA) among the other non-Western migrants; short-term mortality following CVA (1.10; 1.01 to 1.19) and long-tem mortality following CVA (1.10; 1.03 to 1.17), and, to a lesser extent, CHF and myocardial infarction among Western migrants; and a long-term mortality following CVA (1.29; 1.05 to 1.57) among Surinamese patients. Conclusion: Higher mortality after a first episode of CVD was found in ethnic minority patients than in Dutch patients. These differences hardly changed after adjusting for possible confounders, suggesting that treatment and secondary prevention strategies may be less effective in these groups. More research is needed to explain the possible causes of these inequalities.

The association of physical inactivity with Type 2 diabetes among different ethnic groups

Diabet. Med. 28, 668–672 (2011)

Lower frequency of the 5/5 homozygous CNDP1 genotype in South Asian Surinamese

We investigated the frequency of the 5/5 homozygous CNDP1 (carnosinase) genotype, which was found to be associated with a reduced risk of developing diabetic nephropathy, in three ethnic groups in The Netherlands. Particularly interesting were the South Asian Surinamese, who have a high prevalence of diabetic nephropathy. Furthermore, we investigated the association between this gene and carnosinase activity in South Asian Surinamese and whether carnosinase was expressed in the kidney. We genotyped 290 South Asian Surinamese, 532 African Surinamese, and 472 White Dutch in a cross-sectional population study. Furthermore, an independent cohort of South Asian Surinamese was genotyped. In this population, carnosinase activity was measured in serum. Immunostaining and in situ hybridization for CNDP1 were performed on kidney tissue. Both South Asian populations had lower frequencies of the 5/5 homozygous genotype than African Surinamese and White Dutch (23.0%, 27.2%, 38.2%, and 41.3%, respectively; chi-square, p<0.001). This genotype showed a lower carnosinase activity in South Asian Surinamese (Wilcoxon rank-sum, p=0.03). CNDP1 was expressed in the kidney. South Asian Surinamese have a lower frequency of the 5/5 homozygous genotype, which was associated with lower carnosinase activity. Our study provides an indication that South Asian Surinamese are genetically at risk for developing diabetic nephropathy.

Dutch versus English advantage in the epidemic of central and generalised obesity is not shared by ethnic minority groups: comparative secondary analysis of cross-sectional data

Background:Ethnic minority groups in Western European countries tend to have higher levels of overweight than the majority populations for reasons that are poorly understood. Investigating relative differences between countries could enable an investigation of the importance of national context in determining these inequalities.Objective:To explore: (1) whether Indian and African origin populations in England and the Netherlands are similarly disadvantaged compared with the White populations in terms of the prevalence of overweight and central obesity; (2) whether the previously known Dutch advantage of relatively low overweight prevalence is also observed in Dutch ethnic minority groups and (3) the contribution of health behaviour and socio-economic position to the differences observed.Methods:Secondary analyses of population-based studies of 16 406 participants from England and the Netherlands. Prevalence ratios were estimated using regression models.Results:Except for African men, ethnic minority groups in both countries had higher rates of overweight and central obesity than their White counterparts. However, the Dutch minority groups were relatively more disadvantaged than English minority groups as compared with the majority populations. The Dutch advantage of the low prevalence of obesity was only seen in White men and women and African men. In contrast, English-Indian (prevalence ratio=0.87, 95% confidence interval (CI): 0.81–0.93) and English-Caribbean (prevalence ratio=0.82, 95% CI: 0.76–0.89) women were less centrally obese than their Dutch equivalents. The Dutch-Indian men were very similar to the English-Indian men. The contribution of health behaviour and socio-economic position to the observed differences were small.Conclusion:Contrary to the patterns in White groups, the Dutch ethnic minority women were more obese than their English equivalents. More work is needed to identify factors that may contribute to these observed differences.

Heterogeneity in sex differences in the metabolic syndrome in Dutch white, Surinamese African and South Asian populations.

Diabet. Med. 29, 1159‐1164 (2012)

Sex difference in blood pressure among South Asian diaspora in Europe and North America and the role of BMI: a meta-analysis

It is unclear whether the sex difference that is known to occur in blood pressure (BP) is similar in some South Asian populations. This study presents a meta-analysis of the sex difference in BP, hypertension and the role of body mass index (BMI) in South Asian diaspora compared with populations of European descent. We systematically searched for studies that reported BP and hypertension among South Asian descent populations living in Europe and North America. Weighted mean differences in BP and risk ratios (RR) for hypertension were calculated for men and women. We included 11 studies in this meta-analysis. In general, men had a higher BP and prevalence of hypertension than women, for example, systolic BP was higher in men than in women among the Indian (7.21 mm Hg, 95% confidence interval (CI): 4.46–9.95) and European populations (6.12 mm Hg, 95% CI: 4.45–7.80). The difference was less in the Pakistani population (4.00 mm Hg, 95% CI: 2.65–5.36). The Bangladeshi population showed a comparatively small sex difference in systolic (2.93 mm Hg, 95% CI: 1.20–4.66) and diastolic BP (0.68 mm Hg, 95% CI: −1.76 to 3.12) and prevalence of hypertension (RR 1.28, 95% CI: 0.66–2.46). Sex differences in BMI for the South Asian populations were greater than those in Europeans. The Indian population had similar sex differences in BP and hypertension compared with Europeans, but Pakistani and Bangladeshi had smaller sex differences. Sex differences in BMI might relate to the blunted sex differences in BP in Pakistani and Bangladeshi populations. Further research should focus on factors that underlie this intriguing sex difference among South Asian populations.

Ethnic disparities in the association of impaired fasting glucose with the 10-year cumulative incidence of type 2 diabetes

AIMS Evidence of ethnic disparities in the conversion of prediabetes to type 2 diabetes is scarce. We studied the association of impaired fasting glucose (IFG) and fasting plasma glucose (FPG) with the 10-year cumulative incidence of type 2 diabetes in three ethnic groups. METHODS We analyzed data for 90 South-Asian Surinamese, 190 African-Surinamese, and 176 ethnic Dutch that were collected in the periods 2001-2003 and 2011-2012. We excluded those with type 2 diabetes or missing FPG data. We defined baseline IFG as FPG of 5.7-6.9 mmol/L. We defined type 2 diabetes at follow-up as FPG ≥ 7.0 mmol/L, HbA1c ≥ 48 mmol/mol (6.5%), or self-reported type 2 diabetes. RESULTS 10-Year cumulative incidences of type 2 diabetes were: South-Asian Surinamese, 18.9%; African-Surinamese, 13.7%; ethnic Dutch, 4.5% (p<0.05). The adjusted association of baseline IFG and FPG with the 10-year cumulative incidence of type 2 diabetes was stronger for South-Asian Surinamese than for African-Surinamese and ethnic Dutch. The IFG (compared to normoglycaemia) ORs were 11.1 [3.0-40.8] for South-Asian Surinamese, 5.1 [2.0-13.3] for African-Surinamese, and 2.2 [0.5-10.1] for ethnic Dutch. CONCLUSIONS The 10-year cumulative incidence of type 2 diabetes was higher and associations with baseline IFG and FPG were stronger among South-Asian Surinamese and African-Surinamese than among ethnic Dutch. Our findings confirm the high risk of type 2 diabetes in South-Asians and suggest more rapid conversion in populations of South-Asian origin and (to a lesser extent) African origin than European origin.

A CROSS-NATIONAL COMPARATIVE STUDY OF DIABETES PREVALENCE BETWEEN ENGLISH AND DUTCH SOUTH ASIAN INDIAN AND AFRICAN ORIGIN POPULATIONS

Background Ethnic minority groups in western European countries tend to have higher levels of type 2 diabetes mellitus (DM) than the majority populations for reasons that are poorly understood. Investigating differences between countries could enable an investigation of the importance of national context in determining these inequalities. We determined whether the lower prevalence of DM in England vs the Netherlands is also observed in South-Asian-Indian and African-Caribbean populations. Additionally, we assessed the contribution of health behaviour, body sizes and socio-economic position to any observed differences between countries. Methods Secondary analyses of population-based standardised individual level data of 3386 participants. Differences in prevalence ratios (PR) of DM were estimated using regression models. Results Indian and African-Caribbean populations had higher prevalence rates of diabetes than Whites in both countries. In cross-country comparisons, similar to Whites, English-Indians had a lower prevalence of diabetes than Dutch-Indians; the difference in women remained after adjustments for other covariates (PR=0.35, 95% CI 0.22 to 0.55). English-African women also had a lower prevalence of diabetes than Dutch-Africans (PR=0.43, 95% CI 0.20 to 0.89). For African men the difference was small (p=0.249). Conclusion These findings suggest that the increasing prevalence of diabetes following migration may be modified by the context in which ethnic minority groups live.