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?

Abstract

BackgroundThis study compared the incidence of cardiovascular disease (CVD) and acute myocardial infarction (AMI) between native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia. Furthermore, we examined whether different indicators of socioeconomic status (SES), such as employment, income and housing conditions influenced potential differences.MethodsIn this registry-based follow-up study individuals were identified in a large database that included individuals from two major regions in Denmark, corresponding to about 60% of the Danish population. Incident cases of CVD and AMI included fatal and non-fatal events and were taken from registries. Using Cox regression models, we estimated incidence rates at 5-year follow-up.ResultsImmigrant men and women from Turkey and Pakistan had an increased incidence of CVD, compared with native Danish men. In the case of AMI, a similar pattern was observed; however, differences were more pronounced. Pakistanis and Turks with a shorter duration of residence had a lower incidence, compared with those of a longer residence. Generally, no notable differences were observed between former Yugoslavians and native Danes. In men, differences in CVD and AMI were reduced after adjustment for SES, in particular, among Turks regarding CVD. In women, effects were particularly reduced among Yugoslavians in the case of CVD and in Turks in the case of CVD and AMI after adjustment for SES.ConclusionsIn conclusion, country of birth-related differences in the incidence of CVD and AMI were observed. At least some of the differences that we uncovered were results of a socioeconomic effect. Duration of residence also played a certain role. Future studies should collect and test different indicators of SES in studies of CVD among immigrants.

Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland

“…Similar findings have previously been reported in the general population [22][23][24]; here we have shown this for the first time in a population with diabetes and demonstrated that the excess risk persists even after full statistical adjustment for BMI, metabolic, lifestyle, SES and disease factors. Independent of the effect of age and age of diabetes diagnosis, rates of CVD differed among the various ethnic groups.…”

“…Other studies reporting ethnic differences were conducted in the general population and used diabetes as an adjustment factor [8,[22][23][24] rather than investigating ethnic differences among people with diabetes. Studies performed in people with type 2 diabetes were small to modest cohort studies (n=4,974) [11,12,28,38,41,42] or combined different ethnic groups (Pakistani, Indian, Bangladeshi and Sri Lankan) as one group of South Asians [8,12,24,26,28,38,42].…”

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

“…20,21,24,26,27,29,31,34 Among first-generation immigrants, although there was some heterogeneity across these studies, immigrants from Eastern and some other Western European countries, the Middle East, and South Asia were found to be at an overall greater risk than the host population, and those from Africa and North America were at lower risk. Notably, male immigrants to Sweden from other Nordic countries (eg, Finland), Eastern Europe, the Middle East, and Asia had particularly greater incidence of IHD than the host male population.…”

Morbidity, Self-Perceived Health and Mortality Among non-Western Immigrants and Their Descendants in Denmark in a Life Phase Perspective

“…An increased incidence for cardiovascular disease (CVD) was found among Turkish and Pakistani immigrants but similar incidence found among former Yugoslavian immigrants compared with ethnic Danes. Likewise, an increased incidence of Acute Myocardial infarction was found for Turkish immigrant men and Pakistani immigrant men and women while a similar incidence for Turkish immigrant women as well for former Yugoslavian men and women was seen compared with ethnic Danes [18]. Self-reported high blood pressure and heart issues were more common in immigrants than in ethnic Danes [2] in one study; in another study, no differences were detected [19].…”