title: Health status of newly arrived refugees in Toronto, Ont: Part 2: chronic diseases.
abstract: OBJECTIVE
  To determine the prevalence of selected chronic diseases among newly arrived refugee patients and to explore associations with key demographic factors.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Primary care clinic for refugee patients in Toronto, Ont.
  
  
  METHODS
  A total of 1063 refugee patients rostered at the clinic from December 2011 to June 2014.
  
  
  METHODS
  Demographic information (age, sex, and region of birth) and prevalence of abnormal Papanicolaou test results, anemia, elevated blood pressure (BP), and markers of prediabetes or diabetes (elevated random glucose, fasting glucose, or hemoglobin A1c levels).
  
  
  RESULTS
  More than half of our patients were female (56%) and the median age was 29 years. Patients originated from 87 different countries of birth. Top source countries were Hungary (210 patients), North Korea (119 patients), and Nigeria (93 patients). Most patients were refugee claimants (92%), as opposed to government-assisted refugees (5%). Overall, 11% of female patients who underwent Pap tests had abnormal cervical cytology findings, with the highest rates among women from Asia (26%, P = .028). The prevalence of anemia among children younger than 15 years was 11%; for children younger than 5 years the prevalence was 14%. Approximately 25% of women older than 15 years had anemia, with the highest rates among African women (37%, P < .001). Elevated BP was observed in 30% of adult patients older than 15 years, with higher prevalence among male patients (38%, P < .001) and patients from Europe (42%, P < .001). Laboratory markers of prediabetes or diabetes were identified in 8% of patients older than 15 years, with higher rates among patients from Europe (15%, P = .026).
  
  
  CONCLUSIONS
  This study found a notable burden of chronic diseases among refugee patients, including anemia, elevated BP, and impaired glycemic control, as well as abnormal cervical cytology findings. These results underscore the importance of accessible, comprehensive primary care for refugees, with attention to prevention and management of chronic diseases in addition to management of infectious disease.
authors.affiliation: Fellow in the Global Health and Vulnerable Populations program in the Department of Family and Community Medicine (DFCM) at the University of Toronto in Ontario. vredditt@gmail.com.
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Redditt
authors.affiliation: Summer research intern at the Crossroads Clinic at Women's College Hospital in Toronto through the Women's College Hospital Institute for Health System Solutions and Virtual Care program.
authors.forename: Daniela
authors.initials: D
authors.lastname: Graziano
authors.affiliation: Staff physician at the Crossroads Clinic and Lecturer in the DFCM at the University of Toronto.
authors.forename: Praseedha
authors.initials: P
authors.lastname: Janakiram
authors.affiliation: Director of the Crossroads Clinic and Lecturer in the DFCM at the University of Toronto.
authors.forename: Meb
authors.initials: M
authors.lastname: Rashid
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D000740:Anemia / Q000453:epidemiology; D001794:Blood Pressure; D002908:Chronic Disease / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D065006:Papanicolaou Test; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult