Diabetes among Ethiopian Immigrants to Israel: Exploring the Effects of Migration and Ethnicity on Diabetes Risk.
OBJECTIVE
Diabetes 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.


METHODS
The 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.


RESULTS
Younger (<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.


CONCLUSIONS
Ethiopian 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.
Endocrinology & Diabetes Unit Hillel Yaffe Medical Center, Hadera, Israel.|Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Anat
http://orcid.org/0000-0003-3976-0923
A
Jaffe
Clalit Health Services, Department of Family Practice, Sharon Shomron District, Department of Family Practice, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Shmuel
S
Giveon
Unit of Biostatistics; Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Liat
L
Wulffhart
Unit of Biostatistics; Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Bernice
B
Oberman
Unit of Biostatistics; Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Laurence
L
Freedman
Unit of Information and Computing, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Arnona
A
Ziv
Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Ofra
O
Kalter-Leibovici
D000328:Adult; D044383:Black People; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007585:Jews; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult