Cardiovascular Risk Profile of Somali Refugees in Minneapolis
Preliminary Results of a study
In 2001 Douglas J. Pryce, M.D (from Hennepin County Medical Center) and Ahmed Dalmar, M.D., M.S (from Medical College of Wisconsin) with many other Somali doctors in Minneapolis, conducted a cross sectional study to assess the prevalence of cardiovascular risk factors in Somali immigrants in Minneapolis. The study was funded by MMRF 2000 International Health Grant.
The rationale was that those who migrate to the US usually adapt the eating and exercise patterns described as (MacDonalization) of the US population. This generally leads to weight gain, higher salt intake, higher alcohol intake, more stress, higher blood pressure, higher lipids, more diabetes and more CVD.
Design: Cross-sectional study to assess the prevalence of cardiovascular risk factors in Somalis living in Minneapolis, using Rapid Epidemiological survey (RES). RES was developed by Centers for Disease Control and prevention (CDC) to assess vaccination and nutritional status in the third world countries; it is a two-stage cluster design and provides rapid feedback.
We initially identified Somali Households and then randomly selected 36 clusters. In each selected cluster we identified first household and measured height, weight, waist and hip circumferences, three seated blood pressures and blood sampled for HbA1C, Cholesterol (TC) and HDL in all persons 18 years of age and older; in all 7 subjects. A two-page survey questionnaire was administered to all participants
If there were not enough people in the first household, we went to the next household until we got 7 people
Descriptive statistics were calculated and confidence intervals calculated by standard methods.
Results:
•In all 253 (female 58%) subjects were studied; the mean age was 38.5. Participation rate was 95%. 
•Age distribution of Somalis: 18-29(38%), 30-39(22%), 40-59 (22%) > 60(17%)
Women outnumber men (age 38-80) Total countMale Female
Characteristics of the sample
Variable Mean (95% CI)
SBP (mm Hg)115113-117
DBP (mm Hg) 7472-76
BMI 26.725-29
Waist (cm)9190-94
HgA1c5.53.54-7.46
T. Cholesterol 186184-190
HDL4745-49
Somali exercise status: 40% were physically active daily, 18% once or twice a week. 40% only five times a month.
Somali Educational Attainment: 14% had college or professional degree, 24% high school diploma, 24 % grade 7-12, 15% Elementary and 22% no formal education.
English Proficiency: None 22%, Little 26%, Enough to get by 35%, and fluent 18%.
Smoking status: Sixteen percent of males were smokers and 31% were 30-39 years of age. Less than 1% of females smoke, Somalis may not admit to cigarette smoking.
Cigarette Smoking Data
Asian/Pacific Island.261314
Family History of Early CVD. Unknown family history, Personal history of CAD also limited
Health Insurance 2000 (Somalis 81%)
Primary Provider
59% have a regular MD or NP. 50% of age group 18-39 has no primary care
ER Utilization: 29% visited the ER within one year
BMI 30: Somali 25 % MN 17% USA 20%
BMI 30 Males
AgeSomali %WhiteBlackMex/American
BMI 30 Females
AgeSomali %WhiteBlackMex/American
Hypertension (HTN):
HTN in Somalis: Most cases (88%) Poor control despite prescription medication, M = F
Diabetes in Somalis: Prevalence = 5.5% •Hg A1C 7.0 or treated. All cases age 40.
Most already diagnosed but poorly controlled. M = F
Hyperlipidemia
(TC: HDL Ratio > 5:1), Prevalence 17% in Somalis. M > F in age group 18-39.
M = F 40 age group. Prevalence 38% Somali males (age 30-39)
Summary
Somali cardiovascular risk profile appears to be different than some other ethnic groups.
Type 2 diabetes and Hypertension (HTN) occur after age 40, are less prevalent than US population, but are not well controlled.
Cholesterol is high in males age 30-39 and obesity reaches epidemic proportions in females age 40-65 .
Smoking status is similar to that of Minnesota population. Almost 60% of Somalis are less active physically.
At this time in the epidemiologic transition, major focus should be health education to improve compliance in the treatment of diabetes and hypertension.
The role of exercise, healthy nutrition and smoking cessation should also be part of health education to stop the epidemic of obesity in females age 40-65 and hyperlipidemia in males (age 30-39).
Considering further studies:
Consider further study of nontraditional markers of CVD risk.
Is cardiovascular risk profile of the cohort the same after five years? A follow study is needed to answer that question and to further study the impact of acculturation in the general well being of Somali immigrants in Minneapolis.
