Ethnically-tailored approach could combat diabetes risks

South Asian men and black women in Ontario, Canada currently face much higher heart disease risk factors than they faced 10 years ago, according to a study published in BMJ Open. The study shows dramatic increases in the rates of particular risk factors for these groups including diabetes, high blood pressure and obesity.

Maria Chiu, PhD, lead author of the study and scientist at the Institute for Clinical Evaluative Sciences (ICES), and colleagues identified 219,276 respondents (205,326 white, 5,620 South Asian, 4,368 Chinese, and 3,962 black) to the Canadian Community Health Survey from 2001 to 2012. The researchers examined these individuals' self-reported measures of cardiovascular risk factors, including current smoking, diabetes, high blood pressure and obesity (having a body mass index of 30 or more). 

The researchers found that in the 12-year period from 2001 to 2012, rates of diabetes doubled among South Asian men (6.7% to 15.2%) and nearly doubled among black women (6.3% to 12.2%).

"Physicians and healthcare providers need to be aware of these ethnic differences and provide culturally sensitive and relevant advice about the importance of diet, physical activity and maintaining a healthy weight,” Chiu says. “In order to change policies and programs, we need to have empirical evidence and this study provides this evidence.”

Other findings include:

• Generally, black women were most likely to be obese and less likely to consume fruits and vegetables regularly; they were also among those reporting the highest levels of psychosocial stress, the largest increase in high blood pressure rates, and one of the only groups that saw increases in smoking rates.

• Obesity increased in all ethnic groups for both men and women, with largest relative increase observed among Chinese men whose rate of obesity more than doubled from 2.8% to 5.9%.

• The proportion of South Asian men with inadequate consumption of fruits and vegetables increased significantly in 12 years, suggesting a progressively poorer diet.

• White men had the highest rates of smoking, but smoking rates have been declining for most groups except black women and Chinese men.

Knowledge of risk factors and their trends across ethnicities is an important step in understanding the relative distribution of the burden of cardiovascular disease and to anticipate future incidence within ethnically diverse populations, according to Chiu.

“A combination of a population-wide strategy to combat obesity and diabetes and ethnically-tailored strategies to combat other risk factors might be optimal for reducing ethnic disparities and CVD overall,” she says. “Improving neighborhood walkability is an example of a population-wide approach to encouraging more physical activity.”        

The study is the first in Canada to examine ethnic-specific cardiovascular risk factor trends over time.