Advertisement

Journal of Community Health

, Volume 37, Issue 5, pp 1110–1118 | Cite as

High Prevalence of Chronic Non-Communicable Conditions Among Adult Refugees: Implications for Practice and Policy

  • Katherine YunEmail author
  • Kelly Hebrank
  • Lauren K. Graber
  • Mary-Christine Sullivan
  • Isabel Chen
  • Jhumka Gupta
Original Paper

Abstract

The global rise in non-communicable disease (NCD) suggests that US-based refugees are increasingly affected by chronic conditions. However, health services have focused on the detection of infectious disease, with relatively limited data on chronic NCDs. Using data from a retrospective medical record review of a refugee health program in the urban Northeast (n = 180), we examined the prevalence of chronic NCDs and NCD risk factors among adult refugees who had recently arrived in the US, with attention to region of origin and family composition. Family composition was included because low-income adults without dependent children are at high risk of becoming uninsured. We found that half of the adult refugees in this sample had at least one chronic NCD (51.1%), and 9.5% had three or more NCDs. Behavioral health diagnoses were most common (15.0%), followed by hypertension (13.3%). Half of adults were overweight or obese (54.6%). Chronic NCDs were somewhat more common among adults from Iraq, but this difference was not significant (56.8 vs. 44.6%). Chronic NCDs were common among adults with and without dependent children (61.4 vs. 44.6%, respectively), and these two groups did not significantly differ in their likelihood of having a chronic NCD after adjustment for age and gender (AOR = 0.78, 95% CI = 0.39, 1.55). This study suggests that chronic NCDs are common among adult refugees in the US, including refugees at high risk for uninsurance. We propose that refugee health services accommodate screening and treatment for chronic NCDs and NCD risk factors, and that insurance outreach and enrollment programs target recently arrived refugees.

Keywords

Emigrant and immigrant/chronic diseases Refugees/chronic diseases Refugees/epidemiology 

Notes

Acknowledgments

This study was made possible by CTSA Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

References

  1. 1.
    Yearbook of Immigration Statistics, 2000–2010. Washington, DC: Department of Homeland Security, Office of Immigration Statistics, Accessed July 27, 2011, Available at http://www.dhs.gov/files/statistics/publications/yearbook.shtm.
  2. 2.
    Refugee Act, S. 643, Congress of the United States of America, 96th Congress. (1980).Google Scholar
  3. 3.
    (2010). 2009 Global trends: Refugees, asylum-seekers, returnees, internally displaced and stateless persons. Geneva: United Nations High Commissioner for Refugees, Division of Programme Support and Management.Google Scholar
  4. 4.
    Yearbook of immigration statistics, 2010. Washington, DC: Department of Homeland Security, Office of Immigration Statistics, Accessed July 27, 2011. Available at http://www.dhs.gov/files/statistics/publications/yearbook.shtm.
  5. 5.
    Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028–1035.PubMedCrossRefGoogle Scholar
  6. 6.
    Wong, E. C., Marshall, G. N., Schell, T. I., Elliott, M. N., Babey, S. H., & Hambarsoomians, K. (2010). The unusually poor physical health status of Cambodian refugees two decades after resettlement. Journal of Immigrant and Minority Health, 13(5), 876–882.CrossRefGoogle Scholar
  7. 7.
    Ku, L., & Matani, S. (2001). Left out: Immigrants’ access to health care and insurance. Health Affairs, 20(1), 247–256.PubMedCrossRefGoogle Scholar
  8. 8.
    Guendelman, S., Schauffler, H. H., & Pearl, M. (2001). Unfriendly shores: How immigrant children fare in the U.S. health system. Health Affairs, 20(1), 257–266.PubMedCrossRefGoogle Scholar
  9. 9.
    Bischoff, A., Bovier, P. A., Rrustemi, I., Gariazzo, F., Eytan, A., & Loutan, L. (2004). Language barriers between nurses and asylum seekers: Their impact on symptom reporting and referral. Social Science and Medicine, 57(3), 503–512.Google Scholar
  10. 10.
    Huang, Z. J., Yu, S. M., & Ledsky, R. (2006). Health status and health service access and use among children in U.S. immigrant families. American Journal of Public Health, 96(4), 634–640.PubMedCrossRefGoogle Scholar
  11. 11.
    Lopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. L. (2006). Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. The Lancet, 367(9524), 1747–1757.CrossRefGoogle Scholar
  12. 12.
    Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M., & Strong, K. (2007). The burden and costs of chronic diseases in low-income and middle-income countries. The Lancet, 370(9603), 1929–1938.CrossRefGoogle Scholar
  13. 13.
    Liu, Y., Weinberg, M. S., Ortega, L. S., Painter, J. A., & Maloney, S. A. (2009). Overseas screening for tuberculosis in US-bound immigrants and refugees. New England Journal of Medicine, 360(23), 2406–2415.PubMedCrossRefGoogle Scholar
  14. 14.
    Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, the Journal of the American Medical Association, 302(5), 537–549.CrossRefGoogle Scholar
  15. 15.
    Vergara, A. E., Miller, J. M., Martin, D. R., & Cookson, S. T. (2003). A survey of refugee health assessments in the United States. Journal of Immigrant Health, 5(2), 67–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Dookeran, N. M., Battaglia, T., Cochran, J., & Geltman, P. L. (2010). Chronic disease and its risk factors among refugees and asylees in Massachusetts, 2001–2005. Preventing Chronic Disease, 7(3), A51.PubMedGoogle Scholar
  17. 17.
    Culhane-Pera, K., Moua, M., DeFor, T., & Desai, J. (2009). Cardiovascular disease risks in Hmong refugees from Wat Tham Krabok, Thailand. Journal of Immigrant and Minority Health, 11(5), 372–379.PubMedCrossRefGoogle Scholar
  18. 18.
    Barnes, D. M., Harrison, C. L., & Heneghan, R. (2004). Health risk and promotion behaviors in refugee populations. Journal of Health Care for the Poor and Underserved, 15(3), 347–356.PubMedCrossRefGoogle Scholar
  19. 19.
    Ramos, M., Orozovich, P., Moser, K., Phares, C. R., Stauffer, W., & Mitchell, T. (2010). Health of resettled Iraqi refugees—San Diego County, California, October 2007-September 2009. Morbidity and Mortality Weekly Report, 59(49), 1614–1618.Google Scholar
  20. 20.
    Reilly, R. (2008). Disabilities among refugees and conflict-affected populations. New York: Women’s Refugee Commission.Google Scholar
  21. 21.
    Carrasquillo, O., Carrasquillo, A. I., & Shea, S. (2000). Health insurance coverage of immigrants living in the United States: Differences by citizenship status and country of origin. American Journal of Public Health, 90(6), 917–923.PubMedCrossRefGoogle Scholar
  22. 22.
    Connor, P. (2010). Explaining the refugee gap: economic outcomes of refugees versus other immigrants. Journal of Refugee Studies, 23(3), 377–397.CrossRefGoogle Scholar
  23. 23.
    Alker, J. C., & Ng’andu, J. (2006). The role of employer-sponsored health coverage for immigrants: A primer. Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation.Google Scholar
  24. 24.
    Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A., & Zaslavsky, A. M. (2000). Unmet health needs of uninsured adults in the United States. JAMA, the Journal of the American Medical Association, 284(16), 2061–2069.CrossRefGoogle Scholar
  25. 25.
    Weissman, J. S., Stern, R., Fielding, S. L., & Epstein, A. M. (1991). Delayed access to health care: Risk factors, reasons, and consequences. Annals of Internal Medicine, 114(4), 325.PubMedGoogle Scholar
  26. 26.
    Hafner-Eaton, C. (1993). Physician utilization disparities between the uninsured and insured. JAMA, the Journal of the American Medical Association, 269(6), 787–792.CrossRefGoogle Scholar
  27. 27.
    Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2008). A national study of chronic disease prevalence and access to care in uninsured U.S. adults. Annals of Internal Medicine, 149(3), 170–176.PubMedGoogle Scholar
  28. 28.
    McWilliams, J. M. (2009). Health consequences of uninsurance among adults in the United States: Recent evidence and implications. The Milbank Quarterly, 87(2), 443–494.PubMedCrossRefGoogle Scholar
  29. 29.
    Schoen, C., Osborn, R., How, S. K. H., Doty, M. M., & Peugh, J. (2009). In chronic condition: Experiences of patients with complex health care needs, in eight countries, 2008. Health Affairs, 28(1), w1–w16.PubMedCrossRefGoogle Scholar
  30. 30.
    Ward, E., Halpern, M., Schrag, N., et al. (2008). Association of insurance with cancer care utilization and outcomes. CA: A Cancer Journal for Clinicians, 58(1), 9–31.CrossRefGoogle Scholar
  31. 31.
    (2002). Care without coverage: Too little, too late. Washington, DC: Institute of Medicine, Committee on the Consequence of Uninsurance. National Academies Press.Google Scholar
  32. 32.
    Anderson, G., & Horvath, J. (2004). The growing burden of chronic disease in America. Public Health Reports, 119(3), 263–270.PubMedCrossRefGoogle Scholar
  33. 33.
    (2010). Defining Overweight and Obesity. Atlanta: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Accessed May 1, 2011, Available at http://www.cdc.gov/obesity/defining.html.
  34. 34.
    (2008). SAS 9.2. Cary, NC: SAS Institute Inc.Google Scholar
  35. 35.
    Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V., & Steel, Z. (1997). Anxiety, depression and PTSD in asylum-seekers: Associations with pre- migration trauma and post-migration stressors. The British Journal of Psychiatry, 170(4), 351–357.PubMedCrossRefGoogle Scholar
  36. 36.
    Gerritsen, A. A., Bramsen, I., Deville, W., van Willigen, L. H., Hovens, J. E., & van der Ploeg, H. M. (2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 41(1), 18–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Kim, G., Aguado Loi, C. X., Chiriboga, D. A., Jang, Y., Parmelee, P., & Allen, R. S. (2011). Limited english proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders. Journal of Psychiatric Research, 45(1), 104–110.PubMedCrossRefGoogle Scholar
  38. 38.
    Beiser, M., & Hou, F. (2006). Ethnic identity, resettlement stress and depressive affect among Southeast Asian refugees in Canada. Social Science and Medicine, 63(1), 137–150.PubMedCrossRefGoogle Scholar
  39. 39.
    Snowden, L. R., Masland, M. C., Peng, C. J., Wei-Mien Lou, C., & Wallace, N. T. (2010). Limited English proficient Asian Americans: Threshold language policy and access to mental health treatment. Social Science and Medicine, 72(2), 230–237.PubMedGoogle Scholar
  40. 40.
    Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309–1314.CrossRefGoogle Scholar
  41. 41.
    Swinkels, H., Pottie, K., Tugwell, P., Rashid, M., & Narasiah, L. (2010). Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions. Canadian Medical Association Journal, 183(12), e928–e932.PubMedCrossRefGoogle Scholar
  42. 42.
    Eckstein, B. (2011). Primary care for refugees. American Family Physician, 83(4), 429.PubMedGoogle Scholar
  43. 43.
    Geltman, P. L., & Cochran, J. (2005). A private-sector preferred provider network model for public health screening of newly resettled refugees. American Journal of Public Health, 95(2), 196–199.PubMedCrossRefGoogle Scholar
  44. 44.
    Dicker, S., Stauffer, W. M., Mamo, B., Nelson, C., & O’Fallon, A. (2010). Initial refugee health assessments: New recommendations for Minnesota. Minnesota Medicine, 93(4), 45.PubMedGoogle Scholar
  45. 45.
    Kennedy, J., Seymour, D. J., & Hummel, B. J. (1999). A comprehensive refugee health screening program. Public Health Reports, 114(5), 469–477.PubMedCrossRefGoogle Scholar
  46. 46.
    Cochran, J., O’Fallon, A., & Geltman, P. L. (2007). US medical screening for immigrants and refugees: Public health issues. In P. F. Walker & E. D. Barnett (Eds.), Immigrant medicine (pp. 123–134). Philadelphia, PA: Elsevier Health Sciences.CrossRefGoogle Scholar
  47. 47.
    Fowler, N. (1998). Providing primary health care to immigrants and refugees: The North Hamilton experience. Canadian Medical Association Journal, 159(4), 388–391.PubMedGoogle Scholar
  48. 48.
    Feldman, R. (2006). Primary health care for refugees and asylum seekers: A review of the literature and a framework for services. Public Health, 120(9), 809–816.PubMedCrossRefGoogle Scholar
  49. 49.
    Finkelstein, A., Taubman, S., Wright, B., et al. (2011). The Oregon health insurance experiment: Evidence from the first year NBER working paper no 17190. Cambridge: National Bureau of Economic Research.CrossRefGoogle Scholar
  50. 50.
    Yun, K., Fuentes-Afflick, E. & Desai, M. M. (in submission). Prevalence of chronic disease and insurance coverage among refugees in the United States.Google Scholar
  51. 51.
    Maxwell, J., Cortes, D. E., Schneider, K. L., Graves, A., & Rosman, B. (2011). Massachusetts’ health care reform increased access to care for Hispanics, but disparities remain. Health Affairs, 30(8), 1451–1460.PubMedCrossRefGoogle Scholar
  52. 52.
    Cortes, D. E. (2011). “No one asked me”: Latinos’ experience with Massachusetts health care reform. Princeton, NJ: Robert Wood Johnson Foundation.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Katherine Yun
    • 1
    • 7
    Email author
  • Kelly Hebrank
    • 2
  • Lauren K. Graber
    • 3
  • Mary-Christine Sullivan
    • 4
  • Isabel Chen
    • 5
  • Jhumka Gupta
    • 6
  1. 1.Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.IRIS—Integrated Refugee and Immigrant ServicesNew HavenUSA
  3. 3.Yale School of MedicineYale UniversityNew HavenUSA
  4. 4.Lahey ClinicIpswichUSA
  5. 5.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  6. 6.Chronic Disease Epidemiology, Yale School of Public HealthYale UniversityNew HavenUSA
  7. 7.34th and Civic Center BlvdThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations