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Prevalence of Cardiovascular Disease and Risk Factors Among Somali Immigrants and Refugees

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Cardiovascular disease (CVD) risks are of concern among immigrants and refugees settling in affluent host countries. The prevalence of CVD and risk factors among Somali African immigrants to the U.S. has not been systematically studied.


In 2015–2016, we surveyed 1156 adult Somalis in a Midwestern metropolitan area using respondent-driven sampling to obtain anthropometric, interview, and laboratory data about CVD and associated risk factors, demographics, and social factors.


The prevalence of diabetes and low physical activity among men and women was high. Overweight, obesity, and dyslipidemia were also particularly prevalent. Levels of calculated CVD risk across the community were greater for men than women.


Though CVD risk is lower among Somalis than the general U.S. population, our results suggest significant prevalence of risk factors among Somali immigrants. Comparison with prior research suggests that CVD risks may be increasing, necessitating thoughtful intervention to prevent adverse population outcomes.

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  1. Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis. 2007;17(1):143–52.

    PubMed  Google Scholar 

  2. Terrazas A. African immigrants in the United States, Migration Information Source, Migration Policy Institute. 2009; Accessed September 4, 2019.

  3. O'Connor MY, Thoreson CK, Ricks M, et al. Worse cardiometabolic health in African immigrant men than African American men: reconsideration of the healthy immigrant effect. Metab Syndr Relat Disord. 2014;12(6):347–53.

    Article  CAS  Google Scholar 

  4. Venters H, Gany F. African immigrant health. J Immigr Minor Health. 2011;13(2):333–44.

    Article  Google Scholar 

  5. McDonald JT, Kennedy S. Insights into the 'healthy immigrant effect': health status and health service use of immigrants to Canada. Soc Sci Med. 2004;59(8):1613–27.

    Article  Google Scholar 

  6. Tollman SM, Kahn K, Sartorius B, Collinson MA, Clark SJ, Garenne ML. Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study. Lancet. 2008;372(9642):893–901.

    Article  Google Scholar 

  7. BeLue R, Okoror TA, Iwelunmor J, et al. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Glob Health. 2009;5:10.

    Article  Google Scholar 

  8. National Research Council. The continuing epidemiological transition in Sub-Saharan Africa: a workshop summary. Washington, D. C.: The National Academies Press; 2012.

    Google Scholar 

  9. Peacock JM, Fashanu O, Styles E, Lindgren P. Foreign-born African-Americans and the impact on racial disparities in cardiovascular disease mortality in Minnesota, 2001–2015. Paper presented at: Council of State and Territorial Epidemiologists (CSTE)2017; Boise, ID.

  10. Commodore-Mensah Y, Sampah M, Berko C, et al. The Afro-cardiac study: cardiovascular disease risk and ccculturation in West African immigrants in the United States: rationale and study design. J Immigr Minor Health. 2016;18(6):1301–8.

    Article  Google Scholar 

  11. Kumar R, Einstein G. Cardiovascular disease in Somali women in the diaspora. Curr Cardiovasc Risk Rep. 2012;6(3):229–37.

    Article  Google Scholar 

  12. Njeru JW, Tan EM, St Sauver J, et al. High rates of diabetes mellitus, pre-diabetes and obesity among Somali immigrants and refugees in Minnesota: a retrospective chart review. J Immigr Minor Health. 2016;18(6):1343–9.

    Article  Google Scholar 

  13. U.S. Census Bureau American FactFinder. Place of birth for the foreign-born population in the United States. Foreign-born population excluding population born at sea: 2007–2011 American Community Survey 5-year estimates . Washington, D. C.: U.S. Department of Commerce; 2019 Sep 4.

  14. U.S. Census Bureau American FactFinder. Place of birth for the foreign-born population in the United States. Foreign-born population excluding population born at sea: 2012–2016 American Community Survey 5-year estimates . Washington DC: U.S. Department of Commerce; 2019 Sep 9.

  15. Gele AA, Mbalilaki AJ. Overweight and obesity among African immigrants in Oslo. BMC Research Notes. 2013;6:119.

    Article  Google Scholar 

  16. Kinnunen TI, Skogberg N, Harkanen T, Lundqvist A, Laatikainen T, Koponen P. Overweight and abdominal obesity in women of childbearing age of Russian, Somali and Kurdish origin and the general Finnish population. J Public Health (Oxf). 2018;40(2):262–70.

    Article  Google Scholar 

  17. Guerin PB, Elmi FH, Corrigan C. Body composition and cardiorespiratory fitness among refugee Somali women living in New Zealand. J Immigr Minor Health. 2007;9(3):191–6.

    Article  Google Scholar 

  18. Tu JV, Chu A, Rezai MR, et al. The Incidence of major cardiovascular events in Immigrants to Ontario, Canada: The CANHEART immigrant study. Circulation. 2015;132(16):1549–59.

    Article  Google Scholar 

  19. Sewali B, Harcourt N, Everson-Rose SA, et al. Prevalence of cardiovascular risk factors across six African Immigrant Groups in Minnesota. BMC Public Health. 2015;15:411.

    Article  Google Scholar 

  20. Dalmar A, Pryce D, Grim CE, Jama S, Magan S. Overweight and obesity in Somali immigrants to the United States. Ethn Dis. 2006;16:S4–35.

    Google Scholar 

  21. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.

    Article  CAS  Google Scholar 

  22. Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.

    Article  Google Scholar 

  23. Salganik MJ, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Methodol. 2004;34:193–239.

    Article  Google Scholar 

  24. Rudolph AE, Crawford ND, Latkin C, et al. Individual, study, and neighborhood level characteristics associated with peer recruitment of young illicit drug users in New York City: optimizing respondent driven sampling. Soc Sci Med. 2011;73(7):1097–104.

    Article  Google Scholar 

  25. Gile KJ, Handcock MS. Respondent-driven sampling: an assessment of current methodology. Sociol Methodol. 2010;40(1):285–32727.

    Article  Google Scholar 

  26. Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49(1):11–34.

    Article  Google Scholar 

  27. Samuelsson LB, Hall MH, McLean S, et al. Validation of biomarkers of CVD risk from dried blood spots in community-based research: methodologies and study-specific serum equivalencies. Biodemography Soc Biol. 2015;61(3):285–97.

    Article  Google Scholar 

  28. Fokkema MR, Bakker AJ, de Boer F, Kooistra J, de Vries S, Wolthuis A. HbA1c measurements from dried blood spots: validation and patient satisfaction. Clin Chem Lab Med. 2009;47(10):1259–64.

    Article  CAS  Google Scholar 

  29. Bland JM, Kerry SM. Statistics notes. Trials randomised in clusters. BMJ. 1997;315(7108):600.

    Article  CAS  Google Scholar 

  30. Donner A, Birkett N, Buck C. Randomization by cluster. Sample size requirements and analysis. Am J Epidemiol. 1981;114(6):906–14.

    Article  CAS  Google Scholar 

  31. Wejnert C. An empirical test of respondent-driven sampling: point estimates, variance, degree measures, and out-of-equilibrium data. Sociol Methodol. 2009;39(1):73–116.

    Article  Google Scholar 

  32. Goel S, Salganik MJ. Assessing respondent-driven sampling. Proc Natl Acad Sci USA. 2010;107(15):6743–7.

    Article  CAS  Google Scholar 

  33. Simpson JM, Klar N, Donnor A. Accounting for cluster randomization: a review of primary prevention trials, 1990 through 1993. Am J Public Health. 1995;85(10):1378–83.

    Article  CAS  Google Scholar 

  34. Spiller MW, Cameron C, Heckathorn DD, Barash V, Volz E, Degani I. Respondent-driven sampling analysis tool (RDSAT) Version 7.1. Ithaca, NY: Cornell University; 2012.

  35. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586–613.

    Article  Google Scholar 

  36. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circ. 2017;135(10):e146–e603.

    Article  Google Scholar 

  37. National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES)—National Cardiovascular Disease Surveillance System. Atlanta: Centers for Disease Control and Prevention (CDC); 2019.

    Google Scholar 

  38. Warfa N, Curtis S, Watters C, Carswell K, Ingleby D, Bhui K. Migration experiences, employment status and psychological distress among Somali immigrants: a mixed-method international study. BMC Public Health. 2012;12:749.

    Article  Google Scholar 

  39. Bell CN, Thorpe RJ Jr, Bowie JV, LaVeist TA. Race disparities in cardiovascular disease risk factors within socioeconomic status strata. Ann Epidemiol. 2018;28(3):147–52.

    Article  Google Scholar 

  40. Pool LR, Ning H, Lloyd-Jones DM, Allen NB. Trends in racial/ethnic disparities in cardiovascular health among US Adults from 1999–2012. J Am Heart Assoc. 2017;6(9):e006027.

    Article  Google Scholar 

  41. Commodore-Mensah Y, Himmelfarb CD, Agyemang C, Sumner AE. Cardiometabolic health in African immigrants to the United States: a call to re-examine research on African-descent populations. Ethn Dis. 2015;25(3):373–80.

    Article  Google Scholar 

  42. Hauck FR, Corr KE, Lewis SH, Oliver MN. Health and health care of African refugees: an underrecognized minority. J Natl Med Assoc. 2012;104(1–2):61–71.

    Article  Google Scholar 

  43. Read JG, Emerson MO, Tarlov A. Implications of black immigrant health for U.S. racial disparities in health. J Immigr Health. 2005;7(3):205–12.

    Article  Google Scholar 

  44. Mohamed AA, Hassan AM, Weis JA, Sia IG, Wieland ML. Physical activity among Somali men in Minnesota: barriers, facilitators, and recommendations. Am J Mens Health. 2014;8(1):35–44.

    Article  Google Scholar 

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Funding was supported by National Heart, Lung, and Blood Institute [Grant No. R01 HL118282].

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Authors and Affiliations



Bjorn Westgard, Brian C. Martinson, Michael Maciosek, Osman Ahmed, Ahmed Dalmar, and Douglas Pryce contributed to the study conception and design, material preparation, and data collection. Farhiya Farah, Diana Dubois and Laura Sanka contributed to material preparation and data collection. Brian Martinson, Morgan Brown, and Zhiyuan Xu performed the analyses. The first draft of the manuscript was written by Bjorn Westgard and Douglas Pryce. All authors commented on previous versions and have read and approved the final manuscript for submission.

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Correspondence to Bjorn Westgard.

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Westgard, B., Martinson, B.C., Maciosek, M. et al. Prevalence of Cardiovascular Disease and Risk Factors Among Somali Immigrants and Refugees. J Immigrant Minority Health 23, 680–688 (2021).

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