Background
High blood pressure, followed by elevated blood glucose, obesity, and abnormal plasma lipids levels are the major modifiable risk factors for cardiovascular mortality in both developed and developing countries [
1]. Globally, approximately 17 million deaths a year are associated with cardiovascular diseases and complications related to hypertension account for over 50 % (≈9.4 million) of these deaths [
2]. In adults, an increase of 20 mm Hg in usual systolic blood pressure (SBP) or 10 mmHg in usual diastolic blood pressure (DBP) is associated with more than a twofold increase in stroke death rates and a twofold increase in the mortality rates from ischemic heart disease and other cardiovascular causes [
3]. In addition, a significant proportion of adults with hypertension have found to be unaware of their hypertension [
4]. Indeed, studies have shown that the morbidity and mortality associated with hypertension can be significantly reduced by increasing awareness, treatment, and control of hypertension [
5].
Previous studies have shown that South Asian populations (India, Pakistan, Bangladesh, Sri Lanka, and Nepal) contribute the highest proportion of the burden of cardiovascular diseases compared with any other region globally [
6]. In addition, risk factors for myocardial infarction, hypertension and type 2 diabetes are developed at a lower age in South Asians than in other ethnic groups [
7,
8]. Moreover, South Asian migrants living in other countries had higher death rates from coronary heart disease at relatively younger ages compared to the local population [
9,
10].
The United Arab Emirates (UAE) has experienced significant economic, industrial, and population growth, for the last few years. Expatriates account for 80 percent of the UAE population and about two-thirds of the immigrant population are South Asian migrant workers from India, Pakistan and Bangladesh [
11]. The majority of South Asian immigrants are unskilled males with low literacy levels, working in low salary jobs, separated from their families in their home country, and living in large labour camps (shared accommodation). Consequently, many of these male South Asian workers suffer from stress, anxiety and depression [
12]. Additionally, studies of migrant populations in economically developed countries showed that exposure to environmental factors and a transition in lifestyle may place immigrants at a higher risk for developing metabolic risk factors (e.g. hypertension) for cardiovascular diseases [
13,
14]. These studies provide evidence to support the notion of a
Healthy Migrant Effect seen in Western countries where upon arrival, immigrants are healthier than the native population; however, their health status declines as the duration of their stay increases. Currently, there is a lack of information on the status of risk factors for cardiovascular diseases including hypertension in the South Asian population living in the UAE. This study aimed to determine the prevalence of hypertension, its correlates and the level of awareness, treatment, and control of hypertension among male immigrants from India, Pakistan and Bangladesh residing in the UAE.
Results
Out of 1800 eligible males, 1375 (76.4 %) participated, from India (n = 433), Pakistan (n = 383) and Bangladesh (n = 559). The mean age of study population was 34.0 years (95 % confidence interval (CI): 33.4, 34.5). Table
1a and b show the general characteristics of the study population. Compared to Indian and Pakistani immigrant workers, Bangladeshis were younger and a higher proportion (60.4 %) earned less than AED 1000 per month compared to Indians (20.6 %) and Pakistanis (32.3 %). Bangladeshis and Pakistanis were less educated than Indians (only 13.5 % had college or university level education compared to 31.7 %, respectively). Over two-thirds of the study participants (68.0 %, 95 % CI 66.1, 71.1) were from a rural/village background in their home countries and the majority (70.0 %) of the immigrants were married with an average of three children. More than half (52.2 %) shared accommodation with non-relatives and the remaining participants reported either residing with their sponsor (13.4 %), in single accommodation (11.1 %), in labor camps (12.2 %) or with family members (11.1 %). The majority (55.1 %) of participants had been living in UAE for more than six years. The most common occupational categories of the immigrants included driver (23.1 %), laborer (17.1 %), agriculture worker (17.1 %), construction worker (12.5 %) and sales man (5.7 %).
Table 1
Characteristics of the South Asian Immigrants in Abu Dhabi, UAE 2012
a | | | | |
Age-years (mean) | 36.3 (35.3, 37.2) | 34.8 (33.7, 35.9) | 31.7 (31.0, 32.5) | 0.000 |
Age group-years (%) | | | | |
18-35 (years) | 50.0 (48.7, 51.3) | 59.6 (54.4, 64.7) | 71.1 (66.3, 75.7) | 0.000 |
36-45 (years) | 28.1 (23.5, 32.7) | 20.5 (16.4, 24.9) | 20.8 (16.7, 25.1) | |
46+ (years) | 21.9 (17.8, 26.3) | 19.9 (15.8, 24.2) | 8.1 (5.1, 11.1) | |
Education (%) | | | | |
None | 3.1 (1.6, 5.0) | 23.9 (19.6, 28.4) | 12.9 (10.2, 15.9) | 0.000 |
Primary or middle | 23.3 (19.2, 27.6) | 31.4 (26.7, 36.2) | 46.0 (41.7, 50.2) | |
Secondary or high school | 36.9 (32.2, 41.7) | 28.3 (23.7, 33.1) | 27.6 (23.8, 31.5) | |
College or university | 36.7 (31.7, 41.5) | 16.4 (12.7, 20.4) | 13.5 (6.6, 22.3) | |
Income – AED (%) | | | | |
Bottom quartile | 13.5 (10.4, 16.8) | 17.2 (7.7, 21.2) | 44.2 (13.6, 48.3) | 0.000 |
Second quartile | 19.8 (16.2, 23.7) | 21.1 (8.6, 25.4) | 22.0 (8.9, 25.5) | |
Third quartile | 39.5 (34.9, 44.1) | 28.2 (10.2, 32.8) | 21.5 (8.8, 25.0) | |
Top quartile | 27.2 (23.2, 31.5) | 33.4 (11.4, 38.2) | 12.3 (6.4, 15.2) | |
Immigrated from a rural village (%) | 64.3 (59.3, 69.1) | 56.7 (51.3, 61.9) | 83.2 (79.7, 86.3) | |
Married (%) | 78.5 (74.1, 82.5) | 75.3 (70.5, 79.7) | 60.1 (55.7, 64.3) | |
Do not live with immediate family (%) | 88.6 (85.0, 91.6) | 88.4 (84.7, 91.6) | 81.0 (77.4, 84.3) | |
Type of accommodation (%) | | | | |
Shared with non-relatives | 51.4 (46.4, 56.3) | 41.1 (36.1, 46.2) | 58.6 (54.5, 62.8) | 0.000 |
Shared with family | 10.5 (7.6, 13.7) | 15.0 (11.8, 19.3) | 7.8 (5.6, 10.2) | |
Single accommodation | 13.3 (10.1, 16.8) | 11.1 (8.1, 14.5) | 8.9 (6.6, 11.5) | |
Live with sponsor | 13.3 (10.1, 16.8) | 16.7 (13.0, 20.7) | 12.2 (9.5, 15.1) | |
Live in a labor camp | 11.5 (8.5, 14.8) | 16.1 (12.5, 20.1) | 12.4 (9.7, 15.3) | |
Years in UAE (%) | | | | |
Up to 1 year | 11.2 (8.1, 14.6) | 10.5 (7.4, 14.1) | 10.3 (7.6, 13.3) | 0.000 |
2 to 5 years | 31.3 (26.6, 36.2) | 30.5 (25.5, 35.7) | 38.6 (34.1, 43.2) | |
6 to 10 years | 21.2 (17.1, 25.6) | 17.1 (13.1, 21.4) | 23.1 (19.3, 27.1) | |
>10 years | 36.3 (31.4, 41.3) | 41.9 (36.5, 47.4) | 28.0 (23.9, 32.2) | |
b | | | | |
Occupation (%) | | | | |
Driver | 21.5 (17.5, 25.7) | 33.9 (29.1, 38.8) | 19.2 (16.0, 22.7) | 0.000 |
Laborer | 14.1 (10.8, 17.2) | 12.8 (9.5,16.4) | 20.3 (17.0, 23.8) | |
Construction worker | 12.6 (9.5, 16.1) | 8.3 (5.7, 11.4) | 13.1 (10.4, 16.1) | |
Agriculture worker | 8.2 (5.6,11.1) | 25.0 (20.7, 29.6) | 20.5 (17.2, 24.1) | |
Salesman | 12.6 (9.5, 16.1) | 3.1 (1.6, 5.1) | 3.3 (2.2, 5.4) | |
Professional, office worker | 10.8 (7.9, 14.1) | 6.7 (4.4, 9.5) | 3.6 (2.2, 5.4) | |
Business shop keeper | 5.4 (3.4, 7.8) | 4.2 (2.4, 6.5) | 4.0 (2.5, 5.8) | |
Hospitality worker (cook, waiter) | 8.2 (5.7, 11.1) | 0.8 (0.5, 11.0) | 6.5 (4.6, 8.8) | |
Tailor | 3.6 (1.9, 5.7) | 1.9 (0.7, 3.5) | 6.8 (4.8, 9.1) | |
Other | 3.1 (1.6, 5.0) | 3.3 (1.7, 5.4) | 2.7 (1.5, 4.3) | |
Family history of hypertension (%) | 14.8 (11.4, 18.8) | 15.0 (11.5, 19.1) | 23.2 (19.6, 27.1) | 0.001 |
Family history of diabetes (%) | 15.9 (12.4, 19.9) | 8.1 (5.5, 11.4) | 8.9 (6.6. 11.7) | 0.000 |
Body mass index – kg/m [ 2] (mean) | 31.5 (21.1, 41.9) | 26.6 (25.1, 27.9) | 26.2 (24.2, 28.2) | 0.000 |
Waist-to-hip ratio (mean) | 0.93 (0.92, 0.94) | 0.93 (0.92, 0.94) | 0.92 (0.90, 0.93) | 0.033 |
Waist circumference – cm (mean) | 89.5 (88.5, 90.5) | 92.9 (90.8, 93.5) | 85.6 (84.7, 86.6) | 0.000 |
Smoking (%) | 34.3 (29.6, 39.3) | 35.8 (30.1, 41.0) | 49.1 (44.7, 53.4) | 0.000 |
Smokeless tobacco (%) | 5.2 (3.1, 7.9) | 11.1 (8.0, 14.9) | 15.6 (12.6, 19.1) | 0.000 |
Exposure to second hand tobacco (%) | 40.7 (35.8, 45.8) | 49.7 (44.4, 55.0) | 46.7 (42.4, 51.1) | 0.000 |
Drinking alcohol – ever (%) | 20.1 (16.1, 24.4) | 3.1 (1.6, 5.5) | 7.8 (5.6, 10.4) | 0.000 |
Walk 7 days a week (%) | 81.1 (76.7, 84.9) | 85.9 (81.9, 89.4) | 77.2 (73.3, 80.8) | 0.006 |
Reported vigorous physical activity (%) | 17.1 (13.5, 20.6) | 18.8 (14.8, 22.7) | 18.6 (15.4, 21.8) | 0.774 |
Reported moderate physical activity (%) | 20.5 (16.7, 24.4) | 18.9 (14.8, 22.7) | 37.0 (33.1, 41.0) | 0.000 |
BP measurement – never (%) | 57.3 (51.9, 62.4) | 62.7 (57.2, 67.9) | 68.8 (64.0, 73.2) | 0.004 |
Hypertension (%) | 34.5 (30.1, 39.1) | 28.2 (23.6, 32.7) | 28.8 (25.0, 32.6) | 0.073 |
Physician diagnosed diabetes (%) | 10.8 (7.9, 13.8) | 6.5 (4.0, 9.0) | 6.8 (4.7, 8.9) | 0.030 |
HbA1c ≥ 6.5 % | 11.6 (1.6, 21.6) | 4.3 (−0.4, 13.4) | 9.1 (1.2, 19.4) | 0.618 |
Systolic Blood Pressure – mmHg (mean) | 132.6 (130.9, 134.4) | 129.2 (127.4, 131.0) | 129.1 (127.7, 130.5) | 0.003 |
Diastolic Blood Pressure – mmHg (mean) | 79.6 (78.4, 80.8) | 75.9 (74.7, 77.2) | 76.7 (75.6, 77.7) | 0.000 |
On average, Indians had a higher BMI (31.5 kg/m [
2]) compared to Pakistanis (26.6 kg/m [
2]) and Bangladeshis (26.2 kg/m [
2]). Bangladeshis reported a higher rate of smoking (49.1 %) compared to their Indian (34.3 %) and Pakistani (35.8 %) counterparts. In this study, over half of participants (61.6 % 95 % CI 58.8, 64.4 %), had never had their blood pressure measured and nearly a third of all South Asian males had hypertension (n = 419; 30.5 %; 95 % CI 28.0, 32.9). The overall age-standardized prevalence of hypertension was 34.2 % (95 % CI 31.7, 36.5). The crude prevalence of hypertension varied by the nationality, 34.6 % (95 % CI 30.2, 39.3) in Indians, 28.2 % (95 % CI 23.7, 32.9) in Pakistanis, and 28.8 % (95 % CI 25.1, 32.7) in Bangladeshi immigrants. The age-standardized prevalence of hypertension was 35.7 % (95 % CI 31.2, 40.3) in Indians, 31.3 % (95 % CI 24.8, 38.2) in Pakistanis, and 33.9 % (30.0, 37.8) in Bangladeshi participants.
Only a quarter of participants (n = 99; 23.6 %) classified as hypertensive were aware of their condition and the prevalence of hypertension awareness varied by nationality. The prevalence of awareness was 22.0 % (95 % CI 15.6, 29.4) among Indians, 28.3 % (95 % CI 19.9, 37.8) among Pakistanis and 23.1 % (95 % CI 16.7, 30.4) among Bangladeshis. Of those aware of hypertension, 48 (48.5 %) reported use of antihypertensive drugs in the past two days and only 4 (8.3 %) had their hypertension under control (<140/90 mmHg).
Table
2 show the prevalence of hypertension and awareness and the factors correlated with hypertension prevalence and awareness. The prevalence of hypertension was higher in Indians compared to Pakistani and Bangladeshi immigrants. Hypertension prevalence was lower among those with no formal schooling compared to their literate counters parts. Prevalence of hypertension also varied by occupational category and the lowest prevalence (23.3 %) was noted among agricultural workers and the highest prevalence (40.0 %) among those who were shop keepers or salesmen. The prevalence was lower in people who came from rural villages and was higher among those who had been in UAE for more than 10 years. The prevalence was higher among those who were married, overweight or obese, or had central obesity or did not walk for at least 30 minutes a day. Similarly, hypertensive participants were more likely to be aware of their condition if their age was greater than 35 years, had a higher monthly salary, worked as a hospitality worker, had been in UAE for more than five years, were married, overweight and obese, or had a central obesity.
Table 2
Prevalence and crude odds ratios (COR) of factors associated with hypertension prevalence and awareness, in South Asian Immigrants, Al Ain, Abu Dhabi, UAE, 2012 (n = 1,375)
Nationality | | | | | | | |
India | 433 | 150 (34.6) | 1.0 | | 33 (22.0) | 1.0 | |
Pakistan | 383 | 108 (28.2) | 0.74 (0.55, 0.99) | 0.049 | 30 (28.3) | 1.35 (0.76, 2.39) | 0.250 |
Bangladesh | 559 | 161 (28.8) | 0.76 (0.58, 0.99) | 0.049 | 36 (23.1) | 1.02 (0.60, 1.76) | 0.822 |
Age group | | | | | | | |
18-35 years | 810 | 179 (22.1) | 1.0 | | 19 (10.9) | 1.0 | 1.000 |
36-45 years | 307 | 115 (37.5) | 2.11 (1.58, 2.81) | 0.000 | 26 (23.2) | 2.45 (1.28, 4.68) | 0.007 |
46+ years | 200 | 111 (55.5) | 4.39 (3.18, 6.08) | 0.000 | 51 (46.8) | 7.13 (3.88, 13.08) | 0.000 |
Monthly income | | | | | | |
Bottom quartile | 371 | 94 (25.3) | 1.0 | | 13 (13.9) | 1.0 | |
Second quartile | 290 | 89 (30.7) | 1.30 (0.92, 1.83) | 0.13 | 21 (12.1) | 1.96 (0.91, 4.210 | 0.085 |
Third quartile | 399 | 132 (33.1) | 1.46 (1.06, 1.99) | 0.02 | 33 (25.8) | 2.13 (1.05, 4.33) | 0.035 |
Top quartile | 315 | 104 (33.0) | 1.45 (1.04, 2.02) | 0.03 | 32 (30.8) | 2.73 (1.33, 5.61) | 0.006 |
Education | | | | | | | |
No formal schooling | 173 | 35 (20.2) | 0.61 (0.36, 1.01 | 0.06 | 5 (14.3) | 0.68 (0.20, 2.33) | 0.548 |
Primary or middle | 473 | 149 (31.5) | 1.09 (0.72, 1.66) | 0.653 | 40 (27.4) | 1.15 (0.66, 3.65) | 0.310 |
Secondary or high school | 586 | 192 (32.7) | 1.16 (0.77, 1.74) | 0.459 | 46 (24.5) | 1.33 (0.57, 3.09 | 0.499 |
College or university | 139 | 41 (29.5) | 1.0 | | 8 (19.5) | 1.0 | |
Occupation | | | | | | | |
Driver | 317 | 94 (29.6) | 1.38 (0.94, 2.04) | 0.097 | 29 (30.8) | 2.97 (1.30, 6.79) | 0.010 |
Laborer | 234 | 71 (30.3) | 1.43 (0.95, 2.16) | 0.086 | 9 (13.0) | 1.0 | |
Construction worker | 172 | 64 (37.2) | 1.95 (1.26, 3.00 | 0.002 | 11 (17.7) | 1.43 (0.55, 3.74) | 0.457 |
Agriculture worker | 236 | 55 (23.3) | 1.0 | 1.0 | 11 (21.1) | 1.79 (0.68, 4.70) | 0.238 |
Salesman | 79 | 26 (32.9) | 1.61 (0.92, 2.82) | 0.092 | 9 (34.6) | 3.52 (1.21, 10.28) | 0.021 |
Professional, office worker | 95 | 29 (30.5) | 1.44 (0.85, 2.45) | 0.173 | 7 (23.3) | 2.02 (0.67, 6.08) | 0.207 |
Business/shop keeper | 60 | 24 (40.0) | 2.19 (1.21, 3.99) | 0.010 | 7 (29.2) | 2.74 (0.89, 8.45) | 0.079 |
Hospitality worker | 71 | 19 (26.8) | 1.20 (0.65, 2.20) | 0.551 | 8 (42.1) | 4.85 (1.54, 15.29) | 0.007 |
Tailor | 70 | 24 (34.3) | 1.72 (0.96, 3.06) | 0.067 | 4 (16.7) | 1.33 (0.37, 4.80) | 0.660 |
Other | 40 | 12 (30.0) | 1.41 (0.67, 2.96) | 0.363 | 4 (36.4) | 3.80 (0.92, 15.67) | 0.064 |
Type of accommodation | | | | | | |
Shared with non-relatives | 717 | 232 (32.4) | 1.75 (1.17, 2.62) | 0.006 | 55 (23.9) | 1.52 (0.59, 3.84) | 0.378 |
Shared with family | 152 | 44 (28.9) | 1.49 (0.89, 2.48) | 0.122 | 14 (31.8) | 2.25 (0.76, 6.67) | 0.141 |
Single accommodation | 153 | 60 (39.2) | 2.36 (1.44, 3.86) | 0.001 | 16 (28.1) | 1.89 (0.66, 5.40) | 0.237 |
Live with sponsor | 184 | 46 (25.0) | 1.22 (0.74, 2.01) | 0.429 | 8 (17.8) | 1.04 (0.32, 3.35) | 0.941 |
Live in a labor camp | 168 | 36 (21.3) | 1.0 | | 6 (17.1) | 1.0 | |
Home country setting | | | | | | | |
Rural | 932 | 269 (28.9) | 1.0 | | 59 (22.3) | 1.0 | |
Urban or semi-urban | 426 | 149 (34.9) | 1.32 (1.01, 1.69) | 0.02 | 40 (27.4) | 1.32 (0.82, 2.09) | 0.245 |
Length of stay in UAE | | | | | | |
1 to 5 years | 547 | 137 (25.1) | 1.0 | | 9 (6.7) | 1.0 | |
6 to 10 years | 257 | 78 (30.8) | 1.32 (0.94, 1.81) | 0.11 | 19 (25.3) | 4.75 (2.02, 11.15) | 0.000 |
>10 years | 414 | 178 (43.0) | 2.26 (1.71, 2.96) | 0.000 | 71 (40.1) | 9.38 (4.47, 19.65) | 0.000 |
Marital status | | | | | | | |
Single | 412 | 83 (20.1) | 1.0 | | 5 (6.3) | 1.0 | |
Married | 963 | 336 (34.9) | 2.12 (1.61, 2.79) | 0.000 | 94 (28.2) | 1.82 (2.28, 14.85) | 0.000 |
Body mass index – kg/m [ 2] | | | | | | |
<25.0 | 758 | 170 (22.4) | 1.0 | | 28 (16.8) | 1.0 | |
25.0 - 29.9 | 486 | 182 (37.4) | 2.07 (1.61, 2.66) | 0.000 | 46 (25.7) | 1.72 (1.01, 2.91) | 0.044 |
≥30.0 | 129 | 66 (51.2) | 3.62 (2.46, 5.32) | 0.000 | 24 (36.9) | 2.91 (1.52, 5.55) | 0.001 |
Waist-to-hip ratio | | | | | | | |
<0.90 cm | 503 | 84 (16.7) | 1.0 | | 8 (9.8) | 1.0 | |
≥0.90 cm | 872 | 335 (38.4) | 3.11 (2.37, 4.08) | 0.000 | 91 (27.6) | 3.52 (1.63, 7.59) | 0.001 |
Waist circumference – cm | | | | | | |
Waist < 94 | 925 | 234 (25.3) | 1.0 | | 40 (17.4) | 1.0 | |
Waist ≥ 94 | 450 | 185 (44.1) | 2.06 (1.62, 2.62) | 0.000 | 59 (32.4) | 2.28 (1.44, 3.61) | 0.000 |
Smoking ever | | | | | | | |
Never | 827 | 254 (30.7) | 1.0 | | 50 (20.0) | 1.0 | |
Ever | 548 | 165 (30.1) | 0.97 (0.76, 1.22) | 0.81 | 49 (30.2) | 1.73 (1.09, 2.73) | 0.081 |
Smokeless tobacco | | | | | | |
| 1162 | 346 (29.8) | 1.0 | | 83 (24.5) | 1.0 | |
Ever | 150 | 53 (35.3) | 1.29 (0.90, 1.84) | 0.17 | 12 (23.1) | 0.92 (0.46, 1.85) | 0.826 |
Drinking alcohol | | | | | | | |
Never | 1119 | 302 (26.9) | 1.0 | | 82 (27.4) | 1.0 | |
Ever | 130 | 45 (34.6) | 1.43 (0.97, 2.10) | 0.07 | 10 (22.2) | 0.75 (0.35, 1.59) | 0.670 |
Walk for at least 30 minutes daily | | | | | | | |
Yes | 1018 | 267 (26.2) | 1.0 | | 65 (25.0) | 1.0 | |
No | 314 | 134 (42.7) | 2.09 (1.61, 2.72) | 0.002 | 33 (24.8) | 0.99 (0.61, 1.60) | 0.463 |
Family history of hypertension | | | | | | | |
No | 887 | 223 (25.1) | 1.0 | | 52 (23.5) | 1.0 | |
Yes | 249 | 91 (36.5) | 1.71 (1.27, 2.31) | 0.000 | 38 (43.2) | 2.47 (1.46, 4.17) | 0.001 |
Known diabetic | | | | | | | |
No | 1261 | 358 (28.4) | 1.0 | | 66 (18.7) | 1.0 | |
Yes | 114 | 61 (53.5) | 2.90 (1.97, 4.28) | 0.000 | 33 (55.0) | 5.29 (2.98, 9.41) | 0.000 |
Table 3
Adjusted odds ratios (AOR) of factors correlated with hypertension prevalence, awareness, in South Asian Immigrants Al Ain, Abu Dhabi, UAE, 2012 (n = 1,375)
Nationality | | | | |
India | 1.0 | | 1.0 | |
Pakistan | 1.17 (0.74, 1.86) | 0.496 | 2.40 (0.89, 6.49) | 0.084 |
Bangladesh | 0.98 (0.64, 1.50) | 0.930 | 1.65 (0.62, 4.31) | 0.310 |
Age group | | | | |
18-35 years | 1.0 | | 1.0 | |
36-45 years | 1.82 (1.17, 2.85) | 0.008 | 1.25 (0.43, 3.61) | 0.675 |
46+ years | 4.76 (2.78, 8.13) | <0.001 | 4.31 (1.32, 14.05) | 0.015 |
Monthly income – AED | 1.00 (0.99, 1.01 | 0.873 | | |
Education | | | | |
No formal schooling | 0.65 (0.26, 1.59) | 0.593 | 0.52 (0.06, 4.55) | 0.554 |
Primary or middle | 1.22 (0.58, 2.56) | 0.825 | 1.52 (0.32, 7.30) | 0.596 |
Secondary or high school | 1.27 (0.64, 2.49) | 0.482 | 1.82 (0.43, 7.57) | 0.408 |
College or university | 1.0 | | 1.0 | |
Occupation | | | | |
Driver | 0.84 (0.49, 1.44) | 0.670 | 2.54 (0.62, 10.45) | 0.197 |
Laborer | 1.03 (0.57, 1.88) | 0.918 | 1.0 | |
Construction worker | 1.19 (0.60, 2.37) | 0.616 | 1.46 (0.31, 6.96) | 0.634 |
Agriculture worker | 1.0 | | 0.81 (0.17, 3.81) | 0.790 |
Salesman | 1.89 (0.88, 4.04) | 0.099 | 3.01 (0.64, 14.16) | 0.162 |
Professional, office worker | 1.28 (0.55, 3.01) | 0.562 | 0.94 (0.14, 6.21) | 0.952 |
Business/shop keeper | 1.02 (0.40, 2.57) | 0.968 | 1.21 (0.20, 7.29) | 0.831 |
Hospitality worker | 0.88 (0.38, 2.04) | 0.766 | 5.99 (0.81, 44.08) | 0.079 |
Tailor | 0.55 (0.19, 1.64) | 0.286 | 0.61 (0.04, 8.77) | 0.717 |
Other | 0.94 (0.33, 2.64) | 0.903 | 2.11 (0.22, 19.78) | 0.513 |
Type of accommodation | | | |
Shared with non-relatives | 1.22 (0.71, 2.11) | 0.469 | 2.54 (0.62, 10.45) | 0.197 |
Shared with family | 0.92 (0.43, 1.96) | 0.837 | 1.19 (0.21, 6.68) | 0.846 |
Single accommodation | 1.32 (0.66, 2.64) | 0.433 | 1.78 (0.36, 8.86) | 0.477 |
Live with sponsor | 1.16 (0.59, 2.27) | 0.670 | 0.77 (0.14, 4.02) | 0.754 |
Live in a labor camp | 1.0 | | 1.0 | |
Length of stay in UAE | | | | |
1 to 5 years | 1.0 | | 1.0 | |
6 to 10 years | 0.97 (0.61, 1.53) | 0.890 | 5.47 (1.65, 18.23) | 0.006 |
>10 years | 1.04 (0.65, 1.67) | 0.865 | 4.35 (1.32, 14.39) | 0.016 |
Body mass index – kg/m [ 2] | | | |
<25.0 | 1.0 | | 1.0 | |
25.0-29.9 | 1.51 (1.04, 2.19) | 0.030 | 1.22 (0.53, 2.84) | 0.629 |
≥30.0 | 2.39 (1.38, 4.16) | 0.002 | 1.23 (0.42, 3.62) | 0.703 |
Waist-to-hip ratio | | | | |
<0.90 cm | 1.0 | | 1.0 | |
≥0.90 cm | 1.78 (1.18, 2.69) | 0.006 | 3.01 (0.96, 9.64) | 0.058 |
Smoking ever | | | | |
Never | 1.0 | | | |
Ever | 0.90 (0.64, 1.27) | 0.560 | 0.94 (0.46, 1.94) | 0.880 |
Drinking alcohol | | | | |
Never | 1.0 | | 1.0 | |
Ever | 1.49 (0.89, 2.48) | 0.123 | 0.90 (0.32, 2.54) | 0.847 |
Walk for at least 30 minutes daily | | | | |
Yes | 1.0 | | 1.0 | |
No | 1.72 (1.15, 2.58) | 0.008 | 1.22 (0.97, 5.08) | 0.059 |
Family history of hypertension | | | | |
No | 1.0 | | 1.0 | |
Yes | 1.56 (1.05, 2.32) | 0.029 | 4.91 (2.09, 11.55) | <0.001 |
Known diabetic | | | | |
No | 1.0 | | 1.0 | |
Yes | 1.23 (0.72, 2.08) | 0.443 | 5.76 (2.21, 15.00) | <0.001 |
Table
3 shows the factors correlated with prevalence and awareness of hypertension, after adjusting for the potential confounders including age, income, education, occupation, residency, cigarette smoking and alcohol use. Independent risk factors for hypertension included increase in age over 35 years, overweight and obesity, central obesity, lower levels of physical activity, and family history of hypertension. However, the difference in prevalence of hypertension was not statistically significant across occupational categories. We did not find a statistically significant increase in the prevalence of hypertension among immigrants as the duration of their stay increased. We noted that the awareness increased with increase in the duration of residency for more than five years in the UAE, having a family history of hypertension, and if the participant had been diagnosed with diabetes (Table
3).
Discussion
The prevalence of hypertension in our sample of young South Asian adult immigrant males was higher than published estimates in home countries: India (34.6 % versus 22.8 %) [
22], Pakistan (28.2 % versus 18.0 %) [
23] and Bangladesh (28.8 % versus 11.3 %) [
24]. The overall prevalence of hypertension in the study population (30.5 %) was also higher than the native Emirati population (14.0 %) and in Arab immigrants (21.9 %) during same the study year [
25]. The prevalence of hypertension among study participants aged 46 years and older was particularly high (55.5 %) compared to a recent study that reported sex-specific and age-specific prevalence of hypertension in representative population samples from all over the world [
26]. In this study Kearney and colleagues reported lower age-specific prevalence rates of hypertension for men aged 40–49 years and 50–59 years from India (24.8 % and 32.6 %), Egypt and Turkey (26.1 % and 37.2 %), Sub Saharan Africa (38.5 % and 48.1 %), and an aggregated rate for USA, Canada and Japan (32.6 % and 44.8 %) grouped as established market economies. Our study findings fill an important gap in the literature pertaining to migrant worker health; namely, local estimates of chronic disease risk factors (viz. hypertension) among immigrant populations residing in the UAE. Prevalence statistics are vital for researchers, practitioners, and policy makers that are interested in surveillance, screening and developing cost-effective interventions for this at-risk population.
Our findings are in agreement with other studies [
27] reporting that among the three nationalities Indians had the highest mean systolic and diastolic blood pressure and prevalence rates of hypertension, followed by Pakistanis and then Bangladeshis. In the present study, both overall obesity (indexed by BMI) and central obesity were strongly associated with an increased prevalence of hypertension. After adjustment of confounding variables, the study showed a significant relationship between hypertension and advancing age, lower levels of physical activity, obesity, central obesity, and family history of hypertension. These findings are in agreement with several other studies [
28‐
30]. Alarmingly, 76 % of participants classified as hypertensive were not aware of their condition and 62 % of study participants had never had their blood pressure examined. The lack of awareness in the study population compares with home-country populations in India (46.7 %) [
31], Pakistan (70.0 %) [
23] and Bangladesh (62.0 %) [
32]. A clinic-based study in Al Ain showed that under-diagnosis of hypertension among non-Emiratis was much more common than UAE nationals [
33]. In our study treatment and control of hypertension was very low. This underscores the urgent need for strategies to reduce inadequate control of hypertension. A high proportion (68 %) of participants had a rural background and studies have shown that people with rural background and low socioeconomic status have limited access to medical care resulting in poor control of blood pressure [
34,
35].
Our findings suggest that the assessment of common risk factors for NCDs such as body mass and blood pressure measurement should be considered for inclusion in the battery of tests required as part of the medical examination at the time of applying or renewing visas for immigrants in the UAE. In this study, there was a high prevalence of hypertension awareness among those who had a family history of hypertension, those who were diabetic, and those who had lived in UAE for five or more. Previous research has shown that familial history of high blood pressure in a first-degree relative increases the likelihood by about twofold that an individual will have high blood pressure [
36]. The high rate of awareness among diabetics is probably because they receive more frequent contact with primary health care providers [
37]. Although a basic health insurance system has been developed for the working population in the UAE, a significant proportion of the study population, particularly those who have been in UAE for less than five years remained unaware of their hypertension status. In this study, of those aware of their hypertension, less than half reported use of antihypertensive drugs in the past two days and of these only 8.3 % had their hypertension controlled to 140/90 mm Hg or below. Treatment and control of hypertension is crucial for reducing cardiovascular death rates as the study population is already prone to developing coronary heart disease at a younger age (<40 in men) [
38] and have a 3- to 5-fold increase in the risk for myocardial infarction and cardiovascular death compared with other ethnic groups [
39,
40]. As such, there should be more emphasis on improving the provision of primary health care services to South Asians living in the UAE coupled with educational campaigns to encourage people to check their BP more regularly, particularly if they have familial history of hypertension and/or diabetes.
Limitations of the study
There a number of study limitations that needs to be acknowledged. Firstly, the cross sectional design does not permit a causal relationship between risk factors and hypertension. Secondly, we recruited the sample in the only visa screening centre in the city of Al Ain (Abu Dhabi Emirate). However, we would not expect the socioeconomic and lifestyle characteristics of the study population to differ from South Asian male immigrants living in other Emirates of the UAE. Due to funding limitation we did not measure lipid levels and only measured HbA1c levels in a small sub-sample (n = 99) of study population. We have included current medication as taking medicine in the last two days instead of daily. Other studies have similarly included those taking medications less than daily [
41]. Nonetheless; this is the first population-based study to report the prevalence of hypertension among a representative sample of South Asian male immigrants living in the UAE.
Conclusions
Our study revealed a high prevalence of hypertension among a relatively young South Asian male immigrant population living in the UAE. Based on the findings of our study, we would like to recommend that blood pressure, height and body mass measurements should be included in the medical screening tests at the time of obtaining or renewing a residency visa for expatriates living in the UAE. Population-based public health interventions targeting the maintenance of a healthy body size (both total and central adiposity), coupled with regular assessment of blood pressure in South Asian male immigrants are urgently required. Future initiatives need to consider the sociocultural, religious, ethnic, and educational diversity of this population in the design, development, and implementation of campaigns, interventions, and strategies.
Acknowledgements
We thank the participants for their great contribution to the study. This study was supported by Faculty of Medicine and Health Sciences United Arab Emirates Individual Faculty Grant (No NP09-30) titled “Chronic Diseases Prevention in Immigrants: Putting Cardiovascular Disease Risk Factors on Surveillance Screen”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
SS, RA, TL, and TCA designed the study; IE and SAD led the data collection with support from MSH, MES and LAM; SS led the data analysis and interpretation, SS and TL drafted the manuscript, and all authors critically reviewed, provided intellectual input to the manuscript and approved the final version of the manuscript.