Forecasting chronic diseases in Africans – Evidence from an immigrant population cohort experience

Abstract

Background: Many African countries have seen a decline in communicable diseases and infant mortality with a concomitant emergence of Western-type, resource-draining, chronic diseases in a growing mid-aged population. This poses a threat to countries with very limited resources and points to the urgent need for data to predict the impact of this emerging trend on health and economy.Methods: A cohort of 76,356 unselected immigrants to Israel, from the Gondar area in Ethiopia, was studied for patterns of non-communicable diseases emergence following their move to a Western environment. Age-specific prevalence rates of cardiovascular disease, cancer, and important risk factors (hypertension, diabetes, hyperlipidemia, BMI and smoking) were calculated by time since immigration and compared to those of 767,082 same period immigrants from the Former Soviet Union (FSU) and to the Israeli Jewish population, using the Clalit Chronic Disease Registry.Results: Prevalence rates of diabetes, hypertension, hyperlipidemia, obesity and smoking all increased significantly in every age-group among the Ethiopian immigrants. The increase started within 5 years of immigration and sometimes exceeded the rate in the local Israeli population, most notably with diabetes. Disease rates among the FSU immigrants were lower in magnitude and different in trend. Rates of malignancies changed differentially by type and etiology of disease.Conclusion: Major temporal increases of chronic diseases morbidity were documented in immigrants from semi-rural Ethiopia to a Western environment.  African countries undergoing gradual Westernization need to take immediate preventive measures to tackle the emerging problem. These can involve health education measures or the use of risk reducing drugs as possible approaches.