1. ORIGINAL PAPER
Prevalence of Blood Pressure, Blood Glucose and Serum
Lipids Abnormalities Among Ethiopian Immigrants:
A Community-Based Cross-Sectional Study
Maryam Ghobadzadeh • Ellen W. Demerath •
Yisehak Tura
Ó Springer Science+Business Media New York 2014
Abstract The main objective of this study was to
investigate the prevalence of hypertension, glucose and
blood lipid abnormalities among a community of Ethiopian
immigrants in Minnesota. This cross-sectional study used
data from the parish nursing program 2007–2012. A total
of 673 encounters were included in this study. Various
dependent variables including systolic blood pressure
(SBP), diastolic blood pressure (DBP), blood glucose (BG),
and serum lipids were examined. High blood pressure was
defined as a mean SBP equal to or higher than 140 mm/Hg
and/or DBP equal to or higher than 90 mmHg. Elevated
fasting glucose defined as levels equal to or higher than
126 mg/dL. High level of total cholesterol (TC), total tri-
glyceride (TG), low-density lipoprotein (LDL) cholesterol,
and low high-density lipoprotein (HDL) cholesterol were
defined as C240, C200, C160 and B40 mg/dL, respec-
tively. General linear regression models were used to
investigate the relationship of participants’ age and gender,
to the continuously distributed response variables, which
included systolic and DBP, BG, TC, TG, LDL cholesterol
and HDL cholesterol. This is a nonrandom sample of adult
Ethiopian church members who were invited to participate
in a parish nurse cardiovascular disease (CVD) risk factor
screening program. Participants in this sample were 43 %
male and 57 % female. The overall prevalence of hyper-
tension was 30.1 % with a cut off mark of 140/90 mm/Hg.
The prevalence of hypertension was 33 and 24 % among
men than among women, respectively (p 0.01). Of all
participants, 12 % had BG level of equal to or higher than
126 mg/dL. Low levels of HDL were reported in 30 % of
the participants (40 mg/dL). A higher prevalence of high
LDL level (20 %) was observed among women compared
to those found in men (16 %). High TC levels ([240 mg/
dL) were observed in 15 % of the women and 10 % of the
men (p = 0.2). Higher SBP and DBP were significantly
higher in male participants than their female counterparts
(p 0.05) and in contrast, women showed a significantly
higher TC (p 0.01) and LDL (0.05) and HDL
(p 0.001). Female participants also had higher BG than
male participants but the difference was not statistically
significant (p [ 0.05). This opportunity sample suggests
high prevalence of CVD risk factors in a community of
Ethiopian-American adults, and a pressing need for more
comprehensive and systematic assessment of chronic dis-
ease health needs in this growing community.
Keywords Blood pressure Á Prevalence Á Cardiovascular
risk factors Á Ethnic groups
Background
Immigrants of African ethnicity represent one of the
fastest-growing immigrant groups in the United States.
According to Bureau of the Census [18] data, 13 % of the
general population of central Minnesota was from Africa.
Demographic trends indicate the number of Ethiopian
M. Ghobadzadeh (&)
School of Nursing, University of Minnesota, 5-140 Weaver-
Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455,
USA
e-mail: ghoba001@umn.edu
E. W. Demerath
Division of Epidemiology & Community Health, University of
Minnesota, 1300 2nd Street S, Suite 300, Minneapolis,
MN 55455, USA
Y. Tura
School of Nursing, Minnesota State University, Mankato,
MN, USA
123
J Immigrant Minority Health
DOI 10.1007/s10903-014-0051-6

2. immigrants will increase over time throughout the US and
Minnesota. Minneapolis-St. Paul happens to be home to
one of the largest populations of Ethiopian immigrants in
the US. According to the US Census American Community
Survey, 14,070 Ethiopians live in Minnesota [18, 19].
However, the health status of this diverse group remains
relatively understudied compared with many other immi-
grant populations. As immigrants become long-term resi-
dents, a particular focus on screening, prevention of non-
communicable chronic diseases, and treatment of these
conditions will become a public health priority and adopting
and implementing necessary interventions are recommended
to meet needs of this diverse group of people [20, 21].
This study is the description of recent trends in the prev-
alence of selected cardiovascular disease (CVD) risk factors
in a vulnerable understudied population with potentially high
rates of undiagnosed disease due to their recent immigration
to the US, lack of health insurance, and exposure to high
physical and emotional stress during their childhood and
adulthood period secondary to their immigration status.
Cardiovascular disease is a combination of hyperten-
sion, heart disease, and stroke and is the leading cause of
mortality and morbidity in the USA. [12]. Hypertension is
one of the most significant health problems for people of
African origin and has been shown to be strongly associ-
ated with other diseases such as diabetes mellitus and
hyperlipidemia [1, 14]. When left uncontrolled, hyperten-
sion causes serious conditions such as CVD and kidney
failure. Patients with hypertension tend not to seek medical
care until complications are already apparent and affect
their quality of life. One major emphasis of the primary
prevention of CVD since the early 1970s has focused on
early detection and treatment of hypertensive patients. The
literature indicates that timely screening of high blood
pressure is beneficial in terms of reducing the occurrence of
these outcomes and helps to reduce the chance of the
aforementioned complications [6]. Although nation-wide
programs for timely screening of hypertension have been
carried out in many places, community-based data
regarding the prevalence of hypertension and hypertension
subtypes among Ethiopian populations are scarce. In
Ethiopia, incomplete and irregular reporting of routine
health care has made it impossible to understand the risk
factor of non-communicable diseases. The prevalence of
high blood pressure in urban areas of Ethiopia was reported
to be comparable to the situation in the developed countries
and the risk of CVD morbidity and mortality associated
with elevated blood pressure may even be higher in Afri-
cans. A study carried out among residents of Addis Ababa
found prevalence of 31.5 and 28.9 % for hypertension
among men and women, respectively [16].
Although hypertension and diabetes are two indepen-
dent risk factors for developing coronary heart disease
(CHD), they often coexist and diabetic patients are twice as
likely to develop hypertension as general population [22].
Diabetes also leads to pathological changes including ath-
erosclerosis and subsequent chronic diseases. It was esti-
mated that 10.8 million Africans in Sub-Saharan Africa had
diabetes in 2006 and this figure is estimated to increase to
18.7 million by 2025 [9].
Some information on chronic disease risk factors among
Ethiopians has been made available from studies conducted
in Israel on Ethiopian immigrants. The studies in Israel
found a higher prevalence of diabetes among the Ethiopian
immigrants compared to the other Israelis. They also
reported a higher risk for development of diabetes and its
complications among population of Ethiopian immigrants
in comparison to the general population [5].
Elevated serum lipids are also a major, potentially risk
factor for cardiovascular chronic diseases in adults. How-
ever, elevated blood lipids are modifiable and can be
reduced by healthy lifestyle and timely medical interven-
tion. Thus, screening procedures that detect elevated lipid
levels appear justifiable as a public health care measure.
Furthermore, there is a myriad of evidence to support
screening for hypertension, blood sugar and lipid abnor-
malities in women. More women die each year due to
CVDs than from all types of cancers combined [10].
However, of those sudden cardiac deaths among women,
approximately two-thirds (64 %) have no previous symp-
toms [13].
To our knowledge, few studies have evaluated the
prevalence of serum lipids, blood sugar and blood pressure
abnormalities among African immigrants in the United
States. This work sets the foundation for future efforts of
prevention and control of chronic diseases among African
immigrants in the Twin Cities region.
Objective results from this study may also be used to
identify the health needs of the community members and
suggest possible intervention strategies to reduce risk fac-
tors for developing CHD.
The main objective of this analysis was to study the
prevalence of hypertension, glucose and blood lipid
abnormalities as well as mean levels of blood pressure,
serum glucose, and blood lipids among adults in an Ethi-
opian community using recently available data from a
Parish Nursing Program conducted 2007–2012 in Minne-
apolis, MN. Particular attention is given to sex and age
differences in the prevalence and levels of these risk fac-
tors, and to the extent of risk factor clustering.
Methods
The current study was based entirely on an existing com-
munity-based CVD risk factor screening and referral
J Immigrant Minority Health
123

3. program completed in three Ethiopian Orthodox Christian
Churches whose members are approximately 100 %
Amharic-speakers, and thus are likely to be fairly homo-
geneous in terms of cultural background and dietary habits.
The church attendees came from different regions of
Ethiopia, however. Individual-level information on region
of origin was not collected in the Parish Nurse risk factor
survey. The target population is Ethiopian immigrants
living in the Twin Cities metro area. Hundreds of Ethio-
pians are parishioners or attendees of the DSMA church
and other Ethiopian churches in the Twin Cities. At a given
Sunday service, over one hundred children, thirty to forty
teenagers, young parents, middle age and elderly Ethiopi-
ans attend the church. This allows the program to have
access to a wide range of Ethiopian families. Most mem-
bers of the community are first generation immigrants, and
they lack access to health care, face linguistic barriers, and
generally have limited knowledge in the critical areas of
health and wellness. As first generation immigrant com-
munity, members are often engaged in entry level jobs or
attend higher education for career development. Some are
considered middle income families. The gathering of the
community in one place allowed the program to easily
reach the community after services. The program has also
expanded its health screening services to two other Ethio-
pian churches in St. Paul, Minnesota that have the same
demographic, socio economic status and understanding of
health and wellness.
A series of annual cross-sectional surveys were con-
ducted in St. Paul and Minneapolis between 2007 and 2012.
The screening events were advertised in the church bulletin,
local Ethiopian radio (KFAI, Voices of Ethiopia) and flyers
which included information announced after services about
the direction for fasting prior to the tests. Participation in the
disease prevention programs was also encouraged by the
church’s leaders and priests. The parish nurse coordinator
organized screenings and health fairs, as well as provided
literature and health information to volunteers. The screen-
ing programs were carried out right after worship services.
Upon completion of the screening events, participants
were provided necessary education tailored to their risk
status as well as referral services for screening findings
needing immediate attention. Information on how to access
low cost health care services and clinics was also provided
to the participants.
Survey Data (2007–2012)
As stated above, study data came from a parish nursing
screening program for hypertension, hyperlipidemia, and
high blood sugar among people aged 18 or over supported
by the Minnesota Department of Health, Refugee Health
Program. Registered nurses working as volunteers collected
the clinical data. The data collection form included age,
gender, Systolic blood pressure (SBP), Diastolic blood
pressure (DBP), blood glucose (BG), total cholesterol (TC),
Triglyceride (TG), low density lipoprotein (LDL) and high
density lipoprotein (HDL). A database was developed for
quantitative analysis. To increase anonymity of the partici-
pants (a concern for the community), age was recorded in
three categories: 18–37, 38–57, and C58 year.
Blood Pressure Measurement
Sitting blood pressure was measured by nurses after wor-
ship services. Clients rested for 5–10 min before mea-
surement, one blood pressure reading was taken in right
arm. A second measurement was made in the opposite arm
if the first blood pressure reading was 10 mm/Hg higher or
20 mm/Hg lower than normal range (120/80 mmHg) [3].
All reading measurements were recorded on the data
collection sheets. The average of all readings recorded for
each participant was calculated and used in the analysis.
Individuals were classified as hypertensive if their SBPs
were equal to or higher than 140 mmHg and/or DBPs equal to
orhigherthan90 mmHg.Ifaperson’sSBPrangesfrom120to
139 mmHg or DBP rises to a level of 80–89 mmHg, the
person is considered ‘‘pre-hypertensive’’. We further classi-
fied the severity of hypertension as pre-hypertension
(SBP C 120 mmHg and DBP C 80 mmHg), hypertensive
stage 1 (SBP 140-159 mmHg or DBP 90-99 mmHg), stage 2
(SBP C 160 or BP C 100 mmHg for DBP) according to the
blood pressure classifications set by the Seventh Report of the
Joint National Committee on Prevention, Detection, Evalua-
tion, and Treatment of High Blood Pressure (JNC 7) [3].
Blood Glucose Measurement
The level of blood sugar was measured in the fasting state.
Before the test, the participants fasted for 12–15 h. The
tests were performed with participants in a sitting position
at a constant temperature room. BG measurements were
measured from finger blood sample using FreeStyle LiteÒ
(Abbott Diabetes Care Inc), Accu-check or True track. The
participants were classified into three subgroups according
to the level of fasting BG: (1) B100 mg/dL, (2) 101–125
mg/dL, (3) 126–199 mg/dL, and (4) C200 mg/dL, as rec-
ommended by the American Diabetes Association (ADA),
with 100 mg/dL defined as the upper limit of normality for
fasting BG levels.
Serum Lipids Measurement
A handheld Professional Blood Testing Device (Cardi-
oChekÒ
PA POC cholesterol testing system) was used to
measure the blood lipid levels. A drop of fresh capillary
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123

4. blood (35-40 lL for Lipid Panel tests) was applied directly
to the test strip. The results were available within 2 min for
LDL, HDL, TG, and TC. Samples were collected after a
12-hour overnight fasting. Blood lipid levels were classi-
fied according to the Third Report of the National Cho-
lesterol Education Program Expert Panel [11]. TC
concentrations are classified into 3 categories: Desirable
(200 mg/dL), borderline (200–239 mg/dL), and high
(Above 240 mg/dL). It has been suggested that HDL cho-
lesterol concentrations defined as ‘‘desirable’’ (40–59 mg/dL),
‘‘low’’ (40 mg/dL), and ‘‘optimal ([60 mg/dL). LDL cho-
lesterol levels were classified as ‘‘optimal’’ (100 mg/dL),
‘‘desirable’’ (100–129 mg/dL), ‘‘borderline’’ (130–159 mg/
dL), ‘‘high (160–189) and ‘‘very high’’ ([189 mg/dL). Ele-
vated TG levels were defined as ‘‘desirable’’ (150 mg/dL),
borderline (150–199 mg/dL), high (200–499 mg/dL) and
very high ([500 mg/dL).
Risk Score Determination
The participants were classified into four groups as 0, 1, 2
and 3 based on the number of risk factors they had for
CHD: SBP C 140 mmHg or DBP C 90, glucose [ 100,
dyslipidemia: TC [ 200 or LDL [ 130 or HDL 40 or
TG [ 150. The participants with none of these above
cutoff points were coded as 0, and so forth, with maximum
being 3 (hypertension?, high BG?, high serum lipids?).
Statistical Analysis
Chi-square tests were used to assess sex differences in the
distribution of categorical variables (e.g., the prevalence of
different blood lipid, glucose, and blood pressure catego-
ries). General linear regression models were constructed to
examine the relationship of participants’ age and gender, to
the continuously distributed response variables, which
included systolic and DBP, BG, TC, TG, LDL cholesterol
and HDL cholesterol. In order to account for differences in
measurement conditions over repeated survey years, a
covariate term for year of data collection was also included
in the models. Gender is a dichotomous variable with
males coded as 0 and females as 1. We implemented SAS
Proc MI to impute the missing value based on gender and
age. We then used Proc MIANALYZE to provide param-
eter estimates, standard errors of the estimates, and p val-
ues for the association of gender and age group with the
cardiovascular risk factors using the imputed datasets.
Participants were divided into three age groups: 18–37,
38–57, and C58 years and age was entered as a categorical
variable in the regression models. In all analyses, statistical
significance was set at a = 0.05. Values are expressed as
mean ± SE and frequency ± [95 % confidence interval
(CI)]. The analyses were performed using SAS software,
version 9.3.
Results
Nurses recorded services provided for a total of 718 indi-
viduals from 2007 to 2012. A total 673 encounters were
included in the analyses, following the exclusion of 35
incomplete forms.
We examined the association of outcome variables by
survey year and found that prevalence and mean values for
the outcomes were relatively consistent across survey years
(data not shown). For this reason, and because the program
included some of the same individuals across multiple
survey years (but did not assign individual-level identifiers)
we chose to use only the 2012 data for the subsequent
analysis to avoid non-independence of the observations.
According to US Census Bureau, 51 % of all Ethiopian
living in Twin Cities was male and 49 % was female and
the mean age reported 30.2 for the males and 29.3 for the
females [18]. In 2012, the sample comprised 197 partici-
pants, 83 (43 %) men and 111(57 %) women. Over 80 %
of the study participants were older than 38 years of age
and more than 18 % were 58 years or older. The partici-
pants’ age were entered as a categorical variable in the
regression models.
Overall, only 31.6 % of the participants had blood pres-
sure values within normal ranges. A large number of those
surveyed had blood pressures that were within the pre-
hypertensive (SBP[ 130 mm Hg or DBP [ 80 mm Hg)
(38.3 %). Overall, prevalence of hypertension with a cut off
mark of 140/90 mm Hg was 30.1 %. The prevalence of
hypertension was significantly higher among men than
among women (33 and 24 % of all men and women
respectively, p = 0.01) (Table 1). The gender- and age-
specific mean BP, BG and serum lipids among participants
are shown in Table 2. Overall, the mean SBP was 127.7 ±
1.6 mmHg (124.4 ± 6.2 and 130.57 ± 4.8 for women and
men respectively) and the mean DBP was 78.36 ±
0.82 mmHg (80.8 mmHg ± 3.6 for men and 75.78 mm/
Hg ± 3.4 for women) (Table 2). SBP and DBP increased
with age in both men and women throughout the age groups
(p = 0.001). There was also a significant relationship
between gender and SBP (F = 5.07, p = 0.001), and the
association remained significant after age groups included as
a covariate (F = 15.5, p = 0.001).
The overall mean value for blood sugar was 109.4 ±
2.5 mg/100 ml. The fasting BG mean was higher in women
(113.7 ± 3.7 mg/100 ml vs. 104.7 ± 3 mg/100 ml). Of all
participants, 45 % had normal BG levels; 41.2 % were
considered as pre-diabetic (101–125 mg/dL) and 12 % had
BG level of equal to or higher than 126 mg/dL-199 (9 and
J Immigrant Minority Health
123

5. 12 % of all men and women respectively, p = 0.7) and
only 1.8 % participants had BG level of equal to or higher
than 200 mg/dL. Neither the prevalence of elevated BG nor
mean fasting BG levels rose with age (p [ 0.05). A linear
regression was also performed and BG dependence on
gender and age was tested. Significant differences were not
observed between average fasting BG values and gender
after adjusting for age (F = 1.48, p = 0.2).
The mean serum cholesterol concentration was 168.5 ±
2.7 mg/dL. The mean TC was higher for women (171.9 ±
3.6 mg/dL) compared to male participants (162.39 ±
4.03 mg/dL). We found significant differences between
male and female participants in cholesterol levels
(p = 0.03) after adjusting for age. The mean LDL cho-
lesterol and TG concentration was 95 ± 5 and 130 ±
5.7 mg/dL, respectively.
Elevated TC and LDL were observed in 13.5 and
18.3 % of the sample, respectively. There were no differ-
ences in the prevalence of elevated TG between men
(22 %) and women (18 %) (p = 0.3).
High TC levels were observed in 15 % of the women
and 10 % of the men (p = 0.2). TC concentration was
significantly associated with gender and age as a cofactor
(F = 5.78, p = 0.03). Elevated levels of LDL were also
marginally associated with gender (F = 1.73, p = 0.05).
Women showed a higher prevalence of high LDL levels
(20 %) when compared with those found in men (16 %)
(Table 1).
The overall mean for HDL concentration was 48.93 ±
2.3 mg/dL. Reduced levels of HDL were observed in 30 %
of the participants (40 mg/dL), and this percentage was
higher in men (37.4 %) than in women (20 %) (p 0.05).
A linear regression model that adjusted for age showed an
association between HDL and gender (F = 5.2, p = 0.006).
Table 3 shows the age-stratified prevalence of 0, 1, 2,
and 3 risk factor groups among men and women. Of all
female participants, 42 % had at least one risk factor for
CHD while the figure was 39 % for their male counter-
parts. Using the study criteria, 15 % of women and 22.5 %
of men had two risk factors. The criteria also showed that a
Table 1 Prevalence of elevated blood pressure, blood glucose and
serum lipids among participants by sex
Gender BPa
BGb
TCc
TGd
LDLe
HDLf
Female 24 % 12 % 15 % 18 % 20 % 20 %
Male 33 % 9 % 10 % 22 % 16 % 37.4 %
P value 0.01 0.7 0.2 0.3 0.2 0.001
a
Blood pressure cutoff point C140/80
b
Blood glucose cutoff point C126 mg/dL
c
Total cholesterol cutoff point C240 mg/dL
d
Total glyceride cutoff point C200 mg/dL
e
Low-density lipoprotein cutoff point C160 mg/dL
f
High-density lipoprotein cutoff point B40 mg/dL
Table 2 Mean (SD) of blood pressure, blood glucose and serum lipids among participants by sex and age
Age SBP DBP BG TC TG LDL HDL
Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE
Women (n = 111)
18–37 110 1.5 72 0.7 103 2.4 152 2.7 120 1.9 89 2.9 51.3 1.1
38–57 124.8 1.2 77 1.1 119 4.6 173 2.6 125 2.1 97 2.2 50 1.6
C58 126 1.1 74 1.7 106 2.5 183 1.3 139 2.9 128 2.3 43 1.2
Overall mean 124 6.2 75.78 3.4 113.7 3.7 171.9 3.6 128 2.3 98.22 3.4 52.87 1.5
Men (n = 80)
18–37 122 1.6 73 1.5 97.6 1.8 154 2.3 121 1.8 79 3 41 2.2
38–57 130 2.1 83 1.4 107 1.3 162 1.4 137.6 2.5 90 3.3 43 1.2
C58 135.5 6.5 82.5 2.6 104 3.2 171 1.5 131.5 1.2 94 1.4 50 2.1
Overall mean 130.57 4.8 80.8 3.6 104.7 3 162.39 4.03 135.47 7.8 90.54 3.01 44.27 2.1
p* 0.001 0.001 0.1 0.04 0.01 0.1 0.3
p** 0.02 0.002 0.2 0.01 0.04 0.05 0.001
p*** 0.001 0.001 0.2 0.03 0.07 0.3 0.006
p**** 0.1 0.001 0.1 0.1 0.7 0.2 0.001
SBP systolic blood pressure, DNP diastolic blood pressure, BP blood glucose, TC total cholesterol, TG total glyceride, LDL low-density
lipoprotein, HDL high-density lipoprotein
p * age effect
p ** sex effect
p *** sex effect after adjustment for age
p ****sex age interaction
J Immigrant Minority Health
123

6. higher of number of men who had three risk factors com-
pared to women (13 vs. 7 %) but this difference was not
statistically significant (See Fig. 1). As expected, the
number of risk factors increased strikingly with age in both
sexes (p 0.001).
Discussion
The impact of hypertension on cardiac function and its
economic consequences makes it a major public health
concern both in the US and in the world [4]. This study was
the first to-investigate the prevalence of blood pressure, BG
and serum lipid abnormalities in a group of adult Ethiopian
immigrants in the US. Overall, the prevalence rate of
hypertension in the study population was 30 %. Of all men
33 % were hypertensive while the figure was 24 % for their
female participants (p = 0.01). Higher SBP and DBP were
more common in male participants than their female
counterparts and in contrast, women tended to have higher
BG, TC and LDL, although the difference was marginally
significant for LDL and not significant for BG levels.
In the current study the overall prevalence of high blood
pressure was high among both male and female partici-
pants and indicates hypertension is a major public health
problem in this community. Awoke et al. [1] found similar
results in a study in Northwest Ethiopia on the prevalence
of hypertension in which the overall prevalence of hyper-
tension was reported as 28.3 % (n = 679). However, the
finding that higher blood pressure is more prevalent in men
than women in this study appears to be not in agreement
with [1] study in which the prevalence of hypertension was
slightly higher in women (30.3 %) than men (26.0 %).
Worldwide prevalence of hypertension also showed that
males had a slightly higher prevalence of hypertension than
females, but the statistical difference was not significant
except for the region of America and European countries
[7, 23]. Kinzie et al. [8] found a high prevalence of blood
pressure among Vietnamese, Cambodian, Somali, and
Bosnian refugees which was higher than US norms (45 %).
In all participants combined, 41.2 % had BG level of
higher than 101 mgdL but less than 126 mg/dL, a condi-
tion that is known as pre-diabetes. The overall diabetes
prevalence of 12 % in this group of (n = 197) Ethiopian
adults is higher than that found in other communities. In
the study by Kinzie et al. [8] the prevalence of diabetes
(fasting BG greater than 126 mg/dL) reported as to be
15.5 % which was also higher than the prevalence esti-
mated from most previous epidemiologic surveys of the US
population. Identification of those people who are pre-
diabetic and at risk of developing diabetes mellitus might
lead us to select an appropriate target group for interven-
tions targeted at preventing Type 2 diabetes [15].
The high prevalence of hypertension and high BG may be
explained by the fact that the participants are mostly
immigrants. Longitudinal studies on immigrants in Israel
found that African immigrants had more hypertension and a
higher prevalence of diabetes compared to the general
population [2]. Furthermore, the rates of diabetes and
hypertension are dramatically increasing in African coun-
tries including Ethiopia [1, 14]. Therefore this increase in
prevalence may merely reflect alterations in rates of diabetes
and hypertensive disorders in the country of origin [8].
Table 3 Frequency of risk
factors by age and gender
F frequency, P percent
p value for sex [0.05, p value
for age 0.001
Female Male
Age groups Age groups
Risk 1 (18–37) 2 (38–57) 3 C 58 Total Risk 1 (18–37) 2 (38–57) 3 (C58) Total
F P F P F P F P F P F P F P F P
0 20 71 12 21 7 26 39 35 0 7 37 10 20 3 19 20 25
1 8 29 27 49 12 44 47 42 1 8 42 17 35 6 33 31 39
2 0 0 13 23 4 15 17 15 2 1 5 13 27 4 22 18 22
3 0 0 4 7 4 15 8 7 3 0 0 8 18 3 16 11 14
25
39
22
14
35
43
15
7
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
0 1 2 3
Percent
Number of Risk Factors
Male Female
Fig. 1 Number of selected CVD risk factors by sex. p value for
gender effect [0.05, p value for age effect 0.001
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123

7. We found that the overall prevalence of high TC and
LDL was 13.5 and 18.3 % among the participants and the
higher prevalence of both factors were observed among
women compared to those found in men. Little information
exists concerning the prevalence of serum lipid abnor-
malities among Ethiopian population. However, a study
conducted in 1993 by Swai et al. [14] in Tanzania, also
found that female participants had significantly higher
mean TC levels than male participants. CVD events are
commonly perceived as less serious threats to women than
men. Normally, premenopausal women are somewhat
protected from heart disease by estrogen. However, pre-
vious studies indicated that the female advantage is
decreased in women when other risk factors including high
blood sugar and hyperlipidemia presented. According to
the World Health Organization’s Global Burden Disease,
CVD is the leading cause of death among women and
accounted for approximately 32 % of death among women
in 2004 [24].
A study conducted by Tran [17] in Ethiopia reported a
high number of participants with one (40 and 35.4 % for
women and men respectively) or two (20.4 % of women
and 18.6 % of men) metabolic syndrome components. The
number of risk for CHD also increased significantly with
age in this study which used the same cutoff values. The
estimates are higher in the current study which may be due
to a smaller sample size. Tran [17] also used different
definitions to evaluate the risk prevalence among the par-
ticipants including Adult Treatment Panel III (ATP III) and
International Diabetes Federation (IDF) criteria. It is worth
mentioning that in the current study the evaluation of risk
prevalence based on the above mentioned standard criteria
was not possible due to the available data.
Although most of CVD risk factors are amenable to
change, not enough attention has been paid to identifica-
tion, screening and prevention of them in many under-
served communities. Health disparities, including
inadequate access to care, linguistic barriers and lack of
health insurance, certainly impact the availability of health
services for Ethiopian community. Consequently, despite
their risks and high rates of medical problems, they tend
not to seek professional help as much as they need. This is
concerning and necessitates interventions at the community
level that improve identification of problems and early
access to health services.
Several limitations should be considered when inter-
preting results of the present survey. The first limitation is
the non-random sampling design of the survey, which
suggests caution in interpretation of prevalence estimates
and the generalizability of the findings to all Ethiopian
immigrants. Further, due to the data deficiencies this study
could not investigate the impact of lifestyle and socio-
economic variables on the associations with blood
pressure, BG and serum lipid abnormalities. Body mass
index (BMI) and physical activity levels would be of par-
ticular importance to address in future surveys, as obesity
and sedentary behavior are upstream determinants of all of
the risk factors examined here. Therefore, larger studies
with more detailed information on demographic as well as
lifestyle characteristics including smoking status, BMI,
dietary habits and years living in the US will be needed to
help develop effective interventions and health promotion
programs among African immigrants. In the future, we also
hope to track individuals over time so that longitudinal
changes across all survey years can be assessed.
Acknowledgments We thank all the volunteers of the parish nurs-
ing program at the DSMA Parish Nursing Program (Debre Selam
Medhane Alem Ethiopian Orthodox Tewahedo Church) for their
excellent participation in collecting data and their incredibly valuable
role in educating and serving their community.
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