Elderly Iranians in Sweden : the impact of migration on risk factors for cardiovascular disease

Abstract

Aim: To analyze determinants of and differences in risk factors for cardiovascular disease (CVD) among elderly Iranians in Sweden, elderly Swedes, and elderly Iranians in Iran.

Method: A total of 1212 men and women aged 60 84 were studied. Study I included 167 Iranianborn and 235 Swedish-born residing in Stockholm, Sweden. The outcome variables, body mass index (BMI) and self-reported leisure-time physical activity were analyzed by linear regression and unconditional logistic regression. Study II included 176 Iranians in Stockholm and 300 Iranians in Tehran and was designed to determine the prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes. Unconditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for outcome variables. In Study III, the Short Form Health Survey (SF-36) was administered to collect information about health-related quality of life in elderly Iranians in Sweden (n=176), elderly Iranians in Iran (n=298), and an elderly Swedish control group (n = 151) randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age and education. In Study IV, dietary intakes were assessed by administering a semi-quantitative food frequency questionnaire to 121 Iranians living in Stockholm and 52 Iranians living in Tehran. Differences in dietary habits between the two groups and association of dietary habits with prevalence of overweight, general obesity, and central obesity were analyzed by linear and unconditional logistic regression.

Results: In Study I, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference group) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher average BMI than the reference group after adjustment for age, education, and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later. Iranians and Swedes had almost the same odds of >= once-weekly leisure-time physical activity. In Study II, the risks of hypertension and smoking were higher in Iranian women and men in Sweden than in Iran in the age-adjusted model and remained significant after adjusting for all other independent variables. Abdominal obesity was found in nearly 80% of the women in both groups. In Study III, Iranian women in Sweden with shorter times of residence scored lower vitality than other women in this study. Among elderly Iranian women, more than 15 years of residence in Sweden was positively associated with social functioning and role limitation due to emotional problems. In general, the Swedish women scored higher in all dimensions of the SF-36 than the women in the other two subsamples. The Swedish men scored higher in six of eight dimensions than the men in the other two subsamples. Study IV, Iranians living in Sweden consumed more protein, total fat, fiber, and all food groups than Iranians living in Iran, with the exception of bread and grain. The only association found between diet and prevalence of overweight, general obesity, and central obesity was an inverse association between fruit consumption and central obesity in Iranians who had lived in Sweden >15 years.

Conclusions: There is a strong association between migration status and the prevalence of cardiovascular disease among elderly Iranians living in Sweden. However, length of time since migration to Sweden is not associated with poorer health-related quality of life among elderly Iranians. In fact, the partial adoption of favorable dietary habits may be associated with increasing number of years in Sweden. The adoption of such favorable habits may lead to increased healthrelated quality of life, decreased CVD risk factors, and increased life expectancy. Health promotion in the public health care system and interventions aimed at the prevention and treatment of overweight and obesity should include a special focus on recent elderly female immigrants, who exhibited the largest difference in BMI and lowest score of health-related quality of life compared to the reference groups. Such resources could empower individuals to achieve a lifestyle that includes more physical activity and healthier dietary habits. This could increase health-related quality of life and decrease risk of obesity and CVD, especially as regular physical activity clearly attenuates many of the health risks associated with overweight or obesity. Treatments and prevention programs that focus on lifestyle changes, carried out by dieticians, physiotherapists, district nurses and physicians in primary health care are therefore recommended.