High Stress Reasons for Immigration May Increase Risk for Diabetes: The Africans in America Study

Background: Scant data exists on whether reason for immigration (work, asylum/refugee, study, family reunification and lottery) affects physiologic stress experienced by Africans living in America. It is also uncertain if high stress measured by allostatic load score (ALS), translates into risk for diseases such as diabetes. Goals: Working with self-identified healthy African-born blacks enrolled in the Africans in America study (n=147, men 66% (97/147), age 42±10y (mean±SD), BMI 27.6±4.3 kg/m 2 ), we (a) determined whether ALS varies by reason for immigration; (b) examined the relationship of ALS to risk factors for diabetes including insulin resistance and visceral adipose tissue (VAT) volume. Methods: A priori it was decided immigration reasons above the median ALS would be defined as high stress and below the median, low stress. ALS was calculated using 10 variables from 3 domains: cardiac (SBP, DBP, pulse, cholesterol, HDL, homocysteine), metabolic (BMI, A1C, albumin) and immunological (hsCRP). One point was assigned if a variable was determined high-risk range and 0 if not. According to the distribution of the variables in the cohort, high-risk was defined by being in the highest quartile for each variable, except for albumin and HDL, which required the lowest quartile. Diabetes was diagnosed by OGTT, insulin resistance by Matsuda Index and VAT by abdominal CT scan. Results: Three reasons for immigration were identified as high stress: work, asylum/refugee and study (Fig). Low stress reasons were: family and lottery (Fig). Mean ALS for high and low stress reasons for immigration were: 2.8±0.2 vs 1.8±0.2, P <0.01. (Fig). DM was diagnosed in 7% (10/147) of participants, but 90% (9/10) of the immigrants with DM had high stress reasons for living in America. ALS was positively correlated with fasting glucose, 2h glucose, insulin resistance and VAT (all P <0.01). Conclusion: High stress reasons for immigration were work, asylum/refugee and study. They may be associated with adverse physiologic consequences including diabetes.