Chronic diseases and their behavioural risk factors among South Asian immigrants in Australia
Mehwish Nisar A * , Tracy Kolbe-Alexander B C and Asaduzzaman Khan AA
B
C
Abstract
The prevalence of chronic diseases among immigrants varies across different ethnic groups attributed to the disparities in their risk factors. This study aimed to explore the prevalence and correlates of chronic diseases among the rapidly growing South Asian population in Australia.
An online survey was administered (2020–2021) among South Asian immigrants in Australia. Diagnosed chronic diseases, smoking habits, physical activity, alcohol consumption, body mass index, and fruit and vegetable intake were assessed. A multivariable logistic regression model was used to examine factors associated with chronic disease.
Overall, 50% of the study participants had one chronic disease and 39% had more than one chronic disease (n = 282). Back pain (30%), depression (22%), diabetes (21%), hypertension (19%), and heart disease (12%) were the most reported diseases. Approximately 78% of participants were insufficiently active and 38% regularly consumed alcohol. Approximately three-quarters consumed fruits and vegetables less than once per day. Multivariable analyses showed that those who were aged more than 50 years (OR = 4.38, 95% CI 1.66–11.56), consumed alcohol more than once/month (OR = 3.25, 95% CI 1.17–8.96), and ate less than one serving of vegetables/day (OR = 2.94, 95% CI 1.19–7.26) had higher odds of having two or more chronic diseases.
Fifty percent of study participants presented with preventable diseases, signifying a substantial health burden. Public health interventions should primarily focus on reducing alcohol intake and increasing fruit and vegetable consumption, particularly among individuals of advanced age, to reduce the overall burden on the healthcare system.
Keywords: Australia, chronic illness, diabetes, healthy diet, lifestyle risk factors, migrants, multimorbidity, prevention, risk factors, South Asia.
References
1 Pefoyo AJ, Bronskill SE, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y, et al. The increasing burden and complexity of multimorbidity. BMC Public Health 2015; 15(1): 415.
| Crossref | Google Scholar | PubMed |
2 Harrison C, Henderson J, Miller G, Britt H. The prevalence of diagnosed chronic conditions and multimorbidity in Australia: a method for estimating population prevalence from general practice patient encounter data. PLoS One 2017; 12(3): e0172935.
| Crossref | Google Scholar | PubMed |
3 Ibiebele T, Wattanapenpaiboon N, Hsu-Hage BH-H, Wahlqvist M. Prevalence of non-insulin dependent diabetes mellitus in Indian migrants in Melbourne, Australia, using fasting plasma glucose. Int J Diabetes Metabo 2000; 8: 56-68.
| Crossref | Google Scholar |
4 Zhang Y, Misra R, Sambamoorthi U. Prevalence of Multimorbidity among Asian Indian, Chinese, and Non-Hispanic White Adults in the United States. Int J Environ Res Public Health 2020; 17(9): 3336.
| Crossref | Google Scholar | PubMed |
5 Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia 2006; 49(11): 2580-8.
| Crossref | Google Scholar | PubMed |
6 Patel AP, Wang M, Kartoun U, Ng K, Khera AV. Quantifying and understanding the higher risk of atherosclerotic cardiovascular disease among South Asian individuals: results from the UK Biobank prospective cohort study. Circulation 2021; 144(6): 410-22.
| Crossref | Google Scholar | PubMed |
7 Gimeno-Feliu LA, Calderón-Larrañaga A, Díaz E, Laguna-Berna C, Poblador-Plou B, Coscollar C, et al. Multimorbidity and immigrant status: associations with area of origin and length of residence in host country. Fam Pract 2017; 34(6): 662-6.
| Crossref | Google Scholar | PubMed |
8 ABS. Migration, Australia. 2020. Available at https://www.abs.gov.au/statistics/people/population/migration-australia/latest-release
9 Fernandez R, Rolley JX, Rajaratnam R, Everett B, Davidson PM. Reducing the risk of heart disease among Indian Australians: knowledge, attitudes, and beliefs regarding food practices–a focus group study. Food Nutr Res 2015; 59(1)): 25770.
| Crossref | Google Scholar | PubMed |
10 Anikeeva O, Bi P, Hiller JE, Ryan P, Roder D, Han G-S. Trends in migrant mortality rates in Australia 1981–2007: a focus on the National Health Priority Areas other than cancer. Ethn Health 2015; 20(1): 29-48.
| Crossref | Google Scholar | PubMed |
11 Mohan S, Wilkes L, Jackson D. Lifestyle of Asian Indians with coronary heart disease: the Australian context. Collegian 2008; 15(3): 115-21.
| Crossref | Google Scholar | PubMed |
12 Nisar M, Kolbe‐Alexander TL, Khan A. Physical activity and sedentary behaviour among South Asian immigrants in Australia. Health Promot J Austr 2023; 35: 57-67.
| Crossref | Google Scholar |
13 Sarich PE, Ding D, Sitas F, Weber MF. Co-occurrence of chronic disease lifestyle risk factors in middle-aged and older immigrants: A cross-sectional analysis of 264,102 Australians. Prev Med 2015; 81: 209-15.
| Crossref | Google Scholar | PubMed |
14 Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 2003; 49(2): 156-63.
| Crossref | Google Scholar | PubMed |
15 AIHW. The Active Australia Survey: a guide and manual for implementation, analysis and reporting. 2003. Available at https://www.aihw.gov.au/reports/physical-activity/active-australia-survey/summary
17 Naimi TS, Nelson DE, Brewer RD. The intensity of binge alcohol consumption among US adults. Am J Prev Med 2010; 38(2): 201-7.
| Crossref | Google Scholar | PubMed |
18 Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med 2011; 40(1): 67-71.
| Crossref | Google Scholar | PubMed |
19 Stea TH, Nordheim O, Bere E, Stornes P, Eikemo TA. Fruit and vegetable consumption in Europe according to gender, educational attainment and regional affiliation—A cross-sectional study in 21 European countries. PLoS One 2020; 15(5): e0232521.
| Crossref | Google Scholar | PubMed |
20 WHO. Body mass index - BMI. 2021. Available at https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
21 Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes 2011; 5(1): 45-56.
| Crossref | Google Scholar | PubMed |
22 Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol 1993; 138(11): 923-36.
| Crossref | Google Scholar | PubMed |
23 AIWH. Chronic conditions and multimorbidity. 2020. Available at https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity
24 Bellary S, Paul O’Hare J, Raymond NT, Mughal S, Hanif WM, Jones A, et al. Premature cardiovascular events and mortality in south Asians with type 2 diabetes in the United Kingdom Asian Diabetes Study–effect of ethnicity on risk. Curr Med Res Opin 2010; 26(8): 1873-9.
| Crossref | Google Scholar | PubMed |
25 AIHW. Australia’s health 2020. 2020. Available at https://www.aihw.gov.au/reports-data/australias-health
26 Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Primary Care Diabetes 2011; 5(1): 45-56.
| Crossref | Google Scholar | PubMed |
27 Ebrahim S, Smeeth L. Non-communicable diseases in low and middle-income countries: a priority or a distraction? Int J Epidemiol 2005; 34(5): 961-6.
| Crossref | Google Scholar | PubMed |
28 Garduño-Diaz SD, Khokhar S. Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians. Diabetes Metab Res Rev 2012; 28(1): 6-24.
| Crossref | Google Scholar | PubMed |
29 Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world — a growing challenge. N Engl J Med 2007; 356: 213-5.
| Crossref | Google Scholar | PubMed |
30 Tiedje K, Wieland ML, Meiers SJ, Mohamed AA, Formea CM, Ridgeway JL, et al. A focus group study of healthy eating knowledge, practices, and barriers among adult and adolescent immigrants and refugees in the United States. Int J Behav Nutr Phys Act 2014; 11(1): 63.
| Crossref | Google Scholar | PubMed |
31 Ahmed ST, Rehman H, Akeroyd JM, Alam M, Shah T, Kalra A, et al. Premature coronary heart disease in South Asians: burden and determinants. Curr Atheroscler Rep 2018; 20(1): 6.
| Crossref | Google Scholar | PubMed |
32 Wickramasinghe SN, Corridan B, Izaguirre J, Hasan R, Marjot DH. Ethnic differences in the biological consequences of alcohol abuse: a comparison between south Asian and European males. Alcohol Alcohol 1995; 30(5): 675-80.
| Google Scholar | PubMed |
33 Fisher NC, Hanson J, Phillips A, Rao JN, Swarbrick ET. Mortality from liver disease in the West Midlands, 1993-2000: observational study. BMJ 2002; 325(7359): 312-3.
| Crossref | Google Scholar | PubMed |
34 Fortin M, Stewart M, Poitras M-E, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012; 10(2): 142-51.
| Crossref | Google Scholar | PubMed |
35 Burgard SA, Chen PV. Challenges of health measurement in studies of health disparities. Soc Sci Med 2014; 106: 143-50.
| Crossref | Google Scholar | PubMed |
36 Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL, et al. Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health 2020; 17(11): 4065.
| Crossref | Google Scholar | PubMed |
37 Hammami A, Harrabi B, Mohr M, Krustrup P. Physical activity and coronavirus disease 2019 (COVID-19): specific recommendations for home-based physical training. Manag Sport Leis 2022; 27(1–2): 26-31.
| Crossref | Google Scholar |
38 AIWH. Alcohol, tobacco & other drugs in Australia. 2024. Available at https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/about