Diabetes in migrants and ethnic minorities in a changing World

Abstract

On a worldwide scale, the total number of migrants exceeds 200 million and is not expected to reduce, fuelled by the economic crisis, terrorism and wars, generating increasing clinical and administrative problems to National Health Systems. Chronic non-communicable diseases (NCD), and specifically diabetes, are on the front-line, due to the high number of cases at risk, duration and cost of diseases, and availability of effective measures of prevention and treatment. We reviewed the documents of International Agencies on migration and performed a PubMed search of existing literature, focusing on the differences in the prevalence of diabetes between migrants and native people, the prevalence of NCD in migrants vs rates in the countries of origin, diabetes convergence, risk of diabetes progression and standard of care in migrants. Even in universalistic healthcare systems, differences in socioeconomic status and barriers generated by the present culture of biomedicine make high-risk ethnic minorities under-treated and not protected against inequalities. Underutilization of drugs and primary care services in specific ethnic groups are far from being money-saving, and might produce higher hospitalization rates due to disease progression and complications. Efforts should be made to favor screening and treatment programs, to adapt education programs to specific cultures, and to develop community partnerships.

Keywords: Diabetes; Ethnic minorities; Genetics; Health Systems; Migrants; Non communicable diseases; Social determinants; Socioeconomic development.

Figure 1

Worldwide numbers of migrants (over 200 million) in relation to continent of birth and host continent. Note that most migration occurred intra-continentally. Massive inter-continental migration is recorded from Africa, Asia and Latin America to Europe, as well as from Asia and Latin America to North America, with virtually no migrants to Africa and Latin America and from Oceania.

Figure 2

Factors associated with non-communicable diseases in migrants. A complex interaction between genetic, cultural and socio-economic factors is the basis for the development of NCDs, variably associated in different ethnic groups. NCD: Non-communicable diseases.

Figure 3

Differences in drug use and overall pharmacologic cost of diabetes in migrants, compared with native Italians. Both drug use and total costs were lower in migrants, with a different use of insulin and oral hypoglycemic agents. Non-steroidal anti-inflammatory drug use was higher, possibly as a consequence of more common traumas and manual work.