International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe

Abstract

Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.

Keywords: Europe; USA; cardiovascular disease; ethnic minority groups; migration; review.

Figure 1. Mortality rate ratios (MRRs) and 95% CIs in cardiovascular‐related death among recent migrant groups compared with European people in 6 European countries (Denmark, England and Wales, France, the Netherlands, Scotland, and Spain).

MRRs were adjusted for sex, age, and country of destination. Migrants are grouped based on region of origin as classified by the Global Burden of Diseases 2010 study, except for migrants from Turkey, who were not included as part of a larger regional grouping. Data source: Ikram et al.

Figure 2. Factors contributing to cardiovascular disease in migrant populations.

Adapted from Agyemang et al. Copyright ©2022, Springer Nature.