Cardiovascular health and risk factors in African refugees and immigrants in the United States: a narrative review.

ABSTRACT

OBJECTIVES: Refugees and immigrants often experience challenges pre- and post-settlement that expose them to risk factors of cardiovascular disease (CVD). Literature on CVD among the growing population of African refugees and immigrants in the United States (US) is scant. This narrative review aimed to evaluate existing studies reporting on CVD and its risk factors among African refugees and immigrants in the US, and to recognize limitations in the current research, policy, and healthcare for adequate CVD-related care for African refugees and immigrants. DESIGN: Articles on African refugee and/or immigrant health were searched on PubMed using multiple key search terms. Studies conducted between 1995 and 2020 and reporting on CVD-related measures in individuals from African countries of origin were included. Six articles were found discussing refugee health only and seven articles discussed refugee and immigrant health together. RESULTS: Overall, the studies showed the varying prevalence of CVD risk factors, mostly depending on the country of origin. Worsening cardiometabolic health with longer residency in the US was generally reported. Refugee-only studies relied mostly on medical records data, while refugee and immigrant studies used both medical records and primary data collection. Limitations in data pertain to the geographical representation of both African countries (predominantly from Somalia despite migrants arriving from diverse African countries) and of regions of settling in the US (predominantly the north/northeast), scarce longitudinal studies, and lack of distinction between refugees and immigrants. Multiple social and structural barriers to cardiovascular health were identified, mostly related to cultural and linguistic challenges and to inadequate or complex health insurance and healthcare systems. CONCLUSION: The cardiovascular health of African refugees and immigrants remains understudied and underserved. Further research and interventions to alleviate barriers and improve cardiovascular health in African refugees and immigrants in the US should be developed using culturally appropriate, accessible, flexible, and multifaceted strategies.