One Size Does Not Fit All: Diabetes Prevalence Among Immigrants of the South Asian Diaspora
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ORIGINAL PAPER
One Size Does Not Fit All: Diabetes Prevalence Among Immigrants of the South Asian Diaspora Ananya Tina Banerjee1 · Baiju Shah2,3 Accepted: 21 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The risk of diabetes is higher in South Asians compared to the general population. As a result of migration during the twentieth-century postindependence, the South Asian diaspora is incredibly vast. We examined the diabetes prevalence between groups of the South Asian diaspora based on their distinct migration patterns. Population-based health care and immigration administrative data were used to compare crude and standardized diabetes prevalence between immigrants from nine regions of the South Asian diaspora and the non-immigrant population. Diabetes prevalence across groups were also stratified by gender. There were 199,003 South Asian immigrants; 33,882 (crude prevalence of 17.0%) of whom had a diagnosis of diabetes. The nine subgroups varied significantly in the prevalence of diabetes after adjusting for age, sex and income: Sri Lanka 24.3%, Pakistan 22.2%, Fiji 21.5%, Bangladesh 20.7%, the Caribbean 20.4%, India 16.0%, East Africa 13.8%, South Africa 10.8%, and the Middle East 9.6% in comparison to the non-immigrant population 17.8%. Higher prevalence was evident among men compared with women in each subgroup with the exception of Pakistan. Diabetes prevalence is not uniform among South Asians. Our findings highlight potential impacts of their unique migration histories on the risk and burden of diabetes, and move beyond a one size fits all approach in the South Asian population of Ontario to develop targeted interventions. Keywords Diabetes · South asian diaspora · migration · Gender
Introduction South Asians living in Ontario experience the highest burden of diabetes compared to the general population [1–3]. During the last 200 years, due largely to the influence of the British Empire, South Asians migrated and settled to many parts of the world [4]. As a result of the social, economic and political consequences of migration, the South Asian diaspora is incredibly vast. Many South Asians now living in Canada have an established history in the Caribbean, Africa and the Middle East and not limited to the Indian subcontinent comprised of India, Pakistan, Sri Lanka, Bangladesh and Nepal [5]. The evidence shows clear differences in the * Ananya Tina Banerjee [email protected] 1
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
2
Institute of Evaluative Sciences, Toronto, ON, Canada
3
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
aggregate diabetes prevalence estimates amongst South Asian immigrants primarily from the Indian subcontinent in comparison to groups of European ancestry. However, combining all South Asian subgroups into a single South Asian category masks heterogeneity among South Asians based on the country of origin. Further, limiting South Asians from the Indian subcontinent excludes
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