Immigrant, Refugee and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America.
PLoS Med. 2020 May 13;17(5):e1003118. doi: 10.1371/journal.pmed.1003118. eCollection 2020 May.
Between 2,000 and 19,000 Special Immigrant Visa (SIV) holders (SIVH) from Iraq and Afghanistan resettle in the United States annually. Despite the increase in SIV admissions to the US over recent years, little is known about the health conditions in SIV populations. We assessed the burden of select communicable and noncommunicable diseases (NCDs) in SIV adults to guide recommendations to clinicians in the US.
We analyzed overseas medical exam data in Centers for Disease Control and Prevention's (CDC) Electronic Disease Notification system (EDN) for 19,167 SIV Iraqi and Afghan adults who resettled to the US from April 2009 through December 2017 in this cross-sectional analysis. We describe demographic characteristics, tuberculosis screening results, self-reported NCDs, and risk factors for NCDs (such as obesity and tobacco use). In our data set, most SIVH were male (Iraqi: 59.7%; Afghan: 54.7%) and aged 18-44 (Iraqi: 86.3%; Afghan: 95.6%). About 2.3% of Afghan SIVH and 1.1% of Iraqi SIVH had a tuberculosis condition. About 0.3% of all SIVH reported having chronic hepatitis. Among all SIVH, 56.5% were overweight or had obesity, 2.4% reported hypertension, 1.1% reported diabetes, and 19.4% reported current or previous tobacco use. Iraqi SIVH were 3.7 times more likely to have obesity (95% CI: 3.4-4.0), 2.5 times more likely to report diabetes (95% CI: 1.7-3.5), and 2.5 times more likely to be current or former smokers (95% CI: 2.3-2.7) than Afghan SIVH. Limitations include the inability to obtain all SIVH records, self-reported medical history of NCDs, and the underdiagnosis of NCDs such as hypertension and diabetes because formal laboratory testing for NCDs is not used during overseas medical exams.
In this analysis, we found that 56.5% of all SIVH were overweight or had obesity, 2.4% reported hypertension, 1.1% reported diabetes, and 19.4% reported current or previous tobacco use. In general, Iraqi SIVH were more likely to have obesity, diabetes, and be current or former smokers than Afghan SIVH. State public health agencies and clinicians doing domestic screening examinations of SIVH should consider screening for obesity-as per the CDC's Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees-and smoking and, if appropriate, referral to weight management and smoking cessation services. US clinicians can consider screening for other NCDs at the domestic screening examination. Future studies can explore the health profile of SIV populations, including the prevalence of mental health conditions, after integration into the US.
每年有 2000 至 19000 名来自伊拉克和阿富汗的特殊移民签证（SIV）持有者（SIVH）移民到美国。尽管近年来美国 SIV 入境人数有所增加，但对于 SIV 人群的健康状况知之甚少。我们评估了 SIV 成年人中某些传染性和非传染性疾病（NCD）的负担，以指导美国临床医生的建议。
在这项横断面分析中，我们分析了美国疾病控制与预防中心（CDC）电子疾病报告系统（EDN）中 19167 名从 2009 年 4 月至 2017 年 12 月移民到美国的伊拉克和阿富汗 SIV 成年成年人的海外医疗检查数据。我们描述了人口统计学特征、结核病筛查结果、自我报告的 NCD 以及 NCD 的风险因素（如肥胖和吸烟）。在我们的数据集中，大多数 SIVH 为男性（伊拉克：59.7%；阿富汗：54.7%），年龄在 18-44 岁（伊拉克：86.3%；阿富汗：95.6%）。约 2.3%的阿富汗 SIVH 和 1.1%的伊拉克 SIVH 患有结核病。约 0.3%的所有 SIVH 报告有慢性肝炎。在所有 SIVH 中，56.5%超重或肥胖，2.4%报告高血压，1.1%报告糖尿病，19.4%报告目前或曾经吸烟。伊拉克 SIVH 肥胖的可能性是阿富汗 SIVH 的 3.7 倍（95%CI：3.4-4.0），报告糖尿病的可能性是阿富汗 SIVH 的 2.5 倍（95%CI：1.7-3.5），并且目前或曾经吸烟者的可能性是阿富汗 SIVH 的 2.5 倍（95%CI：2.3-2.7）。局限性包括无法获得所有 SIVH 记录、自我报告的 NCD 病史以及高血压和糖尿病等 NCD 的漏诊，因为海外医疗检查中不使用 NCD 的正式实验室检测。
在这项分析中，我们发现所有 SIVH 中 56.5%超重或肥胖，2.4%报告高血压，1.1%报告糖尿病，19.4%报告目前或曾经吸烟。一般来说，伊拉克 SIVH 比阿富汗 SIVH 更容易肥胖、患糖尿病和吸烟。美国州公共卫生机构和对 SIVH 进行国内筛查检查的临床医生应考虑按照美国疾病预防控制中心（CDC）对新抵达难民的国内医疗检查指南进行肥胖筛查，并进行吸烟筛查，如果适当，还应转介到体重管理和戒烟服务。美国临床医生可以考虑在国内筛查检查中筛查其他 NCD。未来的研究可以探索 SIV 人群的健康状况，包括心理健康状况在融入美国后的流行情况。
