10th European Public Health Conference: Parallel sessions 153
Ideal Cardiovascular Health among Ghanaian
residence in Europe and Ghana: The RODAM study
Charles Agyemang
B van Nieuwenhuizen, M Zafarman, C Agyemang
Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Contact: c.o.agyemang@amc.uva.nl
Background
Cardiovascular health (CVH) is a construct defined by the
American Heart Association (AHA) as part of its 2020 Impact
Goal definition. CVH has, until now, not been evaluated in
Sub-Saharan African populations. This study aimed to
investigate differences in prevalence of ideal CVH and its
constituent metrics among Ghanaians living in rural and urban
Ghana and Ghanaian migrants living in three European
countries.
Methods
The AHA construct of CVH was evaluated among 3510
Ghanaian adults (aged 25-70 years) residing in rural and urban
Ghana and three European cities (Amsterdam, London and
Berlin) in the multi-centre RODAM study. The differences
between groups were assessed using logistic regression analysis
with adjustments for sex, age and education.
5.L. Migrant health: settlement and adaptation
Hypertension in Sub-Saharan African migrants in
Europe and non-migrants in Africa – The RODAM
study
Charles Agyemang
G Nyaaba, E Beune, K Meeks, K Stronks, C Agyemang
Department of Public Health, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
Contact: c.o.agyemang@amc.uva.nl
Background
Hypertension is a major burden among African origin
populations, but the extent of the differences in prevalence,
treatment and control across similar populations living in
different contexts in high-income countries and rural and
urban Africa has not yet been assessed. We assessed differences
in hypertension prevalence and its management among
relatively homogenous African migrants (Ghanaians) living
in three European cities (Amsterdam, London and Berlin) and
non-migrants living in rural and urban Ghana.
Methods
A multi-centre cross-sectional study was conducted among
Ghanaian adults (n = 5659) aged 25-70 years. Comparisons
between sites were made using prevalence ratios (PRs) with
adjustment for age, education and BMI.
Results
The prevalence of hypertension was 22% and 28% in rural
Ghanaian men and women. The prevalence was higher in
urban Ghana (men, 34%; adjusted PR = 1.37, 95% CI, 1.10-
1.70); and much higher in migrants in Europe, especially in
Berlin (men, 57%;PR:2.21, 1.78-2.73; women, 51%; PR = 1.74,
1.45-2.09) than in rural Ghana. Hypertension awareness and
treatment levels were higher in Ghanaian migrants than in
non-migrant Ghanaians. However, adequate hypertension
control was lower in Ghanaian migrant men in Berlin
(20%;PR=0.43 95%, 0.23-0.82), Amsterdam (29%;PR=0.59,
0.35-0.99) and London (36%;PR=0.86, 0.49-1.51) than rural
Ghanaians (59%). Among women, no differences in hyperten-
sion control were observed. About 50% of migrants to 85% of
rural Ghanaians with severe hypertension (Blood pres-
sure>180/110) were untreated. Antihypertensive medication
prescription patterns varied considerably by site.
Conclusions
Hypertension prevalence, awareness and treatment levels were
generally higher in African migrants, but BP control level was
Results
Only 0.3% of all participants met all 7 metrics of the AHA’s
definition of idea CVH. Compared to rural Ghana (25.7%),
the proportions and adjusted odds ratio (OR) of individuals
that had 6-7 CVH metrics in the ideal range were significantly
lower in urban Ghana, (7.5%; OR, 0.204, 95% CI: 0.15-0.29),
Amsterdam (4.4%; OR, 0.13, 95% CI: 0.08-0.19), Berlin (2.7%;
OR, 0.06, 95% CI: 0.03-0.11) and London (1.7%; OR, 0.04,
95% CI: 0.02-0.09), respectively. The prevalence of ideal CVH
for the various metrics ranged from 96% for all sites in the
smoking metric to below 6% in the diet metric.
Conclusions
The prevalence of ideal CVH is extremely low especially among
Ghanaian migrants in Europe. More work is needed to identify
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the key underlying factors to support the CVH promotion
efforts in order to improve the CVH among these populations.
Key messages:
 Ideal CVH rate is extremely low especially among Ghanaian
migrants in Europe
 Further research is required to identify the underlying
factors in order to improve CVH among these populations
especially urban and migrant populations.
lower in Ghanaian migrant men compared to their non-
migrant peers. Further work is needed to identify key
underlying factors to support prevention and management
efforts.
Key messages:
 Hypertension awareness and treatment levels were generally
higher in Ghanaian migrants, but adequate BP control was
lower in Ghanaian migrant men in Amsterdam and Berlin
than rural Ghanaians.
 Antihypertensive medication prescription patterns varied
considerably by site with Berlin Ghanaians being the least
likely to be prescribed recommended antihypertensives for
SSA populations.
Improving understanding of food choices and dietary
changes among migrants in host countries
Aravinda Berggreen-Clausen
S Pha1, A Berggreen-Clausen2, M Daivadanam2, A Berggreen-Clausen2
1
Karolinska Institutet, Stockholm, Sweden
2
Uppsala University, Uppsala, Sweden
Contact: aravinda.berggreen-clausen@ikv.uu.se
Background
Dietary acculturation refers to dietary changes and the
inherent processes following migration. However, multiple
terms exist and it is unclear how the process can be influenced
to allow for maintenance of or change to healthy food habits.
In order to critically inform interventions targeting dietary
behaviours among immigrants, an unpacking of this concept is
essential.
Methods
A combination of literature review with in-depth interviews
were applied to explore: 1) factors that affected dietary choices
among immigrants; and 2) additional factors to help
immigrants with non-communicable diseases (NCDs) through
a healthy dietary transition. Relevant studies on dietary choices
in relation to migration and NCDs between 2007-17 were
included in the scoping literature review, complemented by in-
depth interviews among seven immigrant health researchers
with at least 2.5 years in Sweden to explore additional factors
that affect dietary changes.
154 European Journal of Public Health, Vol. 27, Supplement 3, 2017
Results
Five major themes affecting dietary choices of immigrants
through delay and (or) support mechanisms were identified: 1)
demographics of dietary change; 2) psychosocial and cultural
factors; 3) home food environment; 4) physical food environ-
ment; and 5) lifestyle change. In addition, the expert
consultations identified two themes related to practical
assistance for healthy dietary transition: 1) practical support
measures to adapt to the new food environment, and 2) use of
supportive modern technology to enable healthy food choices.
Practical support measures also included assistance from
healthcare providers to specifically address dietary change
following migration, especially for NCD patients.
Conclusions
The expert consultations further reiterated the key themes
identified through the review. The need to address the issue of
dietary transition following migration and provision of
practical support through systematic and integrated assistance
or through the use of technology were key additional findings.
Key messages:
 Identified factors that support or delay dietary change
following migration should inform public health interven-
tions and health care.
 While dietary transition following migration is influenced
by many factors, the study identifies the need for practical
multi-sectoral support to individuals and families to enable
healthy transition.
Changes in migrants’ access and in quality of
healthcare during the Spanish economic crisis. MEISI
Luisa Vázquez Navarrete
ML Vázquez1, V Porthé1, I Vargas1, L Bosch2, B Sanz-Barbero3,
JL Heras4, I Plaza5, M Ballesta6, D Malmusi7, E Ronda8
1
CSC, Barcelona, Spain
2
SSIBE, Palamós, Spain
3
ISCIII.CIBERESP, Madrid, Spain
4
H.U.Ramón y Cajal, Madrid, Spain
5
ICS, Barcelona, Spain
6
Serv.Epidemio.R.Murcia, Murcia, Spain
7
ASPB, Barcelona, Spain
8
Univ.Alicante, Alicante, Spain
Contact: mlvazquez@consorci.org
Background
During the economic crisis, Spain reduced its public health
expenditure and limited healthcare entitlements (RDL-16/
2012) which especially affected undocumented migrants. We
present the results of changes in migrant population access and
perceived care quality during the economic crisis.
Methods
Study I: Cross-sectional study, based on the analysis of the
National Health Surveys of Spain of 2006 and 2011/12 (before
RDL16/2012), of a representative sample of non-institutiona-
lized population aged 16-59 years (n = 21818 in 2006,
n = 15200 in 2011/12, respectively 13.3% and 15.9% immi-
grants). Comparative analysis of health services use between
natives and migrants. Study II: Qualitative descriptive-inter-
pretative study, based on individual interviews with a
theoretical sample of primary (19) and secondary (24) care
professionals and migrant users (20) conducted in 2015.
Results
Comparative analysis of surveys showed that access to health
services didn’t decrease while the unmet need for health care in
general did. Likewise, the inequalities in access to specialized
care between natives and migrants decreased. The qualitative
study revealed the existence of new entry barriers to the system
(rights limitations, increase requirements). Besides, the pre-
existing barriers of access to services increased due to the worst
interaction between service factors (insufficient resources,
waiting lists) and migrants (living and working conditions
deterioration). Professionals and users perceived changes in
technical and interpersonal care quality. These changes affected
the whole population, and especially vulnerable groups such as
migrants.
Conclusions
Data prior to RDL16/2012 show that the national health
system was significantly modulating access inequalities due to
origin. Later, an increase of healthcare access barriers and a
deterioration in perceived quality of care were detected. Those
changes that particularly affected migrants are attributed to
implemented policies.
Key messages:
 Until 2012, Spain had a national health system with
universal access, which had a significant cushioning effect
on social inequalities protecting especially the most vulner-
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able population groups.
 Neoliberal measures adopted by Spain to face the crisis
aggravated the existing health access barriers and create of
new ones.
Increasing burden of geriatric syndromes among
foreign born older Swedes
Yajun Liang
CP Rausch, L Laflamme, J Möller, Y Llang
Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden
Contact: yajun.liang@ki.se
Background
As population is aging rapidly worldwide, geriatric syndromes
(GS) as a group of common conditions in older adults, are
becoming common and require increased attention. However,
evidence is scarce on the prevalence of GS among community-
dwelling older adults. Furthermore, due to the changes in
composition of Swedish population resulting from high levels
of migration as well as the greater vulnerability to GS in some
of those population groups, trends in the prevalence of GS
deserve attention. We aim to assess the trend in prevalence of
GS in old Swedes and to determine if the trend differs by
country of birth.
Methods
In total, 17560 older adults (aged 65-84 years) were identified
from three public health surveys conducted in Stockholm in
2006 (n = 6295), 2010 (n = 6733) and 2014 (n = 4532). Based
on questionnaires, GS was defined as having at least one of the
following disorders: insomnia, urinary incontinence, severe
hearing/vision problem, functional decline, fall and depression.
Logistic regression was performed to assess the trend after
controlling for possible confounders.
Results
Overall, the prevalence of GS did not vary significantly from
2006 (70.4%), 2010 (68.7%) to 2014 (71.2%) (Ptrend=0.54).
Within each survey, the prevalence was higher in foreign born
older adults than in Swedish born ones. After controlling for
covariates, the prevalence increased significantly from 73.0% in
2006, 78.0% in 2010 to 83.0% in 2014 among the foreign born
(Ptrend<0.001), whereas it remained stable among the Swedish
born (69.7% in 2006, 67.1% in 2010 to 69.8% in 2014)
(Ptrend>0.10).
Conclusions
In Sweden, there seems to be an increasing burden of GS
among foreign born older adults that cannot be seen in their
Swedish born counterparts. Further evidence is needed to
explain the underlying reasons of the difference.
Key messages:
 Geriatric syndromes are common among Swedish commu-
nity-dwelling older adults, and the prevalence has remained
consistently high over time, 2006-2014.
 The prevalence of geriatric syndromes varies by country of
birth with an increasing prevalence over time among the
foreign born older adults while a stable prevalence among
the Swedish born.