Risk Factors of Diabetes in Canadian Immigrants: A Synthesis of Recent Literature

Diabetes is a public health issue impacting population health and Canadian health systems, with earlier onset and poorer outcomes among nonwhite Canadians-most of whom are immigrants-as compared to European descendants. This review aims to summarize and identify deficiencies in the existing literature on prevalence and risk factors of diabetes in Canadian immigrants who constitute the majority of nonwhite Canadians. Peer-reviewed articles published between January 2000 and May 2011, were retrieved from PubMed. Prevalence of diabetes ranges between 1.3% and 12% among immigrants and varies across ethnocultural groups. Studies tend to uniformly suggest that nonwhite Canadian immigrants particularly from South Asia, the Caribbean, sub-Saharan Africa and Latin America seem to experience a higher burden of diabetes. Risk factors include time since immigration to Canada, ethnicity, gender, immigrant category, income and education level. Some risk factors such as income and education level seem to be mediated by gender. No study has investigated the impact of structural and contextual factors such as discrimination, social and economic inequalities on diabetes. As the immigrant population continues to grow, the impact on the Canadian health system is expected to increase. Therefore, to guide the development of culturally appropriate interventions aimed at reducing the burden of diabetes among immigrants, there is a need to accelerate research pertaining to this issue. Future research on diabetes among Canadian immigrants will benefit from using a perspective that situates the drivers of the disease into a multidimensional framework. Such a multidimensional perspective should go beyond the individual centered approach based on cultural and biological processes, and include the structural and contextual determinants such as poverty, discrimination, racism and "othering." This is important to gain a better understanding of the multilevel risk factors of diabetes in immigrant populations, and subsequently to inform prevention strategies aimed at reducing their disease burden. (C) 2012 Canadian Diabetes Association