Non-Communicable Disease

Chronic, noninfectious health conditions account for a considerable disease burden among all screened Iraqi refugees (3) ^28-30. One study showed that 27% (5,095) of Iraqi refugees screened by IOM in Jordan had at least one chronic condition, including hypertension, elevated cholesterol, elevated blood glucose (or diabetes), ischemic heart disease, cerebrovascular disease, or were overweight or obese ²⁸. Among adult Iraqi refugees screened in California, the most commonly diagnosed chronic conditions were obesity (25%) and hypertension (15%) ²⁶. Other chronic conditions included vision problems; ear, nose, and throat problems (5%); hearing problems (2%); and asthma (2%), arthritis, dental caries, asthma, goiter, hernia, skin allergies, and epilepsy ²⁶.

Cancer

Breast cancer was the most common cause of cancer morbidity among Iraqi refugee women screened outside of Iraq. From 1985-2001 breast cancer was the leading cause of death among Arab-American women in Michigan ³¹. Although many Arab-American women indicated that their health insurance covered cancer screening, they either had low screening rates or delayed screening ^{32 33}. Availability of health insurance coverage may not be the only barrier to timely cancer screening. Other barriers may include transportation, language, and beliefs about cancer causation and prevention ^{32 33}. Health care providers should be aware of the health perspectives of newly resettled Iraqi refugees and should provide cancer education materials in Arabic to encourage timely screening.

Hypertension

Blood pressure is measured during the visa medical exam and during domestic medical examinations in the United States. Although two or three measurements are required to diagnose an individual with hypertension, single measurements may be used to estimate prevalence of hypertension in a population. In Jordan, of 13,299 US-bound screened Iraqis ≥15 years of age, 33% (4,382) had hypertension. An additional 42% (5,565) of Iraqi refugees were pre-hypertensive ²⁸. Of Iraqi refugees ≥15 years of age arriving to the US from 2008- 2013, 10% self-reported having a history of hypertension.

Diabetes Mellitus

Of the 18,990 Iraqi refugees screened in Jordan in IOM clinics from 2007 through 2009, 514 (3%) were diagnosed with diabetes mellitus. Of these, 11% (58) had type I and 89% (456) had type II diabetes. Of those who were diagnosed with diabetes, 84% (343) had hypertension, 22% (113) had pre-hypertension, and 2% (8) had hypertension and a history of angina or myocardial infarction ²⁸.

Obesity

Obesity is a major health issue impacting this population. Of the 11,898 Iraqi refugees ≥ 20 years of age with available weight and height information screened in IOM clinics in Jordan, 38% (4,495) were overweight (BMI = 25.5-29.9 kg/m2), and 34% (3,982) were obese (BMI ≥30 kg/m2). Of those who were overweight, 35% (1,581) also had hypertension and of those who were obese, 50% (2,006) had hypertension. Of 5,734 Iraqi refugees 2-19 years of age with available weight and height information, 10% (572) were underweight (<5% of BMI for age), 14% (820) were overweight (85%-95% of BMI for age), and 11% (632) were obese ²⁸.

Smoking

Smoking is widely accepted among Iraqis, particularly Iraqi men (Figure 6). Of Iraqi male refugees ≥15 years old who arrived in the US from 2008 – 2013, 40% had a history of smoking and 31% were current smokers.  Smoking among Iraqi women was less common than among Iraqi men.

Figure 6: Self-reported tobacco use among Iraqi refugees during visa medical examinations at panel physician sites, 2008-2013 (N=63,322)

 

Source: CDC’s Electronic Disease Notification system (EDN) (18)

Congenital and Genetic Disorders

Congenital and genetic disorders are a concern among the Iraqi population. Of the 18,990 screened refugees, 1.7% (325) had congenital disorders: .1% (16) had congenital cardiovascular defects, 0.2% (33) had glucose-6-phosphate dehydrogenase (G6PD) deficiency, 0.02% (4) had sickle cell disease, 7 (0.03%) thalassemia, and 116 (0.6%) congenital hemangioma. The Iraq Family Health Survey reported that 37% of Iraqi women are married to their cousins and 23% to other relatives, which may partially account for the high prevalence of certain recessively inherited disorders ^{9 28}. Health care providers serving Iraqi families should inquire about consanguinity and become familiar with the genetic disorders common among Arabs, such as G6PD deficiency, sickle cell disease, and thalassemia ²⁸.

Lead Poisoning

Iraqi refugee children specifically do not appear to be at higher risk of lead poisoning than US children. Only 1.3% of Iraqi children ≤5 years of age screened in San Diego during 2008–2009 had elevated blood lead levels (≥10 µg/dL) ²⁶. However, refugee children in general are thought to be at higher risk for lead poisoning, not only because anemia and malnutrition increase lead absorption, but also because of an increased risk for exposure to products containing lead.