Body Size and Other Epidemiologic Characteristics of West African Men: Body Size and Other Epidemiologic Characteristics of West African Men: Implications for Racial Disparity in Chronic Diseases and CancerImplications for Racial Disparity in Chronic Diseases and Cancer

BACKGROUNDBACKGROUND

OBJECTIVEOBJECTIVE

RATIONALERATIONALE

METHODSMETHODS RESULTSRESULTS

STRENGTHSSTRENGTHS

LIMITATIONS LIMITATIONS

ON-GOING and FUTURE ON-GOING and FUTURE WORK WORK

SUMMARY SUMMARY

Jamie Ritchey 1, Richard B. Biritwum2, Edward D. Yeboah2, Yao Tettey2, Andrew Adjei2, Kai Yu1, Anand Chokkalingam3, Lisa Chu1, Sabah M. Quraishi1, Susan S. Devesa1, Ann W. Hsing1

1Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD; 2 School of Medicine, University of Ghana, Ghana; 3 University of California at Berkeley

• To investigate the prevalence of several risk factors for chronic diseases in West African men using a population-based probability sample

West Africans and African Americans:

• Share a similar genetic ancestry

• Have different lifestyles

• Knowing the prevalence of risk factors in West Africans may help provide unique insights into why rates for many diseases are so high in African Americans

•Population-based Survey

•1.1 million greater Accra area

7,500 Households were enumerated and visited, only one subject recruited per household

•1,037 Ghanaian men aged 50-74 years randomly selected from the population in Accra, Ghana

• African American men have higher risks for chronic diseases compared to European Americans, such as: diabetes, hypertension, cardiovascular disease, and several cancers

•High quality population-based data on risk factors and disease specific to Africa is scant

Among Ghanaian Men:

•Smoking and drinking are common

•Prevalence of obesity and abdominal obesity is low, but overweight is high

•Hypertension is common but diabetes is less common

•Consumption of grains, fish is high, while intake of other meats and dairy foods is low

•Prevalence of malaria, measles, and yellow fever is high

• Access to medical care is limited

•Population-based study with probability samples, providing unbiased estimates

•High response rate >98%

•Validity of self-reported conditions among Africans has not been assessed

•Misclassification of exposure is possible

• Studies of hormone, metabolic, and genetic profiles of African and African American men

•Identify screening-detected prevalence of prostate cancer

•Assess prevalence of benign prostatic hyperplasia (BPH)

•Identify risk factors for BPH

At interview: Self-reported smoking drinking, diet, medical history, and medical utilization

Anthropometric measurements and blood pressure were taken

Cigarette and Alcohol Use Diet (times/week)

Body Mass Index (BMI kg/m2)

Waist-to-Hip Ratio (WHR)

Selected Characteristics of Male Subjects Accra, Ghana, 2004-2006

Disease History

Medical Care Access

•Ghanaian men eat a diet high in fish compared to other animal products and high in whole grains compared to fruits and fresh vegetables

African American Men 1,3 Ghanaian Men

Overweighta 35-39% 30-35% Overall Obesityb 31-38% 9-8% Abdominal Obesityc 34-43% 10% (waist circumference >102 cm)

a, b, c African Americans 40-59 and 60 and over and Ghanaians 50-59 and 60-74

Abdominal Obesity by BMI (kg/m2)

African American Men 6,7 Ghanaian Men

Ever had a PSA testa 60% 3%

Had Blood pressure takenb 97% 80%aAfrican Americans >40, Ghanaians >50bAll African Americans 20 and over, Ghanaians >50

References 1 The National Center for Health Statistics (NCHS). Health, United States, 2007. Hyattsville, MD. http://www.cdc.gov/nchs/hus.htm). (Accessed July 15, 2008).2 The Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Abuse and Mental health data archive, National Survey on Drug Use and Health, 2006. Washington, D.C. (http://www.icpsr.umich.edu/SAMHDA/). (Accessed July 15, 2008). 3 Okosun IS, Chandra KM, Boev A, et al. Abdominal adiposity in U.S. adults: prevalence and trends, 1960-2000. Prev Med 2004;39:197-206. 4 The Centers For Disease Control and Prevention. Data & Trends. Age-specific prevalence of diagnosed diabetes by race/ethnicity and sex, United States, 2005. 5 Wyatt SB, Akylbekova EL, Wofford MR, et al. Prevalence, awareness, treatment, and control of hypertension in the Jackson Heart Study. Hypertension 2008;51:650-6.6 Behavioral Risk Factor Surveillance System. 2006. Prevalence data: Men aged +40 who have had a PSA test within the past two years. Atlanta, GA. (http://apps.nccd.cdc.gov/BRFSS/race.asp?cat=PC&yr=2006&qkey=4423&state=US). (Accessed July 15, 2008). 7 The Centers For Disease Control and Prevention. Racial/Ethnic Disparities in Prevalence, Treatment, and Control of Hypertension---United States, 1999-2002. Atlanta, GA. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a3.htm. (Accessed July 25, 2008).

6.365 No Religion11.6119 Muslim78.4804 Christian

Religion 3.940 Other/DK13.9142 Higher18.1186 Senior/Secondary46.0472 Junior/Middle 8.1186 None/ Primary

Education 5.355 Other 0.78 Grussi 1.515 Mole-Dagbani 2.526 Hausa18.0186 Ewe33.5347 Akan38.5399 Ga/Adangbe

Ethnic Group(7.2) 60.5 Mean (SD) 5.0156 70-7436.1374 60-6948.9507 50-59

Age1001037Total Men

%NSelected Characteristics

1.212 Other

10.2103 Divorced / Separated

5.052 Widow

83.8869 Married

Marital Status0.66 Other

1.3 13 Traditional

1.818 Spiritualist

Ghana

WHR and BMIWaist circumference

and BMI

0

10

20

30

40

50

60

Pre

va

len

ce

(%

)

Smoking Drinking

Never

Former

Current

0

5

10

15

20

25

30

35

40

45

50

Abd

omin

al O

besi

ty (

WH

R >

=1,

%)

<18.5 18.5-22.9 23.0-24.9 25.0-29.9 >30

BMI group

0

5

10

15

20

25

30

35

Pre

vale

nce (

%)

<0.9 0.9-0.94 0.95-0.99 >1.0

Waist to Hip Ratio

0

5

10

15

20

25

30

35

Prevale

nce (

%)

<18.5 18.5-22.9 23.0-24.9 25.0-29.9 >30

Body Mass Index 0

10

20

30

40

50

60

70

80

90

Pre

va

len

ce

(%

)

Diabetes Hypertension Malaria Measles Yellow fever

Chronic Diseases Infectious diseases

0

10

20

30

40

50

60

70

Pre

va

len

ce

(%

)

Hasinsurance

PSA test Rectalexam

Bloodpressure

Cholesteroltest

Access to Medical Care

0

10

20

30

40

50

60

70

80

Abd

omin

al O

besi

ty(W

C>=

102

cm, %

)

<18.5 18.5-22.9 23.0-24.9 25.0-29.9 >30

BMI group

IMPLICATIONSIMPLICATIONS

•Differences in the prevalence of risk factors among Ghanaian men suggests that lifestyle and other factors may contribute to the high rates of prostate cancer among African American men

African American Men 1,2 Ghanaian Men

Current Smokinga 33-16% 14-12% Ever Drinkingb 88% 66%

aAfrican Americans 45-64 and 65 and over and Ghanaians 50-64 and 65 and overbAfrican Americans >=50 and Ghanaians 50-74

African American Men 1,4,5 Ghanaian Men

Diabetesa 17-27% 9-7% Hypertensionb 71-84% 58-62%

Among Ghanaian men, a history of malaria, measles and yellow fever is high

a,African Americans 45-64 and 65-74 and Ghanaians 50-64 and 65-74bAfrican Americans males and females 50-64 and 65 and over, Ghanaian men

Age-Standarized Incidence Rates of prostate cancer, 1950-2002

Years

1950 1960 1970 1980 1990 2000 2010

Rate

per

100,0

00

1

10

100

US: Black US: White Zimbabwe, Harare, Africans Uganda, Kyadondo Jamaica Mali, Bamako Algeria, Serif Wilaya

0

10

20

30

40

50

60

70

Foo

d I

tem

Co

nsu

mp

tio

n (

%)

Grains Fruits Freshvegetables

Milk Meat, Beef Fish

Food Item Consumption Per Week

Never

1 or less

1 to 3

4 to 7

8 to 14

>=15

Probability Sampling300 Enumeration Units

(EU)

25 Households from each (EU)

Door-to-Door visits men 50-74 years

1,037 men98% response

2.5% Past PSA test