The 2,363 Arab-American patients from the ACCESS clinic had a median age of 37 years (range: 18–98), with 67.3% females (n = 1591) and 32.7% males (n = 772). The majority (30%) of Arab-Americans were in the 25–35 year age group. Based on the international BMI classification, 30% (n = 707) were of normal weight, 2% (n = 47) were underweight, 37% (n = 876) were overweight and 31% (n = 733) were obese. The age and BMI distributions of Southeast MI’s Arab-American population are summarized in Table 1.
Table 1
Baseline characteristics by obesity in ACCESS/Arab American patients
| All (N = 2363) | Obesity | p |
| No (N = 1630) | Yes (N = 733) |
Age, year – median (range) | 37 (18,98) | 34 (18,98) | 44 (19,93) | < 0.001 |
Age, year – no. (%) | | | | < 0.001 |
18–24 | 319 (13) | 269 (17) | 50 (7) | |
25–35 | 714 (30) | 562 (34) | 152 (21) | |
35–44 | 447 (19) | 277 (17) | 170 (23) | |
45–54 | 391 (17) | 230 (14) | 161 (22) | |
55–64 | 289 (12) | 171 (10) | 118 (16) | |
65+ | 203 (9) | 121 (7) | 82 (11) | |
Sex – no. (%) | | | | 0.421 |
Female | 1591 (67) | 1106 (68) | 485 (66) | |
Male | 772 (33) | 524 (32) | 248 (34) | |
Height, in – median (range) | 64 (51,79) | 65 (52,79) | 64 (51,78) | < 0.001 |
Weight, lbs – median (range) | 163 (79,346) | 150 (79,248) | 198 (117,346) | < 0.001 |
BMI, lbs/in2 – median (range) | 27.43 (12.34,58.51) | 25.39 (12.34,29.99) | 33.47 (30.02,58.51) | < 0.001 |
BMI, lbs/in2 – no. (%) | | | | - |
Underweight | 47 (2) | 47 (3) | - | |
Normal | 707 (30) | 707 (43) | - | |
Overweight | 876 (37) | 876 (54) | - | |
Obese | 733 (31) | - | 733 (100) | |
Employment – no. (%) | | | | 0.739 |
No | 387 (16) | 275 (17) | 112 (15) | |
Yes | 312 (13) | 218 (13) | 94 (13) | |
missing | 1664 (70) | 1137 (70) | 527 (72) | |
Marital status – no. (%) | | | | 0.266 |
No | 119 (5) | 88 (5) | 31 (4) | |
Yes | 472 (20) | 323 (20) | 149 (20) | |
missing | 1772 (75) | 1219 (75) | 553 (75) | |
Hypertension – no. (%) | | | | < 0.001 |
No | 985 (42) | 734 (45) | 251 (34) | |
Yes | 392 (17) | 191 (12) | 201 (27) | |
missing | 986 (42) | 705 (43) | 281 (38) | |
Diabetes Mellitus – no. (%) | | | | < 0.001 |
No | 956 (40) | 701 (43) | 255 (35) | |
Yes | 370 (16) | 195 (12) | 175 (24) | |
missing | 1037 (44) | 734 (45) | 303 (41) | |
Hyperlipidemia – no. (%) | | | | < 0.001 |
No | 875 (37) | 646 (40) | 229 (31) | |
Yes | 455 (19) | 254 (16) | 201 (27) | |
missing | 1033 (44) | 730 (45) | 303 (41) | |
Alcohol use – no. (%) | | | | 0.737 |
No | 1048 (44) | 713 (44) | 335 (46) | |
Yes | 42 (2) | 30 (2) | 12 (2) | |
missing | 1273 (54) | 887 (54) | 386 (53) | |
Smoking status – no. (%) | | | | 0.497 |
No | 1560 (66) | 1073 (66) | 487 (66) | |
Yes | 377 (16) | 252 (15) | 125 (17) | |
missing | 426 (18) | 305 (19) | 121 (17) | |
Hookah use – no. (%) | | | | > 0.99 |
No | 1230 (52) | 837 (51) | 393 (54) | |
Yes | 174 (7) | 118 (7) | 56 (8) | |
missing | 959 (41) | 675 (41) | 284 (39) | |
Interestingly, the prevalence of obesity in Arab-Americans was not statistically different between males and females, 32.1% and 30.5%, respectively (p = 0.421). Among Arab-Americans, patients with HTN, DM and HLD had a higher prevalence of obesity, 51.3%, 47.3% and 44.2%, respectively, than patients without these comorbidities, 25.4%, 26.7%and 26.2%, respectively, (all p-value < 0.001) as illustrated in Table 1. Furthermore, in a univariable analysis, patients with HTN were 3 times more likely to be obese than those without HTN (95% CI: 2.4–3.9; p < 0.001). Similarly, the odds of being obese were 2.5 times higher if the patient was diabetic (95% CI: 1.92–3.16; p < 0.001) and 2.2 times higher if the patient had HLD (95% CI: 1.75–2.83; p < 0.001), as summarized in Table 2.
Table 2
Univariable and multivariable logistic regression analyses of factors associated with obesity (Yes vs. No, No as reference) in Arab-American patients
| Univariable | Multivariable |
| E/N | OR (95% 95% CI) | p | E/N | OR (95% 95% CI) | p |
Age | 733/2363 | 1.028 (1.022,1.033) | < 0.001 | 339/1130 | 1.016 (1.006,1.027) | 0.002 |
Sex | | | | | | |
Female | 485/1591 | Reference | | | | |
Male | 248/772 | 1.079 (0.896,1.298) | 0.419 | | | |
Employment | | | | | | |
No | 112/387 | Reference | | | | |
Yes | 94/312 | 1.059 (0.763,1.467) | 0.732 | | | |
Marital status | | | | | | |
No | 31/119 | Reference | | | | |
Yes | 149/472 | 1.309 (0.84,2.085) | 0.243 | | | |
Hypertension | | | | | | |
No | 251/985 | Reference | | 219/899 | Reference | |
Yes | 201/392 | 3.077 (2.411,3.933) | < 0.001 | 120/231 | 2.263 (1.533,3.348) | < 0.001 |
Diabetes Mellitus | | | | | | |
No | 255/956 | Reference | | 231/895 | Reference | |
Yes | 175/370 | 2.467 (1.923,3.167) | < 0.001 | 108/235 | 1.048 (0.685,1.593) | 0.828 |
Hyperlipidemia | | | | | | |
No | 229/875 | Reference | | 224/861 | Reference | |
Yes | 201/455 | 2.232 (1.759,2.835) | < 0.001 | 115/269 | 1.129 (0.778,1.628) | 0.518 |
Alcohol use | | | | | | |
No | 335/1048 | Reference | | | | |
Yes | 12/42 | 0.851 (0.415,1.642) | 0.644 | | | |
Smoking status | | | | | | |
No | 487/1560 | Reference | | | | |
Yes | 125/377 | 1.093 (0.858,1.386) | 0.468 | | | |
Hookah use | | | | | | |
No | 393/1230 | Reference | | | | |
Yes | 56/174 | 1.011 (0.715,1.413) | 0.951 | | | |
Univariable, Univariable logistic regression analysis; Multivariable, Multivariable logistic regression analysis; E/N, the number of events (i.e., obesity) and patients; OR, odds ratio; 95% CI, Confidence interval. |
Subgroup analysis of obesity in Arab-Americans by sex and employment status are illustrated in Figs. 1 and 2, respectively. It appears that there is no interaction by either sex or employment. Based on the outcomes of univariable and subgroup logistic analyses, age, HTN, DM and HLD were further selected for the multivariable logistic analyses. The multivariable analysis showed that age and hypertension are independent risk factors associated with obesity (Table 2).
Of the 9,589 individuals from the Michigan BRFSS population data, 51% were female (n = 4,922) and 49% were male (n = 4,667). 33% (n = 3,128) were obese and the prevalence of obesity was higher in females (53%; n = 1,635) compared to males (47%; n = 1,493), but not statistically significant (p = 0.206). Non-Hispanic African Americans had the highest prevalence of obesity with 40% followed by 32.5% in non-Hispanic Americans. Comparing BMI distribution between Arab-Americans and MI’s BRFSS population showed that there was no difference in the rates of obesity between Arab-Americans (31%) and the BRFSS population (33%) (p = 0.141).
Moreover, in Arab-Americans, a trend was observed in which obesity increased with age up to 44 years and declined thereafter, as shown in Table 3. Descriptively, the prevalence of obesity was 7% in the 18–24 year age-group, 21% in the 25–34 year age-group, 24% in the 35–44 year age-group and showed a decline to 17% and 9% in the 55–64 and > 65 year age-groups, respectively. This was not the case in the BRFSS patients, where a consistent increase in obesity was observed with increasing age with 5%, 10%, 13%, 17%, 24% and 31% in the 18–24, 25–34, 35–44, 45–54, 55–64 and > 65 year age-groups, respectively (test for trend, p = 0.003).
Table 3
Comparison of BMI distribution and age-wise prevalence of obesity among Arab-American/ACCESS, MI-BRFSS and FernCare Free Clinic data
| Arab-Americans/ACCESS | MI-BRFSS | FCFC patients | p* |
vs. MI-BRFSS | vs. FCFC |
BMI – no. (%) | | | | 0.278 | < 0.001 |
Underweight | 47 (2) | 157 (2) | 5 (1) | | |
Normal | 707 (30) | 2879 (30) | 201 (19) | | |
Overweight | 876 (37) | 3425 (35) | 284 (27) | | |
Obese | 733 (31) | 3128 (33) | 543 (53) | | |
Total | 2363 (100) | 9589 (100) | 1033 (100) | | |
Age among obese patients – no. (%) | | | | < 0.001 | < 0.001 |
18–24 | 50 (7) | 145 (5) | 29 (6) | | |
25–34 | 152 (21) | 327 (10) | 80 (15) | | |
35–44 | 170 (23) | 404 (13) | 98 (18) | | |
45–54 | 161 (22) | 546 (17) | 152 (28) | | |
55–64 | 118 (16) | 741 (24) | 178 (33) | | |
65+ | 82 (11) | 965 (31) | 0** | | |
Total | 733 (100) | 3128 (100) | 543 (100) | | |
*, Pair-wise Chi-squared p-values between ACCESS and BRFSS and between ACCESS and FernCare. |
**, FCFC does not serve patients aged > 65 who are eligible for Medicare |
Of the 1,033 patients from the FCFC cohort, the male:female gender breakdown was 46% (n = 471):54% (n = 562) and the prevalence of obesity was higher in females (60%; n = 327) compared to males (40%; n = 216) (p < 0.001). Analysis of BMI categories between ACCESS Arab-Americans and FCFC patients indicated a higher obesity rate in FCFC patients (53% vs 31%; p < 0.001) and followed a trend that increased with age, as illustrated in Table 3 (test for trend, p = 0.017). Furthermore, the results also show significantly higher rates of HTN, DM and HLD (80.5%, 85.7% and 69.6% respectively) in the FCFC patient population compared to the ACCESS Arab-American population (51.7%, 47.9% and 44.9% respectively; all p-values = 0.001).