Cardiovascular disease and type 2 diabetes: an exploration amongst South Asians and Anglo-Australians living in Victoria, Australia

Background: As Australia becomes an increasingly culturally diverse society through migration, there is a need to better understand the health of migrant groups. While literature on migrant health in Australia exists, there are gaps in coverage. Research indicates that South Asians (SA) have higher rates of both cardiovascular disease (CVD) and type 2 diabetes (T2D) in comparison to host populations in other western countries. This also occurs at younger ages and with greater severity of CVD. However, there is a paucity of studies that compare and examine the presentation of T2D and/or CVD in SA Australian dwelling migrants with members of the host population and there are equally few studies that explore their experiences and perceptions of living with these diseases.

Aim: The body of work presented in this dissertation aimed to address the patterns of CVD presentation amongst Anglo-Australians (AA) and Australian dwelling SAs and to examine and explore the perceptions and experiences of SAs and AAs living with T2D and/or CVD.

Methods: This study was divided into two phases. Phase 1 was a retrospective hospital clinical case audit to determine patterns of CVD presentation. The study population included SA and AA patients hospitalised for ischaemic heart disease. Baseline characteristics, evidence of diabetes and other CVD risk factors were compared. Angiographic data were also compared to determine severity and these were assessed using a modified Gensini score. In phase 2, semi-structured indepth interviews were conducted with 57 participants (41 SAs and 16 AAs) with either T2D and/or CVD.

Results: Phase 1 confirmed the SA pattern of CVD presentation in other western nations, i.e. high rates of cardiovascular disease at younger ages, with greater severity, higher rates of T2D and low BMI measurements (a conventional risk factor). Findings from phase 2 indicated key similarities and differences between the perceptions and experiences of the participants drawn from the two ethnic groups. These pertained to their engagement with health professionals and the health system, their self-management practices such as physical activity and dietary patterns, as well as the bidirectional effects of migration on their health related behaviours.

Conclusions and future direction: The findings presented in this thesis have made an original contribution in an area where there is a strong need for an evidence base to inform health service delivery and public health action to alleviate the increasing burden of CVD and T2D among SAs. This group should be targeted for more aggressive screening for these diseases at younger ages with more intensive treatment strategies. Prevention and management strategies need to be individually and communally tailored as well as culturally appropriate. Health professionals should bear this in mind when providing clinical advice. Similarly, those responsible for the development and implementation of health promotion interventions for prevention and management of these diseases will need to consider culturally sensitive approaches.