Public health data often show that some immigrant groups — such as those from South Asia — have a higher risk of cardiovascular disease. Therefore, when researchers turned their attention to Middle Eastern immigrants — a region with one of the highest rates of diabetes in the world — many expected to see a similar or even greater level of risk.
However, a large Canadian study conducted in 2019 by Frank Sharifi on the cardiovascular health of these immigrants revealed a far more complex and unexpected reality. The findings challenge common stereotypes and provide a much more nuanced picture. Here are three key and surprising takeaways from the research:
1. Middle Eastern immigrants have significantly better cardiovascular outcomes than the general population.
A large population-based study in Ontario found that, despite originating from a region with extremely high diabetes prevalence, both Iranian immigrants and immigrants from other Middle Eastern countries had much lower rates of serious heart problems compared with non-immigrants.
After adjusting for age, sex, and pre-existing conditions, both immigrant groups had a 15–20% lower risk of acute coronary events (such as heart attacks). The difference in mortality was even more striking, with a 37% to 52% lower risk of death from ischemic heart disease.
This is a powerful example of the “healthy immigrant effect,” a well-known phenomenon indicating that people who migrate tend to be, on average, healthier than the general population of their destination country upon arrival.
2. Treating all Middle Eastern immigrants as one group masks critical health differences.
The study highlighted a common public health mistake: treating a diverse regional group as a single, homogeneous category. Significant differences were found between Iranian immigrants and non-Iranian Middle Eastern immigrants (predominantly Arab).
One clear example was diabetes prevalence. After standardizing for age and sex, the difference was substantial: 16.2% among non-Iranian Middle Eastern immigrants (higher than the 12.1% in non-immigrants), while among Iranian immigrants it was only 11.0%.
As the authors note: “This heterogeneity in morbidity and mortality is clinically significant and shows that these populations should be disaggregated when assessing health status.”
This finding highlights the importance of disaggregated data for effective clinical care and informed public health policy.
3. The “healthy immigrant effect” diminishes the longer immigrants live in Canada.
Although many immigrants arrive with a health advantage, the study found that this advantage tends to decline over time. A clear pattern emerged: negative health outcomes — including acute coronary events, ischemic heart disease mortality, and all-cause mortality — were more common among immigrants who had lived in Canada longer.
For those who had lived in Canada for 10 years or more, the increase in all-cause mortality risk was statistically significant: 44% higher for Iranian immigrants and 26% higher for non-Iranian Middle Eastern immigrants compared with more recent arrivals.
A similar trend was observed for acute coronary events and heart disease mortality, though it did not reach statistical significance — possibly due to the relative rarity of these events and insufficient statistical power.
A More Complex Picture of Immigrant Health
The health of immigrant populations is far more complex than simplistic stereotypes suggest. This study shows that Middle Eastern immigrants arrive in Canada with a significant cardiovascular advantage, but that is not the whole story: there are crucial differences within this population, and the initial health advantage tends to diminish with time spent in the host country.
This leads to an important question: knowing this, what can we do as a society to help newcomers maintain their initial health advantage over the long term?
