Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands

J Med Access. 2024 Jan 25:8:27550834231225159. doi: 10.1177/27550834231225159. eCollection 2024 Jan-Dec.

Abstract

Background: Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI.

Objectives: This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension.

Design: Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll.

Methods: Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure.

Results: Among participants with blood pressure data (N = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (N = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed.

Conclusion: This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.

Keywords: Hypertension; Pacific Islanders; Republic of the Marshall Islands; type 2 diabetes mellitus; undiagnosed cardiometabolic disease.

Plain language summary

Study using data collected during health screenings in the Republic of the Marshall Islands (RMI) to identify the number of Marshallese people with undiagnosed diabetes and/or high blood pressure The Republic of the Marshall Island (RMI) is a nation located in the Pacific Ocean between Hawai’i and New Zealand. The RMI was the location of nuclear testing by the United States (US) in the 1940s and 1950s, changing the diet of Marshallese people, and leading to a high rate of type 2 diabetes and high blood pressure. However, healthcare in the RMI is less available than in the US, meaning Marshallese people may not be aware if they have these chronic conditions. The goal of our study was to determine the prevalence of undiagnosed type 2 diabetes and high blood pressure among participants in church-based health screenings in the RMI. The study team found that 38.1% of people with readings indicating type 2 diabetes and 39.2% of people with readings indicating high blood pressure were undiagnosed. These results show there is additional work needed in the RMI to increase access to healthcare services.