Differences in Health Characteristics of Geographic Subgroups of Arab Americans in a Northern California Health Plan



Arab Americans are a diverse ethnic group originating from a large geographic area in the Middle East and North Africa (MENA). We aim to characterize differences in health between Arab Americans from different geographic subgroups within MENA.


We used cross-sectional electronic health record (EHR) data for a subset of 4913 Arab Americans aged 20–84 in a 2016 Northern California health plan study cohort who could be assigned to one of 4 geographic subgroups (Gulf, African, Levant, and Other) based on EHR ethnicity data. We calculated age-adjusted prevalence estimates for men and women and used generalized linear models to compare Gulf, African, and Other subgroups to Levant Arabs on risk factors (obesity and smoking), chronic conditions (diabetes, hypertension, hyperlipidemia, and asthma), and mental health (depression and anxiety).


Among women, prevalence of smoking was lower among Gulf, African, and Other Arabs than Levant Arabs. Among men, prevalence of obesity, diabetes, and hyperlipidemia was lower among Gulf, African, and Other Arabs than Levant Arabs, while prevalence of depression was higher for these subgroups than Levant Arabs.


We found substantial differences in health characteristics across Arab Americans from different geographic subgroups. Our results suggest that more detailed race and ethnicity information should be collected on Arab Americans to better understand their diverse health risks.

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Data Availability

The Kaiser Permanente Northern California (KPNC) Institutional Review Board has not provided approval for KPNC electronic health record data used for this study to be placed in a public access repository. Additional statistics derived from the data are available from the corresponding author on reasonable request. To request access to data used by this study, researchers should contact the corresponding author, who will then need to get approval for the request from the KPNC Division of Research Data Sharing Workgroup.


  1. 1.

    Demographics - Arab American stories [Internet]. [cited 2020 Oct 30]. Available from: http://www.arabamericanstories.org/arab-americans/demographics/

  2. 2.

    Foundation A-AH. Arab-American Almanac. News Circle; 2003.

  3. 3.

    Batalova JBMC, J. Middle Eastern and North African immigrants in the United States [Internet]. migrationpolicy.org. 2018 [cited 2020 Oct 30]. Available from: https://www.migrationpolicy.org/article/middle-eastern-and-north-african-immigrants-united-states-2016

  4. 4.

    Arab American demographics [Internet]. Yalla Count Me In. [cited 2020 Oct 30]. Available from: https://yallacountmein.org/materials/arab-american-demographics

  5. 5.

    Abuelezam NN, El-Sayed AM, Galea S. Differences in health behaviors and health outcomes among non-Hispanic Whites and Arab Americans in a population-based survey in California. BMC Public Health. 2019;19:892.

    Article  Google Scholar 

  6. 6.

    Dallo FJ, Kindratt TB. Disparities in vaccinations and cancer screening among U.S.- and foreign-born Arab and European American non-Hispanic White women. Womens Health Issues. 2015;25:56–62.

    Article  Google Scholar 

  7. 7.

    Dallo FJ, Ruterbusch JJ, Kirma JD, Schwartz K, Fakhouri M. A health profile of Arab Americans in Michigan: a novel approach to using a hospital administrative database. J Immigr Minor Health. 2016;18:1449–54.

    Article  Google Scholar 

  8. 8.

    Abuelezam NN, El-Sayed AM, Galea S. Relevance of the “immigrant health paradox” for the health of Arab Americans in California. Am J Public Health American Public Health Association. 2019;109:1733–8.

    Article  Google Scholar 

  9. 9.

    Kindratt T, Dallo F, Zahodne L. Cognitive disability among Arab Americans by nativity status: lack of evidence for the healthy migrant effect. Health Serv Res Wiley Online Library. 2020;55:21.

    Article  Google Scholar 

  10. 10.

    Abdulrahim S, Baker W. Differences in self-rated health by immigrant status and language preference among Arab Americans in the Detroit metropolitan area. Soc Sci Med Elsevier. 2009;68:2097–103.

    Article  Google Scholar 

  11. 11.

    Awad GH. The impact of acculturation and religious identification on perceived discrimination for Arab/Middle Eastern Americans. Cult Divers Ethn Minor Psychol. Educational Publishing Foundation. 2010;16:59.

    Article  Google Scholar 

  12. 12.

    Awad GH, Kia-Keating M, Amer MM. A model of cumulative racial–ethnic trauma among Americans of Middle Eastern and North African (MENA) descent. Am Psychol. American Psychological Association. 2019;74:76–87.

    Article  Google Scholar 

  13. 13.

    Abdulrahim S, James SA, Yamout R, Baker W. Discrimination and psychological distress: does whiteness matter for Arab Americans? Soc Sci Med. Elsevier. 2012;75:2116–23.

    Article  Google Scholar 

  14. 14.

    Abuelezam NN. Health equity during COVID-19: the case of Arab Americans. Am J Prev Med Elsevier. 2020;59:455–7.

    Article  Google Scholar 

  15. 15.

    Abuelezam NN, El-Sayed AM, Galea S. Arab American health in a racially charged U.S. Am J Prev Med. 2017;52:810–2.

    Article  Google Scholar 

  16. 16.

    Islam NS, Khan S, Kwon S, Jang D, Ro M, Trinh-Shevrin C. Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions. J Health Care Poor Underserved. NIH Public Access. 2010;21:1354.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Gordon NP, Lin TY, Rau J, Lo JC. Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study. BMC Public Health. 2019;19:1551.

    Article  Google Scholar 

  18. 18.

    Rodriguez F, Hastings KG, Boothroyd DB, Echeverria S, Lopez L, Cullen M, et al. Disaggregation of cause-specific cardiovascular disease mortality among Hispanic subgroups. JAMA Cardiol American Medical Association. 2017;2:240–7.

    Article  Google Scholar 

  19. 19.

    Arab American community in California, the largest [Internet]. Arab Am. [cited 2020 Oct 30]. Available from: https://www.arabamerica.com/california/

  20. 20.

    Bergmans R, Soliman AS, Ruterbusch J, Meza R, Hirko K, Graff J, et al. Cancer incidence among Arab Americans in California, Detroit, and New Jersey SEER registries. Am J Public Health. American Public Health Association. 2014;104:e83–91.

    Article  Google Scholar 

  21. 21.

    Hirko KA, Soliman AS, Banerjee M, et al. Characterizing inflammatory breast cancer among Arab Americans in the California, Detroit and New Jersey Surveillance, Epidemiology and End Results (SEER) registries (1988–2008). Springerplus, vol. 2, 3 Springer; 2013. https://doi.org/10.1186/2193-1801-2-3

  22. 22.

    Arab KW League [Internet]. Investopedia. [cited 2020 Nov 17]. Available from: https://www.investopedia.com/terms/a/arab-league.asp

  23. 23.

    ASDA’A BCW Arab Youth Survey Middle East [Internet]. [cited 2021 Jan 5]. Available from: https://www.arabyouthsurvey.com/whitepaper.html

  24. 24.

    Vella CA, Ontiveros D, Zubia RY, Bader JO. Acculturation and metabolic syndrome risk factors in young Mexican and Mexican–American women. J Immigr Minor Health. 2011;13:119–26.

    Article  Google Scholar 

  25. 25.

    Koya DL, Egede LE. Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants. J Gen Intern Med. 2007;22:841–6.

    Article  Google Scholar 

  26. 26.

    Tailakh AK, Evangelista LS, Morisky DE, Mentes JC, Pike NA, Phillips LR. Acculturation, medication adherence, lifestyle behaviors, and blood pressure control among Arab Americans. J Transcult Nurs SAGE Publications Inc. 2016;27:57–64.

    Article  Google Scholar 

  27. 27.

    Jadalla A, Lee J. The relationship between acculturation and general health of Arab Americans. J Transcult Nurs. SAGE Publications Inc. 2012;23:159–65.

    Article  Google Scholar 

  28. 28.

    Khattab A, Javaid A, Iraqi G, Alzaabi A, Ben Kheder A, Koniski M-L, et al. Smoking habits in the Middle East and North Africa: results of the BREATHE study. Respir Med. 2012;106:S16–24.

    Article  Google Scholar 

  29. 29.

    Costa-Font J, Györi M. The weight of patriarchy? Gender obesity gaps in the Middle East and North Africa (MENA). Soc Sci Med. 2020;266:113353.

    Article  Google Scholar 

  30. 30.

    Cuevas AG, Dawson BA, Williams DR. Race and skin color in Latino health: an analytic review. Am J Public Health. 2016;106:2131–6.

    Article  Google Scholar 

  31. 31.

    Cuevas AG, Reitzel LR, Cao Y, Nguyen N, Wetter DW, Adams CE, et al. Mediators of discrimination and self-rated health among African Americans. Am J Health Behav PNG Publications. 2013;37:745–54.

    Article  Google Scholar 

  32. 32.

    Aprahamian M, Kaplan D, Windham A, Sutter J, Visser J. The relationship between acculturation and mental health of Arab Americans. J Ment Health Couns American Mental Health Counselors Association. 2011;33:80–92.

    Article  Google Scholar 

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Correspondence to Nadia N. Abuelezam.

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This study was approved by Kaiser Foundation Research Institute’s Institutional Review Board (IRB).

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Abuelezam, N.N., El-Sayed, A.M., Galea, S. et al. Differences in Health Characteristics of Geographic Subgroups of Arab Americans in a Northern California Health Plan. J. Racial and Ethnic Health Disparities (2021). https://doi.org/10.1007/s40615-021-00970-4

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  • Health disparities
  • Chronic disease
  • Arab Americans
  • Risk factors
  • California