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Prevalence, control, and treatment of diabetes, hypertension, and high cholesterol in the Amish
  1. Shisi He,
  2. Kathleen A Ryan,
  3. Elizabeth A Streeten,
  4. Patrick F McArdle,
  5. Melanie Daue,
  6. Donna Trubiano,
  7. Yvonne Rohrer,
  8. Patrick Donnelly,
  9. Maryann Drolet,
  10. Sylvia Newcomer,
  11. Susan Shaub,
  12. Nancy Weitzel,
  13. Alan R Shuldiner,
  14. Toni I Pollin,
  15. Braxton D Mitchell
  1. Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Braxton D Mitchell; bmitchel{at}


Background The burden of diabetes and cardiovascular risk is not uniform across the USA, with much of this disparity tracking differences in socioeconomic status, cultural practices and lifestyle. To further evaluate disparities in these disorders, we assessed the prevalence of diabetes, hypertension, and hypercholesterolemia in an Old Order Amish community that is characterized by distinctive sociocultural practices that include a very cohesive social structure and limited use of modern technologies and medications. We compared prevalence of these conditions with that of the overall US population.

Method We performed a community-wide survey in 5377 Amish individuals aged 18 years and older from the Lancaster County, Pennsylvania, Amish settlement that included a basic physical examination and fasting blood draw during the period 2010–2018. We then compared the prevalence of diabetes, hypertension, and high cholesterol, defined using standard criteria, between the Amish and the European Caucasian subsample of the 2013–2014 US National Health and Nutrition Examination Survey (NHANES).

Results Prevalence rates for diabetes, hypertension and hypercholesterolemia were 3.3%, 12.7%, and 26.2% in the Amish compared with 13.2%, 37.8% and 35.7% in NHANES (p<0.001 for all). Among individuals with these disorders, Amish were less likely to be aware that they were affected, and among those aware, were less likely to be treated with a medication for their disorder.

Conclusion There is substantially lower prevalence of diabetes, hypertension and hypercholesterolemia in the Amish compared with non-Amish Caucasians in the USA. Possible factors contributing to this disparity include higher physical activity levels in the Amish or other protective sociocultural factors, a greater understanding of which could inform risk reduction interventions for these chronic diseases.

  • epidemiology
  • adult diabetes
  • cardiovascular disease risk
  • population studies

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  • Contributors Conceived and drafted the paper: SH and BDM; analyzed and interpreted data and drafted the manuscript: SH and KAR; data collection: MeD, DT, YR, PD, MaD, SN, SS and NW; commented on the drafts of the paper: KAR, EAS, PFM, ARS and TP; all authors have approved the final version for submission.

  • Funding This work was supported in part by National Institutes of Health grant P30 DK072488, the Regeneron Genetics Center, and the University of Maryland School of Medicine Program for Personalized and Genomic Medicine.

  • Competing interests ARS is an employee of Regeneron Pharmaceuticals, Inc and receives compensation.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Board at the University of Maryland, Baltimore (University of Maryland, Baltimore IRB HP-00043451).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Some deidentified Amish data are available on dbGaP (dbGaP Study Accession: phs000956.v3.p1). Further inquiries may be directed to the communicating author. National Health and Nutrition Examination Survey (NHANES) data are available through NHANES.

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