Long-term Study of Emirati Health

The UAE has one of the world's highest rates of diabetes, but the causes of this high rate of disease are not clear. Now NYU medical scholars are seeking the answer to that and other public health questions through a long-term study of Emiratis' health.

The NYU Abu Dhabi Public Health Research Center (PHRC) plans to follow a sample of 20,000 UAE nationals in the country's first-ever "cohort" study. Researchers will periodically check in with the individuals over many years. Statistical assessment of longevity and health status, combined with information about behaviors and lifestyle practices, can help to pinpoint the causes of early death and serious illness.

Scott Sherman, an associate professor in NYU's departments of Population Health, Medicine, and Psychiatry, is one of four principal investigators on the project, now in the design stage.

"There are lots of hypotheses" about why 44 percent of Emirati adults have diabetes or the condition known as pre-diabetes, Sherman said, "but nobody has a good answer why. A cohort study will allow us to get at the factors."

Cohort studies are a well-established tool for identifying what contributes to a population's health situation. Sherman explained that the best-known project of this type, the Framingham (Mass.) Heart Study, "has made countless discoveries about cardiovascular risk factors associated with different outcomes." That study began in 1948, he notes, and continues still; it will probably conclude only when all its subjects are dead.

So when Sherman and his colleagues tried to design a project for NYUAD that could contribute to better health outcomes for Emiratis, a cohort study came to mind.

Sherman is working with Ann Marie Schmidt, Richard Hayes, and Ravichandran Ramasamy, all professors at the NYU School of Medicine. The project now also has an Abu Dhabi-based director, Raghib Ali, a clinical epidemiologist at the University of Oxford.

The Abu Dhabi cohort study, to be conducted by the PHRC in conjunction with the PHRC's Diabetes Research Center, will focus on that disease and cardiovascular problems, also common among Emiratis.

Designing a cohort study is not simple, and roughly the first half of the initial grant period of five years is being devoted to organizing the work.

There are lots of hypotheses [about why 44 percent of Emirati adults have diabetes or the condition known as pre-diabetes], but nobody has a good answer why. A cohort study will allow us to get at the factors.

Scott Sherman, NYUNY associate professor of Population Health, Medicine, and Psychiatry.

The first plan was to sign up 5,000 subjects — Emiratis only, because the transience of other UAE residents makes follow-up difficult — but that has now been expanded to an ambitious 20,000. Each will have a detailed initial interview and agree to provide samples of body fluids — blood, urine, and saliva — to establish the cohort's baseline data. A subset of the entire sample will undergo additional non-invasive testing, such as ultrasound imaging of carotid and arm arteries.

Subsequently, each subject will be contacted briefly every three months, and interviewed in detail every five years.

The four principal investigators and their team have worked out an initial questionnaire. Once a cohort study gets rolling, it is common for other researchers to ask to add their own questions, on a range of subjects. The PHRC/DRC group has invited government agencies and other university experts to propose additional questions — road safety is often mentioned — but there is a practical limit to how many queries respondents can handle.

There is also a lot of "back office" planning being done now. For example, information technology specialists must design systems to collect and preserve all the initial data and subsequent updates. Laboratories must be available to process the blood samples.

Further, all human-subject studies must clear the hurdle of approval by research-ethics committees, known in the US as institutional review boards. These typically ask three questions: is the process beneficial to the individual; is the process and concept fair; are participants treated respectfully. This study has won NYU School of Medicine approval and is on its way through Abu Dhabi's equivalent process. It will then go under NYUAD review before recruiting can start.

This summer, the first 500 subjects were recruited in a pilot project to make sure the process works as designed, before it scales up to the full 20,000. The researchers plan to recruit participants through local clinics.

With these sources of participants, the planners will have to take care to make sure that the sample is representative. Another challenge is that because cohort studies are not as well known in the UAE as in the West, cultural factors may discourage participation.

Sherman and his colleagues hope to recruit some prominent Emiratis to take part, and to say so through publicity; he concedes that participation by nationals may be an issue.

For all the challenges, Sherman is encouraged by the progress made so far. Based in New York, he has made more than a dozen trips to Abu Dhabi in the past two years.

All in all, Sherman said, "The people have been wonderful to work with and we think we can do really important research and contribute to improving the population’s health."

This article originally appeared in NYUAD's 2013-14 Research Report (13MB PDF).

Header photo by Stephan Geyer via Flickr. The image is licensed under an Attribution 2.0 Creative Commons license. The work has not been modified.