African Americans, African Immigrants, and Afro-Caribbeans Differ in Social Determinants of Hypertension and Diabetes: Evidence from the National Health Interview Survey

Abstract

In the United States (U.S.), Blacks have higher morbidity and mortality from cardiovascular disease (CVD) than other racial groups. The Black racial group includes African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans (ACs); however, little research examines how social determinants differentially influence CVD risk factors in each ethnic subgroup. We analyzed the 2010-2014 National Health Interview Survey, a cross-sectional, nationally representative survey of non-institutionalized civilians. We included 40,838 Blacks: 36,881 AAs, 1660 AIs, and 2297 ACs. Age- and sex-adjusted hypertension prevalence was 37, 22, and 21% in AAs, ACs, and AIs, respectively. Age- and sex-adjusted diabetes prevalence was 12, 10, and 7% in AAs, ACs, and AIs, respectively. In the multivariable logistic regression analyses, social determinants of hypertension and diabetes differed by ethnicity. Higher income was associated with lower odds of hypertension in AAs (aOR 0.86, 95% CI 0.77-0.96) and ACs (aOR 0.55, 95% CI 0.37-0.83). In AAs, those with some college education (aOR 0.79, 95% CI 0.68-0.92) and college graduates (aOR 0.62, 95% CI 0.53-0.73) had lower odds of hypertension than those with < high school education. In AIs, having health insurance was associated with higher odds of hypertension (aOR 1.59, 95% CI 1.04-2.42) and diabetes (aOR 3.22, 95% CI 1.29-8.04) diagnoses. We observed that the social determinants associated with hypertension and diabetes differed by ethnicity. Socioeconomic factors of health insurance and income were associated with a disparate prevalence of hypertension by ethnic group. Future research among Blacks should stratify by ethnicity to adequately address the contributors to health disparities.

Lessons Learned From the Recruitment of Undocumented African Immigrant Women for a Qualitative Study

“…Given what we know about the relationships between social determinants of health, such as educational attainment and health outcomes, variations in characteristics of social determinants can have implications for health outcomes and for the appropriateness of standardized health interventions that do not consider the unique needs of certain populations (Marmot & Allen, 2014). In fact, there is some evidence suggesting that African Americans, African immigrants, and Afro-Caribbean immigrants, respectively, have unique social determinant characteristics that impact hypertension and diabetes prevalence (Commodore-Mensah et al, 2018). Both social and structural factors that heighten African immigrants' vulnerability to poor health outcomes warrant attention.…”

Perceived Discrimination, Psychological Distress and Cardiovascular Risk in Migrants in Spain

“…It is thus expected that immigrants who had a relatively low exposure to cardiovascular-risk factors in their countries of origin will take on high-risk behaviours from native population in host countries. Nevertheless, results from same levels of exposure to risk factors may vary in individuals or populations from different ethnical origins [30]. Several studies have identified differences in the prevalence of certain diseases related to cardiovascular risks and their subsequent complications in different ethnical groups.…”

Stress Measured by Allostatic Load Varies by Reason for Immigration, Age at Immigration, and Number of Children: The Africans in America Study

“…The challenge is that most epidemiological surveys, including National Health and Nutrition Examination Survey (NHANES), combine all foreign-born blacks into a single group. As African descent populations are diverse in culture, history, and genetics, there are differences in allostatic load triggers, as well as the etiology and presenting phenotype of diabetes and CVD [12][13][14][15].…”