Cardiovascular health: associations with race–ethnicity, nativity, and education in a diverse, population-based sample of Californians

Abstract

Purpose This study examined how race-ethnicity, nativity, and education interact to influence disparities in cardiovascular (CV) health, a new concept defined by the American Heart Association (AHA). We assessed whether race-ethnicity and nativity disparities in CV health vary by education, and whether the foreign-born differ in CV health from their US-born race-ethnic counterparts with comparable education. Methods We used data from the 2009 California Health Interview Survey to determine the prevalence of optimal CV health metrics (based on selected AHA guidelines) among adults ages 25 and over (n = 42,014). We examined the interaction between education and ethnicity-nativity, comparing predicted probabilities of each CV health measure between US-born and foreign-born Whites, Asians, and Latinos. Results All groups were at high risk of suboptimal physical activity levels, fruit and vegetable and fast food consumption, and overweight/obesity. Those with higher education were generally better-off, except among Asians. Ethnicity-nativity differences were more pronounced among those with less than a college degree. The foreign-born exhibited both advantages and disadvantages in CV health compared to their US-born counterparts that varied by ethnicity-nativity. Conclusions Education influences ethnicity-nativity disparities in CV health, with most race-ethnic and nativity differences occurring among the less educated. Studies of nativity differences in CV health should stratify by education in order to adequately address SES differences.

Immigrant status and cardiovascular risk over time: results from the Multi-Ethnic Study of Atherosclerosis

“…23 CVH has been strongly predictive of cardiovascular events and mortality in multi-ethnic populations 31,46-48 but longitudinal changes in the score, and associations with time in US, have rarely been examined. 49,50 Third, we examined differences in these associations between younger and older immigrants. From a life course perspective, it is difficult to disentangle effects of age at immigration from those of length of US residence because of their linear dependency (length of US residence = age – age at immigration).…”

Changes in Cardiovascular Health in the United States, 2003–2011

“…Prevalence of cardiovascular health, as measured with CVHI, has been examined in various populations globally and within the United States in both adults and adolescents . “Ideal” CVHI is associated with decreased CVD and decreased risk of death .…”

“…and within the United States in both adults [13][14][15][16][17] and adolescents. 18 "Ideal" CVHI is associated with decreased CVD 17,19,20 and decreased risk of death.…”

Health-Related Quality of Life and Health Behaviors in a Population-Based Sample of Older, Foreign-Born, Chinese American Adults Living in New York City

“…Research in California has shown low F&V intake among all adults; college-educated native- and foreign-born Asians had fewer servings of F&Vs than their less-educated counterparts (Bostean et al, 2013). Due to the limitations of the measures, reasons for low F&V intake among our sample are unclear.…”