Heterogeneity of Cardiovascular Disease Risk Factors Among Asian Immigrants: Insights From the 2010 to 2018 National Health Interview Survey

Abstract

Background The Asian population is the fastest‐growing immigrant population in the United States. Prior studies have examined the Asian immigrant population as a homogenous group. We hypothesized that there will be heterogeneity in cardiovascular disease risk factors among Asian immigrant subgroups (Indian subcontinent, Southeast Asia, Asia) compared with the non‐Hispanic White population. Methods and Results A cross‐sectional analysis of the 2010 to 2018 National Health Interview Survey was conducted among 508 941 adults who were born in Asian regions or were non‐Hispanic White and born in the United States. Generalized linear models with Poisson distribution were fitted to compare the prevalence of self‐reported hypertension, overweight/obesity, diabetes mellitus, high cholesterol, physical inactivity, and current smoking among Asian immigrants compared with White adults, adjusting for known confounders. We included 33 973 Asian immigrants from Southeast Asia (45%), Asia (29%), the Indian subcontinent (26%), and 474 968 White adults. Compared with non‐Hispanic White adults, Indian subcontinent immigrants had the highest prevalence of overweight/obesity (prevalence ratio, 1.22; 95% CI, 1.19–1.25); Southeast Asian immigrants had the highest prevalence of high cholesterol (prevalence ratio, 1.16; 95% CI, 1.10–1.23); Indian subcontinent (prevalence ratio, 1.69; 95% CI, 1.49–1.93) and Southeast Asian (prevalence ratio, 1.38; 95% CI, 1.26–1.52) immigrants had a higher prevalence of diabetes. All Asian immigrant subgroups were more likely to be physically inactive and less likely to smoke than White adults. Conclusions We observed significant heterogeneity in cardiovascular disease risk factors among Asian immigrants and a varied prevalence of risk factors compared with non‐Hispanic White adults. Providers caring for Asian immigrants should provide tailored and culturally informed care to improve the cardiovascular health of this diverse group.

Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adults

“…Prior studies have shown heterogeneity in cardiovascular risk factor profile among Asian subgroups with a trend towards higher prevalence of diabetes mellitus in Asian Indians, higher prevalence of hypertension among Filipinos, and generally low risk factor burden among Chinese. ( Satish et al, 2021 , Koirala et al, 2021 , Dong, 2021 ) These differences can likely be attributed to varying degrees of acculturation as a result of cultural practices, history, language, time prior to moving to the U.S. and biological factors that are unique to each ethnic group. ( Needham et al, 2017 , Lieber et al, 2001 , Vargas and Jurado, 2015 ) Indeed Asian ethnic groups have different predilections to acculturation (embracing host cultural norms including values, attitudes and beliefs) versus enculturation (resocialization to ethnic cultural norms) though using U.S. birth and duration of time spent in the U.S. as proxies may not fully capture the dimensions of these constructs.…”

Racial/Ethnic Disparities and Determinants of Sufficient Physical Activity Levels

“…Time spent in the U.S. was categorized as < 10 versus ≥ 10 years. 9 Study sample characteristics were summarized using mean (standard error) and numbers (weighted percentages) and compared by whether study participants engaged in sufficient physical activity. Study characteristics were stratified further by race/ethnicity.…”

Leveling the playing field: The utility of coronary artery calcium scoring in cardiovascular risk stratification in South Asians

“…Substantial variability exists in the CVD prevalence, incidence, risk, and health‐seeking behavior among SA subgroups [ 5 , 6 , [24] , [25] , [26] , [27] ]. In addition to frequent and universal screening for traditional risk factors and metrics, the use of CAC, a highly specific marker of subclinical atherosclerosis, therefore may be a useful test to improve risk stratification in SA individiuals [28] .…”