Influence of Stress, Gender, and Minority Status on Cardiovascular Disease Risk in the Hispanic/Latino Community: Protocol for a Longitudinal Observational Cohort Study

Abstract

Background Hispanic/Latino sexual and gender minorities (SGM) are the fastest growing ethnic group of SGM in the United States. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among Hispanics/Latinos. SGM inequities in CVD risk have been identified as early as young adulthood, and minority stress has been identified as a potential mediator. Yet, the small number of ethnic or racial minority participants in SGM studies have precluded the examination of the intersections of sexual orientation, gender identity, and race and ethnicity. Objective Minority stress models conceptualize relationships between stressors in minority groups and health outcomes. In this study, we will (1) examine the influence of sexual orientation and gender identity on CVD risk among all Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants at visit 3 (2021-2024; N~9300); (2) model pathways from sexual orientation and gender identity to CVD risk through stigma, discrimination, and stress in a 1:2 matched subcohort of SGM and non-SGM participants at visit 3 (n~1680); and (3) examine the influence of resilience factors on sexual orientation or gender identity and CVD risk relationships among subcohort participants at visit 3 (n~1680). Methods This study will leverage existing data from the parent HCHS/SOL study (collected since 2008) while collecting new data on sexual orientation, gender identity, stigma, discrimination, stress, coping, social support, and CVD risk. Data analysis will follow the SGM minority stress model, which states that excess stigma against SGM populations leads to minority stress that increases CVD risk. In this model, coping and social support serve as resilience factors that can mitigate the impact of minority stress on CVD risk. Cross-sectional and longitudinal regression models as well as structural equation models will be used to test these relationships. Results This study was funded by the National Heart, Lung, and Blood Institute in March 2020. Recruitment is scheduled to begin in the first quarter of 2021 and continue through 2024. Conclusions Understanding the influence of stigma-induced stress on CVD risk among Hispanic/Latino SGM has significant implications for the development of culturally specific CVD risk reduction strategies. Study findings will be used to build on identified Hispanic/Latino cultural strengths to inform adaptation and testing of family and community acceptance interventions. International Registered Report Identifier (IRRID) PRR1-10.2196/28997

Psychosocial and Sociodemographic Determinants Related to Chronic Diseases in Immigrants Residing in Spain

“…Data obtained in other research confirm that some of these health conditions are more notable and probable among those individuals who lack social support, or the social support they receive is insufficient or unsatisfactory [ 77 , 78 ]. Deficient levels of social support relate to the risk of cardiovascular diseases [ 12 , 18 , 79 ], psychological problems [ 80 , 81 , 82 ], or low levels of health [ 16 , 83 ]. In this sense, interpersonal relationships can act as protective factors against different physical and mental problems.…”

“…Therefore, social support would play a relevant role as a moderating variable between stress by acculturation and symptoms of anxiety and depression in immigrants [ 84 , 85 ]. Likewise, the perception of social support relates positively to coping mechanisms that reduce stress and health problems [ 12 , 86 ]. Studies such as the one carried out by Jia et al (2022) analyze coping mechanisms among other factors and how these affect immigrants’ health [ 11 ].…”

“…This means that migrating can have a negative impact on individuals’ health due to multiple physical and psychosocial tensions suffered during the migration process [ 10 , 11 ]. These tensions can lead to high levels of stress and an increase in risk-behaviors in immigrants, thus affecting their overall health [ 12 , 13 , 14 , 15 ] and potentially causing them to develop certain chronic diseases or worsening existing conditions.…”

“…Ponce-Blandón et al (2021) studied the consequences of migration in the Strait of Gibraltar and concluded that it was necessary to attend to the personal and social factors of immigrants in order to provide them with quality healthcare [ 17 ]. Poteat et al (2021) studied stress models in minority groups within the Hispanic population in the United States and a relationship with the risk of cardiovascular disease was found [ 12 ]. This increase was mediated by social support and coping mechanisms, which would act as resilience factors against stress in the dimension of disease risk.…”

“…From a psychosocial point of view, and based on previous research [ 10 , 12 , 16 , 18 ], the present study aims to analyze the sociodemographic and psychosocial factors that affect chronic diseases in immigrants. For such purpose, common chronic diseases in immigrants have been selected based on long-term effects that can be considered as high risk for immigrants’ health.…”