The association of nativity/length of residence and cardiovascular disease risk factors in the United States

Abstract

Differences by nativity status for cardiovascular disease (CVD) risk factors have been previously reported. Recent research has focused on understanding how other acculturation factors, such as length of residence, affect health behaviors and outcomes. This study examines the association between CVD risk factors and nativity/length of US residence. Using cross-sectional data from 15,965 adults in the 2011-2016 National Health and Nutrition Examination Surveys (analyzed in 2018), prevalence ratios and predicted marginals from logistic regression models are used to estimate associations of CVD risk factors (i.e., hypertension, hypercholesterolemia, diabetes, overweight/obesity and smoking) with nativity/length of residence (<15 years, ≥15 years) in the US. In sex-, age-, education- and race and Hispanic origin- adjusted analyses, a higher percentage of US (50 states and District of Columbia) born adults (86.4%) had ≥1 CVD risk factor compared to non-US born residents in the US <15 years (80.1%) but not ≥15 years (85.1%). Compared to US born counterparts, regardless of length of residence, hypertension overall and smoking among non-Hispanic white and Hispanic adults were lower among non-US born residents. Overweight/obesity overall and diabetes among Hispanic adults were lower among non-US born residents in the US <15 years. In contrast, non-US born non-Hispanic Asian residents in the US <15 years had higher prevalence of diabetes. Non-US born adults were less likely to have most CVD risk factors compared to US born adults regardless of length of residence, although, for smoking and diabetes this pattern differed by race and Hispanic origin.

Keywords: Cardiovascular disease risk factors; Cigarette smoking; Diabetes; High cholesterol; Hypertension; NHANES; Nativity/length of residence; Overweight/obesity.

Fig. 1.

Adjusted predicted prevalence of diabetes (panel A) and cigarette smoking (panel B) among adults 20 years and over by nativity/length of US residence and race and Hispanic origin, United States, 2011–2016. Diabetes is defined as a self-reported physician’s diagnosis of diabetes or having a measured blood glycohemoglobin (A1c) ≥6.5 mg/dL. Cigarette Smoking is defined as self-reported ever smoking at least 100 cigarettes and currently smoking every day or some days. ^aSignificant decreasing trend from most acculturated (US born) to least acculturated (non-US born < 15 years). p < 0.05. ^bSignificant increasing trend from most acculturated (US born) to least acculturated (non-US born < 15 years). p < 0.05. Note: NH indicates non-Hispanic; prevalence estimates are from age, sex and education adjusted predicted marginals from logistic regression. Covariate reference groups in models were age (20–39 years), sex (female), and education (college graduate). Source: National Health and Nutrition Examination Survey