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.

Keywords: Asian immigrant; Indian subcontinent; NHIS; Southeast Asian; cardiovascular disease; disparities; risk factors.

Figure 1. Age‐adjusted prevalence of cardiovascular disease risk factors.

All prevalence for Asian immigrant groups are statistically significantly (P<0.001) different than the non‐Hispanic White group except for the Southeast Asian group in hypertension prevalence. Indian Subcontinent: Afghanistan, Bangladesh, Bhutan, British Indian Ocean Territory, Pakistan, India, Nepal, Pakistan, Sri Lanka or Ceylon, Tibet. Southeast Asia: Borneo, Brunei, Burma or Myanmar, Cambodia, Christmas Island, Hong Kong, Indonesia, Laos, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam. Asia: Asia, Asia Minor, China, Japan, Mongolia, North Korea, South Korea.

Figure 2. Cardiovascular disease risk factors among the Asian immigrant subgroups as compared with the non‐Hispanic White group.

Direction of prevalence (higher or lower) as compared with the non‐Hispanic White group from the fully adjusted model with statistically significant findings. Fully adjusted model: adjusted for age, sex, education, employment, insurance status, usual place to go when sick, and poverty‐income ratio.