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. 2023 Sep;13(3):547-556.
doi: 10.1007/s44197-023-00136-x. Epub 2023 Jul 8.

Migrant status disparities in blood pressure: a multiple mediation analysis of modifiable factors

Teresa Dalla Zuanna  1 , Erich Batzella  1 , Francesca Russo  2 , Gisella Pitter  3 , Cristina Canova  4
Affiliations

Migrant status disparities in blood pressure: a multiple mediation analysis of modifiable factors

Teresa Dalla Zuanna et al. J Epidemiol Glob Health. 2023 Sep.

Abstract

Background: We examined differences in blood pressure (BP) levels between first-generation immigrants and natives in adult residents in Northeast Italy, and investigated the role of lifestyle behaviors, body mass index (BMI), and education as potentially modifiable mediating factors.

Methods: We included 20-69-year-old participants from the Health Surveillance Program of the Veneto Region (n = 37,710). Immigrants born in a high migratory pressure country (HMPC) were further grouped into geographical macro-areas. The outcomes were systolic BP (SBP) and hypertension. Multiple mediation analyses were performed to determine the contribution of each mediator of the SBP/migrant status association.

Results: Of the 37,380 subjects included, 8.7% were born in an HMPC. BMI, education, alcohol, sweets and meat consumption were included as potential mediators. A small advantage in SBP was seen for immigrants compared to natives (β = - 0.71,95%CI - 1.30; - 0.10). The direct effect (net of the covariates) of immigrant status on SBP was a reduction of 1.62 mmHg (95%CI - 2.25; - 0.98). BMI played the highest suppressive role (β = 1.14,95%CI 0.99; 1.35), followed by education. Alcohol consumption amplified the health advantage of immigrants. The suppressing effect of BMI was particularly evident among women and North Africans compared to natives. Similar results were seen for hypertension rates.

Conclusions: Although causation cannot be proven given the cross-sectional design, our findings identify BMI as the most effective target to preserve the health advantage of immigrants with respect to BP levels.

Keywords: Blood pressure; Body mass index; Hypertension; Immigrants; Mediation.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Path diagram of the association of migrant status and blood pressure
Fig. 2
Fig. 2
Multiple mediation analysis for HMPC vs Italy, stratified by gender. βs and corresponding 95% Confidence Intervals in all subjects (A), Males (B), and Females (C)
See this image and copyright information in PMC

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