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Kwon S, Wang-Schweig M, Kandula NR. Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011-2018 NHANES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6187. [PMID: 32858944 PMCID: PMC7504455 DOI: 10.3390/ijerph17176187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Meme Wang-Schweig
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL 60607, USA;
| | - Namratha R. Kandula
- Department of Medicine and Preventive Medicine, Northwestern University, Chicago, IL 60611, USA;
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Aung TNN, Shirayama Y, Moolphate S, Lorga T, Yuasa M, Nyein Aung M. Acculturation and Its Effects on Health Risk Behaviors among Myanmar Migrant Workers: A Cross-Sectional Survey in Chiang Mai, Northern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5108. [PMID: 32679842 PMCID: PMC7399838 DOI: 10.3390/ijerph17145108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 01/31/2023]
Abstract
Thailand hosts many workers who have migrated from neighboring countries and is facing a large burden of non-communicable diseases (NCDs). Health screening for migrant workers routinely emphasizes infectious diseases but overlooks NCDs. We surveyed prevalent health behaviors for NCDs and their influencing factors, particularly cultural adaptation patterns among Myanmar migrant workers in Chiang Mai, Northern Thailand. A total of 414 migrant workers consented to participate in the study. Lack of exercise (75.8%), current alcohol consumption (40.8%), current smoking (26.9%), and central obesity (24.3%) were major lifestyle problems. Being female and uneducated was associated with a lack of exercise. Current alcohol consumption was significantly associated with being male and being of Myanmar ethnicity, with an integrative strategy for acculturation, and with a higher income. Male participants and participants with a lower mean score of marginalization were more likely to smoke. Central obesity was associated with being older than 40 years, being female, engaging in an assimilation strategy, and being uneducated. These findings highlight the need for gender inclusive health promotion, the screening of NCD risk behaviors, and timely health education for migrant workers. It may assist authorities to devise strategies to extend health promotion and universal health coverage to the migrant population.
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Affiliation(s)
- Thin Nyein Nyein Aung
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (T.N.N.A.); (M.Y.)
| | - Yoshihisa Shirayama
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan;
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai 50300, Thailand;
| | - Thaworn Lorga
- School of Nursing, Mae Fah Luang University, Chiang Rai 57000, Thailand;
| | - Motoyuki Yuasa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (T.N.N.A.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan;
| | - Myo Nyein Aung
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan;
- Advanced Research Institute for Health Sciences, Juntendo University, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
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Reinschmidt KM, Salvatore AL, Ji L, Finnell KJ, Giron Lopez AE, Bump ER, Philip TJ, Stoner JA. Diabetes among Hispanics in Oklahoma: Assessing Disparities to Guide Basic and Applied Research. THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 2020; 113:160-166. [PMID: 36204352 PMCID: PMC9534285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND – Diabetes, a leading cause of morbidity and mortality in the United States, disproportionally affects minority populations. In 2015, Hispanics, the largest minority in the country, had the third highest rate of diabetes prevalence and the third highest age-adjusted rate of diabetes-related mortality. Substantial progress in understanding diabetes disparities nationally and in many areas of the country has been made. However, little is known about diabetes and related mortality among Hispanics in Oklahoma, which is known as a Hispanic "new Settlement" state due to the relatively recent and substantial growth of this population. METHODS – We used Oklahoma Behavioral and Risk Factor Surveillance Survey data (2011-2016) to calculate population estimates of diabetes prevalence and selected sociodemographic characteristics for Hispanic and Non-Hispanic adults in the state. We used Oklahoma Death Registry data to estimate diabetes-related mortality rates for Hispanic and Non-Hispanic adults for the same five-year period. We examined differences in diabetes prevalence and diabetes-related mortality across selected sociodemographic characteristics. RESULTS – Hispanics are the largest minority group in Oklahoma. Spanish is the most common non-English language spoken in the state. Hispanics are younger, poorer, less educated and experience less access to health care compared to other populations in Oklahoma. While Hispanics had the fifth highest reported diabetes prevalence rate during the five-year period examined, they had the third highest diabetes-related mortality rate in the state. DISCUSSION AND CONCLUSIONS – There is a need for community engagement and basic and applied research to help identify and reduce diabetes disparities in the growing Hispanic population in Oklahoma.
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Affiliation(s)
- Kerstin M. Reinschmidt
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Alicia L. Salvatore
- Value Institute, ChristianaCare, Previous Affiliation: Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Li Ji
- Kapili Services, LLC – Contractor, Immunization Information Systems Support Branch (IISSB), Centers for Disease Control and Prevention, Previous Affiliation: Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Karla J. Finnell
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Angel E. Giron Lopez
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Eric R. Bump
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Timothy J. Philip
- OUHSC College of Medicine, Previous Affiliation: Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Julie A. Stoner
- Previous Affiliation: Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
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Gray JC, Schvey NA, Tanofsky-Kraff M. Demographic, psychological, behavioral, and cognitive correlates of BMI in youth: Findings from the Adolescent Brain Cognitive Development (ABCD) study. Psychol Med 2020; 50:1539-1547. [PMID: 31288867 DOI: 10.1017/s0033291719001545] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous research has implicated demographic, psychological, behavioral, and cognitive variables in the onset and maintenance of pediatric overweight/obesity. No adequately-powered study has simultaneously modeled these variables to assess their relative associations with body mass index (BMI; kg/m2) in a nationally representative sample of youth. METHODS Multiple machine learning regression approaches were employed to estimate the relative importance of 43 demographic, psychological, behavioral, and cognitive variables previously associated with BMI in youth to elucidate the associations of both fixed (e.g. demographics) and potentially modifiable (e.g. psychological/behavioral) variables with BMI in a diverse representative sample of youth. The primary analyses consisted of 9-10 year olds divided into a training (n = 2724) and test (n = 1123) sets. Secondary analyses were conducted by sex, ethnicity, and race. RESULTS The full sample model captured 12% of the variance in both the training and test sets, suggesting good generalizability. Stimulant medications and demographic factors were most strongly associated with BMI. Lower attention problems and matrix reasoning (i.e. nonverbal abstract problem solving and inductive reasoning) and higher social problems and screen time were robust positive correlates in the primary analyses and in analyses separated by sex. CONCLUSIONS Beyond demographics and stimulant use, this study highlights abstract reasoning as an important cognitive variable and reaffirms social problems and screen time as significant correlates of BMI and as modifiable therapeutic targets. Prospective data are needed to understand the predictive power of these variables for BMI gain.
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Affiliation(s)
- Joshua C Gray
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD20814, USA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD20814, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD20814, USA
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Klugman M, Hosgood HD, Hua S, Xue X, Vu THT, Perreira KM, Castañeda SF, Cai J, Pike JR, Daviglus M, Kaplan RC, Isasi CR. A longitudinal analysis of nondaily smokers: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Ann Epidemiol 2020; 49:61-67. [PMID: 32951805 DOI: 10.1016/j.annepidem.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers. METHODS The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design. RESULTS After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs. <ninth grade: RRR (95% CI) = 0.30 (0.09-0.95)]. Living with smokers was associated with decreased likelihood of quitting [RRR (95% CI) = 0.45 (0.24-0.86)]. Having insurance was associated with quitting [RRR (95% CI) = 2.11 (1.18-3.76)] and becoming a daily smoker [RRR (95% CI) = 3.00 (1.39-6.48)]. CONCLUSIONS Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases.
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Affiliation(s)
- Madelyn Klugman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Thanh-Huyen T Vu
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
| | | | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - James R Pike
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Martha Daviglus
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
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Kim V, Wang W, Mannino D, Diaz A. Association of birthplace and occupational exposures with chronic bronchitis in US Hispanics/Latinos, 2008-2011. Occup Environ Med 2020; 77:344-350. [PMID: 32165546 DOI: 10.1136/oemed-2019-106081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/27/2020] [Accepted: 02/21/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In the US, chronic bronchitis (CB) is common and is associated with substantial morbidity and mortality. Data on CB in the Hispanic/Latino population-a large, diverse US minority-are scarce. We aimed to test whether the prevalence of CB varies across Hispanic/Latino heritages and to identify CB risk factors, including occupational exposures, in this population. METHODS We analysed data from the Hispanic Community Health Study/Study of Latinos, a US population-based probability sample of participants aged 18-74 years (n=16 415) including those with Mexican, Puerto Rican, Dominican, Cuban, Central American and South American heritages. Participants who had a completed respiratory questionnaire and valid spirometric data were included in the analysis (n=13 259). CB, place of birth, heritage, occupational exposures and other risk factors were based on standardised questionnaires. The prevalence of CB was estimated using survey logistic regression-conditional marginal analysis. RESULTS The estimated (mean (95% CI)) overall adjusted prevalence of CB was 12.1% (9.3 to 15.6), with a large variation across heritages. Dominican heritage had a fivefold higher prevalence than South American heritage. US-born participants had a higher adjusted prevalence than their non-US-born counterparts (16.8% (12.5 to 22.1) vs 11.0% (8.5 to 14.10); p=0.022). Compared with non-exposed participants, those exposed to cleaning or disinfecting solutions had a higher adjusted prevalence of CB (12.6% (9.1 to 17.1) vs 11.8% (9.2 to 15.1); p=0.024). CONCLUSIONS The prevalence of CB was higher among Dominicans than other Hispanic/Latino heritages. CB was more prevalent among US-born participants and those exposed to cleaning and disinfecting solutions.
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Affiliation(s)
- Victor Kim
- Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, US
| | - Wei Wang
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - David Mannino
- US Medical Affairs, GlaxoSmithKline, Lexington, Kentucky, US.,Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, US
| | - Alejandro Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, US
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Al-Sofiani ME, Langan S, Kanaya AM, Kandula NR, Needham BL, Kim C, Vaidya D, Golden SH, Gudzune KA, Lee CJ. The relationship of acculturation to cardiovascular disease risk factors among U.S. South Asians: Findings from the MASALA study. Diabetes Res Clin Pract 2020; 161:108052. [PMID: 32113027 PMCID: PMC7445080 DOI: 10.1016/j.diabres.2020.108052] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/22/2022]
Abstract
AIM We investigated the association between acculturation strategies and cardiometabolic risk among South Asian (SA) immigrants in the US. METHODS In this cross-sectional analysis of data from 849 SA participants in the Mediators of Atherosclerosis in SAs Living in America (MASALA), we performed multidimensional measures of acculturation to categorize the participants into three acculturation classes: separation (preference for SA culture), assimilation (preference for US culture), and integration (similar preference for both cultures). Differences in glycemic indices, blood pressure, lipid parameters and body composition by acculturation strategy were examined. RESULTS Women in the integration class had the lowest prevalence of diabetes (16.4%), prediabetes (29.7%), fasting and 2-h glucose compared to women in the separation class with the highest prevalence of diabetes (29.3%), prediabetes (31.5%), fasting and 2-h glucose and 2-hr insulin (all p < 0.05). Women in the assimilation class had significantly lower triglycerides, BMI, and waist circumference and higher HDL compared to women in the separation class after adjusting for age, study site, and years in the US. After additionally accounting for socioeconomic/lifestyle factors, women in the assimilation class had significantly lower triglyceride and higher HDL levels compared to women in the separation class (p < 0.01). There was no significant association between acculturation strategies and cardiometabolic risk in SA men. CONCLUSION SA women who employed an assimilation or integration strategy had a more favorable cardiometabolic profile compared to women using a separation strategy. Future research should investigate the behavioral and psychosocial pathways linking acculturation strategies with cardiometabolic health to inform preventive interventions among SAs living in America.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Susan Langan
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sherita H Golden
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Clare J Lee
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States.
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Fazli GS, Moineddin R, Bierman AS, Booth GL. Ethnic variation in the conversion of prediabetes to diabetes among immigrant populations relative to Canadian-born residents: a population-based cohort study. BMJ Open Diabetes Res Care 2020; 8:e000907. [PMID: 32071198 PMCID: PMC7039599 DOI: 10.1136/bmjdrc-2019-000907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/21/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare absolute and relative rates of conversion from prediabetes to diabetes among non-European immigrants to Europeans and Canadian-born residents, overall, and by age and level of glycemia. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort population-based study using administrative health databases from Ontario, Canada, to identify immigrants (n=23 465) and Canadian born (n=1 11 085) aged ≥20 years with prediabetes based on laboratory tests conducted between 2002 and 2011. Individuals were followed until 31 December 2013 for the development of diabetes using a validated algorithm. Immigration data was used to assign ethnicity based on country of origin, mother tongue, and surname. Fine and Gray's survival models were used to compare diabetes incidence across ethnic groups overall and by age and glucose category. RESULTS Over a median follow-up of 5.2 years, 8186 immigrants and 39 722 Canadian-born residents developed diabetes (7.1 vs 6.1 per 100 person-years, respectively). High-risk immigrant populations such as South Asians (HR: 1.72, 95% CI 1.55 to 1.99) and Southeast Asians (HR: 1.65, 95% CI 1.46 to 1.86) had highest risk of converting to diabetes compared with Western Europeans (referent). Among immigrants aged 20-34 years, the adjusted cumulative incidence ranged from 18.4% among Eastern Europeans to 52.3% among Southeast Asians. Conversion rates increased with age in all groups but were consistently high among South Asians, Southeast Asians and Sub-Saharan African/Caribbeans after the age of 35 years. On average, South Asians converted to diabetes 3.1-4.6 years earlier than Western Europeans and at an equivalent rate of conversion to Western Europeans who had a 0.5 mmol/L higher baseline fasting glucose value. CONCLUSIONS High-risk ethnic groups converted to diabetes more rapidly, at younger ages, and at lower fasting glucose values than European populations, leading to a shorter window for diabetes prevention.
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Affiliation(s)
- Ghazal S Fazli
- MAP- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arlene S Bierman
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gillian L Booth
- MAP- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ngueta G. Impact of lifetime marijuana use on fasting plasma insulin levels and HOMA-IR score in obese adults with and without insulin resistance. Acta Diabetol 2020; 57:133-140. [PMID: 31367991 DOI: 10.1007/s00592-019-01390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
AIMS To explore the association of marijuana use with mean plasma fasting insulin levels and homeostasis model assessment of insulin resistance (HOMA-IR) score in obese adults with different HOMA-IR. METHODS The National Health and Nutrition Examination Survey (NHANES) is a survey research program designed to assess the health and nutrition status of individuals in the United States and to track changes over time. We abstracted data from NHANES 2009-2016. We estimated the minimal lifetime marijuana use (MLU) using the duration of regular exposure and the frequency of use. We assessed the association of MLU and both plasma fasting insulin and HOMA-IR score using log-linear regression models. RESULTS A total of 65,209 obese individuals aged 18 to 59 years were included. In obese individuals who never used marijuana (reference), the mean value (± standard deviation) was 19.0 (± 12.8) μU/mL for plasma fasting insulin and 4.78 (± 3.49) for HOMA-IR. In individuals with HOMA-IR < 2.13 or ≥ 5.72, we found no association of marijuana use with HOMA-IR. In those with HOMA-IR < 5.72, the highest tertile of MLU (i.e., ≥ 1799 times) was associated with 12% decrease (95% confidence intervals, 4-19%) in the fasting insulin and 10% decrease in HOMA-IR (95% CI 1-19%), as compared with their counterparts who never used marijuana. In those with HOMA-IR ≥ 2.13, we found a marked impact of marijuana use only in adults who used marijuana ≥ 1799 times, with 13% decrease (95% CI 5-19%) in fasting insulin and 10% decrease (95% CI 3-18%) in HOMA-IR score. CONCLUSIONS Marijuana use is associated with reduced fasting insulin levels and HOMA-IR score in US obese adults with HOMA-IR ≥ 2.13, but not in those with HOMA-IR < 2.13 or ≥ 5.72. The impact of marijuana use is the greatest after long-term exposure and is independent of BMI.
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Affiliation(s)
- Gerard Ngueta
- National Public Health Institute of Quebec, 945 Avenue Wolfe, Quebec, QC, G1V 5B3, Canada.
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, QC, Canada.
- Faculté de Pharmacie, Université Laval, Quebec, QC, Canada.
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Latino adolescent-father discrepancies in reporting activity parenting practices and associations with adolescents' physical activity and screen time. BMC Public Health 2020; 20:92. [PMID: 31964356 PMCID: PMC6975019 DOI: 10.1186/s12889-020-8199-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background Latino fathers may play important roles in adolescents’ physical activity and screen time. However, informant discrepancies regarding paternal activity parenting practices may challenge studies supporting evidence-based applications. This study examined Latino adolescent-father discrepancies in reporting paternal activity parenting practices, types of discrepancies by participant characteristics, and associations between discrepancy types and adolescents’ physical activity and screen time. Methods The sample for this cross-sectional study included Latino early adolescents and their fathers (n = 138 dyads) from baseline data collected for a family-centered, healthy lifestyle intervention in a metropolitan area. In parallel measures, Latino adolescents and fathers reported paternal activity parenting practices related to expectation or allowance, behavioral modeling, and providing opportunities for physical activity or screen time. Level of agreement and discrepancies were examined using the percentage of agreement, weighted kappa statistics, Pearson correlation coefficients, and paired-sample t-tests. Undesirable discrepancy types included adolescents reporting lower scores for paternal physical activity parenting practices or higher scores for paternal screen time parenting practices than fathers. Participants’ sociodemographic characteristics and weight status were compared by discrepancy type using between-group t-tests or Chi-square tests. Associations between discrepancy type and adolescents’ physical activity and screen time were examined using multivariate regression analyses. Results The study sample was low-income with a high prevalence of overweight and obesity. Adolescent and paternal reports of activity parenting practices had poor agreement (percentages of agreement: 22.2–34.3%, weighted kappa statistics: < 0.2, and correlation coefficients: 0.06–0.25). An undesirable discrepancy type for certain parenting practices was more likely to be observed among fathers without full-time employment, girls, older adolescents, and adolescents and fathers within overweight or obese BMI categories. Discrepancies in paternal expectation regarding physical activity and allowance of screen time had adverse associations with adolescents’ physical activity (β = − 0.18, p = 0.008) and screen time (β = 0.51, p < 0.001). Conclusion and implications Discrepancies in reporting activity parenting practices were evident between Latino adolescents and their fathers, especially among certain sociodemographic and weight status groups. Adolescents’ perceptions on paternal parenting practices tended to be better indicators of their activity levels than fathers’ reports.
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Ngueta G, Ndjaboue R. Lifetime marijuana use in relation to insulin resistance in lean, overweight, and obese US adults. J Diabetes 2020; 12:38-47. [PMID: 31152633 DOI: 10.1111/1753-0407.12958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Obese individuals are more likely to show insulin resistance (IR). However, limited population studies on marijuana use with markers of IR have yielded mixed results. The aim of this study was to examine the association of marijuana use with IR in US adults with different body mass index (BMI) status. METHODS Data from the 2009 to 2016 National Health and Nutrition Examination Survey (NHANES) were abstracted. Minimal lifetime marijuana use was estimated using the duration of regular exposure and frequency of use. The association of marijuana use with both fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR) was determined in lean, overweight, and obese individuals separately using generalized linear models. Interview weight years of data were used to account for the unequal probability of sampling and non-response. RESULTS Of all 129 509 adults aged 18 to 59 years, 50.3% were women. In current obese marijuana consumers, mean FINS in those with less than four uses per month was 52% (95% confidence interval [CI] 19%-71%) lower than in never users. In former obese consumers with eight or more uses per month and who stopped marijuana use <12 months ago, mean FINS was 47% (95% CI 18%-66%) lower than in never users. Mean FINS in those who quit marijuana 12 to 119 and 120 months and more prior the survey was 36% (95% CI 7%-57%) and 36% (95% CI 10%-54%) lower, respectively. CONCLUSIONS Marijuana use is associated with lower FINS and HOMA-IR in obese but not non-obese adults, even at low frequency of less than four uses per month. Former marijuana consumers with high lifetime use had significantly lower FINS levels that persisted, independent of the duration of time since last use.
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Affiliation(s)
- Gerard Ngueta
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada
- National Public Health Institute of Quebec, Quebec, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
- Population Health and Optimal Health Practices Research Unit, Laval University, Quebec, Quebec, Canada
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Chen L, Shi L, Zhang D, Chao SM. Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women. Prev Chronic Dis 2019; 16:E158. [PMID: 31808419 PMCID: PMC6896832 DOI: 10.5888/pcd16.190212] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Asian women have a higher prevalence of gestational diabetes mellitus than women of other races/ethnicities. We aimed to compare the prevalence of gestational diabetes among Asian American women to other racial/ethnic groups and explore whether the higher occurrence of the disorder among Asian women can be explained by acculturation. Methods We conducted a population-based, cross-sectional study among 5,562 women who participated in the 2007 Los Angeles Mommy and Baby Study (LAMB) in Los Angeles County, California. All women included in this study had a live delivery in 2007 and did not have pre-pregnancy type I or II diabetes. We applied multivariate, weighted logistic regressions to compare gestational diabetes prevalence among racial/ethnic groups, adjusting for its known risk factors. We conducted mediation analysis to test whether the difference in prevalence across racial/ethnic groups could be explained by acculturation. Results Among the 5,562 women studied, the weighted prevalence of gestational diabetes was 15.5% among Asian American women, followed by 9.0% among non-Hispanic black women, 10.7% among Hispanic women, and 7.9% among non-Hispanic white women. Compared with non-Hispanic white women, Asian women had 2.44 (95% confidence interval [CI], 1.81–3.29; P < .001) times the odds of having gestational diabetes, independent of maternal age, education, marital status, income, prenatal care adequacy, prepregnancy BMI, and physical activity. Acculturation was negatively associated with having gestational diabetes (odds ratio [OR] = 0.93; 95% CI, 0.86–0.99) and explained 15.9% (95% CI, 11.38%–25.08%; P < .001) of the association between Asian race and the condition. Conclusion We found that Asian race was an independent risk factor for gestational diabetes, and higher acculturation may play a protective role against it in Asian American women.
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Affiliation(s)
- Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634-0745.
| | - Donglan Zhang
- Department of Health Policy and Management, University of Georgia, Athens, Georgia
| | - Shin Margaret Chao
- Department of Public Health Los Angeles County, Maternal, Child, and Adolescent Health Programs, Los Angeles, California
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Burner E, Terp S, Lam CN, Neill E, Menchine M, Arora S. Access to care, nativity and disease management among Latinos with diabetes in a safety-net healthcare setting. AIMS Public Health 2019; 6:488-501. [PMID: 31909069 PMCID: PMC6940585 DOI: 10.3934/publichealth.2019.4.488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Latinos in the U.S. are disproportionately affected by diabetes and its complications. The role of access to care and nativity in diabetes management are important areas of research, as these findings can help direct tailored interventions. Methods We examined associations between access to care, acculturation and glycemic control among Latino patients with diabetes seen in a safety net emergency department. We used regression models to estimate the individual predictors' associations with glycemic control and then estimated adjusted associations by controlling for all relevant predictors. We tested for a moderating role of nativity in the associations between access to care and glycemic control. Results In unadjusted analysis, we found the most significant predictors of glycemic control to be access to primary care (β = −0.89, p = 0.011), capacity for self-monitoring glucose (β = −0.68, p = 0.022), mental health comorbidities (β = 0.95, p = 0.013), male gender (β = −0.49, p = 0.091) and nativity (β = −0.81, p = 0.034). In adjusted analysis, nativity was no longer a significant predictor of glycemic control (β = −0.32, p = 0.541). Nativity did not significantly moderate the association of access to care and glycemic control. Conclusions Our findings show a direct association between access to care and glycemic control among low-income Latinos seeking care in the emergency department. This supports concerns that many researchers, clinicians and policy analysts have expressed regarding access to care for immigrants. The importance of primary care and access to supplies to perform self-management in achieving glycemic control and reducing risk of complications indicate that ensuring access to quality care is critical to the health of this vulnerable group.
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Affiliation(s)
- Elizabeth Burner
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Sophie Terp
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Chun Nok Lam
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Emily Neill
- University of California San Francisco, San Francisco, USA
| | - Michael Menchine
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
| | - Sanjay Arora
- University of Southern California, Keck School of Medicine, LAC+USC Medical Center, Los Angeles, USA
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An Analysis of Acculturation Status and Healthcare Coverage for the Needs of Mental Health Service Utilization among Latinos in Mississippi, Louisiana, and Alabama. PSYCH 2019. [DOI: 10.3390/psych1010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The use of mental health services by Latinos is only 7.3%, despite the high prevalence of depression rates of between 27.0% and 38.0% in the United States. Research is limited concerning Latinos’ acculturation status and healthcare coverage on mental healthcare service utilization in Mississippi, Louisiana, and Alabama. Therefore, the objective of this study is to examine the association of acculturation status and healthcare coverage with mental health service utilization in the Latino population. Methods: During 2011–2012, a Latino Community Health Needs Assessment was administered by a trained bilingual interviewer using participants’ preferred language. Four hundred and eleven community members and leaders participated in the study. Acculturation status and self-reported mental health service utilization were retrieved from the survey instrument. Multivariate logistic regression analyses were performed. Results: In multivariate logistic regression that included gender, education level, healthcare coverage, depression, and acculturation status, individuals with a high acculturation score (3–5) were 1.53 times more likely to utilize mental health services compared to those with a low acculturation score (0–2). Individuals with healthcare coverage were 2.75 times more likely to utilize mental health services compared to those with not having healthcare coverage. Healthcare coverage is only a significant determinant of mental health service utilization. Conclusions: This result underscores the importance of having healthcare coverage for the need of mental health service utilization. Future research should consider the impact of acculturation and healthcare coverage on mental health service utilization.
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Elfassy T, Aiello AE, Schneiderman N, Haan MN, Tarraf W, González HM, Gellman M, Florez HJ, Luchsinger JA, Wright CB, Grober E, Zeki Al Hazzouri A. Relation of Diabetes to Cognitive Function in Hispanics/Latinos of Diverse Backgrounds in the United States. J Aging Health 2019; 31:1155-1171. [PMID: 29577792 PMCID: PMC7020246 DOI: 10.1177/0898264318759379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives:To examine the association between diabetes and cognitive function within U.S. Hispanics/Latinos of Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American background. Method: This cross-sectional study included 9,609 men and women (mean age = 56.5 years), who are members of the Hispanic Community Health Study/Study of Latinos. We classified participants as having diabetes, prediabetes, or normal glucose regulation. Participants underwent a neurocognitive battery consisting of tests of verbal fluency, delayed recall, and processing speed. Analyses were stratified by Hispanic/Latino subgroup. Results: From fully adjusted linear regression models, compared with having normal glucose regulation, having diabetes was associated with worse processing speed among Cubans (β = -1.99; 95% CI [confidence interval] = [-3.80, -0.19]) and Mexicans (β = -2.26; 95% CI = [-4.02, -0.51]). Compared with having normal glucose regulation, having prediabetes or diabetes was associated with worse delayed recall only among Mexicans (prediabetes: β = -0.34; 95% CI = [-0.63, -0.05] and diabetes: β = -0.41; 95% CI = [-0.79, -0.04]). No associations with verbal fluency. Discussion: The relationship between diabetes and cognitive function varied across Hispanic/Latino subgroup.
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Affiliation(s)
- Tali Elfassy
- Department of Public Health Sciences, Division of Epidemiology, University of Miami
| | - Allison E. Aiello
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Mary N. Haan
- Department of Epidemiology & Biostatistics, University of California San Francisco
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare Sciences, Wayne State University
| | | | | | - Hermes J. Florez
- Department of Public Health Sciences, Division of Epidemiology, University of Miami
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Medical Center, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Clinton B. Wright
- Director of Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (CW)
| | - Ellen Grober
- Department of Neurology, Albert Einstein College of Medicine, NY (E.G.)
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
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Deng F, Chan CB. Defining modifiable barriers to uptake of dietary recommendations in Chinese immigrants with type 2 diabetes: a qualitative study. Facets (Ott) 2019. [DOI: 10.1139/facets-2019-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective is to support development of a nutritional intervention for Chinese immigrants with diabetes by defining current deficiencies and identifying modifiable factors and mechanisms of change. Semi-structured interviews conducted with 13 ethnic Chinese with type 2 diabetes identified modifiable problems related to culturally relevant diabetes resources and low cultural acceptability of recommended diets. These factors could be addressed through creation of resources developed in partnership with Chinese-speaking health care professionals and persons with diabetes.
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Affiliation(s)
- Feiyue Deng
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Catherine B. Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada
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Boateng D, Galbete C, Nicolaou M, Meeks K, Beune E, Smeeth L, Osei-Kwasi HA, Bahendeka S, Agyei-Baffour P, Mockenhaupt FP, Spranger J, Grobbee DE, Schulze MB, Stronks K, Agyemang C, Danquah I, Klipstein-Grobusch K. Dietary Patterns Are Associated with Predicted 10-Year Risk of Cardiovascular Disease Among Ghanaian Populations: the Research on Obesity and Diabetes in African Migrants (RODAM) Study. J Nutr 2019; 149:755-769. [PMID: 31050745 PMCID: PMC6533550 DOI: 10.1093/jn/nxz002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/13/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan African populations are disproportionately affected by cardiovascular disease (CVD). Although diet is an important lifestyle factor associated with CVD, evidence on the relation between dietary patterns (DPs) and CVD risk among sub-Saharan African populations is limited. OBJECTIVE We assessed the associations of DPs with estimated 10-y atherosclerotic cardiovascular disease (ASCVD) risk in Ghanaian adults in Ghana and Europe. METHODS Three DPs ('mixed'; 'rice, pasta, meat, and fish'; and 'roots, tubers, and plantain') were derived by principal component analysis (PCA) based on intake frequencies obtained by a self-administered Food Propensity Questionnaire in the multi-center, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. The 10-y ASCVD risk was estimated using the Pooled Cohort Equations (PCE) for 2976 subjects, aged 40-70 y; a risk score ≥7.5% was defined as 'elevated' ASCVD risk. The associations of DPs with 10-y ASCVD risk were determined using Poisson regression with robust variance. RESULTS Stronger adherence to a 'mixed' DP was associated with a lower predicted 10-y ASCVD in urban and rural Ghana and a higher 10-y ASCVD in Europe. The observed associations were attenuated after adjustment for possible confounders with the exception of urban Ghana (prevalence ratio [PR] for Quintile 5 compared with 1: 0.70; 95% CI: 0.53, 0.93, P-trend = 0.013). The 'rice, pasta, meat, and fish' DP was inversely associated with 10-y ASCVD across all study sites, with the adjusted effect being significant only in urban Ghana. A 'roots, tubers, and plantain' DP was directly associated with increased 10-y ASCVD risk. CONCLUSIONS Adherence to 'mixed' and 'rice, pasta, meat, and fish' DPs appears to reduce predicted 10-y ASCVD risk in adults in urban Ghana. Further investigations are needed to understand the underlying contextual-level mechanisms that influence dietary habits and to support context-specific dietary recommendations for CVD prevention among sub-Saharan African populations.
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Affiliation(s)
- Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,Address correspondence to DB (e-mail: )
| | - Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Mary Nicolaou
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karlijn Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research–ScHARR, University of Sheffield, Sheffield, United Kingdom,Department of Clinical Sciences and Nutrition, University of Chester, Chester, United Kingdom
| | | | - Peter Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
| | - Joachim Spranger
- Charité Center for Cardiovascular Research (CCR), Berlin, Germany
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study. J Immigr Minor Health 2019; 20:1137-1146. [PMID: 28852948 DOI: 10.1007/s10903-017-0644-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD risk.
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70
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Divney AA, Echeverria SE, Thorpe LE, Trinh-Shevrin C, Islam NS. Hypertension Prevalence Jointly Influenced by Acculturation and Gender in US Immigrant Groups. Am J Hypertens 2019; 32:104-111. [PMID: 30165394 DOI: 10.1093/ajh/hpy130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/20/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Latinos and Asians in the United States are disproportionately burdened by hypertension, a leading risk factor for cardiovascular disease. Few studies have used multicomponent measures of acculturation to compare cardiovascular risk factors across immigrant-origin groups. Additionally, little is known about how acculturation and gender shape hypertension risk among immigrants. METHODS We created an acculturation score composed of language use, nativity, and years in the United States and fit separate race/ethnicity log-binomial models examining associations with hypertension prevalence (≥130/80 mm Hg) among Latino (n = 4,267) and Asian (n = 2,142) National Health and Nutrition Examination Survey 2011-2016 participants aged 18+. Joint effect models tested the concept of "intersectionality" between acculturation and gender. RESULTS Adjusting for age, gender, and socioeconomic position, Latinos and Asians with high acculturation were 25% and 27% more likely to have hypertension, respectively, compared with low acculturation groups. Latino and Asian American men with high levels of acculturation were 74-79% more likely to have hypertension compared with women with low acculturation (adjusted prevalence ratios (aPR) for Latinos = 1.74, 95% confidence interval (CI): 1.49-2.03; aPR for Asians = 1.79, 95% CI: 1.42-2.25). The gradient of increasing hypertension with increasing acculturation was most apparent among Latino men (adjusted risk differences (aRD) = 12.0%, P < 0.001) and Asian women (aRD = 14.0%, P = 0.003) and nonsignificant among Latino women and Asian men when comparing high vs. low acculturation categories. CONCLUSIONS Our results correspond with prior literature demonstrating increased morbidity among immigrants with increasing acculturation but also suggest differing patterns by race/ethnicity and gender. Future research should explore how migration processes differentially influence hypertension among men and women.
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Affiliation(s)
- A A Divney
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - S E Echeverria
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - L E Thorpe
- NYU-CUNY Prevention Research Center, New York, USA
- NYU School of Medicine, Department of Population Health, New York, New York, USA
| | - C Trinh-Shevrin
- NYU-CUNY Prevention Research Center, New York, USA
- NYU School of Medicine, Department of Population Health, New York, New York, USA
| | - N S Islam
- NYU-CUNY Prevention Research Center, New York, USA
- NYU School of Medicine, Department of Population Health, New York, New York, USA
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Length of Residence and Cardiovascular Health among Afro-Caribbean Immigrants in New York City. J Racial Ethn Health Disparities 2018; 6:487-496. [PMID: 30547300 DOI: 10.1007/s40615-018-00547-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/31/2018] [Accepted: 11/22/2018] [Indexed: 01/16/2023]
Abstract
Cardiovascular disease (CVD) disproportionately affects non-Hispanic blacks (NHB) in the United States (U.S.). Afro-Caribbean (AC) immigrants comprise over 50% of the immigrant black population and are critical in understanding the health trajectories of blacks in the U.S. We assessed the relationship between length of residence (proxy measure for acculturation) and cardiovascular health (CVH) based on the American Heart Association's (AHA) seven ideal cardiovascular health components among AC immigrants in New York City (NYC). CVH scores were categorized into poor/intermediate CVH (0-3 components) or ideal CVH (≥ 4 components). Multivariable logistic regression was used to examine the association between length of residence in the U.S. and poor/intermediate CVH. In adjusted models, the odds of poor/intermediate CVH were significantly higher for Guyanese (OR = 3.51; 95% CI 1.03-11.95) and Haitian immigrants (OR = 8.02; 95% CI 1.88-34.12) residing in the U.S. for ≥ 10 years than for those living in the U.S. for < 10 years. Length of residence was not significantly associated with CVH among Jamaican immigrants. We found evidence of ethnic differences in the association between acculturation and CVH among AC immigrants in a major metropolitan city. Culturally tailored interventions are needed to improve the CVH of AC immigrants as they become integrated into the U.S., with special consideration of country of birth.
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Ibrahim M, Tuomilehto J, Aschner P, Beseler L, Cahn A, Eckel RH, Fischl AH, Guthrie G, Hill JO, Kumwenda M, Leslie RD, Olson DE, Pozzilli P, Weber SL, Umpierrez GE. Global status of diabetes prevention and prospects for action: A consensus statement. Diabetes Metab Res Rev 2018; 34:e3021. [PMID: 29757486 DOI: 10.1002/dmrr.3021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/15/2022]
Abstract
Primary prevention of type 2 diabetes (T2D) should be achievable through the implementation of early and sustainable measures. Several randomized control studies that found success in preventing the progression to T2D in high-risk populations have identified early and intensive intervention based on an individualized prevention model as the key factor for participant benefit. The global prevalence of both overweight and obesity has now been widely recognized as the major epidemic of the 21st century. Obesity is a major risk factor for the progression from normal glucose tolerance to prediabetes and then to T2D. However, not all obese individuals will develop prediabetes or progress to diabetes. Intensive, multicomponent behavioural interventions for overweight and obese adults can lead to weight loss. Diabetes medications, including metformin, GLP-1 agonists, glitazones, and acarbose, can be considered for selected high-risk patients with prediabetes when lifestyle-based programmes are proven unsuccessful. Nutrition education is the cornerstone of a healthy lifestyle. Also, physical activity is an integral part of the prediabetes management plan and one of the main pillars in the prevention of diabetes. Mobile phones, used extensively worldwide, can facilitate communication between health professionals and the general population, and have been shown to be helpful in the prevention of T2D. Universal screening is needed. Noninvasive risk scores should be used in all countries, but they should be locally validated in all ethnic populations focusing on cultural differences around the world. Lifestyle interventions reduce the progression to prediabetes and diabetes. Nevertheless, many questions still need to be answered.
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Affiliation(s)
| | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Kuwait, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland, and Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Bogota, Colombia
| | - Lucille Beseler
- Family Nutrition Center of South Florida, Coconut Creek, FL, USA
| | - Avivit Cahn
- Hadassah Hebrew University Hospital, The Diabetes Unit & Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Robert H Eckel
- University of Colorado Denver Anschutz Medical Campus, University of Colorado Hospital, Denver, CO, USA
| | - Amy Hess Fischl
- University of Chicago Kovler Diabetes Center, Chicago, IL, USA
| | - George Guthrie
- Florida Hospital Graduate Medical Education, Orlando, FL, USA
| | - James O Hill
- Colorado Nutrition Obesity Research Center (NORC), University of Colorado School of Medicine, Aurora, CO, USA
| | | | - R David Leslie
- Blizard Institute, Queen Mary, University of London, London, UK
| | - Darin E Olson
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Sandra L Weber
- Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
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73
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Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
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Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
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74
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Immigrants as Research Partners: A Review of Immigrants in Community-Based Participatory Research (CBPR). J Immigr Minor Health 2018; 19:1457-1468. [PMID: 27491305 DOI: 10.1007/s10903-016-0474-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Community-based participatory research (CBPR) is uniquely suited to engage immigrants in all aspects of research, from research question development to data collection to interpretation and dissemination of results. An increasing number of research studies have utilized the methodology for exploring complex health issues for immigrants. In the current manuscript, we present a review of peer-reviewed articles in health-related research where CBPR was conducted in partnership with immigrants. We examined the role of immigrants in the CBPR process and how immigrant involvement improved/enhanced the research rigor. A total of 161 articles met the inclusion criteria. The results of this literature review enhance our understanding of how CBPR can be used in direct collaboration with immigrants and highlights the many potential benefits for both researchers and immigrant communities.
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75
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Kim EJ, Kim T, Conigliaro J, Liebschutz JM, Paasche-Orlow MK, Hanchate AD. Racial and Ethnic Disparities in Diagnosis of Chronic Medical Conditions in the USA. J Gen Intern Med 2018; 33:1116-1123. [PMID: 29736755 PMCID: PMC6025658 DOI: 10.1007/s11606-018-4471-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/13/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND There exist racial and ethnic disparities in the prevalence of chronic medical illnesses. However, it is unclear if the disparities arise from patients' self-reported estimates on these diseases and whether there is an association between healthcare utilization and diagnosis. OBJECTIVE To estimate national racial/ethnic prevalence of undiagnosed hypertension, diabetes, high cholesterol, and kidney disease and identify characteristics associated with undiagnosed diseases. DESIGN Retrospective analysis of multi-year survey data. PARTICIPANTS Adults 18 years and older who participated in the National Health and Nutrition Examination Survey during 2011-2014 (n = 10,403). MAIN OUTCOMES Undiagnosed hypertension (SBP ≥ 140 or DBP ≥ 90 on physical examination with no history of hypertension), undiagnosed diabetes (hgba1c ≥ 6.5% with no history of diabetes), undiagnosed high cholesterol (LDL ≥ 160 mg/dL with no history of high cholesterol), and undiagnosed kidney disease (eGFR ≤ 30 with no history of kidney disease). RESULTS The study sample was categorized into Whites, Blacks, Hispanics, Asians, and Other. After adjusting for sociodemographic characteristics, Asians had increased odds of undiagnosed hypertension (OR = 1.41 [1.06-1.86]) and diabetes (OR = 6.16 [3.76-10.08]) compared to Whites. Blacks (OR = 2.53 [1.71-3.73]) and Hispanics (OR = 1.88 [1.19-2.99]) had increased odds of undiagnosed diabetes compared to Whites. Multivariate logistic regression analysis indicated that not having any health insurance was associated with increased odds of undiagnosed diabetes and hyperlipidemia (OR = 1.56 [1.00-2.44] and OR = 2.08 [1.44-3.00], respectively). A recent healthcare visit was associated with a lower likelihood of having undiagnosed hypertension (OR = 0.58 [0.41-0.83]) and diabetes (OR = 0.35 [0.18-0.69]). CONCLUSIONS In a nationally representative cohort, Asians had higher rates of undiagnosed hypertension and diabetes, and all minorities were more likely to have undiagnosed diabetes compared to Whites. Healthcare utilization was associated with undiagnosed medical conditions. Our study showed that reliance on self-reported data may systemically underestimate the prevalence of chronic illnesses among minorities and further research is needed to understand the significance of healthcare utilization in health outcomes.
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Affiliation(s)
- Eun Ji Kim
- Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA.
| | - Taekyu Kim
- Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Conigliaro
- Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Amresh D Hanchate
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
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76
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Kim EJ, Kressin NR, Paasche-Orlow MK, Lopez L, Rosen JE, Lin M, Hanchate AD. Racial/ethnic disparities among Asian Americans in inpatient acute myocardial infarction mortality in the United States. BMC Health Serv Res 2018; 18:370. [PMID: 29769083 PMCID: PMC5956856 DOI: 10.1186/s12913-018-3180-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background Acute myocardial infarction (AMI) is a common high-risk disease with inpatient mortality of 5% nationally. But little is known about this outcome among Asian Americans (Asians), a fast growing racial/ethnic minority in the country. The objectives of the study are to obtain near-national estimates of differences in AMI inpatient mortality between minorities (including Asians) and non-Hispanic Whites and identify comorbidities and sociodemographic characteristics associated with these differences. Method This is a retrospective analysis of 2010–2011 state inpatient discharge data from 10 states with the largest share of Asian population. We identified hospitalization with a primary diagnosis of AMI using the ICD-9 code and used self-reported race/ethnicity to identify White, Black, Hispanic, and Asian. We performed descriptive analysis of sociodemographic characteristics, medical comorbidities, type of AMI, and receipt of cardiac procedures. Next, we examined overall inpatient AMI mortality rate based on patients’ race/ethnicity. We also examined the types of AMI and a receipt of invasive cardiac procedures by race/ethnicity. Lastly, we used sequential multivariate logistic regression models to study inpatient mortality for each minority group compared to Whites, adjusting for covariates. Results Over 70% of the national Asian population resides in the 10 states. There were 496,472 hospitalizations with a primary diagnosis of AMI; 75% of all cases were Whites, 10% were Blacks, 12% were Hispanics, and 3% were Asians. Asians had a higher prevalence of cardiac comorbidities, including hypertension, diabetes, and kidney failure compared to Whites (p-value< 0.01). There were 158,623 STEMI (ST-elevation AMI), and the proportion of hospitalizations for STEMI was the highest for Asians (35.2% for Asians, 32.7% for Whites, 25.3% for Blacks, and 32.1% for Hispanics). Asians had the highest rates of inpatient AMI mortality: 7.2% for Asians, 6.3% for Whites, 5.4% for Blacks, and 5.9% for Hispanics (ANOVA p-value < 0.01). In adjusted analyses, Asians (OR = 1.11 [95% CI: 1.04–1.19]) and Hispanics (OR = 1.14 [1.09–1.19]) had a higher likelihood of inpatient mortality compared to Whites. Conclusions Asians had a higher risk-adjusted likelihood of inpatient AMI mortality compared to Whites. Further research is needed to identify the underlying reasons for this finding to improve AMI disparities for Asians.
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Affiliation(s)
- Eun Ji Kim
- General Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, 2001 Marcus Avenue Suite S160, Lake Success, NY, 11042, USA.
| | - Nancy R Kressin
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Michael K Paasche-Orlow
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA
| | - Lenny Lopez
- University of California San Francisco School of Medicine, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Jennifer E Rosen
- MedStar Washington Hospital Center, 106 Irving Street NW POB South 124, Washington, DC, 20010, USA
| | - Mengyun Lin
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA
| | - Amresh D Hanchate
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
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77
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Desai N, Lora CM, Lash JP, Ricardo AC. CKD and ESRD in US Hispanics. Am J Kidney Dis 2018; 73:102-111. [PMID: 29661541 DOI: 10.1053/j.ajkd.2018.02.354] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/08/2018] [Indexed: 12/23/2022]
Abstract
Hispanics are the largest racial/ethnic minority group in the United States, and they experience a substantial burden of kidney disease. Although the prevalence of chronic kidney disease (CKD) is similar or slightly lower in Hispanics than non-Hispanic whites, the age- and sex-adjusted prevalence rate of end-stage renal disease is almost 50% higher in Hispanics compared with non-Hispanic whites. This has been attributed in part to faster CKD progression among Hispanics. Furthermore, Hispanic ethnicity has been associated with a greater prevalence of cardiovascular disease risk factors, including obesity and diabetes, as well as CKD-related complications. Despite their less favorable socioeconomic status, which often leads to limited access to quality health care, and their high comorbid condition burden, the risk for mortality among Hispanics appears to be lower than for non-Hispanic whites. This survival paradox has been attributed to a complex interplay between sociocultural and psychosocial factors, as well as other factors. Future research should focus on evaluating the long-term impact of these factors on patient-centered and clinical outcomes. National policies are needed to improve access to and quality of health care among Hispanics with CKD.
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Affiliation(s)
- Nisa Desai
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Claudia M Lora
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
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Lora CM, Ricardo AC, Chen J, Cai J, Flessner M, Moncrieft A, Peralta C, Raij L, Rosas SE, Talavera GA, Daviglus ML, Lash JP. Acculturation and chronic kidney disease in the Hispanic community health study/study of Latinos (HCHS/SOL). Prev Med Rep 2018; 10:285-291. [PMID: 29868381 PMCID: PMC5984224 DOI: 10.1016/j.pmedr.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/24/2018] [Accepted: 04/01/2018] [Indexed: 01/13/2023] Open
Abstract
Hispanics/Latinos are burdened by chronic kidney disease (CKD). The role of acculturation in this population has not been explored. We studied the association of acculturation with CKD and cardiovascular risk factor control. We performed cross-sectional analyses of 13,164 U.S. Hispanics/Latinos enrolled in the HCHS/SOL Study between 2008 and 2011. Acculturation was measured using the language and ethnic social relations subscales of the Short Acculturation Scale for Hispanics, and proxies of acculturation (language preference, place of birth and duration of residence in U.S.). CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or urine albumin-to-creatinine ratio ≥ 30 mg/g. On multivariable analyses stratified by age, lower language subscale score was associated with higher odds of CKD among those older than 65 (OR 1.29, 95% CI, 1.03, 1.63). No significant association was found between proxies of acculturation and CKD in this age strata. Among individuals aged 18–44, a lower language subscale score was associated with lower eGFR (β = −0.77 ml/min/1.73 m2, 95% CI −1.43, −0.10 per 1 SD increase) and a similar pattern was observed for ethnic social relations. Among those older than 65, lower language subscale score was associated with higher log-albuminuria (β = 0.12, 95% CI 0.03, 0.22). Among individuals with CKD, acculturation measures were not associated with control of cardiovascular risk factors. In conclusion, lower language acculturation was associated with a higher prevalence of CKD in individuals older than 65. These findings suggest that older individuals with lower language acculturation represent a high risk group for CKD. Among Hispanics/Latinos, lower language acculturation was associated with a higher prevalence of chronic kidney disease in older individuals. Based on our findings, older individuals with lower language acculturation represent a high-risk group for chronic kidney disease.
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Affiliation(s)
- Claudia M. Lora
- University of Illinois at Chicago, Chicago, IL, United States
- Corresponding author at: 820 S. Wood Street M/C 793, Chicago, IL 60612, United States.
| | - Ana C. Ricardo
- University of Illinois at Chicago, Chicago, IL, United States
| | - Jinsong Chen
- University of Illinois at Chicago, Chicago, IL, United States
| | - Jianwen Cai
- University of North Carolina, Chapel Hill, NC, United States
| | - Michael Flessner
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | | | | | - Leopoldo Raij
- University of Miami, Coral Gables, FL, United States
| | - Sylvia E. Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | | | | | - James P. Lash
- University of Illinois at Chicago, Chicago, IL, United States
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López L, Grant RW, Marceau L, Piccolo R, McKinlay JB, Meigs JB. Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey. J Immigr Minor Health 2018; 18:1266-1273. [PMID: 26898955 DOI: 10.1007/s10903-016-0362-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study assessed the effect of acculturation on type 2 diabetes and whether health literacy may mediate this association. The Boston Area Community Health cohort is a multi-stage stratified random sample of adults from Boston including 744 Latinos. We defined dysglycemia as a HbA1c ≥5.7 %. Multivariable analyses examined the associations between acculturation and health literacy adjusting for demographic and clinical variables. Similar analyses were performed among participants with HbA1c ≥7.0 % to assess the association between acculturation and diabetes control. Among an insured primarily foreign born Spanish speaking Latino population, with a long residence period in the US and good healthcare utilization, higher levels of acculturation were not associated with dysglycemia. Lower levels of acculturation were associated with worse diabetes control. Health literacy level did not modify these associations. Elucidating the components of heterogeneity among Latinos will be essential for understanding the influence of acculturation on diabetes.
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Affiliation(s)
- Lenny López
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lisa Marceau
- New England Research Institutes, Boston, MA, USA
| | | | | | - James B Meigs
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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80
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Rodriguez F, Hastings KG, Hu J, Lopez L, Cullen M, Harrington RA, Palaniappan LP. Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults. J Am Heart Assoc 2017; 6:JAHA.117.007207. [PMID: 29237590 PMCID: PMC5779034 DOI: 10.1161/jaha.117.007207] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Hispanic persons represent a heterogeneous and growing population of any race with origins in Mexico, the Caribbean, Central America, South America, or other Spanish‐speaking countries. Previous studies have documented variation in cardiovascular risk and outcomes among Hispanic subgroups. Few studies have investigated whether these patterns vary by nativity status among Hispanic subgroups. Methods and Results We used the National Center for Health Statistics mortality file to compare deaths of Hispanic (n=1 258 229) and non‐Hispanic white (n=18 149 774) adults (aged ≥25 years) from 2003 to 2012. We identified all deaths related to cardiovascular disease (CVD) and categorized them by subtype (all CVD, ischemic, or cerebrovascular) using the underlying cause of death (International Classification of Diseases, 10th Revision codes I00–I78, I20–I25, and I60–I69, respectively). Population estimates were calculated using linear interpolation from the 2000 and 2010 US censuses. CVD accounted for 31% of all deaths among Hispanic adults. Race/ethnicity and nativity status were recorded on death certificates by the funeral director using state guidelines. Nativity status was defined as foreign versus US born; 58% of Hispanic decedents were foreign born. Overall, Hispanic adults had lower age‐adjusted CVD mortality rates than non‐Hispanic white adults (296 versus 385 per 100 000). Foreign‐born Cubans, Mexicans, and Puerto Ricans had higher CVD mortality than their US‐born counterparts (rate ratio: 2.64 [95% confidence interval, 2.46–2.81], 1.17 [95% confidence interval, 1.15–1.21], and 1.91 [95% confidence interval, 1.83–1.99], respectively). Conclusions Mortality rates for total cardiovascular, ischemic, and cerebrovascular disease are higher among foreign‐ than US‐born Hispanic adults. These findings suggest the importance of disaggregating CVD mortality by disease subtype, Hispanic subgroup, and nativity status.
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Affiliation(s)
- Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA
| | - Jiaqi Hu
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA
| | - Lenny Lopez
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Mark Cullen
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA
| | - Robert A Harrington
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Latha P Palaniappan
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA.,Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA
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81
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The Role of Health Literacy in Predicting Multiple Healthcare Outcomes Among Hispanics in a Nationally Representative Sample: A Comparative Analysis by English Proficiency Levels. J Immigr Minor Health 2017; 18:608-615. [PMID: 25894535 DOI: 10.1007/s10903-015-0211-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Health literacy (HL) research among Hispanics currently focuses on individuals with limited English proficiency but impacts of HL on healthcare outcomes among other English language proficiency groups is relatively unknown. Regression models assessed associations between HL and healthcare outcomes for Hispanics overall (n = 4013) and for proficiency level sub-populations using the 2007 Pew Hispanic Health Survey. Overall, Hispanics with adequate HL percieved US medical care as "excellent," were more satisfied with their doctor's help, and reported "excellent" overall health. In the sub-population analysis, "excellent" perception of US healthcare was associated with HL among the Spanish and English dominant groups. Among bilinguals, adequate HL was associated with decreased use of traditional medicine. The effect of adequate HL varied within English proficiency groups. HL research that focuses only on Spanish dominant speakers can exclude a substantial percentage of English proficient or bilingual populations who have low HL.
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82
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Jin K, Gullick J, Neubeck L, Koo F, Ding D. Acculturation is associated with higher prevalence of cardiovascular disease risk-factors among Chinese immigrants in Australia: Evidence from a large population-based cohort. Eur J Prev Cardiol 2017; 24:2000-2008. [PMID: 29064273 DOI: 10.1177/2047487317736828] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Acculturation is associated with increased prevalence of cardiovascular disease (CVD) risk-factors among immigrants in Western countries. Little is known about acculturation effects on CVD risks among Chinese immigrants, one of the fastest growing populations in Western countries. In this study, we aim to examine the association between acculturation and CVD risk-factors among Chinese immigrants, Australia's third-largest foreign-born group. Methods We accessed a subsample of Chinese immigrants ( n = 3220) within the 45-and-Up Study (2006-2009). Poisson regression model with a robust error variance examined the association between acculturation and CVD risk-factors, and prevalence ratios were reported, adjusted for socio-demographic characteristics. Indicators of acculturation included age at migration, length of Australian residence and language spoken at home. The outcomes were self-reported CVD diagnosis and six risk-factors (hypertension, diabetes, high cholesterol, smoking, overweight/obesity, physical inactivity). Results Mean age of Chinese participants was 58.9-years (SD = 10.7) and 55.5% were women. Chinese migrating to Australia aged <18 years were significantly more likely to report diabetes (prevalence ratio = 1.71; p < 0.01), overweight/obesity (prevalence ratio = 1.49; p < 0.001) and ≥ 3 CVD risk-factors (prevalence ratio = 1.47; p < 0.05) compared with those who migrated after 18-years-old. Chinese immigrants who lived in Australia for ≥ 30 years were significantly more likely to have diabetes (prevalence ratio = 1.84; p < 0.01) and ≥ 3 CVD risk-factors (prevalence ratio = 1.84; p < 0.01). There were no significant differences by language spoken at home. The association between indicators of acculturation and CVD risk-factors appeared to differ by sex. Conclusion Greater acculturation was associated with adverse CVD risk-factors among Chinese immigrants in Australia.
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Affiliation(s)
- Kai Jin
- 1 Sydney Nursing School, University of Sydney, Australia
| | - Janice Gullick
- 1 Sydney Nursing School, University of Sydney, Australia
| | - Lis Neubeck
- 2 School of Health and Social Care, Edinburgh Napier University, UK
| | - Fung Koo
- 1 Sydney Nursing School, University of Sydney, Australia
| | - Ding Ding
- 3 Charles Perkins Centre, Sydney School of Public Health, University of Sydney, Australia
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83
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Venditti EM. Behavioral lifestyle interventions for the primary prevention of type 2 diabetes and translation to Hispanic/Latino communities in the United States and Mexico. Nutr Rev 2017; 75:85-93. [PMID: 28049753 DOI: 10.1093/nutrit/nuw041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lifestyle behaviors in overweight and obese individuals are closely linked to the development, course, and outcomes of type 2 diabetes and multiple comorbid health conditions. Behavior change theory and many randomized controlled studies offer strong support for screening and identifying adults at increased cardiometabolic risk and for providing early intervention to mitigate risk factors to prevent or delay the onset of disease. The current article reviews key lifestyle intervention efficacy and dissemination trials conducted with individuals deemed to be at increased risk for diabetes and describes the rationale for training teams of professionals and community health workers (e.g., promotores [in Spanish]) to implement comprehensive programs, with fidelity, in a variety of medical care and community settings. This evidence-based road map may be used to facilitate the design and implementation of strategies for structured behavioral diabetes risk reduction programs in the public and private healthcare sectors and other relevant community-based platforms serving individuals of Hispanic/Latino origin in the United States and Mexico.
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Affiliation(s)
- Elizabeth M Venditti
- E.M. Venditti is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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84
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Yoshida Y, Scribner R, Chen L, Broyles S, Phillippi S, Tseng TS. Role of Age and Acculturation in Diet Quality Among Mexican Americans - Findings From the National Health and Nutrition Examination Survey, 1999-2012. Prev Chronic Dis 2017; 14:E59. [PMID: 28727545 PMCID: PMC5524523 DOI: 10.5888/pcd14.170004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Age and acculturation may play a role in diet quality among Mexican Americans. This study examined diet quality in Mexican Americans by age and whether acculturation influences diet quality across different age groups, using data from the National Health and Nutrition Examination Survey (NHANES). Diet quality, measured by the Healthy Eating Index 2010, improved with age except in categories of dairy, sodium, and refined grains. More acculturation was associated with lower scores in overall diet quality and categories of vegetables, fruits, and sodium and empty calories across almost all ages, but higher scores in grain categories, especially in younger groups. A diet rich in fruits and vegetables but low in fat and sodium should be promoted among more acculturated Mexican Americans, and whole-grain foods should be promoted among young but less acculturated Mexican Americans.
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Affiliation(s)
- Yilin Yoshida
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri
| | - Richard Scribner
- Epidemiology, School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, Louisiana
| | - Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Stephanie Broyles
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, Louisiana.,Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Stephen Phillippi
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, Louisiana
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center at New Orleans, New Orleans, Louisiana.,2020 Gravier St, 3rd Floor, New Orleans, LA 70112.
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85
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Echeverria SE, Mustafa M, Pentakota SR, Kim S, Hastings KG, Amadi C, Palaniappan L. Social and clinically-relevant cardiovascular risk factors in Asian Americans adults: NHANES 2011-2014. Prev Med 2017; 99:222-227. [PMID: 28219784 DOI: 10.1016/j.ypmed.2017.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 12/24/2016] [Accepted: 02/17/2017] [Indexed: 12/17/2022]
Abstract
Little evidence exists examining cardiovascular risk factors among Asian Americans and how social determinants such as nativity status and education pattern risk in the United States (U.S.) context. We used the National Health and Nutrition Examination Survey, which purposely oversampled Asian Americans from 2011 to 2014, and examined prevalence of Type II diabetes, smoking and obesity for Asian Americans (n=1363) and non-Latino Whites (n=4121). We classified Asian Americans as U.S. or foreign-born and by years in the U.S. Obesity status was based on standard body mass index (BMI) cut points of ≥30kg/m2 and Asian-specific cut points (BMI≥25kg/m2) that may be more clinically relevant for this population. We fit separate logistic regression models for each outcome using complex survey design methods and tested for the joint effect of race, nativity and education on each outcome. Diabetes and obesity prevalence (applying Asian-specific BMI cut points) were higher among Asian Americans when compared to non-Latino Whites but smoking prevalence was lower. These patterns remained in fully adjusted models and showed small increases with longer duration in the U.S. Joint effects models showed higher odds of prevalent Type II diabetes and obesity (Asian-specific) for foreign-born Asians, regardless of years in the U.S. and slightly higher risk for low education, when compared to non-Latino Whites with high education. Smoking models showed significant interaction effects between race and education for non-Latino Whites only. Our study supports the premise that social as well as clinical factors should be considered when developing health initiatives for Asian Americans.
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Affiliation(s)
- Sandra E Echeverria
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States.
| | - Mehnaz Mustafa
- New Jersey Department of Health and Human Services, United States
| | - Sri Ram Pentakota
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NY, United States.
| | - Soyeon Kim
- Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NY, United States.
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.
| | - Chioma Amadi
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States.
| | - Latha Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.
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86
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Rosenberg N, Daviglus ML, DeVon HA, Park CG, Eldeirawi K. The Association between Parity and Inflammation among Mexican-American Women of Reproductive Age Varies by Acculturation Level: Results of the National Health and Nutrition Examination Survey (1999-2006). Womens Health Issues 2017; 27:485-492. [PMID: 28410971 DOI: 10.1016/j.whi.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Parity and acculturation are linked with cardiometabolic risk. Their joint association with cardiometabolic health among Mexican-American women is less established, even though immigrant Mexican-American women have the highest fertility rate in the United States. We examined the modifying role of acculturation on the association of parity with a cardiometabolic risk biomarker, C-reactive protein (CRP). METHODS Participants (n = 1,002) were women of Mexican background, ages 16 to 39 years, in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2006. The association between parity and elevated CRP was examined using logistic regression adjusted for age, household food security, access to health care, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol, waist circumference, physical activity, acculturation, and a product term of parity and acculturation. Acculturation was measured on a 6-point score based on nativity status and duration of residence in the United States (0, Mexico born, U.S. resident <10 years; 1, Mexico born, U.S. resident 10-19 years; 2-Mexico born, U.S. resident ≥20 years; and 3, U.S. born), and language used at home (0, Spanish; 1, bilingual; 2, English). Scores of 0 or 1, 2 or 3, and 4 or 5 represented low, moderate, and high acculturation, respectively. RESULTS The association of parity with elevated CRP varied by acculturation level (pinteraction = 0.10). Parity was associated with elevated CRP among women with low (adjusted odds ratio [OR], 2.26; 95% CI, 1.07-4.80) and moderate acculturation (adjusted OR, 2.79; 95% CI, 1.16-6.73), compared with nulliparous women. CONCLUSIONS Higher odds of elevated CRP associated with parity in immigrant Mexican-American women of reproductive age indicate the need for greater use of maternal/women's health care services for cardiometabolic risk screening and interventions.
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Affiliation(s)
- Natalya Rosenberg
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
| | - Martha L Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Holli A DeVon
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Kamal Eldeirawi
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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87
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Modesti PA, Calabrese M, Malandrino D, Colella A, Galanti G, Zhao D. New findings on type 2 diabetes in first-generation Chinese migrants settled in Italy: Chinese in Prato (CHIP) cross-sectional survey. Diabetes Metab Res Rev 2017; 33. [PMID: 27336676 DOI: 10.1002/dmrr.2835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chinese people are one of the fastest growing immigrant populations in Europe, and their health has become a key issue to host nations. Although type 2 diabetes (T2DM) is a big burden among migrant populations, data on Chinese immigrants in Europe are limited. METHODS A cross-sectional survey was performed in 2014, adopting principles of community-based participatory research to investigate T2DM, diagnosed by the American Diabetes Association fasting criteria, in Chinese first-generation migrants aged 16 to 59 years settled in Prato (Italy). Association with different factors was investigated using logistic regression. RESULTS Of the 1608 participants, 177 had T2DM (11.0%), 119 being newly diagnosed (7.4%). Among subjects with diabetes, 58 (32.8%) were aware of the disease; among subjects with diabetes aware of their condition, 46 (79%) were treated with glucose lowering drugs. Age-standardized (World Health Organization 2001 population) prevalence of T2DM was 9.6% (95% CI 9.1 to 10.2%), being 12.0% (95% CI 11.0 to 12.9%) in men, and 7.8% (95% CI 7.1 to 8.4%) in women. At adjusted logistic regression, diabetes was associated with hypertension, current smoking, adiposity indices (waist circumference, waist-to-hip ratio, waist-to-height ratio, and body mass index), and high triglycerides. T2DM, adiposity indices, and high triglycerides were not associated with duration of stay in Italy. CONCLUSIONS The high prevalence of T2DM among first-generation Chinese immigrants in Europe stresses the need for specific health programs for T2DM early diagnosis, treatment, and prevention. There is an urgent need for policies to support this group because current policies will produce major social and economic costs. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Calabrese
- Diabetology Unit, Ospedale Misericordia e Dolce, Prato, Italy
| | - Danilo Malandrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Colella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giorgio Galanti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital, National Institute of Heart, Lung and Blood Disease, Beijing, China
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Shah SM, Ali R, Loney T, Aziz F, ElBarazi I, Al Dhaheri S, Farooqi MH, Blair I. Prevalence of Diabetes among Migrant Women and Duration of Residence in the United Arab Emirates: A Cross Sectional Study. PLoS One 2017; 12:e0169949. [PMID: 28099445 PMCID: PMC5242528 DOI: 10.1371/journal.pone.0169949] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 12/24/2016] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence rate of type 2 diabetes mellitus (T2DM) is one of the highest in United Arab Emirates (UAE), however data for the expatriate population is limited. This study aimed to identify the prevalence of T2DM amongst migrant women and test the hypothesis that acculturation (measured by years of residency) is associated with an increased risk of T2DM. Methods This was a cross-sectional study and we recruited a representative sample (n = 599, 75% participation rate) of migrant women aged 18 years and over in Al Ain, UAE. The American Diabetes Association criteria were used to diagnose T2DM. An adapted WHO STEPS questionnaire was used to collect socio-demographic, lifestyle and clinical data. Logistic regression analysis was performed to identify correlates of T2DM including length of UAE residence. Results The mean age of participants was 34.1 (± 9.5) years. Of the study participants, based on HbA1C levels, 18.6% (95% CI: 13.9–24.4) had prediabetes and 10.7% (95% CI: 7.2–15.6) had T2DM. Prevalence of prediabetes was 8.5% for Filipinos, 16.7% for Arabs and 30.3% for South Asians. Similarly the prevalence of T2DM was 1.7% for Filipinos, 12.2% for Arabs and 16.7% for South Asians. Significant correlates of overall T2DM (measured and known diabetes) included length of UAE residence for more than 10 years (Adjusted Odds Ratio [AOR] 2.74, 95% CI: 1.21–6.20), age ≥40 years (AOR = 3.48, 95% CI: 1.53–7.87) and South Asian nationality (AOR 2.10, 95% CI: 0.94–4.70). Conclusion Diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asians. Longer length of residence in the UAE is associated with a higher prevalence of diabetes.
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Affiliation(s)
- Syed M. Shah
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Raghib Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Tom Loney
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Faisal Aziz
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Iffat ElBarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - M. Hamed Farooqi
- Dubai Diabetes Center, Dubai Health Authority, Dubai, United Arab Emirates
| | - Iain Blair
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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89
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Diet quality and its relationship with central obesity among Mexican Americans: findings from National Health and Nutrition Examination Survey (NHANES) 1999-2012. Public Health Nutr 2016; 20:1193-1202. [PMID: 27974064 DOI: 10.1017/s1368980016003190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women. DESIGN Cross-sectional data from NHANES 1999-2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity. SETTING National Health and Nutrition Examination Survey (NHANES) 1999-2012. SUBJECTS A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status. RESULTS Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women. CONCLUSIONS HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity.
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90
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Yi SS, Beasley JM, Kwon SC, Huang KY, Trinh-Shevrin C, Wylie-Rosett J. Acculturation and activity behaviors in Chinese American immigrants in New York City. Prev Med Rep 2016; 4:404-409. [PMID: 27570733 PMCID: PMC4992039 DOI: 10.1016/j.pmedr.2016.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/05/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022] Open
Abstract
Asian Americans have lower levels of physical activity (PA) compared to other racial/ethnic groups; however, there is little understanding of the social and cultural determinants of PA in this population. Few analyses describe specific PA domains (occupation-, transportation-, recreation-related), focus on one Asian subgroup, or use validated scales. The study objective was to assess the association between acculturation and activity behaviors (meeting 2008 PA guidelines, activity minutes by PA domain, sitting time) in a cross-sectional sample of urban-dwelling, Chinese American immigrants. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010-11 among participants with valid reports of PA minutes, assessed by the WHO Global Physical Activity Questionnaire (n = 1772). Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, a 32-item instrument which characterizes two acculturative dimensions: ethnic society (Chinese) immersion and dominant society (American) immersion (maximum possible scores = 4). Multivariable models regressing activity behaviors on acculturation were run, adjusting for age, sex, household income, education, and age at immigration. Ethnic society immersion was high (mean = 3.64) while dominant society immersion was moderate (mean = 2.23). Higher ethnic society immersion was associated with less recreation-related PA (- 40.7 min/week); higher dominant society immersion was associated with a higher odds of meeting PA guidelines (OR: 1.66 (1.25, 2.20), p < 0.001) and more recreation-related PA (+ 36.5 min/week). Given low PA levels in Chinese adults in China, results suggest that PA for leisure may increase and become a more normative behavior among Chinese American immigrants with acculturation. Understanding acculturation level may inform strategies to increase PA in Chinese Americans.
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Affiliation(s)
- Stella S. Yi
- NYU School of Medicine, Department of Population Health, United States
| | | | - Simona C. Kwon
- NYU School of Medicine, Department of Population Health, United States
| | - Keng-Yen Huang
- NYU School of Medicine, Department of Population Health, United States
| | | | - Judith Wylie-Rosett
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, United States
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91
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Commodore-Mensah Y, Ukonu N, Obisesan O, Aboagye JK, Agyemang C, Reilly CM, Dunbar SB, Okosun IS. Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey. J Am Heart Assoc 2016; 5:JAHA.116.004059. [PMID: 27815269 PMCID: PMC5210341 DOI: 10.1161/jaha.116.004059] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. METHODS AND RESULTS Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10-1.29), diabetic (OR, 1.43; 95% CI, 1.17-1.73), and hypertensive (OR, 1.18; 95% CI, 1.05-1.32) than those residing in the United States for <10 years. CONCLUSIONS In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.
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Affiliation(s)
| | - Nwakaego Ukonu
- Counseling Psychology, Department of Psychology, University of Florida, Gainesville, FL
| | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Carolyn M Reilly
- Nell Hodgson Woodruff, School of Nursing Emory University, Atlanta, GA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff, School of Nursing Emory University, Atlanta, GA
| | - Ike S Okosun
- Department of Epidemiology & Biostatistics, School of Public Health Georgia State University, Atlanta, GA
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92
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Chun KM, Kwan CML, Strycker LA, Chesla CA. Acculturation and bicultural efficacy effects on Chinese American immigrants' diabetes and health management. J Behav Med 2016; 39:896-907. [PMID: 27412776 PMCID: PMC5014659 DOI: 10.1007/s10865-016-9766-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N = 162) recruited for a larger community-based diabetes intervention study (Chesla et al. in Res Nurs Health 36(4):359-372, 2013. doi: 10.1002/nur.21543 ). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants' diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study.
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Affiliation(s)
- Kevin M Chun
- Department of Psychology, University of San Francisco, 2130 Fulton Street, San Francisco, CA, USA.
| | - Christine M L Kwan
- Sau Po Centre on Ageing, The University of Hong Kong, Pok Fu Lam Road, Hong Kong, Hong Kong
| | | | - Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
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93
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Venkatesh S, Conner T, Song WO, Olson BH, Weatherspoon LJ. The Relationship Between Dietary Acculturation and Type 2 Diabetes Risk Among Asian Indians in the U.S. J Immigr Minor Health 2016; 19:294-301. [DOI: 10.1007/s10903-016-0482-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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94
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Relationships of nativity and length of residence in the U.S. with favorable cardiovascular health among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med 2016; 89:84-89. [PMID: 27196144 PMCID: PMC4969108 DOI: 10.1016/j.ypmed.2016.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/11/2016] [Accepted: 05/15/2016] [Indexed: 11/24/2022]
Abstract
Individuals with favorable levels of all readily measured major CVD risk factors (low CV risk) during middle age incur lower cardiovascular morbidity and mortality, lower all-cause mortality, and lower Medicare costs at older ages compared to adults with one or more unfavorable CVD risk factors. Studies on predictors of low CV risk in Hispanics/Latinos have focused solely on Mexican-Americans. The objective of this study was to use data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; enrolled 2008 to 2011) to assess relationships of nativity and length of residence in the US, a commonly used proxy for acculturation, with low CV risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure<120/<80; body mass index <25kg/m(2); and no major ECG abnormalities) in 15,047 Central American, South American, Cuban, Dominican, Mexican, Puerto Rican men and women, and Hispanic/Latino men and women identifying as other or >1 heritage. We also tested whether associations varied by Hispanic/Latino background. Women living in the US<10years were 1.96 (95% confidence interval: 1.37, 2.80) times more likely to be low CV risk than US-born women after adjusting for sociodemographic characteristics, diet, physical activity, and self-reported experiences of ethnic discrimination. Findings varied in men by Hispanic/Latino background, but length of residence was largely unrelated to low CV risk. These findings highlight the role acculturative processes play in shaping cardiovascular health in Hispanics/Latinos.
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95
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Chen X, Acosta S, Barry AE. Evaluating the Accuracy of Google Translate for Diabetes Education Material. JMIR Diabetes 2016; 1:e3. [PMID: 30291056 PMCID: PMC6238856 DOI: 10.2196/diabetes.5848] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 21% of the US population speaks a language other than English at home; many of these individuals cannot effectively communicate in English. Hispanic and Chinese Americans, in particular, are the two largest minority groups having low health literacy in the United States. Fortunately, machine-generated translations represent a novel tool that non-English speakers can use to receive and relay health education information when human interpreters are not available. OBJECTIVE The purpose of this study was to evaluate the accuracy of the Google Translate website when translating health information from English to Spanish and English to Chinese. METHODS The pamphlet, "You are the heart of your family…take care of it," is a health education sheet for diabetes patients that outlines six tips for behavior change. Two professional translators translated the original English sentences into Spanish and Chinese. We recruited 6 certified translators (3 Spanish and 3 Chinese) to conduct blinded evaluations of the following versions: (1) sentences translated by Google Translate, and (2) sentences translated by a professional human translator. Evaluators rated the sentences on four scales: fluency, adequacy, meaning, and severity. We performed descriptive analysis to examine differences between these two versions. RESULTS Cronbach's alpha values exhibited high degrees of agreement on the rating outcome of both evaluator groups: .919 for the Spanish evaluators and .972 for the Chinese evaluators. The readability of the sentences in this study ranged from 2.8 to 9.0 (mean 5.4, SD 2.7). The correlation coefficients between the grade level and translation accuracy for all sentences translated by Google were negative (eg, rMeaning=-.660), which indicates that Google provided accurate translation for simple sentences. However, the likelihood of incorrect translation increased when the original English sentences required higher grade levels to comprehend. The Chinese human translator provided more accurate translation compared to Google. The Spanish human translator, on the other hand, did not provide a significantly better translation compared to Google. CONCLUSION Google produced a more accurate translation from English to Spanish than English to Chinese. Some sentences translated by Google from English to Chinese exhibit the potential to result in delayed patient care. We recommend continuous training and credential practice standards for professional medical translators to enhance patient safety as well as providing health education information in multiple languages.
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Affiliation(s)
- Xuewei Chen
- Transdisciplinary Center for Health Equity Research, Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Sandra Acosta
- Texas A&M University, Department of Educational Psychology, Texas A&M University, College Station, TX, United States
| | - Adam Etheridge Barry
- Texas A&M University, Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
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96
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White JS, Hamad R, Li X, Basu S, Ohlsson H, Sundquist J, Sundquist K. Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden. Lancet Diabetes Endocrinol 2016; 4:517-24. [PMID: 27131930 PMCID: PMC4875844 DOI: 10.1016/s2213-8587(16)30009-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/11/2016] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although studies have shown associations between neighbourhood quality and chronic disease outcomes, such associations are potentially confounded by the selection of different types of people into different neighbourhood environments. We sought to identify the causal effects of neighbourhood deprivation on type 2 diabetes risk, by comparing refugees in Sweden who were actively dispersed by government policy to low-deprivation, moderate-deprivation, or high-deprivation neighbourhoods. METHODS In this quasi-experimental study, we analysed national register data for refugees who arrived in Sweden aged 25-50 years, at a time when the government policy involved quasi-random dispersal of refugees to neighbourhoods with different levels of poverty and unemployment, schooling, and social welfare participation. Individuals in our sample were assigned to a neighbourhood categorised as high deprivation (≥1 SD above the mean), moderate deprivation (within 1 SD of the mean), or low deprivation (≥1 SD below the mean). The primary outcome was new diagnosis of type 2 diabetes between Jan 1, 2002, and Dec 31, 2010. We used multivariate logistic and linear regressions to assess the effects of neighbourhood deprivation on diabetes risk, controlling for potential confounders affecting neighbourhood assignment and assessing effects of cumulative exposure to different neighbourhood conditions. FINDINGS We included data for 61 386 refugees who arrived in Sweden during 1987-91 and who were assigned to one of 4833 neighbourhoods. Being assigned to an area deemed high deprivation versus low deprivation was associated with an increased risk of diabetes (odds ratio [OR] 1·22, 95% CI 1·07-1·38; p=0·001). In analyses that included fixed effects for assigned municipality, the increased diabetes risk was estimated to be 0·85 percentage points (95% CI -0·030 to 1·728; p=0·058). Neighbourhood effects grew over time such that 5 years of additional exposure to high-deprivation versus low-deprivation neighbourhoods was associated with a 9% increase in diabetes risk. INTERPRETATION This study makes use of a pre-existing governmental natural experiment to show that neighbourhood deprivation increased the risk of diabetes in refugees in Sweden. This finding has heightened importance in the context of the current refugee crisis in Europe. FUNDING US National Heart, Lung, and Blood Institute, US National Center for Advancing Translational Sciences, US National Institute on Minority Health and Health Disparities, Swedish Research Council.
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Affiliation(s)
- Justin S White
- Philip R Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, CA, USA.
| | - Rita Hamad
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Xinjun Li
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö University Hospital, Malmö, Sweden
| | - Sanjay Basu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Henrik Ohlsson
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö University Hospital, Malmö, Sweden
| | - Jan Sundquist
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö University Hospital, Malmö, Sweden
| | - Kristina Sundquist
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö University Hospital, Malmö, Sweden
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97
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Afable A, Yeh MC, Trivedi T, Andrews E, Wylie-Rosett J. Duration of US Residence and Obesity Risk in NYC Chinese Immigrants. J Immigr Minor Health 2016; 18:624-635. [PMID: 25963049 PMCID: PMC4658303 DOI: 10.1007/s10903-015-0216-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We evaluated whether duration of time in the US is associated with obesity risk in NYC Chinese immigrants. We analyzed cross-sectional survey data on 2072 men and women. Duration of US residence was categorized into ≤5, 6-15, and 15 years and over. Obesity was defined using WHO Asian standards: BMI of 27.5 kg/m(2) or greater. Diet and physical activity (PA) were assessed as potential explanatory variables. After adjusting for covariates, increased time in the US was associated with an increased obesity risk (OR 1.49; 95 % CI 1.06, 2.08 for 15 years or more vs. ≤5 years); and in separate analysis, with having reported no work related PA (OR 0.76; 95 % CI 0.59, 0.99). Findings suggest that increased time living in the US is associated with an increased obesity risk, a finding possibly explained by a shift to more sedentary lifestyle characteristic of the transition of immigrants to the US.
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Affiliation(s)
- Aimee Afable
- Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY, 11203, USA.
| | - Ming-Chin Yeh
- Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY, 11203, USA
| | - Tushar Trivedi
- Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY, 11203, USA
| | - Erin Andrews
- Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY, 11203, USA
| | - Judith Wylie-Rosett
- Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY, 11203, USA
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98
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Qureshi WT, Leigh JA, Swett K, Dharod A, Allison MA, Cai J, Gonzalez F, Hurwitz BE, Shah SJ, Desai AA, Spevack DM, Rodriguez CJ. Comparison of Echocardiographic Measures in a Hispanic/Latino Population With the 2005 and 2015 American Society of Echocardiography Reference Limits (The Echocardiographic Study of Latinos). Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.003597. [PMID: 26712159 DOI: 10.1161/circimaging.115.003597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reference limits for echocardiographic quantification of cardiac chambers in Hispanics are not well studied. METHODS AND RESULTS We examined the reference values of left atrium and left ventricle (LV) structure in a large ethnically diverse Hispanic cohort. Two-dimensional transthoracic echocardiography was performed in 1818 participants of the Echocardiographic Study of Latinos (ECHO-SOL). Individuals with body mass index ≥30 kg/m(2), hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation were excluded leaving 525 participants defined as healthy reference cohort. We estimated 95th weighted percentiles of LV end systolic volume, LV end diastolic volume, relative wall and septal thickness, LV mass, and left atrial volume. We then used upper reference limits of the 2005 and 2015 American Society of Echocardiography (ASE) and 95th percentile of reference cohort to classify the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) target population into abnormal and normal. Reference limits were also calculated for each of 6 Hispanic origins. Using ASE 2015 defined reference values, we categorized 7%, 21%, 57%, and 17% of men and 18%, 29%, 60%, and 26% of women as having abnormal LV mass index, relative, septal, and posterior wall thickness, respectively. Conversely, 10% and 11% of men and 4% and 2% of women were classified as having abnormal end-diastolic volume and internal diameter by ASE 2015 cutoffs, respectively. Similar differences were found when we used 2005 ASE cutoffs. Several differences were noted in distribution of cardiac structure and volumes among various Hispanic/Latino origins. Cubans had highest values of echocardiographic measures, and Central Americans had the lowest. CONCLUSIONS This is the first large study that provides normal reference values for cardiac structure. It further demonstrates that a considerable segment of Hispanic/Latinos residing in the United States may be classified as having abnormal measures of cardiac chambers when 2015 and 2005 ASE reference cutoffs are used.
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Affiliation(s)
- Waqas T Qureshi
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.).
| | - J Adam Leigh
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Katrina Swett
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Ajay Dharod
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Matthew A Allison
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Jianwen Cai
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Franklyn Gonzalez
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Barry E Hurwitz
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Sanjiv J Shah
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Ankit A Desai
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Daniel M Spevack
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
| | - Carlos J Rodriguez
- From the Departments of Internal Medicine (W.T.Q., J.A.L., A.D., C.J.R.) and Public Health Sciences (K.S., C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; San Diego School of Medicine, University of California (M.A.A.); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (J.C., F.G.); Department of Psychology, University of Miami, FL (B.E.H.); Department of Medicine - Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.J.S.); Department of Medicine, University of Arizona, Tucson (A.A.D.); and Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (D.M.S.)
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99
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Lê-Scherban F, Albrecht SS, Bertoni A, Kandula N, Mehta N, Diez Roux AV. Immigrant status and cardiovascular risk over time: results from the Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol 2016; 26:429-435.e1. [PMID: 27221804 DOI: 10.1016/j.annepidem.2016.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/28/2016] [Accepted: 04/11/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Despite cross-sectional evidence that foreign-born United States (US) residents often have better health than US-born residents of similar race and/or ethnicity, we know little about overall cardiovascular risk progression over time among immigrants as they age in the US. METHODS Using longitudinal data from the Multiethnic Study of Atherosclerosis on 6446 adults aged 45-84 years at baseline, we examined how nativity and length of US residence related to change in cardiovascular health (CVH) and cardiovascular event incidence over 11-year follow-up. CVH was measured using the American Heart Association's CVH measure (range, 0-14; higher is better). RESULTS Immigrants, particularly those with shorter US residence, had better baseline CVH and lower cardiovascular event incidence than the US born. Baseline CVH scores ranged from 8.67 (8.42-8.92) among immigrants living in the US less than 10 years to 7.86 (7.76-7.97) among the US born. However, recent immigrants experienced the largest CVH declines over time: 10-year declines ranged from -1.04 (-1.27 to -0.80) among immigrants living in the US less than 10 years at baseline to -0.47 (-0.52 to -0.42) among the US born. CONCLUSIONS Public health prevention efforts targeting new immigrants may help slow the deterioration of CVH and reduce future cardiovascular risk.
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Affiliation(s)
- Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Sandra S Albrecht
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill
| | - Alain Bertoni
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University, Winston-Salem, NC
| | | | - Neil Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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100
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Gong Z, Zhao D. Cardiovascular diseases and risk factors among Chinese immigrants. Intern Emerg Med 2016; 11:307-18. [PMID: 26350421 DOI: 10.1007/s11739-015-1305-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/18/2015] [Indexed: 02/06/2023]
Abstract
The aim of this study is to identify the prevalence of cardiovascular disease (CVD) and major CVD risk factors, including diabetes, hypertension, dyslipidemia, obesity and smoking among Chinese immigrants by a systematic review of studies from various countries. PubMed and the China National Knowledge Infrastructure databases were searched for studies of the prevalence of major CVDs and risk factors, and of CVD mortality among Chinese immigrants. The search identified 386 papers, 16 of which met the inclusion criteria for this review. In mainland China, there is a pattern of high stroke prevalence but low coronary heart disease (CHD) prevalence. Among Chinese immigrants, there is a much lower prevalence and mortality of stroke, but a higher prevalence and mortality of CHD, even though these are lower than the rates in immigrants of other ethnicities in the host country. The prevalence of CVD risk factors is also markedly different in immigrants. Compared with mainland Chinese, Chinese immigrants have a higher prevalence of diabetes and hypertension, higher serum cholesterol, poorer dietary patterns, and higher prevalence of obesity and smoking. Thus, the epidemiological pattern of CVD among Chinese immigrants changes compared with resident mainland Chinese. The less healthy environmental factor after immigration may be a major trigger in the adverse CVD status of Chinese immigrants. It is important for policy-makers to pay more attention to specific minority immigrant groups, and to implement more effective preventive measures to improve the health of immigrant populations.
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Affiliation(s)
- Zhizhong Gong
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing An Zhen Hospital, Capital Medical University, NO. 2 An Zhen Road, Chaoyang District, Beijing, 100029, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing An Zhen Hospital, Capital Medical University, NO. 2 An Zhen Road, Chaoyang District, Beijing, 100029, China.
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