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)

Strengthening the Voices of Hispanic/Latine Immigrants Managing Chronic Disease: A Mixed Methods Approach to Understanding Perspectives of Health

Individuals who migrate from their home country face a variety of challenges while adapting to the culture in the United States. Immigrant communities are at a significantly higher risk for poor health outcomes; therefore, assessing healthcare treatment for diverse and resilient immigrant populations, including Hispanic/Latine communities, is crucial to preserving their health, culture, and spirit. A paucity of literature exists surrounding perceptions of well-being in immigrant, Hispanic/Latine adults managing chronic diseases. Past studies have shown a discrepancy between providers' and patients' perceptions of healthcare options for overall well-being. We aim to share varying perspectives found within our work geared towards improving the quality of life for Hispanic/Latine immigrants managing chronic disease, especially type 2 diabetes mellitus and hypertension. The primary objective of this article is to strengthen the understanding of intersections between social, physical, financial, and spiritual health within an (im)migrant Hispanic/Latine community using semi-structured ethnographic interviews. These interviews have highlighted community resilience, demonstrating that individuals can adapt to major life transitions while maintaining balance across dimensions of health. This knowledge could be implemented by actively listening to patient concerns regarding their health dimensions to improve individualized and patient-centric care.

Dietary Acculturation Is Associated With Altered Gut Microbiome, Circulating Metabolites, and Cardiovascular Disease Risk in US Hispanics and Latinos: Results From HCHS/SOL

BACKGROUND

Dietary acculturation, or adoption of dominant culture diet by migrant groups, influences human health. We aimed to examine dietary acculturation and its relationships with cardiovascular disease (CVD), gut microbiota, and blood metabolites among US Hispanic and Latino adults.

METHODS

In the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), US exposure was defined by years in the United States (50 states and Washington, DC) and US nativity. A dietary acculturation pattern was derived from 14 172 participants with two 24-hour dietary recalls at baseline (2008-2011) using least absolute shrinkage and selection operator regression, with food groups as predictors of US exposure. We evaluated associations of dietary acculturation with incident CVD across ≈7 years of follow-up (n=211/14 172 cases/total) and gut microbiota (n=2349; visit 2, 2014 to 2017). Serum metabolites associated with both dietary acculturation-related gut microbiota (n=694) and incident CVD (n=108/5256 cases/total) were used as proxy measures to assess the association of diet-related gut microbiome with incident CVD.

RESULTS

We identified an empirical US-oriented dietary acculturation score that increased with US exposure. Higher dietary acculturation score was associated with higher risk of incident CVD (hazard ratio per SD, 1.33 [95% CI, 1.13-1.57]), adjusted for sociodemographic, lifestyle, and clinical factors. Sixty-nine microbial species (17 enriched from diverse species, 52 depleted mainly from fiber-utilizing Clostridia and Prevotella species) were associated with dietary acculturation, driven by lower intakes of whole grains, beans, and fruits and higher intakes of refined grains. Twenty-five metabolites, involved predominantly in fatty acid and glycerophospholipid metabolism (eg, branched-chain 14:0 dicarboxylic acid** and glycerophosphoethanolamine), were associated with both diet acculturation-related gut microbiota and incident CVD. Proxy association analysis based on these metabolites suggested a positive relationship between diet acculturation-related microbiome and risk of CVD (r=0.70, P<0.001).

CONCLUSIONS

Among US Hispanic and Latino adults, greater dietary acculturation was associated with elevated CVD risk, possibly through alterations in gut microbiota and related metabolites. Diet and microbiota-targeted interventions may offer opportunities to mitigate CVD burdens of dietary acculturation.

Association between Depressive Symptoms, Physical Activity, and Health Factors in Hispanic Emerging Adults

Physical activity is a modifiable lifestyle behavior known for reducing symptoms of and being a risk factor for depression and mental health disorders. However, emerging adults (ages 18-25) struggle to meet recommended amounts. In this study, we explore the association between physical activity, depressive symptoms, and health factors in 137 Hispanic emerging adults. Using a cross-sectional survey design, sociodemographic information, depressive symptoms (CES-D score), physical activity (IPAQ score), body composition, and blood pressure measures were obtained. Statistical analyses included correlation and regression analyses. More than half of the participants demonstrated depressive symptomology (59.1%) and body fat percentage greater than 25% (64.2%). Body fat percentage, lean body mass, stress, and heart rate demonstrated notable associations with depressive symptoms and physical activity. When measured continuously and categorically, IPAQ was not a significant predictor of depressive symptoms. When used as a binary variable with a cutoff of 600 MET min/week, IPAQ score revealed a negative relationship with CES-D score (β = -0.169, SE = 2.748, p = 0.034). Our results indicate that a threshold of physical activity, 600 MET min/week, may confer protective effects against depressive symptoms. Future research should investigate the context and quality of physical activity to address mental health disparities in this underrepresented population.

Examining Generalizability across Different Surveys: Comparing Nutrient-Based Food Patterns and Their Cross-Sectional Associations with Cardiometabolic Health in the United States Hispanic/Latino Adults

Background

Ethnicity, cultural background, and geographic location differ significantly within the United States Hispanic/Latino population. These variations can greatly define diet and its relationship with cardiometabolic disease, thus influencing generalizability of results.

Objectives

We aimed to examine nutrient-based food patterns (NBFPs) of Hispanic/Latino adults and their association with cardiometabolic risk factors (dyslipidemia, hypertension, obesity, diabetes) across 2 United States population-based studies with differing sampling strategies.

Methods

Data were collected from Mexican or other Hispanic adult participants from 2007-2012 National Health and Nutrition Examination Survey (NHANES) (n = 3605) and 2007-2011 Hispanic Community Health Survey/Study of Latinos (HCHS/SOL, n = 14,416). NBFPs were derived using factor analysis on nutrient intake data estimated from 24-h dietary recalls and interpreted using common foods in which these nutrients are prominent. Cross-sectional associations between NBFPs (quintiles) and cardiometabolic risk factors, defined by clinical measures and self-report, were estimated using survey-weighted multivariable-adjusted logistic models, accounting for multiple testing.

Results

Five NBFPs were identified in both studies: 1) meats, 2) grains/legumes, 3) fruits/vegetables, 4) dairy, and 5) fats/oils. Associations with cardiometabolic risk factors differed by NBFP and study. In HCHS/SOL, the odds of diabetes were lower for persons in the highest quintile of meats NBFP (odds ratio [OR]: 0.73; 95% confidence interval [CI]: 0.58, 0.92) and odds were higher for those in the lowest quintile of fruits/vegetables (OR: 0.71; 95% CI: 0.55, 0.93) compared to those in the third (moderate intake) quintile. Those in the fourth quintile of dairy NBFP had higher odds of hypertension than those in the third quintile (OR: 1.31; 95% CI: 1.01, 1.70). In NHANES, the odds of hypertension were higher for those in the fourth quintile of dairy (OR: 1.88; 95% CI: 1.10, 3.24) than those in the third quintile.

Conclusions

Diet-disease relationships among Hispanic/Latino adults vary according to 2 population-based studies. These differences have research and practical implications when generalizing inferences on heterogeneous underrepresented populations.

Diets high in subsidized foods and chronic kidney disease in Hispanic communities in the United States: the Hispanic Community Health Study/Study of Latinos

Prior research shows that diets high in government subsidized foods may be associated with cardiometabolic disease risk factors. Our aim was to evaluate the relationship between diets high in subsidized foods and the development of chronic kidney disease (CKD) and other cardiometabolic risk factors in United States (US) Hispanics/Latinos. Using data from 16,172 Hispanics/Latino's living in the United States, we used the Cochran-Armitage test to assess the relationship between subsidized foods in the diets of participants and baseline characteristics. We used survey-weighted Poisson regression models to examine whether intake of subsidized foods was associated with incident CKD or cardiometabolic risk factors. Several baseline characteristics were associated with higher subsidized food scores. Higher subsidized food scores were not associated with incident CKD or cardiometabolic risk factors. These findings may be useful for future researchers, clinicians, and nutritional policy advocates who are interested in the way Hispanic and Latinos consume foods subsidized by the US government and the structural factors that may shape observed dietary and disease patterns.

Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week

Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.

Latino-White Disparities in Identification and Control of Elevated Blood Pressure Among Adults With Hypertension

BACKGROUND

Studies analyzing blood pressure (BP) management using the hypertension control cascade have consistently shown disparities in hypertension awareness, treatment, and BP control between Latino patients and non-Latino White patients. We analyze this cascade using electronic health record data from a multistate network of community health centers.

METHODS AND RESULTS

Data from 790 clinics in 23 US states from 2012 to 2020, including 1 270 174 patients, were analyzed to compare BP documentation in the electronic health record, clinician acknowledgment (diagnosis or treatment) of incident hypertension (BP ≥140/90), medication prescription, and BP control between non-Latino White patients, English-preferring Latino patients, and Spanish-preferring Latino patients, adjusted for patient-level covariates, and clustered on patients' primary clinics. Among the 429 182 patients with elevated BP (≥140/90) during ambulatory visits from 2012 to 2020, we found that clinician acknowledgment of hypertension was more likely in Spanish-preferring and English-preferring Latino patients versus non-Latino White patients (adjusted odds ratio [aOR], 1.17 [95% CI, 1.11-1.24]; aOR, 1.07 [95% CI, 1.02-1.12], respectively). In addition, Spanish-preferring Latino patients were more likely to receive a medication versus non-Latino White patients (aOR, 1.21 [95% CI, 1.16-1.28]). Among those receiving medication, Latino patients were as likely as non-Latino White patients to have their BP controlled (<140/90).

CONCLUSIONS

In a large retrospective study of community health center patients with incident hypertension, the expected disparities in hypertension management between Spanish-preferring Latino, English-preferring Latino, and non-Latino White patients were not identified. These findings add to the hypertension control cascade by examining robust electronic health record data from community health centers and may provide clues to reducing disparities in hypertension management.

Association of Acculturation and Hispanic/Latino Background with Endogenous Sex and Thyroid-Related Hormones Among Middle-Aged and Older Hispanic/Latino Adults: the HCHS/SOL Study

BACKGROUND

Hormones are linked to cardiometabolic diseases and may be impacted by acculturation though multiple mechanisms. We evaluated associations of Hispanic/Latino background and acculturation with levels of sex- and thyroid-related hormones and the potential mediating effect of adiposity, lifestyle factors, and sleep apnea syndrome on these associations.

METHODS

We studied 1789 adults, aged 45-74, from a sub-cohort of the Hispanic Community Health Survey/Study of Latinos. Peri/pre-menopausal women and individuals on medications related to hormones were excluded. Our study assessed eleven sex- and thyroid-related hormones, Hispanic/Latino background, and five acculturation measures. Associations were assessed using multivariable linear and logistic regression adjusted for survey design and confounding variables. We explored potential mediation using a path analysis.

RESULTS

In postmenopausal women, acculturation score-MESA was associated with decreased thyroid-stimulating hormone (β = - 0.13;95%CI = - 0.22, - 0.03) while age at immigration greater than the median (vs US-born) was associated with decreased (β = - 14.6; 95%CI = - 28.2, - 0.99) triiodothyronine (T3). In men, language acculturation and acculturation score-MESA were associated with increased estradiol and sex hormone-binding globulin (SHBG) while age at immigration greater and lesser than the median (vs US-born) was associated with decreased SHBG. Hispanic/Latino background (Mexicans as reference) were selectively associated with sex- and thyroid-related hormone levels in both sexes. Current smoking and sleep apnea syndrome partially mediated the association of Cuban and Puerto Rican heritage (vs Mexican) with T3 levels in men and postmenopausal women, respectively.

CONCLUSION

Selected acculturation measures were associated with thyroid-related hormones in postmenopausal women and sex-related hormones in men. Understanding the mechanisms involved in the relationship of acculturation and Hispanic/Latino background with hormones warrants additional investigation.

Using Community-Based Participatory Research Methods to Inform the Development of Medically Tailored Food Kits for Hispanic/Latine Adults with Hypertension: A Qualitative Study

The Dietary Approaches to Stop Hypertension (DASH) eating plan is the most effective dietary intervention for cardiovascular disease (CVD), but it excludes the consideration of culture and cost. The Hispanic/Latine population is disproportionately affected by CVD, with risks increasing if persons are accustomed to a Westernized diet. This research aims to understand the cultural dietary practices aligned with a DASH eating plan and the social determinants of health impacting fruit and vegetable (F/V) consumption among immigrant Hispanic/Latine individuals at a community-based clinic in Minnesota. Utilizing community-based participatory research methods, a community survey informed the development of DASH-focused, medically tailored food kits of varying F/V modalities. Qualitative feedback was sought out regarding the kits when presented to 15 individuals during in-depth interview sessions to validate the cultural appropriateness of food kits for clinical use. Box A was the highest rated kit (66.7%) and consisted of fresh F/V. The average F/V consumption per day was 2.6 ± 1.4 servings. The food insecurity questionnaires showed high/marginal (40%), low (53.3%), and very low (6.7%) food security. The barriers to consuming F/V were money, time, and transportation. Understanding cultural dietary practices related to the DASH eating plan is necessary to mitigate CVD risk and provide inclusive medical nutrition therapy for Hispanic/Latine populations.

Similarities and Dissimilarities in Diet Quality Differences by Acculturation Level between Mexican Americans and Other Hispanic Americans: National Health and Nutrition Examination Survey 2015-2018

BACKGROUND

Evidence suggests dietary acculturation can increase obesity and chronic disease risks. However, acculturation effects on diet quality among subgroups of Hispanic Americans is not well studied.

OBJECTIVES

Estimating percentages of Hispanic Americans with low, moderate, and high acculturation using 2 proxy measures with different language variables was the first objective. Identifying similarities and dissimilarities in diet quality differences by acculturation level between Mexican Americans and other Hispanic Americans was the second objective.

METHODS

The study sample included 1733 Mexican American and 1191 other Hispanic participants aged ≥16 y from National Health and Nutrition Examination Survey 2015-2018. Proxy measures included in the 2 acculturation scales were nativity/United States residence length, immigration age, language spoken at home (home), and language of dietary recall (recall). Replicate 24-h dietary recalls were conducted, and diet quality was assessed using the 2015 Healthy Eating Index. Analyses included statistical methods for complex survey designs.

RESULTS

For Mexican Americans, 8%, 35%, and 58% had low, moderate, and high acculturation on the home scale compared with 8%, 30%, and 62% on the recall scale. For other Hispanics, 17%, 39%, and 43% had low, moderate, and high acculturation on the home scale compared with 18%, 34%, and 48% on the recall scale. Similarities between ethnicities included higher acculturation associated with lower intakes of fruits, vegetables, total protein foods, seafood and plant proteins, and saturated fats and greater intake of sodium. Dissimilarities included higher acculturation associated with more whole grains and added sugars intakes and less refined grains intake (Mexican Americans), and less total dairy and fatty acids intakes (other Hispanic Americans).

CONCLUSIONS

Higher acculturation is associated with worsening diet quality for fruits, vegetables, and protein foods in all Hispanic Americans. However, associations of higher acculturation with worsening diet quality for grains, added sugars, dairy, and fatty acids were present only in specific subgroups of Hispanic Americans.

Estimation of life's essential 8 score with incomplete data of individual metrics

Background

The American Heart Association's Life's Essential 8 (LE8) is an updated construct of cardiovascular health (CVH), including blood pressure, lipids, glucose, body mass index, nicotine exposure, diet, physical activity, and sleep health. It is challenging to simultaneously measure all eight metrics at multiple time points in most research and clinical settings, hindering the use of LE8 to assess individuals' overall CVH trajectories over time.

Materials and methods

We obtained data from 5,588 participants in the Nurses' Health Studies (NHS, NHSII) and Health Professionaĺs Follow-up Study (HPFS), and 27,194 participants in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) with all eight metrics available. Individuals' overall cardiovascular health (CVH) was determined by LE8 score (0-100). CVH-related factors that are routinely collected in many settings (i.e., demographics, BMI, smoking, hypertension, hypercholesterolemia, and diabetes) were included as predictors in the base models of LE8 score, and subsequent models further included less frequently measured factors (i.e., physical activity, diet, blood pressure, and sleep health). Gradient boosting decision trees were trained with hyper-parameters tuned by cross-validations.

Results

The base models trained using NHS, NHSII, and HPFS had validated root mean squared errors (RMSEs) of 8.06 (internal) and 16.72 (external). Models with additional predictors further improved performance. Consistent results were observed in models trained using NHANES. The predicted CVH scores can generate consistent effect estimates in associational studies as the observed CVH scores.

Conclusions

CVH-related factors routinely measured in many settings can be used to accurately estimate individuals' overall CVH when LE8 metrics are incomplete.

Examining Generalizability of Nutrient-Based Food Patterns and Their Cross-Sectional Associations with Cardiometabolic Health for Hispanic/Latino Adults in the US: Results from the National Health and Nutrition Examination Survey (NHANES) and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

Ethnicity, cultural background, and geographic location differ significantly amongst the US Hispanic/Latino population. These characteristic differences can greatly define measured diet and its relationship with cardiometabolic disease, thus influencing generalizability of results.

Objective

We aimed to examine dietary patterns of Hispanic/Latino adults and their association with cardiometabolic risk factors (high cholesterol, hypertension, obesity, diabetes) across two representative studies with differing sampling strategies.

Methods

Data were collected from Mexican or Other Hispanic adult participants from 2007-2012 National Health and Nutrition Examination Survey (NHANES, n=3,209) and 2007-2011 Hispanic Community Health Survey/Study of Latinos (HCHS/SOL, n=13,059). Nutrient-based food patterns (NBFPs) were derived using factor analysis on nutrient intake data estimated from 24-hour dietary recalls and interpreted using common foods prominent in these nutrients. Cross-sectional association between NBFPs (quintiles) and cardiometabolic risk factors, defined by clinical measures and self-report, were estimated using survey-weighted logistic regression.

Results

Five NBFPs were identified in both studies: (1) meats, (2) grains/legumes, (3) fruits/vegetables, (4) dairy, and (5) fats/oils. Association to cardiometabolic risk factors differed by NBFP and study. In HCHS/SOL, persons in the highest quintile of meats NBFP had higher odds of diabetes (OR=1.43, 95%CI: 1.10, 1.86) and obesity (OR=1.36, 95%CI: 1.14, 1.63). Those in the lowest quintile of grains/legumes NBFP (OR=1.22, 95%CI: 1.02, 1.47) and the highest quintile of fats/oils (OR=1.26, 95%CI: 1.03, 1.53) also had higher odds of obesity. In NHANES, NBFPs associated with higher odds of diabetes included those in the lowest quintile of dairy (OR=1.66, 95%CI: 1.01, 2.72) and highest quintile of grains/legumes (OR=2.10, 95%CI: 1.26, 3.50). Persons in the fourth quintile of meats (OR=0.68, 95%CI: 0.47, 0.99) had lower odds of cholesterol.

Conclusion

Diet-disease relationships among Hispanic/Latino adults vary according to two representative studies. These differences have research and practical implications when generalizing inferences on heterogeneous underrepresented populations.

Immigration and use of preventive aspirin by Hispanics and non-Hispanic whites and non-Hispanic blacks in the US

BACKGROUND

In the US, little is known about aspirin use as a preventive measure for cardiovascular disease by immigration status.

METHODS

Combined data from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 and 2017- March 2020 (pre-pandemic data) were analyzed. Persons were asked about demographics including country of birth and those aged 40 years and older were asked about current use of aspirin to prevent cardiovascular disease (CVD).

RESULTS

Among 2,321 born in the US, preventive aspirin use was significantly more prevalent (39.6%) than among 910 others (27.5%, p < 0.01). However, after stratifying by race/ethnicity and history of CVD, the difference was significant only in Hispanics with CVD. In logistic regression analyses in Hispanics controlling for age, gender and education, the US born had significantly higher odds of aspirin use in those with or without CVD.

DISCUSSION

Among US Hispanics, use of aspirin for prevention of CVD was more prevalent in those born in the US than in others.

A Longitudinal Study of Acculturation in Context and Cardiovascular Health and Their Effects on Cognition Among Older Latino Adults

Background We previously outlined the importance of considering acculturation within the context of older Latino adults' lived experience (ie, acculturation in context) to better capture contributors to cognitive aging. We now examine this conceptual framework as related to level of and change in cardiovascular health, and whether cardiovascular health modifies previously documented associations of acculturation in context with cognition. Methods and Results Acculturation in context data from 192 Latino participants without dementia at baseline (age ~70 years) were compiled into 3 separate composite scores: acculturation-related (nativity, language-, and social-based preferences), contextually related socioenvironmental (experiences of discrimination, social isolation, social networks), and familism-related (Latino-centric family ethos). A modified American Heart Association's Life's Simple 7 (mLS7; ie, smoking, physical activity, body mass index, blood pressure, total cholesterol, blood glucose) was used to measure cardiovascular health. Mixed effects regressions simultaneously tested the association of all 3 composite scores with total mLS7 adjusting for confounders. Separate models tested whether mLS7 modified associations of the 3 composite scores and cognition. The contextually related socioenvironmental composite score reflecting higher discrimination, higher social isolation, and smaller social networks (estimate=0.22, SE=0.10, P=0.02) and the familism score (estimate=0.16, SE=0.07, P=0.02) both significantly associated with change in total mLS7. The acculturation-related composite was not significantly associated with change in mLS7. No composite was significantly associated with level of mLS7. Total mLS7, however, significantly modified associations between the acculturation-related composite and change in working memory (estimate=-0.02, SE=0.01, P=0.043). Conclusions Acculturation within the context of older Latino adults' lived experience is important for maintaining cardiovascular health, relationships that also affect domain-specific cognitive decline.

Estimation of Life's Essential 8 Score with Incomplete Data of Individual Metrics

Background

The American Heart Association's Life's Essential 8 (LE8) is an updated construct of cardiovascular health (CVH), including blood pressure, lipids, glucose, body mass index, nicotine exposure, diet, physical activity, and sleep health. It is challenging to simultaneously measure all eight metrics at multiple time points in most research and clinical settings, hindering the use of LE8 to assess individuals' overall CVH trajectories over time.

Methods and Results

We obtained data from 5,588 participants in the Nurses' Health Studies (NHS, NHSII) and Health Professional's Follow-up Study (HPFS), and 27,194 participants in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) with all eight metrics available. Individuals' overall cardiovascular health (CVH) was determined by LE8 score (0-100). CVH-related factors that are routinely collected in many settings (i.e., demographics, BMI, smoking, hypertension, hypercholesterolemia, and diabetes) were included as predictors in the base models of LE8 score, and subsequent models further included less frequently measured factors (i.e., physical activity, diet, blood pressure, and sleep health). Gradient boosting decision trees were trained with hyper-parameters tuned by cross-validations. The base models trained using NHS, NHSII, and HPFS had validated root mean squared errors (RMSEs) of 8.06 (internal) and 16.72 (external). Models with additional predictors further improved performance. Consistent results were observed in models trained using NHANES. The predicted CVH scores can generate consistent effect estimates in associational studies as the observed CVH scores.

Conclusions

CVH-related factors routinely measured in many settings can be used to accurately estimate individuals' overall CVH when LE8 metrics are incomplete.

Clinical Perspective

What Is New?: Life's Essential 8 (LE8) has great potential to assess and promote cardiovascular health (CVH) across life course, however, it is challenging to simultaneously collect all eight metrics at multiple time points in most research and clinical settings.We demonstrated that CVH-related factors routinely collected in many research and clinical settings can be used to accurately estimate individuals' overall CVH across time even when LE8 metrics are incomplete.What Are the Clinical Implications?: The approach introduced in this study provides a cost-effective and feasible way to estimate individuals' overall CVH.It can be used to track individuals' CVH trajectories in clinical settings.

A Posteriori dietary patterns, insulin resistance, and diabetes risk by Hispanic/Latino heritage in the HCHS/SOL cohort

Objective

We examined links among dietary patterns (DPs), insulin resistance (IR), and diabetes risk by heritage in the Hispanic Community Health Study/Study of Latinos.

Methods

Hispanics/Latinos of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American heritage aged 18–74 years and diabetes-free completed two 24 h dietary recalls at baseline (2008–2011) and provided 6-year follow-up data (2014–2017; n = 7774). We classified 6-year IR status [improved, unchanged (referent), worsened] using a 1-SD change in fasting insulin between visits and defined incident diabetes based on American Diabetes Association criteria. We derived heritage-specific DPs via principal factor analysis and estimated their associations with 6-year IR status (multinomial) and incident diabetes (binary) using complex survey-based logistic regression.

Results

Five overarching DPs based on high-loading foods were shared by two or more heritage groups: “Burger, Fries, & Soft Drinks”; “White Rice, Beans, & Red Meats”; “Fish & Whole Grains”; “Cheese & Sweets”; and “Stew & Corn”. Comparing highest-to-lowest DP quintiles, the Dominican “Burger, Fries, & Soft Drinks” and Cuban “White Rice, Beans, & Red Meats” DPs were associated with worsened 6-year IR status (log-odds: 2.35, 95% CI: 1.02, 3.68, P_trend = 0.037 and log-odds: 1.27, 95% CI: 0.49, 2.06, P_trend = 0.009, respectively). The Puerto Rican “Burger, Fries, & Soft Drinks” and the Central American “White Rice, Beans, & Red Meats” DPs were associated with greater diabetes incidence (OR: 3.00, 95% CI:1.50, 5.99 and OR: 2.41, 95% CI: 1.05, 5.50, respectively).

Conclusions

A diet characterized by higher intakes of burgers, fries, and soft drinks and another characterized by higher intakes of white rice, beans, and red meats may be adversely associated with IR and diabetes risk in some Hispanic/Latino heritage groups. Future work is needed to offer more heritage-specific dietary guidance for diabetes prevention in this population.

Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I² = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I² = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I² = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

Associations of clustered health risk behaviors with diabetes and hypertension in White, Black, Hispanic, and Asian American adults

Background

The clustering of Big Four contributors to morbidity and mortality—alcohol misuse, smoking, poor diet, and physical inactivity—may further elevate chronic health risk, but there is limited information about their specific combinations and associated health risks for racial/ethnic minority groups. We aimed to examine patterns of clustering in risk behaviors for White, Black, Hispanic, and Asian American adults and their associations with diabetes and hypertension. As these behaviors may be socioeconomically-patterned, we also examined associations between clustering and socioeconomic status (SES).

Methods

Latent class analyses and multinomial and logistic regressions were conducted using a nationally-representative sample of United States (US) adults ages 40–70 (N = 35,322) from Waves 2 (2004–2005) and 3 (2012–2013) of the National Epidemiologic Survey on Alcohol and Related Conditions. Obesity was used as a proxy for unhealthy diet. The outcomes were diabetes and hypertension.

Results

A relatively-healthy-lifestyle class was found only among White adults. Common patterns of unhealthy clustering were found across groups with some variations: the obese-inactive class among White, Black, and Hispanic adults (and the inactive class among Asian adults); the obese-inactive-smoking class among White, Black, and Hispanic adults; the smoking-risky-drinking class among White and Hispanic adults; and the smoking-risky-drinking-inactive class among Black and Asian adults. Positive associations of unhealthier clustering (having a greater number of risk behaviors) with lower SES (i.e., family income and education) and with health conditions were more consistent for Whites than for other groups. For racial minority groups, lower education than income was more consistently associated with unhealthy clusters. The associations between unhealthier clustering and diabetes and hypertension were less clear for Blacks and Asians than for Whites, with no significant association observed for Hispanics.

Conclusion

Concerted efforts to address clustered risk behaviors in most US adults, particularly in racial/ethnic minority groups given the high prevalence of unhealthy clustering, are warranted.

Dietary Patterns and Years Living in the United States by Hispanic/Latino Heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND

Previous diet findings in Hispanics/Latinos rarely reflect differences in commonly consumed and culturally relevant foods across heritage groups and by years lived in the United States.

OBJECTIVES

We aimed to identify and compare a posteriori heritage-specific dietary patterns (DPs) and evaluate their associations with "healthfulness" [using the Alternative Healthy Eating Index-2010 (AHEI-2010)] and years living in the United States.

METHODS

We used baseline data from a population-based cohort of 14,099 Hispanics/Latinos aged 18-74 y in the Hispanic Community Health Study/Study of Latinos. We performed principal factor analysis using two 24-h recalls to derive DPs, separately, in each heritage group (Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American), and identified overarching DPs based on high-loading foods shared by ≥2 groups. We used multivariable linear regression to test associations of DPs with AHEI-2010 and years living in the United States.

RESULTS

We identified 5 overarching DPs (Burgers, Fries, & Soft Drinks; White Rice, Beans, & Red Meats; Fish; Egg & Cheese; and Alcohol). All Burgers, Fries, & Soft Drinks DPs were inversely associated with AHEI-2010, whereas all Fish DPs (except Dominican) were positively associated with this index (all P-trend < 0.001). White Rice, Beans, & Red Meats DPs showed inverse associations in Cuban and Central American groups and positive associations in Mexican-origin individuals (all P-trend < 0.001). Fewer years living in the United States was associated with higher scores for White Rice, Beans, & Red Meats DPs in Cuban and Mexican heritage groups and lower scores on Burgers, Fries, & Soft Drinks DPs in Cuban, Mexican, and Puerto Rican groups (all P-trend < 0.01).

CONCLUSIONS

Our findings show substantial variation in DPs across Hispanics/Latinos and adherence to DPs by time in the United States, which could inform dietary interventions targeting this diverse US population. This trial was registered at clinicaltrials.gov as NCT02060344.

Prevalence of self-reported obesity among diverse Latino adult populations in New York City, 2013-2017

INTRODUCTION

Latinos in the United States represent a heterogeneous population disproportionally impacted by obesity. Yet, the prevalence of obesity by specific Latino group is unclear. Using the New York City Community Health Survey (2013-2017), this study compared self-reported obesity in the city's largest Latino adult populations (Puerto Ricans, Mexicans, Dominicans, Ecuadorians, and Colombians).

METHODS

Age-standardized prevalence using the 2000 Census and prevalence ratios (PRs) for self-reported obesity (BMI ≥30 kg/m2) by country of origin were estimated using weighted multivariable logistic regression adjusting for socio-demographic characteristics, health status, and behaviors.

RESULTS

Obesity prevalence among Mexicans (36.8%; 95% CI [31.5, 42.4]) and Puerto Ricans (36.3%; 95% CI [31.7, 41.3]) was significantly higher than that among Colombians (23.8%; 95% CI [18.8, 29.5]), Ecuadorians (24.2%; 95% CI [20.7, 28.1]), and Dominicans (27.0%; 95% CI [25.0, 29.1]). After adjusting for covariates, compared to Mexicans, the PRs of obesity remained significantly lower for Colombians (PR = 0.80; 95% CI [0.64, 1.00]), Ecuadorians (PR = 0.72; 95% CI [0.61, 0.86]) and Dominicans (PR = 0.75; 95% CI [0.65, 0.85]). There was no significant difference between Mexicans and Puerto Ricans.

CONCLUSION

Obesity prevalence differs by country of origin, suggesting that clustering of Latinos in public health research may obscure unique risks among specific groups. Despite group differences, all Latino groups exhibit high prevalence of obesity and warrant renewed efforts tailored to the specific context and culture of each group to prevent and reduce obesity.

Understanding Immigration as a Social Determinant of Health: Cardiovascular Disease in Hispanics/Latinos and South Asians in the United States

PURPOSE OF REVIEW

The main purpose of this review is to summarize the epidemiology of cardiovascular disease and its risk factors among two of the largest and most diverse immigrant groups in the United States (Hispanics/Latinos and South Asians).

RECENT FINDINGS

While the migration process generates unique challenges for individuals, there is a wide heterogeneity in the characteristics of immigrant populations, both between and within regions of origin. Hispanic/Latino immigrants to the United States have lower levels of cardiovascular risk factors, prevalence, and mortality, but this assessment is limited by issues related to the "salmon bias." South Asian immigrants to the United States generally have higher levels of risk factors and higher mortality. In both cases, levels of risk factors and mortality generally increase with time of living in the United States (US). While immigration acts as a social determinant of health, associations between immigration and cardiovascular disease and its risk factors are complex and vary across subpopulations.

Volunteerism and Cardiovascular Health: The HCHS/SOL Sociocultural Ancillary Study

OBJECTIVES

The objective of this study was to examine the association between volunteerism and favorable cardiovascular health (CVH) among Hispanics/Latinos living in the US.

METHODS

Data from the Hispanic Community Health Study/Study of Latinos (2008-2011) Sociocultural Ancillary Study were used (N = 4,926; ages 18-74 years). Favorable CVH was defined as positive profiles of all major CVD risk factors: low total serum cholesterol, blood pressure, and body mass index; not having diabetes; and not smoking. Survey-weighted logistic regression models were adjusted for sociodemographic, lifestyle, and psychological factors. In secondary analyses, we tested whether the volunteerism-CVH association was modified by sex, age, or years lived in the US (<10 vs. ≥10 years; a proxy acculturation measure).

RESULTS

Prevalence of volunteerism was 14.5%. Compared to non-volunteers, volunteers had 1.67 higher odds of favorable CVH in the fully-adjusted model (Odds Ratio [OR] = 1.67, 95% Confidence Interval [CI] = 1.11, 2.52). There was evidence of effect modification by acculturation; only volunteers who had lived in the US ≥10 years had 2.41 higher odds of favorable CVH (OR = 2.41, 95% CI=1.53, 3.80). There was no evidence of effect modification by sex or age.

CONCLUSIONS

Volunteerism was associated with favorable CVH among US Hispanics/Latinos.

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

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

DASH diet and prevalent metabolic syndrome in the Hispanic Community Health Study/Study of Latinos

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for lowering blood pressure and preventing cardiovascular disease (CVD), but little data exist on these associations in US Hispanics/Latinos. We sought to assess associations between DASH score and prevalence of metabolic syndrome (MetS) and its components in diverse Hispanics/Latinos. We studied 10,741 adults aged 18–74 in the multicenter Hispanic Community Health Study/Study of Latinos. Dietary intake was measured using two 24-hour recalls, and MetS defined per the 2009 harmonized guidelines. We assessed cross-sectional associations of DASH score and MetS (and its dichotomized components) using survey logistic regression, and DASH and MetS continuous components using linear regression. We also stratified these models by Hispanic/Latino heritage group to explore heritage-specific associations. We found no associations between DASH and MetS prevalence. DASH was inversely associated with both measures of blood pressure (p < 0.01 for systolic and p < 0.001 for diastolic) in the overall cohort. DASH was also inversely associated with diastolic blood pressure in the Mexican (p < 0.05), Central American (p < 0.05), and South American (p < 0.01) groups; triglycerides (p < 0.05) in the Central American group; fasting glucose overall (p < 0.01) and in the Mexican group (p < 0.01); and waist circumference overall (p < 0.05) and in the South American group (p < 0.01). DASH was positively associated with HDL-cholesterol (p < 0.01) in the Central American group. DASH may better capture diet-MetS associations in Hispanic/Latino subpopulations such as Central/South Americans; this study also adds evidence that Hispanics/Latinos should be analyzed by heritage. Further research, and/or culturally tailored DASH measures will help further explain between-heritage differences.

Length of Residence and Cardiovascular Health among Afro-Caribbean Immigrants in New York City

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.

Hispanic representation in diabetes cardiovascular outcomes trials

OBJECTIVE

To examine Hispanic/Latino representation in diabetes cardiovascular outcomes trials for novel antidiabetic drugs.

RESEARCH DESIGN AND METHODS

We compared Hispanic/Latino representation, age, gender and body mass index in diabetes cardiovascular outcomes trials published from January 2008 to October 2018 to Hispanic adults with diabetes in the National Health Examination and Nutrition Survey over the same time period.

RESULTS

Hispanics/Latinos comprised 18.5 % of trial subjects, which was similar to the proportion of US adults with diabetes who identify as Hispanic. Trial subjects were significantly younger, more likely to be female, and more obese than US Hispanics/Latinos. At least 10 different Latin American countries and territories were represented across the 10 trials.

CONCLUSIONS

US Hispanics/Latinos differ from subjects in diabetes cardiovascular outcomes trials, which may limit generalizability of trial results.

Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008-2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.

Acculturation of immigrant diet, basic taste responses and sodium appetite

In young new Ethiopian immigrants (EI, about 0·5 years since immigration; n 20), veteran Ethiopian immigrant students (ES, about 13 years since immigration; n 30) and native Israeli students (NS; n 82), dietary macronutrients and electrolytes, and responses to basic tastes were compared in a cross-sectional design. From EI, to ES, to NS, dietary energy, protein, fat, and Na⁺ increase, whereas carbohydrates, K⁺ and Ca²⁺ do not differ. Corrected for energy intake, only Na⁺ increases. EI consume less dietary Na⁺, like foods with less Na⁺ content, salt their food less, yet show a greater hedonic response to salt taste. In contrast, preference for sweet does not differ. Taste psychophysics, 6-n-propylthiouracil (PROP) responses and lingual fungiform papillae density differ by group (and sex), but do not relate to dietary intake. Together, these changes could reflect dietary acculturation, increasing overall intake, Na⁺ in particular, accompanied by decreasing taste sensitivity, and changes in sensory perception and preference in these Ethiopian immigrants. The fact that immigrants find salt more hedonic, yet eat less of it, could suggest increased sensitivity to its taste, and might suggest restoring sensitivity to reduce Na⁺ intake for all. Similar alterations in taste sensory responses might be obtained in other forms of dietary flux. Understanding dietary acculturation can focus efforts (e.g. on Na⁺), to anticipate the disease burden of diets of affluence among immigrants. Yet, these immigrants’ nutrition is healthier in its low fat and Na⁺, suggesting that nutritional advice should focus on preservation, as well as prevention. Our study adds Ethiopian nutritional acculturation to that of the varied immigrant groups around the world.

Trends in Racial/Ethnic and Nativity Disparities in Cardiovascular Health Among Adults Without Prevalent Cardiovascular Disease in the United States, 1988 to 2014

BACKGROUND

Trends in cardiovascular disparities are poorly understood, even as diversity increases in the United States.

OBJECTIVE

To examine U.S. trends in racial/ethnic and nativity disparities in cardiovascular health.

DESIGN

Repeated cross-sectional study.

SETTING

NHANES (National Health and Nutrition Examination Survey), 1988 to 2014.

PARTICIPANTS

Adults aged 25 years or older who did not report cardiovascular disease.

MEASUREMENTS

Racial/ethnic, nativity, and period differences in Life's Simple 7 (LS7) health factors and behaviors (blood pressure, cholesterol, hemoglobin A1c, body mass index, physical activity, diet, and smoking) and optimal composite scores for cardiovascular health (LS7 score ≥10).

RESULTS

Rates of optimal cardiovascular health remain below 40% among whites, 25% among Mexican Americans, and 15% among African Americans. Disparities in optimal cardiovascular health between whites and African Americans persisted but decreased over time. In 1988 to 1994, the percentage of African Americans with optimal LS7 scores was 22.8 percentage points (95% CI, 19.3 to 26.4 percentage points) lower than that of whites in persons aged 25 to 44 years and 8.0 percentage points (CI, 6.4 to 9.7 percentage points) lower in those aged 65 years or older. By 2011 to 2014, differences decreased to 10.6 percentage points (CI, 7.4 to 13.9 percentage points) and 3.8 percentage points (CI, 2.5 to 5.0 percentage points), respectively. Disparities in optimal LS7 scores between whites and Mexican Americans were smaller but also decreased. These decreases were due to reductions in optimal cardiovascular health among whites over all age groups and periods: Between 1988 to 1994 and 2011 to 2014, the percentage of whites with optimal cardiovascular health decreased 15.3 percentage points (CI, 11.1 to 19.4 percentage points) for those aged 25 to 44 years and 4.6 percentage points (CI, 2.7 to 6.5 percentage points) for those aged 65 years or older.

LIMITATION

Only whites, African Americans, and Mexican Americans were studied.

CONCLUSION

Cardiovascular health has declined in the United States, racial/ethnic and nativity disparities persist, and decreased disparities seem to be due to worsening cardiovascular health among whites rather than gains among African Americans and Mexican Americans. Multifaceted interventions are needed to address declining population health and persistent health disparities.

PRIMARY FUNDING SOURCE

National Institute of Neurological Disorders and Stroke and National Center for Advancing Translational Sciences of the National Institutes of Health.

Acculturation and dietary intake pattern among Jamaican immigrants in the US

Information on dietary intakes of Jamaican immigrants in the United States is sparse. Understanding factors that influence diet is important since diet is associated with chronic diseases. This study examined the association between acculturation, socio-cultural factors, and dietary pattern among Jamaican immigrants in Florida. Jamaican persons 25–64 years who resided in two South Florida counties were recruited for participation. A health questionnaire that assessed acculturation, dietary pattern, and risk factors for cardiovascular disease was administered to participants. Generalized Estimating Equations were used to determine associations. Acculturation score was not significantly associated with dietary intake pattern (β = − 0.02 p = 0.07). Age at migration was positively associated with traditional dietary pattern (β = 0.02 p < 0.01). Persons with 12 or fewer years of education (β = − 0.55 p < 0.001), divorced (β = − 0.26 p = 0.001), or engaged in less physical activity (β = − 0.07 p = 0.01) were more likely to adhere to a traditional diet. Although acculturation was not a statistically significant predictor of dietary intake, findings show the role of demographic and lifestyle characteristics in understanding factors associated with dietary patterns among Jamaicans. Findings point to the need to measure traditional dietary intakes among Jamaicans and other immigrant groups. Accurate assessment of disease risk among immigrant groups will lead to more accurate diet-disease risk assessment and development of effective intervention programs.

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Age at migration was associated with traditional diet among Jamaican immigrants.

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Persons with lower educational attainment were more likely to eat traditional foods.

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Residing in an ethnic enclave was not associated with having a traditional diet.

Association Between Immigration History and Inflammatory Marker Profiles Among Older Adult Mexican Americans

Foreign-born Hispanics have better cardiometabolic health upon arrival in the US than their US-born counterparts, yet this advantage diminishes as duration of residence in the US increases. Underlying mechanisms explaining this paradox have been understudied. Using data from the Sacramento Area Latino Study on Aging (SALSA), this study examined immigration history (immigrant generation and duration of US residence) in relation to biomarkers of inflammation (interleukin-6 (IL-6), soluble forms of type 1 and 2 receptors of tumor necrosis factor-alpha (sTNF-R1 and sTNF-R2), C-reactive protein (CRP), leptin, adiponectin) in a sample of 1,290 predominantly Mexican-origin immigrants. Second and ≥3rd generation immigrants had higher IL-6 and leptin levels than 1st generation immigrants living in the US for less than 15 years (2nd generation percent difference = 45.9; 95% CI: 24.7, 70.7 and 3rd generation percent difference = 41.8; 95% CI: 17.7, 70.4). CRP and sTNF-R1 levels were higher among ≥3rd generation immigrants than 1st generation immigrants with less than 15 years of US residency. Worse inflammatory profiles were observed among Mexican-origin immigrants with longer US immigration histories, independent of health, and behavioral factors. Additional research is warranted to understand the factors that shape trajectories of biological risk across generations of Hispanics.

Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults

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.