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Cai X, White Q, Wang DR, DeFilippi CR, Bertoni AG, Wu CO, Liu K, Lima JAC, Budoff MJ, Fonarow GC, Watson KE, McClelland RL, Yang EH. Cardiovascular Risks and Outcomes Among Chinese American Immigrants: Insights From the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e037114. [PMID: 39235461 DOI: 10.1161/jaha.124.037114] [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: 06/17/2024] [Accepted: 08/06/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Immigrants experience changes in cardiovascular risk factors and racial disparities in both cardiovascular health prevention and outcomes upon immigration. We aimed to examine cardiovascular risk factors and outcomes among Chinese American immigrants enrolled in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. METHODS AND RESULTS We analyzed data from 746 Chinese American immigrants in the MESA study with a median follow-up period of 17.8 years. The mean age of the cohort was 62.3 years, with 52.7% being women. Kaplan-Meier curves and Cox proportional hazards models were used to assess the association of immigration history, geographic location, biomarkers, and cardiac imaging parameters with cardiovascular risk factors and cardiovascular outcomes. The Cox hazards models were adjusted for known family history of heart disease, education level, sex, diabetes, hypertension, age, and body mass index. Although immigration history categorized as earlier (<20 years) versus later (≥20 years) showed no association with cardiovascular outcomes, the duration of residence in the United States emerged as a strong predictor for an increased risk of cardiovascular disease death (hazard ratio 1.39 [95% CI, 1.07-1.8]; P=0.012). All-cause mortality differed significantly between the Chinese immigrants from Los Angeles and those from Chicago, with higher survival probability in Chicago (log-rank test, P=0.018). Furthermore, elevated levels of N-terminal pro-brain natriuretic peptide levels, left ventricular mass, and coronary artery calcium scores were associated with the risk of cardiovascular disease among Chinese immigrants. CONCLUSIONS Within the MESA cohort, the duration of residence and geographic location were associated with the risk of cardiovascular disease outcomes among Chinese immigrants.
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Affiliation(s)
- Xinjiang Cai
- Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
| | - Quinn White
- Department of Biostatistics University of Washington School of Public Health Seattle WA
| | - Daniel R Wang
- Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
| | | | - Alain G Bertoni
- Department of Epidemiology and Prevention Wake Forest School of Medicine Winston-Salem NC
| | - Colin O Wu
- Office of Biostatistics Research National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | - Kiang Liu
- Department of Preventive Medicine Northwestern University Chicago IL
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD
| | - Matthew J Budoff
- Division of Cardiology The Lundquist Institute at Harbor-UCLA Medical Center Los Angeles CA
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
| | - Karol E Watson
- Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
| | - Robyn L McClelland
- Department of Biostatistics University of Washington School of Public Health Seattle WA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
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Li J, Zhang L, Lowres N, Shi W, Honda K, Gallagher R. Understand nurse's perspectives on communication with Chinese-speaking cardiac patients. PATIENT EDUCATION AND COUNSELING 2024; 130:108405. [PMID: 39236516 DOI: 10.1016/j.pec.2024.108405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/02/2024] [Accepted: 08/16/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES To explore communication experiences, resource accessibility/quality, and communication strategies cardiac nurses use when caring for Chinese-speaking patients. METHODS In this exploratory qualitative study, nurses were recruited from professional association members and interviewed on communication barriers/facilitators, resource accessibility/quality, and communication strategies used when caring for Chinese-speaking cardiac patients. Transcripts were thematically analysed. RESULTS Nurses (n = 11) were primarily female (7/11), with 2/11 Chinese-speaking. The themes discussed centred on two areas that created difficulty in communication, including the lack of a common language and uncertainty of the Chinese culture. Dependence on interpreters was highlighted and challenges noted included limited availability and difficulty scheduling, variable quality and approaches, and lack of communication resources leading to a dependence on poor quality materials. Nurses were uncertain about Chinese culture and how to communicate, particularly in relation to family-centred beliefs, mental and sexual health, medication, and diet. CONCLUSIONS Health communication with Chinese-speaking patients needs to address multiple challenges to be effective. PRACTICE IMPLICATIONS The findings emphasise the need to optimise interpreting services and provide nurses with cultural competency training and tailored resources to improve their understanding of Chinese immigrants' needs. These recommendations will support nurses to address identified language and cultural uncertainties.
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Affiliation(s)
- Jialin Li
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Nicole Lowres
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Heart Research Institute, 7 Eliza Street, Newtown, NSW, Australia
| | - Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Kazuma Honda
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Heart Research Institute, 7 Eliza Street, Newtown, NSW, Australia
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Wang H, Fu Q, Xiao S, Ma X, Liao Y, Kang C, Yang R. Predictive value of the triglyceride-glucose index for short- and long-term all-cause mortality in patients with critical coronary artery disease: a cohort study from the MIMIC-IV database. Lipids Health Dis 2024; 23:263. [PMID: 39175047 PMCID: PMC11340174 DOI: 10.1186/s12944-024-02252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index is linked to a poor prognosis for cardiovascular condition and is a valid indicator of insulin resistance. This study evaluated the potential predicting usefulness of the TyG index for all-cause mortality, both short- and long-term, for those concerning critical coronary artery disease (CAD). METHODS In this study, information from 5452 critically-ill individuals with CAD in intensive care units were gathered from the Medical Information Marketplace in Intensive Care (MIMIC-IV) database. Depending on the TyG index degree, the patients were categorized into three categories. Clinical outcomes included short-term (30-day) and long-term (365-day) all-cause mortality. The corresponding relationships involving the TyG index and clinical outcomes were examined by deploying restricted cubic spline (RCS) regression analysis and Cox proportional risk regression. RESULTS An increased TyG index was associated with increased 30-day (Tertile 1: 6.1%, Tertile 2: 7.3%, Tertile 3: 9.2%, P = 0.001) and 365-day (Tertile 1: 15.2%, Tertile 2: 17.0%, Tertile 3: 19.6%, P = 0.002) death rates across all causes. Cox regression with multiple variables indicates that higher TyG indices were linked to higher all-caused mortality hazard ratios throughout the short and long terms, with a larger predictive value for the former. RCS regression analyses suggested that the risk of death was notably and linearly that is associated with TyG index. CONCLUSIONS The TyG index is a reliable predictor of all-cause mortality at different stages in critically ill CAD patients, with a higher predictive ability for short-term mortality. Early intervention in patients with elevated TyG index may improve their survival outcomes. Future research should delve into understanding its pathophysiological mechanisms and develop intervention strategies based on the TyG index, providing new insights and strategies to enhance the outlook for critically ill CAD patients.
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Affiliation(s)
- Huijian Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Qingan Fu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Shucai Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Xiaowei Ma
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Yanhui Liao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Changlong Kang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Renqiang Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China.
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Zeng L, Xu X, Perry L. Self-care behaviours of first-generation Chinese immigrants living with cardiovascular disease: A qualitative study. J Adv Nurs 2024. [PMID: 38923031 DOI: 10.1111/jan.16302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/07/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
AIM To identify and describe self-care behaviours performed by Chinese immigrants living with cardiovascular disease in Australia, and factors perceived as barriers and facilitators to evidence-based cardiac self-care. DESIGN A qualitative descriptive design. METHODS Individual semi-structured phone interviews were conducted among participants meeting the following criteria: (1) first-generation Chinese immigrants to Australia, born in Mainland China, Hong Kong, Macao or Taiwan; (2) Australian permanent residents or citizens; (3) self-reported or medically diagnosed with coronary heart disease, stroke or heart failure; (4) able to speak English or Mandarin; (5) able to provide informed consent, excluding those with history or evidence of impaired cognition such as dementia. Participants were recruited via social media, Chinese community associations and medical centres from September 2021 to June 2022. Data were analysed using inductive and deductive thematic analysis, guided by the Middle-Range Theory of Self-Care of Chronic Illness. The study was reported in line with the COREQ checklist. RESULTS Twenty participants were interviewed, 60% female, mean age 69.9 years. Most migrated to Australia at older age following their retirement in China; most had limited English proficiency. Many practiced adequate self-care for their CVD in self-care maintenance and monitoring. Variously, they adopted heart-healthy diets, developed exercise routines, attended medical services and closely monitored their body signs and symptoms. However, self-adjusting medications, taking Traditional Chinese Medicine and self-administering health supplements were prevalent practices and first-response management of acute cardiac symptoms was suboptimal. Linguistic and cultural barriers to obtaining mainstream heart health information meant most participants resorted to informal, anecdotal and mainland Chinese sources. CONCLUSION Diverse factors were held responsible for sub-optimal self-care behaviours but lack of access to linguistically and culturally appropriate heart health information was widely blamed. Linguistically and culturally appropriate community-based heart health education programmes are urgently needed, targeting healthy lifestyle modification, medication literacy and cardiac symptom management. IMPACT Study findings can be used to improve cardiac nurses' cultural sensitivity and practices targeting Chinese immigrants. Partnering with Chinese community associations offers health service providers and policymakers an innovative route to co-design and deliver targeted heart health education interventions and support for this population. PUBLIC CONTRIBUTION Chinese community centre managers contributed to data collection by supporting participant recruitment.
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Affiliation(s)
- Ling Zeng
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Xiaoyue Xu
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Population Health, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Roelfs DJ, Shor E. The problematic nature of existing explanations for differential immigrant mortality: Insights from a comparative cross-national systematic review and meta-analysis. Soc Sci Med 2024; 349:116897. [PMID: 38648707 DOI: 10.1016/j.socscimed.2024.116897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Empirical studies in multiple disciplines have frequently observed an immigrant mortality advantage. Yet, questions remain regarding the possible mechanisms underlying this phenomenon. We obtained data from 61 studies of relative immigrant mortality from single origin-destination country pairings, providing information on immigrants from 77 origin countries. We systematically review the arguments made in these studies about origin-country factors that might influence immigrant mortality and then use meta-analyses to examine the veracity of these arguments. We find that most existing origin-country explanations for immigrant mortality patterns (e.g., health behaviors, genetic characteristics, environmental conditions, and socioeconomic conditions) are problematic or insufficient when accounting for differential mortality by origin country. We identify non-comparative analyses and geographic aggregation as the two major obstacles to understanding the mechanisms underlying the immigrant mortality advantage. We conclude by advocating for a risk-factor-based, cross-national approach.
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Zhang L, Xing M, Yu Q, Li Z, Tong Y, Li W. Blood urea nitrogen to serum albumin ratio: a novel mortality indicator in intensive care unit patients with coronary heart disease. Sci Rep 2024; 14:7466. [PMID: 38553557 PMCID: PMC10980814 DOI: 10.1038/s41598-024-58090-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
The blood urea nitrogen to albumin ratio (BAR) has been demonstrated as a prognostic factor in sepsis and respiratory diseases, yet its role in severe coronary heart disease (CHD) remains unexplored. This retrospective study, utilizing data from the Medical Information Mart for Intensive Care-IV database, included 4254 CHD patients, predominantly male (63.54%), with a median age of 74 years (IQR 64-83). Primary outcomes included in-hospital, 28-day and 1-year all-cause mortality after ICU admission. The Kaplan-Meier curves, Cox regression analysis, multivariable restricted cubic spline regression were employed to assess association between BAR index and mortality. In-hospital, within 28-day and 1-year mortality rates were 16.93%, 20.76% and 38.11%, respectively. Multivariable Cox proportional hazards analysis revealed associations between the increased BAR index and higher in-hospital mortality (HR 1.11, 95% CI 1.02-1.21), 28-day mortality (HR 1.17, 95% CI 1.08-1.27) and 1-year mortality (HR 1.23, 95% CI 1.16-1.31). Non-linear relationships were observed for 28-day and 1-year mortality with increasing BAR index (both P for non-linearity < 0.05). Elevated BAR index was a predictor for mortality in ICU patients with CHD, offering potential value for early high-risk patient identification and proactive management by clinicians.
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Affiliation(s)
- Lingzhi Zhang
- Center of Clinical Big Data and Analytics of The Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Muqi Xing
- Center of Clinical Big Data and Analytics of The Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Qi Yu
- Center of Clinical Big Data and Analytics of The Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Zihan Li
- Center of Clinical Big Data and Analytics of The Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Yilin Tong
- Center of Clinical Big Data and Analytics of The Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Wenyuan Li
- Center of Clinical Big Data and Analytics of The Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.
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Shi W, Zhang L, Fethney J, Ghisi GLM, Gallagher R. Cultural Adaptation and Psychometric Validation of a Cardiac Knowledge Questionnaire for Chinese Immigrants. J Cardiovasc Nurs 2024; 39:178-188. [PMID: 36752750 DOI: 10.1097/jcn.0000000000000976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Disease-related knowledge deficits are common in Chinese immigrants living in Western countries, putting them at risk of disease progression and mortality, particularly those with a coronary heart disease (CHD) diagnosis. However, no measurement instrument is available to assess CHD-related knowledge in this population. OBJECTIVES The aim of this study was to culturally adapt and examine the psychometric properties of the short version of Coronary Artery Disease Education Questionnaire (CADE-Q SV) (simplified Chinese version) in Chinese immigrants with CHD. METHODS Mandarin-speaking people recruited from medical centers and cardiology clinics across metropolitan Sydney completed the 20-item CADE-Q SV (5 domains; potential scores: 0-20). Internal consistency was assessed using Cronbach α . A subgroup (n = 40) repeated the survey 2 weeks later for test-retest reliability by intraclass correlation coefficient. Factor structure (confirmatory factor analysis) and discriminant (known-groups) validation using education and English proficiency (univariate general linear model) were also undertaken. RESULTS Participants (n = 202) had a mean (SD) age of 66.08 (10.93) years, 45.1% were male, and the mean (SD) total CADE-Q SV score was 13.07 (4.57). Reliability and consistency were good (intraclass correlation coefficient > 0.70; Cronbach α coefficients > 0.70, for total and per domain, respectively). The 5-domain structure was validated by confirmatory factor analysis. The scale demonstrated discriminant validity, with low education ( P < .001) and low English proficiency ( P = .017) associated with lower knowledge scores. CONCLUSION The CADE-Q SV (simplified Chinese version) can be used as a valid and reliable instrument, either paper based or digital, to evaluate the CHD-related knowledge of Chinese immigrants. This scale can be adapted to other migrant populations in the future.
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Zhang R, Shi S, Chen W, Wang Y, Lin X, Zhao Y, Liao L, Guo Q, Zhang X, Li W, Zhang K, Liao Y, Fang Y. Independent effects of the triglyceride-glucose index on all-cause mortality in critically ill patients with coronary heart disease: analysis of the MIMIC-III database. Cardiovasc Diabetol 2023; 22:10. [PMID: 36639637 PMCID: PMC9838037 DOI: 10.1186/s12933-023-01737-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index is a reliable alternative biomarker of insulin resistance (IR). However, whether the TyG index has prognostic value in critically ill patients with coronary heart disease (CHD) remains unclear. METHODS Participants from the Medical Information Mart for Intensive Care III (MIMIC-III) were grouped into quartiles according to the TyG index. The primary outcome was in-hospital all-cause mortality. Cox proportional hazards models were constructed to examine the association between TyG index and all-cause mortality in critically ill patients with CHD. A restricted cubic splines model was used to examine the associations between the TyG index and outcomes. RESULTS A total of 1,618 patients (65.14% men) were included. The hospital mortality and intensive care unit (ICU) mortality rate were 9.64% and 7.60%, respectively. Multivariable Cox proportional hazards analyses indicated that the TyG index was independently associated with an elevated risk of hospital mortality (HR, 1.71 [95% CI 1.25-2.33] P = 0.001) and ICU mortality (HR, 1.50 [95% CI 1.07-2.10] P = 0.019). The restricted cubic splines regression model revealed that the risk of hospital mortality and ICU mortality increased linearly with increasing TyG index (P for non-linearity = 0.467 and P for non-linearity = 0.764). CONCLUSIONS The TyG index was a strong independent predictor of greater mortality in critically ill patients with CHD. Larger prospective studies are required to confirm these findings.
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Affiliation(s)
- Rongting Zhang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Shanshan Shi
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Weihua Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Yani Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Xueqin Lin
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Yukun Zhao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Lihua Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Qian Guo
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Xiaoying Zhang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
- The Graduate School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Weiguo Li
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Kaijun Zhang
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Ying Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Yong Fang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
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How and Why Diets Change Post-Migration: A Qualitative Exploration of Dietary Acculturation among Recent Chinese Immigrants in Australia. Nutrients 2022; 14:nu14173573. [PMID: 36079830 PMCID: PMC9460769 DOI: 10.3390/nu14173573] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022] Open
Abstract
Chinese immigrants living in Western countries are at increased risk for cardiometabolic diseases. Dietary acculturation has been implicated as a potential contributor, but little is known about why diets change post-migration. The purpose of this qualitative research study was to explore how and why diets change post-migration for Chinese immigrants living in Australia. Eleven participants undertook semi-structured interviews exploring and comparing their diets when they lived in China to their post-migration diets. Thematic analysis revealed that participants exhibited changed social structures of meal preparation, and made unacknowledged dietary changes, such as recipe modification, to maintain their traditional Chinese diet post-migration. Implications of both deliberate and unrecognized dietary changes post-migration include connections to increased risk for metabolic disease post-migration.
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Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review. J Immigr Minor Health 2021; 24:1564-1579. [PMID: 34807354 PMCID: PMC8606270 DOI: 10.1007/s10903-021-01313-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/10/2023]
Abstract
The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.
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Zeng L, Perry L, Xu X. Self-care behaviours and related cultural factors among Chinese immigrants with cardiovascular disease in western countries: an integrative review. J Clin Nurs 2021; 32:1599-1614. [PMID: 34761466 DOI: 10.1111/jocn.16120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This review aimed to demonstrate the self-care behaviours of first-generation Chinese immigrants with cardiovascular disease in western countries and identify related cultural factors. BACKGROUND Self-care is the cornerstone to mitigate disease symptoms and maintain health status. Chinese immigrants to western countries, operating within a cross-cultural context, may find self-care to manage their cardiovascular disease challenging. DESIGN An integrative review was conducted. METHODS Seven databases were searched Scopus, ProQuest Health & Medicine, Medline (Ovid), Embase (Ovid), AMED (Ovid), PsycINFO and CINAHL, with output limited to peer-reviewed studies published from 2000 to 2020 in English or Chinese. Initially, 2037 papers were screened. Six papers were retained and critiqued using the Joanna Briggs Institute critical appraisal tools. Deductive and inductive approaches were utilised to analyse the findings. The PRISMA 2020 checklist informed review reportage. RESULT In general, Chinese immigrants with cardiovascular disease took an active role in management of their cardiovascular disease, including through diet and activity adaptation and adherence to western medication. Families also played a significant role in disease decision-making and management. However, language and cultural barriers impeded their access to health information and resources in host countries. RELEVANCE TO CLINICAL PRACTICE Understanding self-care behaviours and associated cultural factors among Chinese immigrants with cardiovascular disease is important to improve nurses' culturally sensitive practices and provide tailored health education interventions to promote self-care behaviours among immigrant populations. The scarcity of literature on self-care behaviours among Chinese first-generation immigrants with cardiovascular disease indicates the need for further research in this area. Development of culturally and linguistically sensitive health resources and education programs is urgently needed.
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Affiliation(s)
- Ling Zeng
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Xiaoyue Xu
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
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Liu X, Ghisi GLM, Meng S, Grace SL, Shi W, Zhang L, Gallagher R, Oh P, Aultman C, Sandison N, Ding B, Zhang Y. Establishing a process to translate and adapt health education materials for natives and immigrants: The case of Mandarin adaptations of cardiac rehabilitation education. Heart Lung 2021; 50:794-817. [PMID: 34233218 DOI: 10.1016/j.hrtlng.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a proven model of secondary prevention in which patient education is a core component. OBJECTIVES to translate and culturally-adapt CR patient education for Mandarin-speaking patients living in China as well as immigrants, and offer recommendation for best practices in adaptation for both. METHODS these steps were undertaken in China and Canada: (1) preparation; (2) translation and adaptation; (3) review by healthcare providers based on PEMAT-P; (4) think-aloud review by patients; and (5) finalization. RESULTS Two independent Mandarin translations were undertaken using best practices: one domestic (China) and one international (immigrants). Input by 23 experts instigated revisions. Experts rated the language and content as culturally-appropriate, and perceived the materials would benefit their patients. A revised version was then administered to 36 patients, based on which a few edits were made to optimize understandability. CONCLUSIONS some important differences emerged between translations adapted for native versus immigrant settings.
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Affiliation(s)
- Xia Liu
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Gabriela L M Ghisi
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada.
| | - Shu Meng
- Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sherry L Grace
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada; Faculty of Health, York University, Toronto, Canada
| | - Wendan Shi
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ling Zhang
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Biao Ding
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Yaqing Zhang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
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Li J, Lowres N, Koo FK, Gallagher R. A systematic review of quantitative and qualitative literature on health professionals' experiences communicating with Chinese immigrants. Int J Nurs Pract 2021; 27:e12960. [PMID: 34013647 DOI: 10.1111/ijn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/31/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to determine health professionals' experiences communicating with Chinese immigrants and identify potential education barriers. BACKGROUND Health professionals caring for Chinese immigrants often encounter communication barriers, leading to uncertainty of quality of care. DESIGN This study is a quantitative and qualitative systematic review. DATA SOURCES MEDLINE, Scopus, CINAHL, PubMed and Google Scholar were searched, limited to 1980 to October 2020. REVIEW METHODS Articles were included if they reported results about health professional communication with Chinese patients. Quality was appraised using Consolidated Criteria for Reporting Qualitative Research guidelines and thematic synthesis conducted. RESULTS Of 1363 articles, seven studies were included. These described provider-patient communication in primary care, oncology and palliative settings only. Three core themes were identified: (1) family-centred health communication where family controls provider-patient information exchange; (2) mismatch of provider-patient health beliefs and knowledge on diet, nutrition, traditional medicine, place for death and disease prevention and (3) mismatch of language and resources as skilled providers proficient in specific dialects are limited; communication resources are perceived as infrequently available and content is insufficient. CONCLUSION Studies describing health professionals' experiences communicating with Chinese immigrants are limited. Key barriers identified included cultural and language disparities and communication resources are inadequate to support health professionals' needs.
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Affiliation(s)
- Jialin Li
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Lowres
- Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Fung Kuen Koo
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
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14
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Shor E, Roelfs D. A Global Meta-analysis of the Immigrant Mortality Advantage. INTERNATIONAL MIGRATION REVIEW 2021. [DOI: 10.1177/0197918321996347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A large body of research on the “Healthy Immigrant Effect” (or “Paradox”) has reported an immigrant mortality advantage. However, other studies do not find such significant effects, and some even present contradictory evidence. This article is the first systematic meta-analysis that investigates the immigration-mortality relationship from a global perspective, examining 1,933 all-cause and cardiovascular mortality risk estimates from 103 publications. Our comprehensive analysis allows us to assess interactions between origin and destination regions and to reexamine, on a global scale, some of the most notable explanations for the immigrant mortality advantage, including suggestions that this paradox may be primarily the result of selection effects. We find evidence for the existence of a mild immigrant mortality advantage for working-age individuals. However, the relationship holds only for immigrants who moved between certain world regions, particularly those who immigrated from Northern Africa, Asia, and Southern Europe to richer countries. The results highlight the need in the broader migration literature for an increased focus on selection effects and on outcomes for people who chose not to migrate or who were denied entry into their planned destination country.
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15
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Vyas MV, Austin PC, Fang J, Laupacis A, Silver FL, Kapral MK. Immigration Status, Ethnicity, and Long-term Outcomes Following Ischemic Stroke. Neurology 2021; 96:e1145-e1155. [PMID: 33472924 DOI: 10.1212/wnl.0000000000011451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/30/2020] [Accepted: 10/28/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the association between immigration status and ethnicity and the outcomes of mortality and vascular event recurrence following ischemic stroke in Ontario, Canada. METHODS We conducted a retrospective cohort study using linked administrative and clinical registry-based data from 2002 to 2018 and compared hazards of all-cause mortality and vascular event recurrence in immigrants and long-term residents using inverse probability of treatment weighting accounting for age, sex, income, and comorbidities. We stratified analyses by age (≤75 and >75 years) and used interaction terms to evaluate whether the association between immigration status and outcomes varied with age or ethnicity. RESULTS We followed 31,918 adult patients, of whom 2,740 (8.6%) were immigrants, for a median follow-up of 5 years. Immigrants had lower mortality than long-term residents (46.1% vs 64.5%), which was attenuated after adjustment (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.88-1.00), but persisted in those younger than 75 years (HR 0.82; 0.74-0.91). Compared to their respective ethnic long-term resident counterparts, the adjusted hazard of death was higher in South Asian immigrants, similar in Chinese immigrants, and lower in other immigrants (p value for interaction = 0.003). The adjusted hazard of vascular event recurrence (HR 1.01; 0.92-1.11) was similar in immigrants and long-term residents, and this observation persisted across all age and ethnic groups. CONCLUSIONS Long-term mortality following ischemic stroke is lower in immigrants than in long-term residents, but is similar after adjustment for baseline characteristics, and it is modified by age at the time of stroke and by ethnicity.
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Affiliation(s)
- Manav V Vyas
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Peter C Austin
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Jiming Fang
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Andreas Laupacis
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Frank L Silver
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Moira K Kapral
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK.
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16
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Zhang L, Ding D, Fethney J, Gallagher R. A psychometric evaluation of the Health Literacy Questionnaire for Chinese immigrants: Linguistic and cultural considerations. Int J Nurs Pract 2021; 27:e12909. [PMID: 33501737 DOI: 10.1111/ijn.12909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Health literacy is an important predictor of health outcomes. The Health Literacy Questionnaire has been widely adopted to measure health literacy and has been translated into multiple languages including Chinese. This study aims to evaluate the psychometric properties of the simplified Chinese Health Literacy Questionnaire. METHODS Data were obtained from a sample of 362 Chinese immigrants from Chinese community organizations in New South Wales, Australia. Statistical analyses include descriptive and exploratory factor analyses. RESULTS A seven-factor solution was derived from 39 of the original 44 items, all with acceptable to excellent internal consistency but differing from the original construction. The health literacy subscale scores were negatively associated with age and with age at immigration, but positively associated with duration of stay (years) in Australia, better English proficiency and current employment. Differing interpretations of the questions based on Chinese culture could possibly explain the variations between the two versions. CONCLUSION The simplified Chinese Health Literacy Questionnaire measures some central concepts of health literacy well. However, the questionnaire may require further development, especially in linguistic and cultural aspects.
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Affiliation(s)
- Ling Zhang
- Susan Wakil School of Nursing and Midwifery/Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Ding Ding
- The Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery/Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery/Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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17
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Beasley JM, Wagnild JM, Pollard TM, Roberts TR, Ahkter N. Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review. BMC Public Health 2020; 20:1019. [PMID: 32600296 PMCID: PMC7322842 DOI: 10.1186/s12889-020-08805-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants. METHODS Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups. RESULTS Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m2; (95% CI: - 2.06, - 0.21), I2 = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I2 = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I2 = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG). CONCLUSIONS This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families. TRIAL REGISTRATION The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).
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Affiliation(s)
- Jeannette M. Beasley
- Department of Medicine, NYU Grossman School of Medicine, 462 First Avenue CD 673, New York, NY 10016 USA
| | - Janelle M. Wagnild
- Department of Anthropology, Durham University, South Road, Durham, DH1 3LE UK
| | - Tessa M. Pollard
- Department of Anthropology, Durham University, South Road, Durham, DH1 3LE UK
| | - Timothy R. Roberts
- NYU Health Sciences Library, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Nasima Ahkter
- Department of Anthropology, Durham University, South Road, Durham, DH1 3LE UK
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18
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Ding D, Ramirez Varela A, Bauman AE, Ekelund U, Lee IM, Heath G, Katzmarzyk PT, Reis R, Pratt M. Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health. Br J Sports Med 2020; 54:462-468. [PMID: 31562122 PMCID: PMC7146932 DOI: 10.1136/bjsports-2019-101001] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/25/2022]
Abstract
In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancet series on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancet series and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an 'upstream' public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as 'roadmaps' in progress to encourage moving the field of physical activity towards achieving population-level impact globally.
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Affiliation(s)
- Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory Heath
- The Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | | | - Rodrigo Reis
- Research Group in Physical Actvity and Quality of Life (GPAQ), Pontifícia Universidade Católica do Paraná,Curitiba, Curitiba, Brazil
- Postgraduate Program in Urban Management (PPGTU), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Michael Pratt
- Institute for Public Health, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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19
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Wu B, Pei Y, Zhang W, Northridge M. Immigrant Status, Resilience, and Perceived Oral Health Among Chinese Americans in Hawaii. Res Aging 2020; 42:186-195. [PMID: 32195629 DOI: 10.1177/0164027520912493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aims to examine the associations among immigrant status, resilience, and perceived oral health for Chinese American older adults in Hawaii. METHOD Data derived from 430 Chinese American adults aged 55 years and older residing in Honolulu, HI. We compared the self-rated oral health and oral health problems between U.S.-born Chinese Americans and foreign-born Chinese Americans by using ordered logistic regression and ordinary least squares regression models. RESULTS Findings suggest that immigrant status and lower levels of resilience are associated with poorer self-rated oral health and more oral health problems for Chinese American older adults in Hawaii. Resilience is more strongly associated with self-rated oral health for U.S.-born Chinese American than for foreign-born Chinese Americans, but this pattern was not evident for oral health problems. DISCUSSION Older Chinese American immigrants in Hawaii are disadvantaged in terms of their oral health. Understanding their susceptibilities may lead to targeted interventions.
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Affiliation(s)
- Bei Wu
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Wei Zhang
- Department of Sociology, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Mary Northridge
- NYU Grossman School of Medicine, New York University, NY, USA
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20
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Han S, Zhao X, Zhang X, Xu Y, Geng J, Wang Y. Acetaldehyde Dehydrogenase 2 rs671 Polymorphism Affects Hypertension Susceptibility and Lipid Profiles in a Chinese Population. DNA Cell Biol 2019; 38:962-968. [PMID: 31361523 DOI: 10.1089/dna.2019.4647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous studies revealed that the rs671 polymorphism in the acetaldehyde dehydrogenase 2 (ALDH2) genes is correlated with alcohol consumption in Japanese population. The ALDH2 gene variants and drinking are associated with hypertension and dyslipidemia. However, it remains unclear whether there might be potent relationships among ALDH2 rs671 polymorphism, alcohol consumption, hypertension, and dyslipidemia in Shandong population. A total of 467 male volunteers from Shandong area were enrolled in this study. The ALDH2 rs671 polymorphism was genotyped using polymerase chain reaction-restriction fragment length polymorphism. The concentrations of total cholesterol (TC), triglycerides, low-density lipoprotein, and high-density lipoprotein (HDL) in serum were measured using commercial kits. SPSS 23.0 was used for statistical analysis. The significance of differences between subgroups was determined using chi-square test, and multiple comparisons were performed with the least-significant difference method. The ALDH2 variant frequencies were 80.5% with GG, 17.1% with GA, and 2.4% with AA. The ALDH2 genotypes had significant correlations with alcohol consumption (p = 0.001), whereas the GA genotype was associated with a decreased risk of alcohol consumption (odds ratio = 0.27; 95% confidence interval = 0.130-0.539; p = 0.001). The ALDH2 genotypes frequencies and drinking habits were significantly different between hypertension and healthy individuals (p = 0.034; p = 0.044). The ALDH2 GG genotype individuals have high average lipids levels, and the proportion of TC disorder among GG individuals was higher than that of GA individuals (p = 0.006). Individuals who had drinking habits have a high average lipids levels; especially average TC levels (p = 0.048), and had high proportions of dyslipidemia (TC and HDL; p = 0.016 and p = 0.033, respectively). The frequencies of ALDH2 variants were evaluated according to the Hardy-Weinberg equilibrium among enrolled population. Our study suggested that the individuals with ALDH2 rs671 GA genotype were less prone to developing a drinking habit in Shandong population. The ALDH2 genotypes and drinking habit were associated with hypertension and lipid profiles especially TC profile in Shandong province. The ALDH2 rs671 genotypes indicated that the gene-related drinking habit and gene variant altogether may affect hypertension and dyslipidemia.
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Affiliation(s)
- Shuyi Han
- Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Xin Zhao
- Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Xiaoqian Zhang
- Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Yihui Xu
- Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Jun Geng
- Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Yunshan Wang
- Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, P.R. China
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Jin K, Neubeck L, Koo F, Ding D, Gullick J. Understanding Prevention and Management of Coronary Heart Disease Among Chinese Immigrants and Their Family Carers: A Socioecological Approach. J Transcult Nurs 2019; 31:257-266. [DOI: 10.1177/1043659619859059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Health disparities among immigrants exist across socioecological domains. While Chinese immigrants face increased risk for coronary heart disease (CHD) after migration, the reasons are not well understood. Method: This descriptive qualitative study collected 18 semistructured interviews with Chinese immigrants with CHD and family carers from two Australian hospitals. Analysis was guided by the social–ecological model. Results: Poor knowledge and limited English proficiency increased CHD risk and difficulty navigating health care systems/resources. Interpersonal and family factors positively influenced health-seeking behaviors, acceptance of cardiac procedures, adoption of secondary preventive behaviors and information acquisition through social networks. A lack of culturally specific health information and programs in Chinese languages was described. Ethnic concordance between Chinese doctors and patients improved health literacy and engendered trust. Discussion: Culturally specific interventions could include health promotion materials in Chinese, inclusion of family in educational programs, and Chinese-focused public health campaigns about warning signs of heart attack.
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Affiliation(s)
- Kai Jin
- University of Sydney, Camperdown, New South Wales, Australia
| | | | - Fung Koo
- University of Sydney, Camperdown, New South Wales, Australia
| | - Ding Ding
- University of Sydney, Camperdown, New South Wales, Australia
| | - Janice Gullick
- University of Sydney, Camperdown, New South Wales, Australia
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22
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King-Shier K, Quan H, Kapral MK, Tsuyuki R, An L, Banerjee S, Southern DA, Khan N. Acute coronary syndromes presentations and care outcomes in white, South Asian and Chinese patients: a cohort study. BMJ Open 2019; 9:e022479. [PMID: 30867199 PMCID: PMC6429729 DOI: 10.1136/bmjopen-2018-022479] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Successful treatment of acute coronary syndrome (ACS) relies on its rapid recognition. It is unclear whether the accepted presentation of chest pain applies to different ethnic groups. We thus examined potential ethnic variations in ACS symptoms and clinical care outcomes in white, South Asian and Chinese patients. DESIGN Cross-sectional survey. SETTING Participants were hospitalised at 1 of 12 Canadian centres across four provinces. PARTICIPANTS 1334 patients with ACS (630 white; 488 South Asian; 216 Chinese). MAIN OUTCOME MEASURES ACS presentation symptoms (classic/typical midsternal pain/discomfort with or without radiation to the left neck, shoulder or arm) were assessed by self-report. Clinical care outcomes (time to emergency room [ER] presentation, cardiac catheterisation; receipt of cardiac catheterisation, percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) were obtained by health record audit. RESULTS The mean age of the sample was 62 years and 30% had ST-elevation myocardial infarction (STEMI). The most common presenting symptom was midsternal pain/discomfort of any intensity regardless of ethnic status. Yet, a substantial proportion of patients reported atypical symptoms (33% white, 19% South Asian, 20% Chinese; p<0.006). After adjustment for age, sex, education, current smoking, extent of coronary artery disease, presence of diabetes or chronic kidney disease and STEMI vs non-STEMI/unstable angina, South Asians were more likely to present with at least moderate intensity midsternal pain/discomfort (adjusted OR [AOR] 1.44; 95% CI 1.05 to 1.98), whereas Chinese were less likely to present with radiating symptoms (AOR 0.53; 95% CI 0.38 to 0.74) compared with whites. South Asians with atypical pain (relative to those with midsternal pain/discomfort) took significantly longer to present to the ER (p=0.037), and were less likely to receive PCI (p=0.008) or CABG (p=0.041). CONCLUSIONS Atypical presentations were associated with greater delays in arrival to the emergency department and reduced invasive cardiovascular care in South Asians.
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Affiliation(s)
| | - Hude Quan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - M K Kapral
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ross Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Libin An
- School of Nursing, Dalian University, Dalian, China
| | - Suvro Banerjee
- Cardiology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | | | - Nadia Khan
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Zhang L, Ding D, Neubeck L, Gallagher P, Paull G, Gao Y, Gallagher R. Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study. JMIR Cardio 2018; 2:e13. [PMID: 31758767 PMCID: PMC6858003 DOI: 10.2196/cardio.9424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/25/2018] [Accepted: 05/13/2018] [Indexed: 01/26/2023] Open
Abstract
Background Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results ‘Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or “other” language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with “other” language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05). Conclusions This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR.
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Affiliation(s)
- Ling Zhang
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Ding Ding
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Lis Neubeck
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Patrick Gallagher
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Glenn Paull
- Cardiology Department, St George Hospital, Kogarah, Australia
| | - Yan Gao
- Cardiology Department, St George Hospital, Kogarah, Australia
| | - Robyn Gallagher
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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24
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Dafoe WA, Wong CC. Acculturation and evolving cardiovascular disease: An unhealthy dyad. Eur J Prev Cardiol 2018; 25:432-436. [DOI: 10.1177/2047487317750438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Candice C Wong
- Institute for Health and Aging, University of California San Francisco, USA
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25
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Odone A, McKee C, McKee M. The impact of migration on cardiovascular diseases. Int J Cardiol 2018; 254:356-361. [PMID: 29407123 DOI: 10.1016/j.ijcard.2017.11.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Odone
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Charlotte McKee
- Department of War Studies, Kings College London, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
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26
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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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27
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Self-management Following a Cardiac Event in People of Chinese Ethnicity Living in Western Countries: A Scoping Review. J Immigr Minor Health 2017; 20:744-754. [DOI: 10.1007/s10903-017-0584-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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