scholarly journals Discrimination Is Associated with Elevated Cardiovascular Disease Risk among African Immigrants in the African Immigrant Health Study

2020 ◽  
Vol 30 (4) ◽  
pp. 651-660
Author(s):  
Ruth-Alma N. Turkson-Ocran ◽  
Sarah L. Szanton ◽  
Lisa A. Cooper ◽  
Sherita H. Golden ◽  
Rexford S. Ahima ◽  
...  
Keyword(s):  
Risk Factors ◽  
Immigrant Health ◽  
African Immigrants ◽  
The United States ◽  
Health Study ◽  
Care Providers ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
African Immigrant ◽  
African Immigrant Health

Background: African Americans and other persons of African descent in the United States are disproportionately affected by cardiovascular diseases (CVD). Discrimi­nation is associated with higher CVD risk among US adults; however, this relationship is unknown among African immigrants.Objective: To examine the associations among discrimination, resilience, and CVD risk in African immigrants.Methods: The African Immigrant Health Study was a cross-sectional study of African immigrants in Baltimore-Washington, DC, with recruitment and data collection taking place between June 2017 and April 2019. The main outcome was elevated CVD risk, the presence of ≥3 CVD risk factors includ­ing hypertension, diabetes, high choles­terol, overweight/obesity, tobacco use, and poor diet. The secondary outcomes were these six individual CVD risk factors. The exposure was discrimination measured with the Everyday Discrimination Scale; summed scores ≥2 on each item indicated frequent experiences of discrimination. Resilience was assessed with the 10-item Connor- Davidson resilience scale. Logistic regression was used to examine the odds of elevated CVD risk, adjusting for relevant covariates.Results: We included 342 participants; 61% were females. The mean (±SD) age was 47(±11) years, 61% had at least a bachelor’s degree, 18% had an income <$40,000, and 49% had lived in the US ≥15 years. Persons with frequent experi­ences of discrimination were 1.82 times (95%CI: 1.04–3.21) more likely to have elevated CVD risk than those with fewer experiences. Resilience did not moderate the relationship between CVD risk and discrimination.Conclusion: African immigrants with frequent experiences of discrimination were more likely to have elevated CVD risk. Tar­geted and culturally appropriate interven­tions are needed to reduce the high burden of CVD risk in this population. Health care providers should be aware of discrimina­tion as a meaningful social determinant of CVD risk. At the societal level, policies and laws are needed to reduce the occurrence of discrimination among African immi­grants and racial/ethnic minorities. Ethn Dis. 2020;30(4):651-660;doi:10.18865/ed.30.4.651

Abstract P474: The Association Between Acculturation and Cardiovascular Disease Risk Factors: The African Immigrant Health Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ruth-alma N Turkson-ocran ◽  
Diana Baptiste ◽  
Oluwabunmi Ogungbe ◽  
Binu Koirala ◽  
Yvonne Commodore-mensah
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Immigrant Health ◽  
African Immigrants ◽  
Health Study ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Us ◽  
African Immigrant Health ◽  
The U.S

Introduction: African immigrants are a growing population with over 2.1 million residing in the United States (U.S). Like African Americans, their African descent counterparts, African immigrants have an increased risk of developing cardiovascular disease (CVD). Hypothesis: We hypothesized that greater length of residence in the U.S. will be associated with an increased number of CVD risk factors among African Immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of African immigrants living in the Baltimore-Washington, D.C Metropolitan area. The main outcome of interest was high CVD risk, defined as the presence of ≥2 CVD risk factors including hypertension, diabetes, high cholesterol, and overweight/obesity. The secondary outcomes were the 4 CVD risk factors examined individually. The exposure was length of U.S. stay, used as a proxy for acculturation and defined as < 10 years or ≥ 10 years in the U.S. Logistic regression was used to examine the odds of high CVD risk and the individual CVD risk factors, adjusting for relevant covariates. Results: We included N=317 African immigrants, with mean(±se) age 48(±12) years, 61% were female, 63% had a Bachelor’s degree or higher, 81% were employed, and 59% had lived in the US ≥10 years. Unadjusted, African immigrants with longer length of stay were more likely to have the four CVD risk factors examined. African Immigrants who had lived in the U.S. ≥ 10 years were 1.89 times (95%CI: 1.03-3.46) more likely to have ≥2 CVD risk factors than those who had lived in the U.S. < 10 years after adjusting for age, income, employment status, insurance status, and routine place for healthcare. The unadjusted and adjusted results are presented in the Table. Conclusion: African immigrants who had lived in the US ≥10 years were more likely to have more CVD risk factors than those who had lived in the U.S. for <10 years. CVD risk increases with length of stay in this population, underscoring the need for length of stay to be considered as a meaningful determinant of CVD risk.

Abstract P354: The “Afro-Cardiac Study” Identifies High Burden of Cardiovascular Disease Risk in West African Immigrants in the United States

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Yvonne Y Commodore-Mensah ◽  
Charles A Berko ◽  
Maame E Sampah ◽  
Joycelyn Cudjoe ◽  
Cheryl D Himmelfarb
Keyword(s):  
Risk Factors ◽  
Social Support ◽  
Health Insurance ◽  
Vigorous Physical Activity ◽  
African Immigrants ◽  
The United States ◽  
West African ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
West African Immigrants

Introduction: The African immigrant population grew 40-fold between 1960 and 2007, from 35,355 to 1.4 million with one third coming from West Africa, primarily Ghana and Nigeria. African immigrants have been understudied and, traditionally, lumped into the racial category of Black/African-American. We have examined the prevalence of CVD risk factors (hypertension, overweight/obesity, diabetes, hyperlipidemia, current smoking and physical inactivity), assessed global CVD risk and identified independent predictors of increased CVD risk by sex in West African immigrants (WAI). Methods: Cross-sectional study of WAI (Ghanaians and Nigerians) aged 35-74 years recruited from churches in the Baltimore/ Washington, DC metropolitan area. CVD risk factors were determined per AHA guidelines. Descriptive statistics were performed on participant’s Pooled Cohort Equations (PCE) scores and CVD risk factors with comparison by sex. Participants with PCE scores ≥7.5% and ≥3 CVD risk factors were deemed high risk. A multivariable logistic regression was fitted to identify independent predictors of high CVD risk. Results: The mean age of the 253 participants was 49.5±9.2 years and 58% were female. Males were more likely to be employed than females (90% vs. 72%; p=0.001). Only 52% of participants had health insurance. The majority [54% [137/253)] had ≥3 CVD risk factors and 28% had PCE score ≥7.5%. Smoking was the least prevalent (<1%) and overweight/obesity the most prevalent (88%) risk factor. Although females (64%) were more likely to be treated for hypertension than males (36%), there was no difference in hypertension control by sex. Diabetes was identified in 16% of the participants. Mean total cholesterol (TC) was 180.9±33.9mg/dL and 32% had TC level ≥200mg/dL. In addition, 44% were found to be physically inactive (<150minutes/week of moderate or <75minutes/week of vigorous physical activity). In females, employment [0.18 AOR, 95%CI: 0.075-0.44)] and health insurance [0.35 AOR, 95%CI 0.14-0.87)] were associated with a PCE score ≥7.5%. In males, higher social support was associated with a 0.92 (95%CI: 0.84-0.98) odds of having ≥3 CVD risk factors. Conclusion: The high prevalence of CVD risk among relatively young WAIs is worrisome and suggests that the “healthy immigrant effect” may no longer hold for 21st century African immigrants. Employment and health insurance were protective against high CVD risk in females with social support protective against high CVD risk in males. CVD prevention strategies must be tailored to the unique needs of the WAI with consideration of socioeconomic status and sex.

Abstract P397: Social Determinants of Hypertension and Diabetes Among African Immigrants: The African Immigrant Health Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Oluwabunmi Ogungbe ◽  
Ruth-alma N Turkson-ocran ◽  
Diana Baptiste ◽  
Binu Koirala ◽  
Cheryl R Dennison Himmelfarb ◽  
...  
Keyword(s):  
Health Insurance ◽  
Marital Status ◽  
Social Determinants ◽  
Immigrant Health ◽  
Cardiovascular Health ◽  
African Immigrants ◽  
Health Study ◽  
Cross Sectional ◽  
African Immigrant ◽  
African Immigrant Health

Introduction: The differences in the risk of cardiovascular disease (CVD) among Black ethnic groups in the U.S. remain largely unexplained. African immigrants are particularly likely to have high rates of hypertension and diabetes, and less likely to be screened, diagnosed or receive treatment. Objective: To examine the association between social determinants of health (SDoH) and hypertension and diabetes among African immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of 465 African immigrants living in the Baltimore-Washington metropolitan area. Data collection was performed through a combination of physical examinations and questionnaires. The outcomes were self-reported hypertension and diabetes. Elements of SDoH collected were education, income, health insurance, employment and marital status. Logistic regression analyses were used to assess the association between SDoH and hypertension/diabetes. Results: The mean age of participants was 46.8(±11.5) years and 60% were women; 64% had ≥ college degree, 83% were employed, 67% had health insurance, and 70% were married/co-habiting. Mean body mass index was 30.7 (±18.3) kg/m 2 . The prevalence of hypertension and diabetes was 32%, and 13% respectively. The odds of diabetes were higher amongst those who were unemployed [aOR: 2.86 (1.39-5.56)] ( Table ). Education, health insurance, income and marital status were not associated with hypertension or diabetes after accounting for age and sex. Conclusion: Among African immigrants, we observed that those who were unemployed had a higher likelihood of self-reported diabetes than those who were employed. Additional studies are needed to further study the contributions of social determinants of hypertension and diabetes as well as and developing health policy and interventions to improve cardiovascular health.

scholarly journals Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ogbonnaya I. Omenka ◽  
Dennis P. Watson ◽  
Hugh C. Hendrie
Keyword(s):  
United States ◽  
Scoping Review ◽  
Immigrant Health ◽  
African Immigrants ◽  
The United States ◽  
Cost Of Care ◽  
African Immigrant ◽  
Healthcare Experiences ◽  
African Immigrant Health ◽  
The U.S

Abstract Background Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the “black” category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. Methods Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. Results Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers. Conclusion Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.

scholarly journals Understanding the Healthcare Experiences and Needs of African Immigrants in the United States: A Scoping Review

2019 ◽  
Author(s):  
Ogbonnaya Isaac Omenka ◽  
Dennis P. Watson ◽  
Hugh C. Hendrie
Keyword(s):  
United States ◽  
Scoping Review ◽  
Immigrant Health ◽  
African Immigrants ◽  
The United States ◽  
Cost Of Care ◽  
African Immigrant ◽  
Healthcare Experiences ◽  
African Immigrant Health ◽  
The U.S

Abstract Background: Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the “black” category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. Methods: Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. Results: Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers. Conclusion: Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.

Abstract P006: Cardiovascular Disease Risk Factor Burden is Associated With Hearing Loss in Young Men: The Hispanic Community Health Study/Study of Latinos

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Rachael R Baiduc ◽  
Brittany Bogle ◽  
Franklyn Gonzalez ◽  
Elizabeth Dinces ◽  
David J Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Hearing Loss ◽  
Total Cholesterol ◽  
Young Women ◽  
Young Men ◽  
Health Study ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Hispanic Community

Introduction: Over 30 million Americans suffer from hearing loss (HL). Studies suggest that established cardiovascular disease (CVD) risk factors may contribute to the pathophysiology of the inner ear. However, the aggregate effect of CVD risk factors on hearing is not well understood. Hypothesis: We hypothesized that high CVD risk burden is associated with worse hearing. Methods: We assessed younger (ages 18-34) and older (ages 55-64) Hispanic Community Health Study / Study of Latinos participants who underwent audiometry in 2008-11. After excluding those with conductive pathology and asymmetric HL, we randomly chose one ear for analysis. Puretone thresholds were obtained at 0.5-8 kHz; puretone average (PTA) was calculated using thresholds at 0.5, 1, 2, and 4 kHz. Low CVD risk burden was defined as having all of: blood pressure (BP) <120/<80 mmHg; total cholesterol <180 mg/dL; not currently smoking; and not having prevalent diabetes. High CVD risk burden was defined as ≥ 2 of: diabetes; currently smoking; BP >160/>100 mmHg (or antihypertensive use); and total cholesterol >240 mg/dL (or statin use). By age group and sex, we estimated hearing thresholds per frequency with linear regression models adjusted for noise exposure. Least squares estimates were calculated using strata-specific means of covariates. Estimates were compared via t-tests. Data were weighted for all analyses and accounted for clustering. Results: Among younger and older individuals in the target population (51.9% female), 28.8% had low and 5.5% had high CVD risk. Younger men with high CVD risk had worse PTA than young men with low risk (7.7 dB HL [7.0-8.4] vs. 10.5 dB HL [8.4-12.5], p =0.02), and had significantly worse thresholds at 1,3,4,6 kHz than those with low risk ( Figure ). There was no difference in PTA or thresholds at any frequency by CVD risk burden in young women, older men, or older women. Conclusions: CVD risk burden is associated with HL among young men, but not young women or older adults. CVD risk burden may be useful for identifying young men at risk for HL.

Abstract P115: Relationship between Cardiovascular Risk Factors and Psychological Distress among Hispanic/Latinos: The Hispanic Community Health Study/ Study of Latinos

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Sheila F Castaneda ◽  
Patricia Gonzalez ◽  
Linda C Gallo ◽  
Gregory A Talavera ◽  
Addie L Fortmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychological Distress ◽  
Depressive Symptomatology ◽  
Health Study ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Sampling Weights ◽  
Hispanic Community ◽  
Unit Increase ◽  
Hispanic Latinos

Background: Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress. Minimal research has been conducted exploring the relationship between psychological distress and CVD risk among Hispanic/ Latinos (H/L) of different background groups. The aim of this study was to investigate which CVD risk factors were most strongly correlated with psychological distress. Methods: The multi-site prospective population-based Hispanic Community Health Study/ Study of Latinos enrolled a cohort of H/L adults (n = 16,415) ages 18-74 in four US communities (Chicago, San Diego, Miami, and Bronx). Households were selected using a stratified two-stage probability sampling design and door-to-door recruitment, and sampling weights calibrated to the 2010 US Population Census. Analyses involve 15,464 participants with complete data. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale and 10 item Spielberger Trait Anxiety Scale), socio-demographics (i.e., age, education, health insurance, gender, and H/L background), acculturation (i.e., years in the U.S., country of birth, and language), and CVD risk factors [i.e., dyslipidemia (HDL cholesterol < 40, LDL cholesterol ≥ 160,or triglycerides ≥ 200), body mass index (BMI), current cigarette smoking, diabetes (i.e., fasting time > 8 hr AND fasting glucose ≥ 126, or fasting time ≤ 8 hr AND fasting glucose ≥ 200, or post-OGTT glucose ≥ 200, or A1C≥ 6.5 or on medication), and hypertension (blood pressure ≥140/90 or on mediations)] were measured during the HCHS/SOL baseline exam. Associations between CVD risk factors and psychological distress were assessed using multiple linear regression models with depression and anxiety as dependent variables, accounting for the complex survey design and sampling weights, and controlling for socio-demographic and acculturation covariates. Results: Current smoking, diabetes, and BMI were significantly associated with depression and anxiety symptoms, after adjusting for covariates. Mean depressive symptomatology was 1.66 higher among smokers, .58 higher among diabetics, and increased by .04 for every one unit increase in BMI; mean anxiety symptomatology was 1.31 higher among smokers, .58 higher among diabetics, and increased by .05 for every one unit increase in BMI, adjusting for other factors. Dyslipidemia and hypertension were not associated with depression or anxiety. Discussion: Results demonstrate that certain CVD risk factors (i.e., smoking, diabetes, and BMI) were associated with psychological distress. Among the multiple CVD risk factors, current smoking was the strongest correlate; indicating its importance in CVD risk reduction among patients with depressive symptomatology.

scholarly journals The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk

Circulation ◽  
2020 ◽  
Vol 141 (7) ◽  
pp. 592-599 ◽  
Author(s):  
Anandita Agarwala ◽  
Erin D. Michos ◽  
Zainab Samad ◽  
Christie M. Ballantyne ◽  
Salim S. Virani
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Increased Risk

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.

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