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

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

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.

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

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.

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

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.

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

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.