New research links social factors to cardiovascular risk in Asian American adults

According to new research published today in Journal of the American Heart Associationan open-access, peer-reviewed journal of the American Heart Association.

The research also noted that the relationship between these adverse social determinants of health variables and CVD risk factors varied widely among individuals in different subgroups of Asian Americans in this study. An association does not mean that the social determinants of health directly caused the risk factor.

“Despite the notion that Asian Americans may be less affected by social determinants of health compared to people of other racial/ethnic groups, our findings suggest that adverse social factors are associated with a higher prevalence of cardiovascular risk factors in Asian American adults.”

Eugene Yang, MD, lead study author, professor of medicine at the University of Washington School of Medicine in Seattle

“The Asian American population is the fastest growing racial/ethnic group in the United States,” Yang said. “South Asians have higher rates of premature heart disease worldwide and have recently been found to have higher cardiovascular mortality than non-Hispanic whites. A better understanding of why differences in cardiovascular risk exist between Asian subgroups is critical to reducing risk and improving results”.

The researchers looked at data from the National Health Interview Survey conducted in the US from 2013 to 2018, which included 6,395 adults who identified themselves as Asian.

The researchers rated 27 social determinants of health as favorable or unfavorable in six areas: economic stability (which included employment and income status); neighborhood and social cohesion (which measured neighborhood trust and whether homes were owned or rented); psychological distress? food safety? education; and health care utilization.

The analysis found a significant relationship between adverse social determinants of health and risk factors for cardiovascular disease. This relationship differed among people in different Asian American subgroups. Among the findings:

• For all Asian groups included in the data, a one standardized unit higher adverse social determinants of health index was associated with a 14% greater risk of hypertension. 17% greater risk of poor sleep. and a 24% greater risk of type 2 diabetes – all of which increase the risk of cardiovascular disease.

• Specifically, more adverse social determinants were associated with:

  • 45% greater likelihood of Type 2 diabetes among Chinese adults and 24% greater likelihood among Filipino adults.
  • 28% greater risk of high blood pressure among Filipino adults.
  • 42% increased likelihood of insufficient physical activity among Indian Asian adults, 58% increased likelihood among Chinese adults, and 24% increased likelihood among Filipino adults.
  • 20% chance of suboptimal sleep in Asian Indian adults. and
  • 56% and 50% probability of nicotine exposure among Chinese adults and Filipino adults, respectively.

• Compared to other Asian American subgroups, Filipino-identified adults reported the highest prevalence—4 of 7—? Cardiovascular risk factors: poor sleep, high cholesterol, high blood pressure and obesity.

Yang said many social determinants of health are often interrelated, such as neighborhood cohesion, economic stability and use of the health care system.

“It’s important to understand how different Asian subgroups are affected,” he said. “When Asians are grouped together, higher-risk groups such as South Asians may not be treated aggressively enough, while lower-risk groups such as people of Korean and Japanese descent may be overtreated for blood pressure or cholesterol.”

Background and study details:

• The large, cross-sectional study looked at data from the 2013-2018 National Health Interview Surveys – annual, nationally representative surveys of US adults.
• Of the 6,395 Asian adults in the survey, about 22% self-identified as Filipino adults. 22% as Asian Indian adults. 21% as Chinese adults. and 36% as other Asians.
• The sample size of Asian Americans in the national survey was too small to analyze several major Asian populations, including Japanese, Korean, and Vietnamese, as well as other smaller Asian subgroups.
• Almost 56% of the group were female and almost 52% were between the ages of 18 and 44. About 77% of participants were born outside the United States.
• Participants were given scores on the social determinants of health by categorizing 27 variables as favorable or unfavorable.
• Cardiovascular risk factors were self-reported and similar to the American Heart Association’s Life’s Essential 8. eight lifestyle metrics that assess ideal cardiovascular health; These eight metrics include: eating a healthy diet, maintaining a healthy weight, exercising regularly and getting enough quality sleep, avoiding nicotine exposure, and maintaining healthy blood pressure, glucose, and cholesterol levels. However, healthy eating was not measured in this study. Achieving optimal levels of these eight metrics improves heart health and reduces the risk of heart disease and stroke.

Limitations of the study include that its small sample size did not allow analysis of certain Asian subgroups (Japanese, Korean, Vietnamese, and other Asians). In addition, it examined self-reported survey data on social and cardiovascular risk factors at a specific point in time. Therefore, the analysis could not assess long-term social determinants of health patterns and could not demonstrate that adverse social factors caused the development of CVD risk factors. Additionally, language barriers may have been a factor for some participants because the National Health Interviews were conducted only in English and Spanish.

The study authors noted that it is vital to include more Asian Americans in national surveys to uncover potential differences in optimal social determinants of health profile and cardiovascular risk factor prevalence and outcomes.

Co-authors, disclosures, and sources of funding are listed in the manuscript.