Acculturation and Cardiometabolic Abnormalities Among Chinese and Korean Americans

Brittany N Morey, Soomin Ryu, Yuxi Shi, Hye Won Park, Sunmin Lee, Brittany N Morey, Soomin Ryu, Yuxi Shi, Hye Won Park, Sunmin Lee

Abstract

Background: Studies generally show that higher acculturation is associated with greater cardiovascular disease (CVD) risk among immigrants in the United States (US). However, few studies have compared how proxies of acculturation are differentially associated with metabolic abnormalities measured using objective biomarkers, self-reported diagnosis, and medication use, particularly among East Asian Americans.

Methods: Survey data and biomarker measurements collected from random (non-fasting) blood samples of Chinese and Korean immigrants in the US (n = 328) were used to examine the associations between two proxies for acculturation (years living in the US and English speaking proficiency) with three cardiometabolic abnormalities (high triglyceride levels, diabetes, and hypercholesterolemia). Poisson regression models estimated prevalence ratios adjusted for demographic characteristics, socioeconomic factors, and body mass index. Gender, Asian subgroup, and household income were tested as potential effect modifiers.

Results: Living longer in the US was associated with greater likelihood of having high triglycerides. In addition, living longer in the US was associated with greater likelihood of diabetes for people with lower household income and greater likelihood of hypercholesterolemia for people with higher household income. Higher level of English proficiency was less consistently associated with higher cardiometabolic risk, although there was a significant association with greater likelihood of hypercholesterolemia.

Conclusions: Longer time lived in the US is associated with higher risk of cardiometabolic abnormalities among Chinese and Korean Americans. Future studies of acculturation and cardiometabolic risk should carefully consider potential mechanisms and what proxy measures of acculturation capture.

Trial registration number: NCT03481296, date of registration: 3/29/2018.

Keywords: Acculturation; Asian Americans; Cardiometabolic disease; Diabetes; Hypercholesterolemia; Immigrants.

Conflict of interest statement

The authors declare no competing interests.

© 2022. W. Montague Cobb-NMA Health Institute.

References

    1. Lutsey PL, et al. Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Public Health. 2008;98(11):1963–1970. doi: 10.2105/AJPH.2007.123844.
    1. Abraido-Lanza AF, Echeverria SE, Florez KR. Latino immigrants, acculturation, and health: promising new directions in research. Annu Rev Public Health. 2016;37:219–236. doi: 10.1146/annurev-publhealth-032315-021545.
    1. Guadamuz JS, et al. Understanding immigration as a social determinant of health: cardiovascular disease in Hispanics/Latinos and South Asians in the United States. Curr Atheroscler Rep. 2021;23(6):25. doi: 10.1007/s11883-021-00920-9.
    1. Serafica RC. Dietary acculturation in Asian Americans. J Cult Divers. 2014;21(4):145–151.
    1. Chen L, Juon H-S, Lee S. Acculturation and BMI among Chinese, Korean and Vietnamese adults. J Community Health. 2012;37(3):539–546. doi: 10.1007/s10900-011-9476-1.
    1. Gee GC, et al. Pre-acculturation as a risk factor for obesity: findings from the Health of Philippine Emigrants Study (HoPES) SSM Popul Health. 2019;9:100482. doi: 10.1016/j.ssmph.2019.100482.
    1. Fu H, VanLandingham MJ. Disentangling the effects of migration, selection and acculturation on weight and body fat distribution: results from a natural experiment involving Vietnamese Americans, returnees, and never-leavers. J Immigr Minor Health. 2012;14(5):786–796. doi: 10.1007/s10903-012-9595-5.
    1. Huang B, et al. Acculturation and prevalence of diabetes among Japanese-American men in Hawaii. Am J Epidemiol. 1996;144(7):674–681. doi: 10.1093/oxfordjournals.aje.a008980.
    1. Jin K, et al. 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(18):2000–2008. doi: 10.1177/2047487317736828.
    1. Commodore-Mensah Y et al. Length of residence in the United States is associated with a higher prevalence of cardiometabolic risk factors in immigrants: a contemporary analysis of the National Health Interview Survey. J Am Heart Assoc. 2016;5(11):e004059.
    1. Oza-Frank R, Stephenson R, Narayan KMV. Diabetes prevalence by length of residence among US immigrants. J Immigr Minor Health. 2011;13(1):1–8. doi: 10.1007/s10903-009-9283-2.
    1. O'Brien MJ, et al. Acculturation and the prevalence of diabetes in US Latino Adults, National Health and Nutrition Examination Survey 2007–2010. Prev Chronic Dis. 2014;11:E176.
    1. Rodriguez F, Hicks LS, Lopez L. Association of acculturation and country of origin with self-reported hypertension and diabetes in a heterogeneous Hispanic population. BMC Public Health. 2012;12:768. doi: 10.1186/1471-2458-12-768.
    1. Anderson C, et al. Acculturation and diabetes risk in the Mexican American Mano a Mano cohort. Am J Public Health. 2016;106(3):547–549. doi: 10.2105/AJPH.2015.303008.
    1. Bayog MLG, Waters CM. Nativity, chronic health conditions, and health behaviors in Filipino Americans. J Transcult Nurs. 2017;29(3):249–257. doi: 10.1177/1043659617703164.
    1. Kandula NR, et al. Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA) Diabetes Care. 2008;31(8):1621–1628. doi: 10.2337/dc07-2182.
    1. Al-Sofiani ME, et al. The relationship of acculturation to cardiovascular disease risk factors among U.S. South Asians: findings from the MASALA study. Diabetes Res Clin Pract. 2020;161:108052. doi: 10.1016/j.diabres.2020.108052.
    1. Fryar CD, et al. The association of nativity/length of residence and cardiovascular disease risk factors in the United States. Prev Med. 2020;130:105893. doi: 10.1016/j.ypmed.2019.105893.
    1. Osibogun O, et al. Greater acculturation is associated with poorer cardiovascular health in the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2021;10(8):e019828. doi: 10.1161/JAHA.120.019828.
    1. Lopez L, et al. Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans. Ann Epidemiol. 2014;24(10):714–719. doi: 10.1016/j.annepidem.2014.07.011.
    1. Chang A, et al. Is greater acculturation associated with an increased prevalence of cardiovascular risk factors among Latinos in South Florida? Med Care. 2015;53(5):417–422. doi: 10.1097/MLR.0000000000000337.
    1. Dodani S, Dong L. Acculturation, coronary artery disease and carotid intima media thickness in South Asian immigrants—unique population with increased risk. Ethn Dis. 2011;21(3):314–321.
    1. Lee S, Hoang AN, Tsui J. Interview language: a proxy measure for acculturation among Asian Americans in a population-based survey. J Immigr Minor Health. 2011;13(2):244–252. doi: 10.1007/s10903-009-9278-z.
    1. Chen L, et al. Influence of acculturation on risk for gestational diabetes among Asian women. Prev Chronic Dis. 2019;16:E158. doi: 10.5888/pcd16.190212.
    1. Muncan B. Cardiovascular disease in racial/ethnic minority populations: illness burden and overview of community-based interventions. Public Health Rev. 2018;39:32. doi: 10.1186/s40985-018-0109-4.
    1. Toth PP, et al. Elevated triglycerides (≥150 mg/dL) and high triglycerides (200–499 mg/dL) are significant predictors of hospitalization for new-onset kidney disease: a real-world analysis of high-risk statin-treated patients. Cardiorenal Med. 2019;9(6):400–407. doi: 10.1159/000502511.
    1. American Diabetes Association. Understanding A1C: diagnosis. 2021. Available from: . Accessed 03/06/2021.
    1. He J, et al. Serum total and lipoprotein cholesterol levels and awareness, treatment, and control of hypercholesterolemia in China. Circulation. 2004;110(4):405–411. doi: 10.1161/01.CIR.0000136583.52681.0D.
    1. Budoff M, et al. Effect of Vascepa (icosapent ethyl) on progression of coronary atherosclerosis in patients with elevated triglycerides (200–499 mg/dL) on statin therapy: Rationale and design of the EVAPORATE study. Clin Cardiol. 2018;41(1):13–19. doi: 10.1002/clc.22856.
    1. Azar II AM. Annual update of the HHS poverty guidelines. In: D.o.H.a.H. Services, Editor. Department of Health and Human Services: Washington, DC. 2020;Notice 85 FR 3060(2020-00858):3060–3061.
    1. Richardson DB, et al. Standardized binomial models for risk or prevalence ratios and differences. Int J Epidemiol. 2015;44(5):1660–1672. doi: 10.1093/ije/dyv137.
    1. Tamhane AR, et al. Prevalence odds ratio versus prevalence ratio: choice comes with consequences. Stat Med. 2016;35(30):5730–5735. doi: 10.1002/sim.7059.
    1. Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280(19):1690–1691. doi: 10.1001/jama.280.19.1690.
    1. Budiman A, Ruiz NG. Key facts about Asian origin groups in the U.S. 2021 April 29, 2021. Available from: . Accessed 04/28/2022.
    1. Heron M. Deaths: leading causes for 2018. Natl Vital Stat Rep. 2021;70(4):1–115.
    1. Jose PO, et al. Cardiovascular disease mortality in Asian Americans. J Am Coll Cardiol. 2014;64(23):2486–2494. doi: 10.1016/j.jacc.2014.08.048.
    1. Miller M, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123(20):2292–2333. doi: 10.1161/CIR.0b013e3182160726.
    1. Takeuchi DT, et al. Immigration-related factors and mental disorders among Asian Americans. Am J Public Health. 2007;97(1):84–90. doi: 10.2105/AJPH.2006.088401.
    1. Leu J, Walton E, Takeuchi D. Contextualizing acculturation: gender, family, and community reception influences on Asian immigrant mental health. Am J Community Psychol. 2011;48(3–4):168–180. doi: 10.1007/s10464-010-9360-7.
    1. Lee S, et al. Change in self-reported health status among immigrants in the United States: associations with measures of acculturation. PLoS One. 2013;8(10):e76494. doi: 10.1371/journal.pone.0076494.
    1. Jang Y, et al. The risk typology of healthcare access and its association with unmet healthcare needs in Asian Americans. Health Soc Care Community. 2018;26(1):72–79. doi: 10.1111/hsc.12463.
    1. Coronado G, et al. Health disparities of cardiometabolic disorders among Filipino Americans: implications for health equity and community-based genetic research. J Racial Ethn Health Disparities. 2021 doi: 10.1007/s40615-021-01190-6.
    1. Hiza HA, et al. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet. 2013;113(2):297–306. doi: 10.1016/j.jand.2012.08.011.
    1. Lee SD, et al. Assessment of dietary acculturation in East Asian populations: a scoping review. Adv Nutr. 2021;12(3):865–886. doi: 10.1093/advances/nmaa127.
    1. Lv N, Cason KL. Dietary pattern change and acculturation of Chinese Americans in Pennsylvania. J Am Diet Assoc. 2004;104(5):771–778. doi: 10.1016/j.jada.2004.02.032.
    1. Gee GC, et al. Health of Philippine Emigrants Study (HoPES): study design and rationale. BMC Public Health. 2018;18(1):771. doi: 10.1186/s12889-018-5670-8.
    1. Gerber M, Barker D, Puhse U. Acculturation and physical activity among immigrants: a systematic review. J Public Health-Heidelberg. 2012;20(3):313–341. doi: 10.1007/s10389-011-0443-1.
    1. Yi SS, et al. Acculturation and activity behaviors in Chinese American immigrants in New York City. Prev Med Rep. 2016;4:404–409. doi: 10.1016/j.pmedr.2016.08.007.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren