Commodore-Mensah Yvonne, Ukonu Nwakaego, Cooper Lisa A, Agyemang Charles, Himmelfarb Cheryl Dennison
Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD, 21205, USA.
Counseling Psychology, University of Florida, 945 Center Drive, P.O. Box 112250, Gainesville, FL, 32611-2250, USA.
J Immigr Minor Health. 2018 Oct;20(5):1137-1146. doi: 10.1007/s10903-017-0644-y.
The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD risk.
在美国，少数族裔患心血管疾病（CVD）的风险负担很高。文化适应可能会使移民的心血管健康状况恶化或改善。我们试图研究文化适应与美国日益增多的非洲移民群体中心血管疾病风险升高之间的关联。我们对在美国出生的加纳和尼日利亚非洲移民进行了一项横断面研究。为了确定文化适应是否与CVD风险升高（定义为≥3个CVD风险因素或合并队列方程得分≥7.5%）相关，我们进行了未调整和调整后的逻辑回归分析。对于这两个结果，都拟合了按性别分类的模型。参与者（N = 253）年龄在35 - 74岁之间，居住在巴尔的摩 - 华盛顿特区。平均年龄（标准差）为49.5（9.2）岁，58%为女性。在美国居住≥10年的男性超重/肥胖几率增加近四倍（95%置信区间1.05 - 14.35），CVD风险升高几率增加八倍（95%置信区间2.09 - 30.80）。在美国居住≥10年的女性患高血压的几率是新移民的2.60倍（95%置信区间1.04 - 6.551）。参与者根据文化适应策略进行分类：融合主义者，166人（66%）；传统主义者，80人（32%）；边缘主义者，5人（2%）；同化主义者，2人（1%）。与传统主义者相比，融合主义者有≥3个CVD风险因素的几率低0.46（95%置信区间0.24 - 0.87），CVD风险升高（合并队列方程得分≥7.5%）的几率低0.38（95%置信区间0.18 - 0.78）。尽管停留时间较长与CVD风险相关，但融合主义者的CVD风险低于传统主义者。我们的结果表明，美国针对CVD风险因素流行的协调公共卫生应对措施应针对这一研究不足的人群。应将文化适应视为CVD风险增加的一个重要因素，并且文化适应策略可用于为非洲移民量身定制干预措施。促进成功融合可能会降低移民的CVD风险。
