Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA.
NYU-CUNY Prevention Research Center, New York, USA.
Am J Hypertens. 2019 Jan 1;32(1):104-111. doi: 10.1093/ajh/hpy130.
Latinos and Asians in the United States are disproportionately burdened by hypertension, a leading risk factor for cardiovascular disease. Few studies have used multicomponent measures of acculturation to compare cardiovascular risk factors across immigrant-origin groups. Additionally, little is known about how acculturation and gender shape hypertension risk among immigrants.
We created an acculturation score composed of language use, nativity, and years in the United States and fit separate race/ethnicity log-binomial models examining associations with hypertension prevalence (≥130/80 mm Hg) among Latino (n = 4,267) and Asian (n = 2,142) National Health and Nutrition Examination Survey 2011-2016 participants aged 18+. Joint effect models tested the concept of "intersectionality" between acculturation and gender.
Adjusting for age, gender, and socioeconomic position, Latinos and Asians with high acculturation were 25% and 27% more likely to have hypertension, respectively, compared with low acculturation groups. Latino and Asian American men with high levels of acculturation were 74-79% more likely to have hypertension compared with women with low acculturation (adjusted prevalence ratios (aPR) for Latinos = 1.74, 95% confidence interval (CI): 1.49-2.03; aPR for Asians = 1.79, 95% CI: 1.42-2.25). The gradient of increasing hypertension with increasing acculturation was most apparent among Latino men (adjusted risk differences (aRD) = 12.0%, P < 0.001) and Asian women (aRD = 14.0%, P = 0.003) and nonsignificant among Latino women and Asian men when comparing high vs. low acculturation categories.
Our results correspond with prior literature demonstrating increased morbidity among immigrants with increasing acculturation but also suggest differing patterns by race/ethnicity and gender. Future research should explore how migration processes differentially influence hypertension among men and women.
拉丁裔和亚裔美国人高血压负担过重，高血压是心血管疾病的主要危险因素。很少有研究使用多成分的文化适应措施来比较移民原籍群体的心血管风险因素。此外，对于文化适应和性别如何塑造移民的高血压风险知之甚少。
我们创建了一个文化适应评分，由语言使用、出生国和在美国的年限组成，并拟合了单独的种族/族裔对数二项式模型，以检验与 2011-2016 年全国健康和营养调查中拉丁裔（n=4267）和亚裔（n=2142）参与者的高血压患病率（≥130/80mmHg）之间的关联。联合效应模型检验了文化适应和性别之间的“交叉性”概念。
调整年龄、性别和社会经济地位后，与文化适应程度较低的群体相比，文化适应程度较高的拉丁裔和亚裔患高血压的可能性分别增加 25%和 27%。与文化适应程度较低的女性相比，文化适应程度较高的拉丁裔和亚裔美国男性患高血压的可能性高 74-79%（拉丁裔的调整患病率比（aPR）=1.74，95%置信区间（CI）：1.49-2.03；亚洲人的 aPR=1.79，95%CI：1.42-2.25）。随着文化适应程度的增加，高血压患病率逐渐增加，这在拉丁裔男性中最为明显（调整风险差异（aRD）=12.0%，P<0.001），在亚洲裔女性中也很明显（aRD=14.0%，P=0.003），而在拉丁裔女性和亚洲裔男性中，当比较高与低文化适应类别时，这种差异不显著。
我们的研究结果与先前的文献一致，即随着文化适应程度的增加，移民的发病率增加，但也表明不同种族/族裔和性别之间存在不同的模式。未来的研究应该探索移民过程如何在男性和女性中不同地影响高血压。
