Shah Lochan M, Kwapong Yaa A, Boakye Ellen, Ogunwole S Michelle, Bennett Wendy L, Blumenthal Roger S, Hays Allison G, Blaha Michael J, Nasir Khurram, Zakaria Sammy, Wang Guoying, Wang Xiaobin, Sharma Garima
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
CJC Open. 2022 Feb 19;4(6):540-550. doi: 10.1016/j.cjco.2022.02.008. eCollection 2022 Jun.
Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and duration of US residence are not well studied.
We analyzed data from 6088 women (mean age: 27.5 years [standard deviation: 6.3 years]) from the Boston Birth Cohort who self-identified as non-Hispanic Black (NHB; n = 2697), Hispanic (n = 2395), or non-Hispanic White (NHW; n = 996). Using multivariable logistic regression, we examined the cross-sectional association of nativity and duration of US residence (< 10 vs ≥ 10 years) with GDM within each race/ethnicity group.
Foreign-born NHB, NHW, and Hispanic women with a duration of US residence of < 10 years had a lower prevalence of CVD risk factors than those with US residence of ≥ 10 years, respectively, as follows: smoking (NHB: 1.7% vs 3.1%; NHW: 5.7% vs 8.1%; Hispanic: 0.4% vs 2.6%); obesity (NHB: 17.1% vs 23.4%; NHW: 3.8% vs 15.6%; Hispanic: 10.9% vs 22.7%); and severe stress (NHB: 8.7% vs 11.9%; NHW: 5.7% vs 28.1%; Hispanic: 3.8% vs 7.3%). In analyses adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women with a duration of US residence of < 10 years had higher odds of having GDM (adjusted odds ratio: 1.60, 95% confidence interval: 0.99-2.60), compared with their US-born counterparts, whereas foreign-born Hispanic women with a duration of US residence of < 10 years had lower odds of having GDM (adjusted odds ratio: 0.54, 95% confidence interval: 0.32-0.91). The odds of having GDM in Hispanic and NHB women with a duration of US residence of ≥ 10 years were not significantly different from those of their US-born counterparts.
The "healthy immigrant effect" and its waning with longer duration of US residence apply to the prevalence of GDM among Hispanic women but not NHB women. Further research on the intersectionality of race and nativity-based disparities is needed.
妊娠期糖尿病（GDM）与心血管疾病（CVD）风险增加相关。GDM患病率的种族/民族差异已有描述，但出生地和在美国居住时间的差异尚未得到充分研究。
我们分析了来自波士顿出生队列的6088名女性（平均年龄：27.5岁[标准差：6.3岁]）的数据，她们自我认定为非西班牙裔黑人（NHB；n = 2697）、西班牙裔（n = 2395）或非西班牙裔白人（NHW；n = 996）。使用多变量逻辑回归，我们在每个种族/民族群体中研究了出生地和在美国居住时间（<10年与≥10年）与GDM的横断面关联。
在美国居住时间<10年的外国出生的NHB、NHW和西班牙裔女性，其CVD危险因素的患病率分别低于在美国居住时间≥10年的女性，如下：吸烟（NHB：1.7%对3.1%；NHW：5.7%对8.1%；西班牙裔：0.4%对2.6%）；肥胖（NHB：17.1%对23.4%；NHW：3.8%对15.6%；西班牙裔：10.9%对22.7%）；以及严重应激（NHB：8.7%对11.9%；NHW：5.7%对28.1%；西班牙裔：3.8%对7.3%）。在调整社会人口学特征和CVD危险因素的分析中，在美国居住时间<10年的外国出生的NHB女性患GDM的几率高于美国出生的同行（调整后的优势比：1.60，95%置信区间：0.99 - 2.60），而在美国居住时间<10年的外国出生的西班牙裔女性患GDM的几率较低（调整后的优势比：0.54，95%置信区间：0.32 - 0.91）。在美国居住时间≥10年的西班牙裔和NHB女性患GDM的几率与美国出生的同行没有显著差异。
“健康移民效应”及其随在美国居住时间延长而减弱适用于西班牙裔女性中GDM的患病率，但不适用于NHB女性。需要对基于种族和出生地的差异的交叉性进行进一步研究。
