Background: The burden of cardiometabolic disease and associated risk factors including overweight/obesity, diabetes and hypertension is high in ethnic minorities in the United States (US). The size of the immigrant population in the US continues to grow rapidly. It has been posited that acculturation to the US society results in an elevation or reduction of risk for cardiometabolic disease in immigrants.
Hypothesis: We hypothesized that increased years of US residence (proxy measure for acculturation) would be associated with a higher prevalence of overweight/obesity, diabetes and hypertension, known risk factors for cardiometabolic disease, in US immigrants.
Methods: We analyzed data on adult US immigrants in the National Health Interview Survey (NHIS) from 2010-2014. The immigrants were from the following 9 regions of birth: Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, India, Central and Southeast Asia. The main independent variable was length of US residence; <10 years and ≥10 years. The main outcome variables were hypertension, overweight/obesity and diabetes. We used multivariable logistic regression to examine these associations and adjusted for known confounders.
Results: Of the 54,984 immigrants, 62% were overweight/obese, 20 % had hypertension and 8% had diabetes. The mean age (± SE) was 43 (±0.15) years. Half were females and those who had resided in the US for ≥10 years were more likely to have health insurance coverage (70% vs 54%, p<0.001) and older (46 years vs 35years, p<0.001) compared to immigrants with <10 years of duration of stay. After adjusting for region of birth, poverty income ratio, age and sex, we observed that immigrants residing in the US for ≥10 years were more likely to be overweight/obese (Odds Ratio[OR] 1.21, 95% CI 1.11-1.31), diabetic (OR: 1.58, 95% CI 1.32-1.90) and hypertensive(OR: 1.34, 95% CI 1.19-1.50) than those residing in the US for <10 years.
Conclusion: In an ethnically diverse sample of contemporary US immigrants, we found that increased length of US residence (acculturation) was associated with overall presence of cardiometabolic risk factors. Culturally-tailored public health strategies should be developed and implemented in immigrant sub-populations in the US to prevent the development of cardiometabolic disease.