Explaining the Variance in Cardiovascular Health Indicators among Asian Americans: A Comparison of Demographic, Socioeconomic, and Ethnicity

Abstract

BACKGROUND: The Asian American (AA) population is the fastest-growing major racial or ethnic group in the U.S. Typically treated as a monolith in research, disaggregated data show disproportionate cardiovascular disease (CVD) burden among certain AA ethnic groups. This analysis aimed to identify which factors explain variance in cardiovascular health among AA ethnic groups. METHODS: We analyzed pooled 2010-2018 National Health Interview Survey cross-sectional data from Chinese, Asian Indian, Filipino, and Other Asian adults in the U.S. Coronary heart disease, heart attack, and stroke were the CVD outcomes of interest. Covariates included sociodemographic characteristics, CVD-related health behaviors (e.g., smoking tobacco, physical inactivity), and health conditions (e.g., diabetes, hypertension). The distribution of self-reported CVD outcomes and covariates were examined among the full AA sample and disaggregated ethnic groups. Variance explained by sociodemographic, health behaviors, and health conditions were calculated based on the adjusted R-squared from a series of five models for each CVD health outcome. RESULTS: Of the 10,353 AAs in the sample, 53% identified as female and 86% between the ages of 18-64 years old. Compared to the aggregate AA sample and the other ethnic groups, Filipinos had a higher burden of any CVD outcome (5.9%), particularly for coronary heart disease (4.0%) and heart attack (2.5%).The combination of all predictors explained at most 13% of variance, with sociodemographic characteristics accounting for at least half of the variance explained among all participants. Health behaviors explained a greater amount of additional variance for all CVD outcomes among Asian Indians, including an additional 3.1% for stroke. Inversely, existing health conditions were significant predictors of CVD for all AA ethnic groups compared to Asian Indians. CONCLUSIONS: There is heterogeneity in CVD outcomes and related risk factors in AA ethnic groups, emphasizing the need for culturally-tailored prevention and intervention strategies.