Status of cardiovascular health in United States immigrants using the American Heart Association's Life's Essential 8 framework: a population-based study of prevalence estimates and determinants

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-05-13 DOI:10.1016/j.lana.2025.101107

Nour Makarem , Rahul Hosalli , Ariana Lopez , Vanessa Dinh , Billy A. Caceres , Amanda C. McClain , Pricila H. Mullachery , Tala Al-Rousan , Odayme Quesada

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引用次数: 0

Abstract

Background

The United States (US) has the largest immigrant population globally. Immigrants endure social and structural factors that adversely influence cardiovascular health (CVH), a construct focused on health preservation, not merely the absence of disease, and defined by eight modifiable health factors and behaviors that support healthy longevity. We compared overall and individual CVH metrics between immigrants and non-immigrants and characterized CVH and its determinants among immigrant sub-populations.

Methods

The analytic sample included 13,471 adults (19% immigrants, i.e., foreign-born, 51% female), ages 20–79 y (mean ± SD for immigrants and non-immigrants: 44.8 ± 4.8 y and 45.7 ± 11.2 y, respectively) from the 2013 to 2018 National Health and Nutrition Examination Survey. CVH was characterized consistent with the American Heart Association's (AHA) Life's Essential 8 (LE8) guidelines (metrics: body mass index (BMI), blood glucose, blood lipids, blood pressure, nicotine use, sleep health, diet quality, and physical activity; score range: 0–100, low CVH: LE8 score <50). CVH scores were compared among immigrants and non-immigrants and by sex, ethnicity, years in the US, and citizenship among immigrants. Survey-weighted regression models evaluated psychosocial and demographic factors in relation to CVH.

Findings

Immigrants had higher overall CVH scores (69.1 vs. 66.4) (p < 0.0001) and significantly higher subscores for diet (52.5 vs. 38.8), nicotine exposure (80.3 vs. 68.0), BMI (61.6 vs. 57.1), and blood pressure (74.1 vs. 71.8), but lower physical activity (47.0 vs. 52.6), glucose (82.2 vs. 86.1), and cholesterol (63.0 vs. 68.5) scores compared to non-immigrants. Among immigrants, those who were male vs. female (67.5 vs. 70.7) (p = 0.003), Hispanic vs. non-Hispanic (66.6 vs. 71.5) (p < 0.0001), and living in the US ≥15 y vs. <15 y (67.7 vs. 71.8) (p < 0.0001) had lower CVH. In regression models, being male, 45+ y, or Hispanic, having food insecurity, lower education and income, depression, no health insurance, and ≥15 y living in the US were associated with lower CVH.

Interpretation

While US immigrants have more favorable overall CVH compared to US-born persons, CVH status is complex and heterogenous across immigrant sub-populations. Glycemic control, physical inactivity, and blood lipids may be important targets for CVH promotion interventions in this population; Hispanic immigrants and those who lived in the US for ≥15 y may represent key subpopulations to engage in these efforts.

Funding

National Institutes of Health and American Heart Association.

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使用美国心脏协会生命基本8框架的美国移民心血管健康状况：患病率估计和决定因素的基于人群的研究

美国拥有全球最多的移民人口。移民忍受不利影响心血管健康（CVH）的社会和结构因素，CVH是一种关注健康保护的结构，而不仅仅是没有疾病，并由八种可改变的健康因素和支持健康长寿的行为来定义。我们比较了移民和非移民之间的总体和个体CVH指标，并描述了移民亚人群中的CVH及其决定因素。方法分析样本为2013 - 2018年全国健康与营养检查调查的13471名成年人（移民占19%，即外国出生，女性占51%），年龄20-79岁（移民和非移民平均±SD分别为44.8±4.8岁和45.7±11.2岁）。CVH的特征符合美国心脏协会（AHA）的生命基本8 （LE8）指南(指标：体重指数（BMI）、血糖、血脂、血压、尼古丁使用、睡眠健康、饮食质量和身体活动；评分范围：0-100分，低CVH: LE8分<；50分)。研究人员比较了移民和非移民的CVH得分，以及移民的性别、种族、在美年限和国籍。调查加权回归模型评估了与CVH相关的社会心理和人口因素。发现移民的CVH总分更高（69.1比66.4）(p <；在饮食（52.5 vs. 38.8）、尼古丁暴露（80.3 vs. 68.0）、BMI （61.6 vs. 57.1）和血压（74.1 vs. 71.8）方面得分显著高于非移民，但体力活动（47.0 vs. 52.6）、葡萄糖（82.2 vs. 86.1）和胆固醇（63.0 vs. 68.5）得分低于非移民。在移民中，男性vs.女性（67.5 vs. 70.7）（p = 0.003），西班牙裔vs.非西班牙裔（66.6 vs. 71.5） (p <；0.0001)，居住在美国≥15岁vs. 15岁（67.7 vs. 71.8） (p <；0.0001) CVH较低。在回归模型中，男性、45岁以上或西班牙裔、食品不安全、教育程度和收入较低、抑郁、无医疗保险以及≥15岁居住在美国与较低的CVH相关。虽然与美国出生的人相比，美国移民的CVH总体上更有利，但移民亚群体的CVH状况是复杂和异质性的。在这一人群中，血糖控制、缺乏运动和血脂可能是促进CVH干预的重要目标；西班牙裔移民和那些在美国居住≥15年的人可能是参与这些努力的关键亚人群。资助国家卫生研究院和美国心脏协会。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.