Association of Hispanic ethnicity and linguistic acculturation with cardiovascular medication adherence in patients with suspected acute coronary syndrome

Abstract

Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites – a phenomenon known as the Hispanic health paradox . However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16–1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75–0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.

Language Preference and its Moderating Role in Coping with Stress: The Hispanic Community Health Study/Study of Latinos

“…Overall, this investigation emphasizes stress as a key health indicator among the Hispanic/Latino population, while further suggesting that Spanish language use may play a role in stress appraisal and processing, potentially contributing to the Hispanic paradox via effects on both risk factors and chronic disease. This study joins a growing body of literature linking Spanish language preference with health protective factors such as medication adherence 77 , improved sleep quality compared to non-Hispanic Whites 78 , and better patterns of surgical intervention for colorectal cancer 79 among Hispanic/Latino patients. These patterns could be partially related to greater expression of Hispanic/Latino cultural values, such as familism, shown to buffer against negative health consequences of stress and risky health behaviors 80 , 81 , though importantly they emerge even controlling for participants’ social acculturation (i.e., relative interaction with Hispanic/Latino vs non-Hispanic/non-Latino contexts).…”

Cancer‐related knowledge, beliefs, and behaviors among Hispanic/Latino residents of Indiana

“… 48 However, none of these studies looked exclusively at the Hispanic population, and definitions of lower income differed between studies. There is also a possibility that social desirability bias (making individuals more likely to report screening if perceived as the appropriate action) may operate differentially among low‐ and high‐income groups; additionally, it is possible that acculturation, which was not measured by this survey, could play a part in these outcomes, as Hispanic people with higher acculturation levels have in general higher incomes, 49 and have been noted to have worse self‐reported physical health 50 and lower rates of healthy behavior 51 when compared to less acculturated Hispanics, however, this inverse impact of acculturation on cancer screening has been inconsistent. 52 Another important negative finding was the lack of significant differences in reported cancer screening adherence among urban and rural Hispanic populations.…”

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

“…This research complements a growing body of literature on the association(s) between acculturation, subjective norms, and health behavior in Hispanic populations. Most prior research on these associations has focused on other health outcomes, including postpartum depression, nutrition, exercise, obesity, and cardiovascular disease (CVD), rather than inappropriate antibiotic use [ 11 , 13 , 27 , 28 ]. In this study, acculturation and subjective norms played an important role in Hispanic patients’ decisions to use non-prescription antibiotics.…”