Cardiovascular Risk in Middle‐Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage

Abstract

Purpose It is reported that while immigrants are, initially, healthier than the native‐born upon resettlement, this advantage erodes over time. In the United States, uninsured aging immigrants are increasingly experiencing severe complications of cardiovascular disease (CVD). The purpose of this study was to compare overall CVD risk and explore the importance of health insurance coverage on CVD risk relative to other health access barriers, from 2007 to 2012, in recent and long‐term immigrants >50 years of age. Methods This study was based on secondary cross‐sectional analysis of the National Health and Nutrition Examination Survey (N = 1,920). The primary outcome, CVD risk category (high or low), was determined using the American College of Cardiology and American Heart Association Pooled Cohort equation. Differences between immigrant groups were examined using independent‐samples t tests and chi‐square analysis. The association between insurance and CVD risk was explored using a hierarchical block logistic regression model, in which variables were entered in a predetermined order. Changes in pseudo R2 measured whether health insurance explained variance in cardiac risk beyond other variables. Results Recent immigrants had lower overall CVD risk than long‐term immigrants but were twice as likely to be uninsured and had higher serum glucose and lipid levels. Based on regression models, being uninsured contributed to CVD risk beyond other health access determinants, and CVD risk was pronounced among recent immigrants who were uninsured. Conclusions Health insurance coverage plays an essential part in a comprehensive approach to mitigating CVD risk for aging immigrants, particularly recent immigrants whose cardiovascular health is susceptible to deterioration. Clinical Relevance Nurses are tasked with recognizing the unique social and physical vulnerabilities of aging immigrants and accounting for these in care plans. In addition to helping them access healthcare coverage and affordable medication, nurses and clinicians should prioritize low‐cost lifestyle interventions that reduce CVD risk, especially diet and exercise programs.

Immigrant Status, Resilience, and Perceived Oral Health Among Chinese Americans in Hawaii

“…Improving oral health among U.S. older adult populations is an important public health priority . Due to large-scale immigration in recent decades, the older immigrant population in the United States increased by 70% between 1990 and 2010 (C. N. Anderson & Kim, 2009;Sadarangani et al, 2019). The increase in the numbers of older immigrants in the United States has motivated a pressing need to better understand their perceived oral health, given that oral health is strongly associated with the overall health and well-being of older adults (Nihtilä et al, 2017).…”

Association between acculturation and sociodemographic factors and cardiovascular disease among immigrants to the United States

“…Population-based research has shown that the longer immigrant adults reside in the U.S., the higher the risk of cardiovascular disease (Lê-Scherban et al, 2016;Sadarangani et al, 2019;Salinas et al, 2014). Immigrants to the U.S. have lower rates of disease compared to U.S. born population, supporting the Healthy Immigrant Effect (Kennedy et al, 2015).…”

“…Arrival to the U.S. introduces immigrants to an unfamiliar environment, infrastructure, resources, and cultural context. Compared to long-term immigrants (>10 years U.S. residence), recent immigrants had lower relative cardiovascular risk but were more likely to be uninsured and have higher rates of hyperglycemia and hyperlipidemia (Sadarangani et al, 2019). Acculturation with adaption to the U.S. culture presents risks of cardiovascular disease.…”

“…Inadequate access and underutilization limit health screening, other primary prevention interventions, and chronic disease management (Chen, 2013;Hall & Cuellar, 2016;Read & Smith, 2018). The lack of access to care related to underinsurance has been consistently predictive of deleterious health outcomes in chronic disease, especially cardiovascular-related disease (Sadarangani et al, 2019;Yun et al, 2012).…”

“…In our study, among the acculturation factors of the number of years in the U.S., citizenship status, and English proficiency, only having U.S. citizenship was a significant factor in the multivariate model of cardiovascular disease among immigrant adults. The acculturation measures used in similar studies ranged from time in U.S., time in U.S. being less than or greater than 10 years(Sadarangani et al, 2019;Salinas et al, 2014), categories of 5-year increments of time in the U.S (Lu et al, 2017),. place of birth and time in the U.S (Lê-Scherban et al, 2016),.…”