Highlights of the statement:
Differences in cardiovascular health among Asian Americans are due to a variety of interrelated social and structural factors, and these factors may differ within individual Asian ethnic subgroups. Asian Americans and Asian immigrants are very diverse and are made up of many ethnic groups. Social determinants such as immigration-related factors, discrimination, socioeconomic status, English proficiency, and cultural beliefs can impact Asian Americans’ health behaviors, access to health care, and ability to follow medical recommendations. there is. Gain a deeper understanding of the specific cardiovascular health needs of individual Asian ethnic groups and understand the underlying reasons why Asian Americans experience differences in the quality of cardiovascular care compared to other races and ethnicities. Further research is needed to identify and reduce disparities in these communities.
Embargoed until Monday, September 16, 2024 at 4:00 a.m. Central Time/5:00 a.m. Eastern Time
DALLAS, September 16, 2024 — Many social and structural factors, including immigration status, socioeconomic status, and access to health care, contribute to differences in cardiovascular health and heart disease risk among Asian Americans. These factors affect Asian ethnic subgroups in different ways. , according to a new scientific statement published today in the American Heart Association’s journal Circulation.
This AHA scientific statement, “Social Determinants of Cardiovascular Health in Asian Americans,” highlights evidence regarding the role of social determinants of health in cardiovascular health among Asian American adults, and Identifying future directions for research to advance health equity for Asian Americans. Reduce health disparities in these communities.
Asian Americans are the fastest growing racial group in the United States, with a population projected to reach up to approximately 46 million people by 2060. At that point, Asian Americans will make up more than 10% of the total U.S. population, according to the U.S. Census Bureau. .
However, Asian Americans continue to be underrepresented as participants in medical research. Previous research has shown that Asian Americans are less likely to participate in health research than other racial/ethnic groups. Studies conducted only in English may also underrepresent Asian Americans, who have lower English proficiency among the various ethnic subgroups in Asia.
“Due to the small number of Asian Americans recruited into research studies, even when Asian American participants are included, they are often lumped into a single ‘Asian’ category or Native Hawaiian and grouped with the Pacific Islander community, leading to clinical obscurity. “Relevant differences in health among subgroups of people of Asian descent,” said Niray S. Shah, M.D., chair of the statement writing group and assistant professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. , MPH, FAHA said.
As of 2021, the six largest Asian ethnicities in the United States were Chinese, Indian, Filipino, Vietnamese, Korean, and Japanese American. People of other Asian ethnicities, such as those of Pakistani, Thai, and Cambodian descent, are less frequently identified in research studies, and our understanding of their health status is limited.
“Asian American ethnic groups should be identified separately because each subgroup represents a unique population with different social, cultural, and health characteristics,” Shah said. There are several social factors that uniquely influence health behaviors and disease risk for each ethnic group in Asia, including reasons for migration, socio-economic status, and differences in access and utilization of health care. ”
Immigration status and structural racism
Immigration policy, citizenship status, and legal documents are widely recognized as important social determinants of health for people immigrating to the United States, including people from Asia.
Historically, Asian American immigrants have faced structural racism and anti-Asian bias, resulting in policies restricting immigration to the United States. The Chinese Exclusion Act of 1882 restricted immigration and citizenship based solely on nationality, and Executive Order 9066 led to the unjust internment of Japanese people. American during World War II in 1942.
Differences in migration and resettlement history and reasons may contribute to suboptimal heart health. For example, Bhutanese, Burmese, Cambodians, Hmong, Lao, and Vietnamese frequently arrive in the United States as refugees. Refugees are more likely to experience chronic stress from exposure to war, violence, hunger, and trauma, which can worsen heart health. Actual or perceived discrimination can impact cardiovascular health by causing increased stress, poor sleep habits, and other suboptimal health behaviors.
Asian Americans without verified immigration status often lack employer-based health insurance. Non-U.S. citizens also have limited access to federal and state health insurance programs, which can contribute to disparities in health outcomes. Furthermore, lack of health insurance or concerns about immigration status can limit access to timely medical care and may also deter people from receiving preventive treatment for cardiovascular risk factors.
Socioeconomic and social factors
Due to the socio-economic diversity of the Asian community, there are significant differences in the physical and social characteristics of the neighborhoods where Asian Americans live. A complex interplay of social determinants of health, including social support, neighborhood walkability, and access to nutritious food, influences cardiovascular health and contributes to ethnic differences .
Although the Asian American population as a whole is a relatively high-income group, there are significant differences within individual ethnic groups. Median annual household income in 2019 ranged from approximately $44,000 per year for Burmese Americans to $119,000 per year for Indian Americans (the average for Asian Americans overall was $85,800). ).
Employment status in the United States is often associated with health insurance coverage, residence in resource-rich areas, and housing stability. A nationally representative survey of Asian Americans from 10 ethnic backgrounds found that employed adults were more likely to report good health.
Additionally, Asian Americans with less than a high school education were 73% less likely to have ideal heart health compared to those with a college degree. A potential explanation is that people employed in low-wage occupations, such as the service and food industries, may experience greater discrimination and receive fewer benefits and employee protections.
Previous research has identified food insecurity, defined as limited or uncertain access to adequate amounts of food, and the availability, accessibility, and affordability of healthy foods. Nutritional security has been found to be associated with increases in overweight and obesity, type 2 diabetes and cardiovascular disease. Mortality rates in all communities. Estimates of food insecurity increased by about 25% for Vietnamese American adults and by about 53% for Filipino American adults in the wake of the COVID-19 pandemic.
Acculturation, the process of adjusting to a different culture, also influences risk factors for heart disease in people immigrating to the United States. For example, increased availability and consumption of processed and fast foods, and increased sedentary lifestyles are known risk factors associated with increased rates of heart disease. obesity.
The difference between access to healthcare and literacy
Asian Americans, especially those not born in the United States, experience difficulty accessing health care services, inadequate medical communication between clinicians and patients, cultural differences in health-related beliefs, and discrimination in the health care system. I often experience this.
Previous research has shown that disparities in health insurance coverage among some Asian American subgroups, such as Korean Americans and Vietnamese Americans, are similar to those in the construction, maintenance, and transportation industries, which have less health insurance coverage. It has been suggested that this may be due to the high employment rate in occupations that do not offer such services. Whether you work for a small business or are a small business owner.
English proficiency varies widely among Asian ethnic groups in the United States. Limited English proficiency can prevent patients from properly reporting symptoms and health concerns, which can impact cardiovascular health. Additionally, inadequate access to interpretation/translation services may prevent health care professionals from adequately understanding and addressing the health concerns of Asian Americans with limited English proficiency.
Health literacy, or knowledge of medical services, also varies by Asian American ethnic group. Limited health literacy can negatively impact access to preventive care and taking prescribed medications as directed by a doctor. Asian immigrants may also be attracted to traditional, complementary, and alternative medicine practices that are common in Asian countries, such as acupuncture and herbal medicine.
Professor Shah said, “All of these social determinants of health are likely interrelated, and the cumulative impact of these structural and social risk factors contributes to cardiovascular outcomes in Asian Americans. “This is a contributing factor to suboptimal health conditions.” There is an urgent need to understand these challenges and address them with effective preventive strategies to improve long-term cardiovascular health. Achieving health equity in this rapidly growing population requires multilevel interventions that target key factors influencing cardiovascular health and consider the unique experiences within individual subgroups in Asia. will be required. ”
This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association’s Council on Epidemiology and Prevention and the Cardiovascular and Stroke Nursing Council’s Prevention Science Committee. Hypertension Council; Council on Lifestyle and Cardiometabolic Health. Cardiovascular Basic Science Council. Council on Clinical Cardiology. Council on Peripheral Vascular Disease. Care Quality and Outcomes Research Council. American Heart Association scientific statements help raise awareness about cardiovascular disease and stroke issues and promote informed medical decisions. A scientific statement outlines what is currently known about a topic and areas where additional research is needed. Scientific statements serve to create guidelines, but do not recommend treatments. American Heart Association guidelines provide the association’s official clinical practice recommendations.
Co-authors are Vice Chair Stella Yi, Ph.D., MPH; Namratha R. Kandula, MD, MPH. Dr. Yvonne Commodore Mensah, MHS, RN, FAHA; Dr. Brittany N. Morley, MPH. Shivani A. Patel, PhD, MPH. Sally Wong, Ph.D., RD, FAHA. and Eugene Yang, MD, MS Author disclosure information is provided in the manuscript.
The association is primarily funded by individuals. Foundations and corporations (including pharmaceuticals, device manufacturers, and other companies) also make contributions, which help fund specific programs and events for the association. The Society has strict policies in place to ensure that these relationships do not influence scientific content. Revenues from pharmaceutical companies, biotech companies, device manufacturers, health insurance companies, and overall financial information for the association are available here.
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