Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups

Abstract

BACKGROUND: Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. METHODS AND RESULTS: We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% selfidentified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04–2.03) and Filipino (OR, 1.24; 95% CI, 1.02–1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03–1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22–1.65), Chinese (OR, 1.58; 95% CI, 1.33–1.88), and Filipino (OR, 1.24; 95% CI, 1.06–1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01–1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15–2.11) and Filipino (OR, 1.50; 95% CI, 1.14–1.97) adults. CONCLUSIONS: Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.