The Relationship between Immigration Status and Cardiovascular Disease Risk Factors in United States Adults with Diabetes—A 14-Year Study

Introduction: Chronic diseases such as heart disease, stroke, and type 2 diabetes are common health issues in the U.S. About 9.4% of the U.S. population has diabetes. Research shows there is a relationship between immigration status and prevalence of chronic disease. The aim of this study is to understand the relationship between immigration status and CVD risk factors such as LDL, blood pressure, hemoglobin A1c (HbA1C), and body mass index (BMI).

Methods: The study included seven waves of data from the National Health and Nutrition Examination Survey (NHANES) for individuals with diabetes, aged 20 and older between 2001-2014. Survey participants were categorized as foreign-born and U.S. born based on self-report responses. Outcome measures included BMI, blood pressure, LDL, and HbA1C, measured as part of the NHANES procedures. Survey general linear regression methods were used to model each outcome and results were weighted to calculate nationally representative estimates.

Results: Approximately, 5,414 individuals (representing 22,788,949 U.S. adults) were included in the study. Twenty-seven percent of the sample were foreign-born representing about 18% of the U.S. population. After controlling for demographics, NHANES waves, access to health care, and years of residence in the U.S. foreign-born individuals had significantly lower BMI (-3.05; p<0.0001) and systolic blood pressure (-2.55; p=0.023). There was no significant difference in diastolic blood pressure, LDL, or HbA1C among foreign-born and U.S.-born.

Conclusions: Foreign-born individuals with diabetes have lower BMI and systolic blood pressure compared to U.S.-born individuals. Prior to adjusting for access to care, foreign-born had higher LDL suggesting the importance of improving access to care and ensuring that CVD risk factors are under control. Interventions focused on lowering LDL among foreign-born individuals will be critical in lowering their cardiovascular disease risk.