Abstract
Background:
Limited disaggregated Asian subgroup data exists on the impact of social determinants of health (SDOH) on optimal cardiovascular (CV) health.
Hypothesis:
Compared to non-Hispanic whites (NHW), Asian subgroups have a greater likelihood of optimal CV health, but this observation may be attenuated after controlling for SDOH.
Methods:
We analyzed results from the National Health Interview Survey (2013-2018), a nationally representative sample. Self-reported SDOH variables include demographics, food security, healthcare access, financial security, and neighborhood cohesion. We conducted stepwise, multivariable logistic regression, analyzing the association between race/ethnicity and CV risk profile score iteratively controlling for SDOH, based on the presence of CV risk factors (RF): diabetes mellitus, hypertension, obesity, smoking, insufficient physical activity, and high cholesterol. CV risk profile sum was categorized as optimal (0-1 RF) or sub-optimal (≥ 2 RF).
Results:
Our study sample included 112,380 individuals [mean age 49.1 (SD 18.6)]: 92.7% NHW, 1.6% Asian Indian, 1.5% Chinese, 1.6% Filipino, and 2.6% other Asian. The final model, adjusted for all domains of SDOH, showed that odds for optimal CV health for Filipinos compared to NHW were not significant (OR= 1.06, 95% CI: 0.90, 1.24, p = 0.47). After adjusting for all SDOH, Chinese had the highest odds of optimal CV health compared to NHWs (OR=2.47, 95% CI: 2.08, 2.94, p < 0.001), while the greatest change was observed for Asian Indians [Model 1: OR 1.94 (95% CI 1.7, 2.22) versus Model 5: OR 1.7 (95% CI 1.47, 1.96)].
Conclusion:
Asian Indian, Chinese, and other Asian subgroups had a higher likelihood of optimal CV health compared to NHWs after controlling for SDOH but no significant differences were observed for Filipinos. This association was modestly attenuated only for Asian Indians after controlling for all SDOH. Future research should focus on the modifying effects that race/ethnicity may have on the association between SDOH and optimal CV health.