Abstract
Introduction: Among US Hispanics/Latinos, greater acculturation to US society is associated with higher blood pressure. However, the extent to which this relationship varies across diverse Hispanic/Latino groups is unclear. Objectives: To determine whether acculturation is differentially associated with six-year change in systolic blood pressure (SBP) across Hispanic/Latino groups. Methods: The Hispanic Community Health Study/Study of Latinos is a prospective population-based study of diverse Hispanics/Latinos aged 18-74 years from four US communities. Acculturation at baseline (2008-2011) was defined by the Short Acculturation Scale for Hispanics (SASH) social and language scales (low, medium, or high acculturation) and nativity/duration of US residence (foreign-born with < 10 or ≥ 10 years of US residence, or US born-not including Puerto Rico). The average of three seated SBP measurements was used; difference in SBP from baseline to follow-up (2014-2017) was calculated in 7,836 adults free from hypertension at baseline (SBP < 140 mmHg; diastolic blood pressure < 90 mmHg; and not taking hypertension medication). Using linear regression models accounting for the complex survey design and adjusted for baseline age, sex, education, income, body mass index, years of follow-up, and hypertension medication at follow-up, we estimated the association of each measure of acculturation with change in SBP. Significant interactions between Hispanic/Latino group and measures of acculturation led to stratified models (SASH interaction p=0.01 for social; p=0.28 for language; and nativity/duration of US residence US interaction, p=0.05). Results: Mean baseline age was 36.7 years (SE: 0.23) and 51.7% were women (SE: 0.77). After an average follow-up of 6.2 years (SE: 0.02), mean change in SBP was 2.01 mmHg (SE: 0.20). Among individuals of Central American background, high vs. low SASH language was associated with +3.21 mmHg SBP increase (95% CI: 0.19, 6.24) and being US born vs. foreign-born < 10 years in US was associated with +5.31 mmHg SBP increase (95% CI: 2.10, 8.53). Among individuals of Puerto Rican background, those with ≥ 10 vs. < 10 years in the US 50 states had a 5.67 mmHg lower increase in SBP (95% CI: -9.85, -1.50). Associations between measures of acculturation and changes in SBP were not significant in other groups (i.e. Cubans, Dominicans, and South Americans), but did suggest a greater SBP increase with greater acculturation among Mexican background individuals (e.g. high vs. low SASH social β=1.67, 95% CI: -0.19, 3.52, p=0.08). Conclusions: Greater acculturation was associated with a greater SBP increase among those of Central American background but a lower SBP increase among individuals of Puerto Rican background. These findings show that consideration of Hispanic/Latino group is warranted when assessing potential health effects of acculturation.
