Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis |
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Authors: | Lutsey Pamela L Diez Roux Ana V Jacobs David R Burke Gregory L Harman Jane Shea Steven Folsom Aaron R |
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Institution: | Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA. |
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Abstract: | Objectives. We assessed whether markers of acculturation
(birthplace and number of US generations) and socioeconomic status (SES) are
associated with markers of subclinical cardiovascular disease—carotid
artery plaque, internal carotid intima-media thickness, and
albuminuria—in 4 racial/ethnic groups.Methods. With data from the Multi-Ethnic Study of
Atherosclerosis (n = 6716 participants aged 45–84 years)
and race-specific binomial regression models, we computed prevalence ratios
adjusted for demographics and traditional cardiovascular risk factors.Results. The adjusted US- to foreign-born prevalence ratio for
carotid plaque was 1.20 (99% confidence interval CI] = 0.97, 1.39)
among Whites, 1.91 (99% CI = 0.94, 2.94) among Chinese, 1.62 (99% CI
= 1.28, 2.06) among Blacks, and 1.23 (99% CI = 1.15, 1.31)
among Hispanics. Greater carotid plaque prevalence was found among Whites,
Blacks, and Hispanics with a greater number of generations with US residence
(P < .001) and among Whites with less education and
among Blacks with lower incomes. Similar associations were observed with
intima-media thickness. There was also evidence of an inverse association
between albuminuria and SES among Whites and Hispanics.Conclusions. Greater US acculturation and lower SES were
associated with a higher prevalence of carotid plaque and greater intima-media
thickness but not with albuminuria. Maintenance of healthful habits among recent
immigrants should be encouraged.Beginning with the Ni-Hon-San study,1,2 which was initiated in the 1960s,
research has associated increased acculturation to Western lifestyles with more-adverse
cardiovascular disease (CVD) risk factor profiles and with increased CVD morbidity and
mortality. Specifically, greater Western acculturation has frequently been linked to
increased body mass index (BMI; weight in kilograms divided by height in meters
squared),3–5 waist circumference and abdominal
obesity,6,7 hypertension,7–9 type II
diabetes,10,11 and CVD morbidity and mortality.1,12,13 However, little
research has explored associations between acculturation and subclinical CVD.14,15Abundant research also exists that links low socioeconomic status (SES) to increased
levels of CVD risk factors, morbidity, and mortality.14,16–18 In
general, SES has been found to be inversely related to subclinical measures of CVD,
including coronary artery calcification (CAC),14,19–22 carotid artery plaque, and
intima-media thickness20,23–26 and albuminuria.27 Relations with peripheral artery disease have been inconsistent.28–30 The extent to which these associations vary by
race/ethnicity has been examined infrequently. There is, however, some evidence that the
relation between SES and disease may differ across racial/ethnic groups.14,31,32 Specifically, in
the Multi-Ethnic Study of Atherosclerosis (MESA) there was a higher prevalence of CAC
among Whites with low education than among those with more education, whereas the
reverse was true for Hispanics.14We investigated whether acculturation and SES were associated with other measures of
subclinical disease, specifically with carotid plaque and albuminuria. The relation of
acculturation and SES to CAC has been described in MESA.14 Although CAC, carotid plaque, and albuminuria are all subclinical measures of CVD
and are related to adverse clinical outcomes, these measures represent different aspects
of the disease process and have relatively weak intercorrelations.33 Thus, they may be differentially related to our exposures of interest.The investigation of these patterns is important from a public health perspective and may
yield clues regarding the etiology of atherosclerosis. On the basis of previous work,14 we hypothesized that increased Western acculturation, as assessed by place of
birth, migration history, and duration of US residence, is associated with increased
carotid plaque, intima-media thickness, and albuminuria. Additionally, we expected there
to be an interaction between race/ethnicity and SES with respect to their associations
with subclinical CVD. Specifically, we expected Whites and Blacks at lower SES to have
more-adverse subclinical CVD profiles than those at higher SES, whereas for Hispanics
and Chinese, we expected the reverse to be true. |
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