Abstract P160: Conflicting Associations of Acculturation and Cardiovascular Risk in Hispanics in the National Health and Nutrition Examination Survey 1999-2010: What Are We Measuring?
Background: Acculturation is the process by which immigrant groups adopt the cultural practices and values of the host country. Research has produced conflicting results in the association between acculturation and cardiovascular disease (CVD) risk among Hispanics. The National Health and Nutrition Examination Survey (NHANES) has collected multiple acculturation measures. We evaluated the hypothesis that the acculturation measure utilized impacts the association with CVD risk.
Methods: The following measures of acculturation were available: Nativity, Language spoken at home (‘mostly English,’ ‘Equal English/Spanish,’ ‘Mostly Spanish’), Years in the US (0-5, 6-10, 11-15, 16-20, >20), and US citizenship. The validated Short Acculturation Scale (SAS) was only used between 1999 and 2004. Chi-squared analyses and logistic regression models were used to examine the independent association of acculturation with CVD risk factors: hypertension, BMI, diabetes (HgbA1c ≥6.5), total cholesterol ≥ 240 mg/dl, HDL (male: <40 mg/dl, female <50 mg/dl). Models were adjusted for age, gender, insurance, education, income, having a usual place of care, and appropriate sampling weights. Nominal association between acculturation variables was assessed with the uncertainty coefficient (UC) (Range: -1 [100% negative association] to 1 [100% positive association]).
Results: Of 8707 Hispanics, less acculturated adults, as measured through language, were slightly older (mean age 41 vs. 39), were more likely to have less than a high school education (66 vs. 25%), less likely to have a usual source of care (61 vs.79%), and more likely to be uninsured (57 vs. 27%). Only 8% were born in the US, 31% were US citizens, and 58% reported 15 yrs or less in the US. In fully adjusted models, the SAS and other language based acculturation measures showed null association with CVD risk while increasing years in the US was consistently associated with increasing risk over time of hypertension (ORs range: 1.1-2.3), obesity (ORs range: 1.2-2.4) and diabetes (ORs range: 1.0-2.6). Only obesity had similar point estimates and confidence intervals across acculturation measures (ORs range: 1.0 - 2.4). Moderate positive correlation was highest between language usually spoken at home and country of birth (UC=0.4) followed by US citizenship (UC=0.3).
Conclusions: NHANES is widely used in the study of Hispanic health. Different acculturation measures demonstrate differing associations with CVD risk factors. In contrast to language-based measures, only length of residence in the US showed consist associations across CVD risk factors. Future research is needed to further characterize acculturation metrics among heterogeneous Hispanic populations.
Author Disclosures: L. Lopez: None. F. Rodriguez: None. J.B. Meigs: None. J.M. Ashburner: None.
- © 2014 by American Heart Association, Inc.