Nativity and prevalence of cardiometabolic diseases among U.S. Asian immigrants

Aims: Acculturation has been shown to be an important factor for immigrants' health in the United States. We investigate whether nativity is associated with a greater risk for cardiometabolic diseases among Asian Americans (Asians) vs. non-Hispanic whites (whites). Methods: Based on data from the U.S. National Health Interview Survey in 2006–2015, 146,862 Asians and whites aged ≥30 years were evaluated. Nativity as a proxy for acculturation was defined using a combination of birthplace and the duration of U.S. residency. Cardiometabolic diseases were defined based on self-reported diagnoses of diabetes, prediabetes, or cardiovascular diseases (CVD). Using 10-year pooled data accounting for complex sampling designs and weights, multiple logistic regression models were used to assess associations. Four Asian subgroups, including Chinese, Filipinos, Asian Indians and other Asians, were evaluated in subgroup analyses. Results: Compared to U.S.-born whites, prevalent type 2 diabetes and prediabetes were higher among Asians depending on nativity. However, the prevalence of CVD was lower among Asians than among whites regardless of nativity (OR_{≥15 years} = 0.5 [95% CI:0.5–0.6], OR_U.S-born = 0.7 [95% CI:0.6–0.8]). In addition, compared to U.S.-born whites, prevalent type 2 diabetes and prediabetes increased with an increasing length of U.S. residency for foreign-born Asians among Asians overall (≥15 years: OR_diabetes = 1.5 [95% CI:1.3–1.7]; OR_prediabetes = 1.3 [95% CI:1.2–1.6]) and Asian Indians and Filipinos. Furthermore, a significant graded association between prediabetes and length of U.S. residency was found among foreign-born Asians. Conclusions: The prevalence of diabetes and prediabetes is higher among Asian immigrants who have spent more years in the U.S., than those in U.S.-born whites. Monitoring and prevention efforts for diabetes should target this group.