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CV risk elevated among recent immigrants without health insurance
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Older adults who recently immigrated to the United States and lacked health insurance were at an increased risk for a CV event compared with immigrants who had been in the U.S. for more than 10 years, according to a study published in the Journal of Nursing Scholarship.
“There are no two issues more divisive in our current political context than immigration and health care,” Tina R. Sadarangani, PhD, RN, ANP-BC, GNP-BC, assistant professor and faculty fellow at New York University Rory Meyers College of Nursing, told Cardiology Today. “Aging immigrants are a growing but often overlooked sector of society and may be disproportionately affected by current and proposed policies, such as the existing 5-year waiting period for Medicaid in the majority of states and the proposed public charge rule, which would jeopardize the citizenship prospects for those who use government-sponsored programs like Medicaid. We are seeing increases in the number of uninsured older immigrants presenting to emergency departments with preventable complications of disease.”
NHANES data
Researchers analyzed data from 1,920 participants older than 50 years who were born outside of the United States from the National Health and Nutrition Examination Survey from 2007 to 2012. Participants did not have a history of coronary disease. During the survey, participants underwent a complete medical examination including laboratory testing.
The primary outcome of interest was CVD risk, which was calculated using the American College of Cardiology and the American Heart Association 2013 Pooled Cohort Risk Equation for atherosclerotic CVD.
Of the participants in the study, 1,607 had been in the U.S. for longer than 10 years. Compared with participants who were long-term immigrants, those who recently immigrated were more likely to be younger (mean age, 59 years vs. 62 years).
Participants who were recent immigrants also had lower systolic BP, BMI, diastolic BP and waist circumference compared with those who were long-term immigrants (P < .001 for all). These participants also had higher total cholesterol, plasma glucose levels and triglycerides and lower HDL (P < .001 for all).
Increased risk for CVD
Participants without health insurance coverage had a 1.7-fold increase in CVD (P < .05). Those who were in the U.S. for less than 10 years and were uninsured (OR = 2.55; 95% CI, 1.88-3.45) were more likely to be at high risk for CVD vs. those in the country for longer than 10 years (OR = 1.53; 95% CI, 1.35-1.73).
“At the moment, we approach the assessment of cardiovascular risk in a very narrow way,” Sadarangani said in an interview. “Risk calculators traditionally focus on clinical measures of risk. However, we need to understand individuals’ social context and how systemic factors affect disease progression. Even if a risk calculator says someone is at low risk of developing CVD, there are other factors we are not thinking about that hasten disease progression and are associated with increased risk. Health insurance coverage must be part of a comprehensive strategy to address CVD, especially in a population that is largely disenfranchised.” – by Darlene Dobkowski
For more information:
Tina R. Sadarangani, PhD, RN, ANP-BC, GNP-BC, can be reached at New York University, Rory Meyers College of Nursing, 433 First Ave., Suite 645F, New York, NY 10010; email: trs233@nyu.edu.
Disclosures: The authors report no relevant financial disclosures.
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