Social factors may affect cardiovascular risk differently among Asian American adults

The lack of a job, health insurance or a college education are social factors linked to an increased likelihood for Asian American adults to have risk factors for heart disease and stroke, new research finds.

But these and other factors, known as social determinants of health, may affect each Asian subgroup differently, according to the study, published Wednesday in the Journal of the American Heart Association.

"Despite the perception that Asian Americans may be less impacted by social determinants of health compared to people in other racial/ethnic groups, our findings indicate unfavorable social factors are associated with higher prevalence of cardiovascular risk factors among Asian American adults," cardiologist Dr. Eugene Yang, the study's lead author, said in a news release. He is a professor of cardiology and medicine at the University of Washington School of Medicine in Seattle.

"The Asian American population is the fastest-growing racial/ethnic group in the United States," Yang said. "People of South Asian heritage have higher rates of premature heart disease globally, and they recently have been found to have higher cardiovascular mortality than non-Hispanic white people."

Understanding why differences in cardiovascular risk exist among Asian subgroups is vital to reducing risk and improving outcomes, he said.

Researchers analyzed national household survey data from 2013 to 2018 for 6,395 adults in the U.S. who identified as Asian. Within this group, 22% self-reported as Filipino, 22% as Asian Indian, 21% as Chinese and 35% as other Asian, which included Japanese, Korean, Vietnamese and other groups. A majority of the participants were born outside the U.S.

Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity or sleep, and exposure to nicotine. A healthy diet was not measured.

The researchers created a composite score for 27 social determinants of health, rating them as favorable or unfavorable. The factors were divided into categories: economic stability, including employment and income status; neighborhood and social cohesion, including neighborhood trust and whether homes were rented or owned; mental health; food security; education; and health care utilization.

Overall, there was a strong link between unfavorable social determinants of health and risk factors for cardiovascular disease. However, the association varied considerably among Asian subgroups.

For example, having more unfavorable social factors was linked to a 58% increased likelihood of insufficient physical activity among Chinese adults, 42% among Asian Indian adults and 24% among Filipino adults. The link to Type 2 diabetes and nicotine exposure also was strongest among Chinese adults. But the link to high blood pressure was strongest for Filipino adults, while Asian Indian adults had higher odds for suboptimal sleep due to negative social factors than their Chinese and Filipino peers.

Yang said many of the social vulnerabilities he and his team ranked were interconnected, such as neighborhood cohesion, economic stability and use of the health care system.

The researchers said it's important to include more Asian American people in national surveys because the study's small sample size did not allow for individual analysis of some Asian subgroups, including Japanese, Korean and Vietnamese people.