Social factors may affect heart health of Asian ethnicities in the US differently

Numerous factors – including immigration status, socioeconomic status and access to health care – contribute to differences in heart disease and stroke risks for Asian American people and may affect the many subgroups in this population differently, according to a new science report.

The American Heart Association scientific statement highlights evidence of the role social determinants of health play in cardiovascular health among Asian American adults and identifies areas where more research is needed to reduce health disparities among them. The statement was published Monday in the AHA journal Circulation.

Asian American people are the fastest-growing ethnic group in the U.S., a population expected to reach 46 million, or 10% of the U.S. population, by 2060. But studies show they have been persistently underrepresented in medical research, in part because they are the least willing of any racial and ethnic group to participate. Issues with English-language proficiency and studies that are only conducted in English also lead to lower representation.

This can make it harder to fully understand the factors contributing to cardiovascular health for Asian American subgroups, the statement's authors found.

"Due to the small numbers of Asian Americans recruited in research studies, even when Asian American participants are included, they are frequently combined into a single 'Asian' category or grouped with Native Hawaiian and Pacific Islander communities, which results in the masking of clinically relevant differences in health among subgroups of people of Asian descent," Dr. Nilay S. Shah, chair of the statement writing group, said in a news release. Shah is an assistant professor of cardiology and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

"Asian American ethnic groups should be individually identified since each subgroup represents a unique population with distinct social, cultural and health characteristics," he said.

In 2021, the six largest Asian ethnic groups in the U.S. were Chinese, Indian, Filipino, Vietnamese, Korean and Japanese American. People of other Asian ethnicities are less often identified in research studies.

Several social factors uniquely influence health behaviors and disease risk in Asian ethnic groups, Shah said, including reasons for immigration, socioeconomic position and differences in health care access and utilization.

Structural racism also can play a role. Historically, Asian immigrants faced structural racism and anti-Asian prejudice stemming from policies such as the 1882 Chinese Exclusion Act restricting immigration and the forced incarceration of Japanese people in the U.S. during World War II.

People who come to the U.S. as refugees also are more likely to experience chronic stress from war, violence, hunger and trauma, which can worsen heart health. Undocumented immigration status can leave people without health insurance or access to timely health care, which can contribute to poor cardiovascular health.

Neighborhood environments, access to nutritious food, employment status, education and how well a person has adapted to American culture or learned the language skills needed to access health systems may also differ greatly among subgroups and can all influence cardiovascular health, according to the statement.

All of these social determinants of health are likely connected, Shah said, and their cumulative impact contributes to poor cardiovascular health among Asian Americans. He said there is an "urgent need" to understand and address the challenges with effective prevention strategies.

"Achieving health equity in this rapidly growing population will require multilevel interventions that target the key factors influencing cardiovascular health and account for the unique experiences within individual Asian subgroups," he said.