Top Things to Know: Social Determinants of Cardiovascular Health in Asian Americans
Prepared by Sally S. Wong, PhD, RD, CDN, FAHA, National Senior Director, Science and Medicine; Bernadette Okwu-Gage, PhD, MPH, MBBS, Associate Science and Medicine Advisor
- The Asian American population is diverse and rapidly growing. This group experiences considerable heterogeneity in cardiovascular health (CVH) and cardiovascular disease (CVD).
- Asian Americans are often underrepresented in health research and when represented are grouped into a single “Asian” category or “Other” racial group. Nonetheless, the six largest Asian origin ethnic groups in the United States (U.S.) are Chinese, Indian, Filipino, Vietnamese, Korean, and Japanese Americans, which in total comprised 85% of the Asian American population in 2019.
- This scientific statement addresses upstream structural and social determinants that effect CVH in the Asian American population and focuses attention on the role of social determinants of health (SDOH) across disaggregated ethnic groups within this population.
- The role of SDOH in CVH among Asian Americans has been established over the past years, within several domains including structural determinants such as racism, immigration-related factors, socioeconomic position (SEP), environmental factors and social contexts, nutrition security and food access and health system-related factors.
- Migration and resettlement may also be closely linked to suboptimal CVH. Some Asian American ethnic groups often enter the U.S. as refugees with higher chances of prior exposure to war, violence, hunger, and trauma. This exposure can lead to poorer CVH through mediators such as greater stress and allostatic load.
- SEP contributes to the heterogeneity in CVH among Asian Americans as there is an unequal distribution of resources across individuals within the different Asian American ethnic groups.
- Neighborhood environments contribute to CVH through the built, physical, and social contextual features. However, there is significant heterogeneity in the physical and social characteristics of neighborhoods in which Asian Americans live.
- Food insecurity is linked with adverse CVH for all communities, but estimates vary across Asian American ethnic groups and across geographic regions with higher food insecurity often observed in Filipino, Vietnamese, and Korean American communities.
- English language proficiency varies considerably among Asian Americans in the U.S. and may influence their CVH because of communication barriers that exist between health care professionals and their patients when health behavior recommendations are given. Additionally, limited English proficiency can deter patients from adequately reporting symptoms or health concerns.
- Advancing the science of CVH in Asian Americans has critical clinical and policy implications. Therefore, there is a need for dedicated investigation to identify and address adverse SDOH in heterogenous Asian American communities, as this will support equitable promotion of CVH of this population.
Citation
Shah NS, Kandula NR, Commodore-Mensah Y, Morey BN, Patel SA, Wong S, Yang E, Yi S; on behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Basic Cardiovascular Sciences; Council on Clinical Cardiology; Council on Peripheral Vascular Disease; and Council on Quality of Care and Outcomes Research. Social determinants of cardiovascular health inAsian Americans: a scientific statement from the American Heart Association. Circulation. Published online September 16, 2024. doi: 10.1161/CIR.0000000000001278