Abstract 14886: The Association Between Acculturation and Hypertension Prevalence among South Asian Immigrants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Abstract

Introduction: South Asians are the second fastest growing ethnic minority group in the US. Despite a modest body mass index, South Asians have a high and early prevalence of cardiovascular disease risk factors, including high blood pressure (BP). The majority of South Asians are immigrants, thus behavior and lifestyle changes may play a role in the development of elevated BP. This paper examines the hypothesis that greater acculturation is associated with hypertension (HTN) in US South Asians. Methods: We examined baseline data (2010 to 2013) of 906 subjects (54% male; mean age 55 ± 9 years) in the Mediators of Atherosclerosis in South Asians Living In America study. HTN was defined by: systolic BP ≥ 140 mmHg, diastolic BP≥ 90 mmHg, and/or use of hypertensive medication. Acculturation was defined by 4 proxy variables and 1 summary score: place of birth, English language proficiency, length of US residency, traditional South Asian beliefs scale, and a summary score of all 4 variables ranging from 0 to 6 (higher score=more acculturated). Multiple logistic regression was used to study the associations between measures of acculturation and HTN, adjusted for sex, age group and education. Interaction with adjustment variables and significant main effects were examined. Likelihood ratio tests were used for statistical significance. Results: The cohort’s overall prevalence of HTN was 41%. We did not find significant associations between HTN and any acculturation measures except English language proficiency, which was associated with lower odds of HTN (OR=0.70; 95% CI: 0.52-0.95; p=0.02). There were evidence of interactions between English proficiency and age (p=0.08), and English proficiency and education (p=0.09): the odds of HTN were lower in older adults who were proficient in English compared to younger adults who were not (OR=0.69; 95% CI: 0.49-0.98; p=0.038) and in South Asians who were English-proficient and had higher education compared to non-fluent speakers who were less educated (OR=0.55; 95% CI: 0.35-0.87; p=0.011). Conclusion: English language proficiency was associated with lower adjusted odds of HTN in older and more highly educated South Asians. The mechanisms through which language and CVD risk factors are linked deserve further exploration.