Abstract P471: Citizenship Status and the Prevalence, Treatment, and Control of Cardiovascular Disease Risk Factors Among Immigrants in United States, 2011-2016

Abstract

Introduction: Immigrants without US citizenship, i.e., noncitizens, encounter barriers in accessing care which may contribute to disparities in cardiovascular disease (CVD), the leading cause of death among immigrants in the US. Despite this, little is known about whether the prevalence, treatment, and control of CVD risk factors differ by citizenship status This study estimates the prevalence, treatment, and control of CVD risk factors (hypercholesterolemia, hypertension, and diabetes) among US immigrants by citizenship status. Methods: We used nationally representative, cross-sectional data from the National Health and Nutrition Examination Survey (2011/12 to 2015/16), restricted to 5,306 immigrant adults (≥20 years). Citizenship status (exposure) was categorized as either citizen or noncitizen. CVD risk factor prevalence (age-standardized), treatment, and control were defined per national guidelines and determined using examinations and prescription-medication inventories. Treatment was estimated among persons with relevant conditions and control was estimated among persons who were receiving treatment. Associations were evaluated using Poisson regressions (prevalence ratios, PR). Results: Hypercholesterolemia (42.0%), hypertension (29.0%), and diabetes (15.7%) were common among immigrants and marginal differences were observed between citizens and noncitizens. However, noncitizens were less likely to be treated for hypercholesterolemia (16.4% vs. 43.3%, PR 0.38 [CI 0.31-0.46], P <0.001), hypertension (60.3% vs. 79.6%, PR 0.76 [CI 0.70-0.84], P <0.001), and diabetes (51.2% vs. 66.6%, PR 0.77 [CI 0.66-0.90], P <0.001) than citizens. Because noncitizens disproportionally lack a usual source of care (30.2% vs. 16.6%, P <0.001) and health insurance (48.8% vs. 19.1%, P <0.001), adjusting for access to care largely explained differences in the treatment of CVD risk factors. Among those treated for CVD risk factors, citizens and noncitizens achieved similar control of hypercholesterolemia (36.2%) and hypertension (67.5%), but disparities in diabetes control were observed (35.3% vs. 46.9% , P =0.04). Conclusions: While CVD risk factors were common in citizens and noncitizens, treatment rates were significantly lower among noncitizens due to poor access to care. Efforts to prevent CVD morbidity and mortality among immigrants should address the undertreatment of risk factors by ensuring access to care among immigrants, regardless of citizenship status.