Abstract
Allostatic load score (ALS) summarizes the physiological effect of stress on cardiovascular, metabolic and immune systems. As immigration is stressful, ALS could be affected. Associations between age of immigration, reason for immigration, and unhealthy assimilation behavior and ALS were determined in 238 African immigrants to the United States (age 40 ± 10, mean ± SD, range 21-64 years). ALS was calculated using 10 variables from three domains; cardiovascular (SBP, DBP, cholesterol, triglyceride, homocysteine), metabolic [BMI, A1C, albumin, estimated glomerular filtration rate (eGFR)], and immunological [high-sensitivity C-reactive protein (hsCRP)]. Variables were divided into sex-specific quartiles with high-risk defined by the highest quartile for each variable except for albumin and eGFR, which used the lowest quartile. One point was assigned if the variable was in the high-risk range and 0 if not. Unhealthy assimilation behavior was defined by a higher prevalence of smoking, alcohol consumption, or sedentary activity in immigrants who lived in the US for ≥10 years compare to <10 years. Sixteen percent of the immigrants arrived in the US as children (age < 18 years); 84% arrived as adults (age ≥ 18 years). Compared to adulthood immigrants, childhood immigrants were younger (30 ± 7 vs. 42 ± 9, P < 0.01) but had lived in the US longer (20 ± 8 vs. 12 ± 9 years, P < 0.01). Age-adjusted ALS was similar in childhood and adulthood immigrants (2.78 ± 1.83 vs. 2.73 ± 1.69, P = 0.87). For adulthood immigrants, multiple regression analysis (adj R2 = 0.20) revealed older age at immigration and more years in the US were associated with higher ALS (both P < 0.05); whereas, current age, education, income, and gender had no significant influence (all P ≥ 0.4). The prevalence of smoking, alcohol intake, and physical activity did not differ in adulthood immigrants living in the US for ≥10 years vs. <10 years (all P ≥ 0.2). Reason for immigration was available for 77 participants. The reasons included: family reunification, lottery, marriage, work, education, and asylum. Compared to all other reasons combined, immigration for family reunification was associated with the lowest ALS (1.94 ± 1.51 vs. 3.03 ± 1.86, P = 0.03). African immigrants do not appear to respond to the stress of immigration by developing unhealthy assimilation behaviors. However, older age at immigration and increased duration of stay in the US are associated with higher ALS; whereas, family reunification is associated with lower ALS. NCT00001853.
Highlights
Allostatic load is defined as stress-induced physiologic dysregulation caused by the chronic over-secretion of catecholamines and glucocorticoids (1, 2)
Evaluating physiologic stress in African immigrants by allostatic load score (ALS), our main findings were (1) family reunification was associated with the lowest ALS; (2) unhealthy assimilation behaviors were not characteristic of African immigrants; (3) older age of immigration and increased duration of stay in the United States were associated with more stress and higher ALS in adulthood immigrants; and (4) higher education, greater income, and gender in African immigrants did not appear to influence ALS
Using ALS as a measure of stress-induced physiologic dysregulation, our study suggests that the stress of living in America may be minimized by reuniting families
Summary
Allostatic load is defined as stress-induced physiologic dysregulation caused by the chronic over-secretion of catecholamines and glucocorticoids (1, 2). Repeated exposure to these sympatheticadrenal-medullary (SAM) and hypothalamic–pituitary–adrenal (HPA) hormones has adverse cardiovascular, metabolic, and immune consequences (1, 2). While allostatic load has been evaluated in African-Americans and to a lesser extent in foreign-born blacks, data specific to African immigrants are not available (3, 4). The reason for this lack of data is that health surveys either exclude African immigrants or place them in general categories, such as Black/African-American or foreign-born blacks (5, 6). An exploration of how social and biological factors interact and influence the health of African immigrants has not previously been possible
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