Abstract
BackgroundAsian Americans represent one of the fastest-growing immigrant groups in the U.S. and are at high risk for cardiometabolic diseases (CMDs), including type 2 diabetes, hypertension, coronary artery disease, and stroke. Despite the growth of Asians in the U. S, there is a gap in understanding the heterogeneity of CMDs across Asian subgroups and how these might be affected by the social determinants of health (SDOH), or the environment in which people live and work.ObjectiveThe purpose of this systematic review is to examine the current literature on CMDs among Asian Americans and identify the SDOH that are associated with the incidence and/or prevalence of CMDs among specific Asian subgroups.MethodsPubMed, Embase, Web of Science were searched for articles published in Jan 2000-Nov 2020. The reproducible strategy yielded 2732 articles. The articles were reviewed based on the following inclusion criteria: (1) observational study published in the U.S., (2) adult population includes specific Asian subgroups, (3) exposures include SDOH, and (4) outcomes include a CMD, defined as type 2 diabetes, hypertension, coronary artery disease, or stroke.ResultsIn this review, 14 studies were identified and organized into four key themes: acculturation (n = 9), socioeconomic status (SES) (n = 6), social context (n = 2), and health literacy (n = 1). The most represented Asian subgroups in the literature were Chinese, Filipino, and South Asians. Acculturation was the most described social factor in the included reviews. Seven studies found associations between higher acculturation levels and higher prevalence of CMD. However, the measure of acculturation varied by study and included various combinations of the country of birth, number of years residing in the U.S., and English proficiency. The effects of SES, measured as income level and educational attainment, varied by racial subgroups. One study found that higher levels of education were associated with CMD among South Asians.ConclusionAcculturation, SES, social context, and health literacy impact the risk of CMD among Asian Americans; these vary across subgroups. Future research disentangling SDOHs on the risk of CMDs by Asian subgroup is necessary to provide better informed preventive practices and interventions.
Highlights
The United States has 18.9 million (5.9% of the U.S population) Asian Americans, defined as a person who belongs to the Asian race as “having origins in any of the original peoples of the Far East, Southeast Asia, or theMin et al BMC Health Services Research (2022) 22:257Indian subcontinent” including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam, between others [1, 2]
The articles were reviewed based on the following inclusion criteria: (1) observational study published in the U.S, (2) adult population includes specific Asian subgroups, (3) exposures include social determinants of health (SDOH), and (4) outcomes include a cardiometabolic disease (CMD), defined as type 2 diabetes, hypertension, coronary artery disease, or stroke
Further research may focus on interventions that address SDOH among Asian subgroups and on other CMD-related outcomes. To our knowledge, this is the first systematic review examining the association of SDOH and CMD risk among specific Asian subgroups
Summary
The United States has 18.9 million (5.9% of the U.S population) Asian Americans, defined as a person who belongs to the Asian race as “having origins in any of the original peoples of the Far East, Southeast Asia, or theMin et al BMC Health Services Research (2022) 22:257Indian subcontinent” including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam, between others [1, 2]. Multiple studies showed that Asian immigrants have an increased risk of cardiometabolic diseases, which includes type 2 diabetes, hypertension, coronary artery disease, stroke [9,10,11]. A recent scientific report from AHA mentions education, income, and occupation to be the most common social determinants influencing cardiometabolic health [13] It reiterates the importance of addressing the specific health needs of the rapidly increasing Asians as they are disproportionately burdened with poor health across a variety of outcomes [13]. Asian Americans represent one of the fastest-growing immigrant groups in the U.S and are at high risk for cardiometabolic diseases (CMDs), including type 2 diabetes, hypertension, coronary artery disease, and stroke. S, there is a gap in understanding the heterogeneity of CMDs across Asian subgroups and how these might be affected by the social determinants of health (SDOH), or the environment in which people live and work
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