Social factors influence Asian Americans’ heart health

Education, employment and other determinants may pose different cardiovascular risks across Asian subpopulations, a study shows.

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Unfavorable social determinants of health, such as being unemployed or not having a degree beyond high school were associated with an increased likelihood of risk for cardiovascular disease among Asian Americans, according to research published today in the Journal of the American Heart Association. 

The authors also noted that the link between these unfavorable factors and cardiovascular disease risk factors varied widely among the Asian subgroups represented in this study.

“Despite the perception that Asian Americans may be less impacted by social determinants of health compared to other racial and ethnic groups, our findings indicate unfavorable social factors are associated with higher prevalence of cardiovascular risk factors among Asian American groups,” said lead author Dr. Eugene Yang, a cardiologist and clinical professor of medicine at the University of Washington School of Medicine.

The investigators examined the responses of 6,395 U.S. adults who self-identified as Asian in the National Health Interview Survey from 2013 to 2018. The study analyzed 27 variables in six domains of social determinants of health: economic stability (including employment and income status), neighborhood trust, measures of community and psychological distress, food security, education and healthcare utilization. Survey-takers’ responses in these domains were identified as favorable or unfavorable.

The analysis showed a significant association between unfavorable social variables and respondents’ responses to survey questions about cardiovascular risk factors such as suboptimal sleep and high blood pressure.

Across all Asian respondents, each additional unit of unfavorable social determinants of health was associated with a 14% higher odds of high blood pressure, a 17% higher odds of unhealthy sleep, and a 24% higher odds of type 2 diabetes.


Of the 6,395 Asian adults in the survey, 22% self-identified as Filipino adults; 22% as Asian Indian adults; 21% as Chinese adults and 36% as other. The numbers of respondents who represented other major Asian populations, including Japanese, Korean and Vietnamese people, were too small to be disaggregated in the analysis.  

Within demographic subgroups, more unfavorable social determinants were associated with:

  • a 45% greater likelihood of type 2 diabetes among Chinese adults and a 24% greater likelihood among Filipino adults. 
  • a 28% greater risk of high blood pressure among Filipino adults.
  • a 42% increased likelihood of insufficient physical activity among Asian Indian adults, a 58% increased likelihood among Chinese adults, and a 24% increased likelihood among Filipino adults.
  • a 20% likelihood of suboptimal sleep among Asian Indian adults.
  • a 56% and 50% likelihood, respectively, of nicotine exposure among Chinese adults and Filipino adults.

Compared with other subgroups, adults who identified as Filipino reported the highest prevalence, 4 out of 7 cardiovascular risk factors: poor sleep, high cholesterol, high blood pressure and obesity.

“It is important to understand how different Asian subgroups are affected,” Yang said. “When Asians are lumped together, higher risk groups like South Asians may not be treated aggressively enough, while lower risk groups like Korean and Japanese people may be overly treated for blood pressure or cholesterol.”

“The Asian American population is one of the fastest growing racial/ethnic groups in the United States,” Yang said. “South Asian people have higher rates of premature heart disease globally, and they recently have been found to have higher cardiovascular mortality than non-Hispanic white people. Better understanding of why differences in cardiovascular risk exist among Asian subgroups is critical.”

Co-authors, disclosures and funding sources are listed in the manuscript.

– Adapted from the news release of the American Heart Association

Related: Download broadcast-ready sound bites with Dr. Eugene Yang.


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