Meeting NewsPerspective

Frequent discrimination raises African immigrants’ risk for CVD

Ruth-Alma N. Turkson-Ocran

PHILADELPHIA — African immigrants who experience frequent discrimination have significantly elevated risk for CVD and high cholesterol, according to findings presented at the American Heart Association Scientific Sessions.

Researchers found that African immigrants who experienced frequent discrimination had elevated risk for CVD (adjusted OR = 1.82; 95% CI, 1.04-3.21) and high cholesterol (aOR = 2; 95% CI, 1.01-3.97) compared with individuals who did not.

“Discrimination is associated with negative health outcomes and contributes to health disparities including higher CVD risk and prevalence of CVD risk factors. It is notable that African immigrants similar to African Americans also experience the negative health impact of discrimination,” Ruth-Alma N. Turkson-Ocran, PhD, MPH, MSN, RN, FNP-BC, who during the conduct of the study was a PhD student in the Johns Hopkins School of Nursing and is now a postdoctoral fellow in the Johns Hopkins School of Medicine, told Healio. “Yet, little research has been conducted to advance our understanding of discrimination in African immigrants in this country who have the unique experience of being both black and immigrants.”

Researchers assessed 395 African immigrants (60% women; mean age, 48 years; 61% had at least a bachelor’s degree; 19% with income < $40,000; 47% lived in the U.S. at least 15 years) living in the Baltimore-Washington, D.C., area. The Everyday Discrimination Scale was used to assess exposure to discrimination; the sum of scores greater than 2 on each item indicated frequent experiences of discrimination. High CVD risk was defined as the presence of three or more risk factors including hypertension, diabetes, high cholesterol, overweight/obesity, tobacco use and poor diet.

Secondary outcomes included each of the six risk factors analyzed individually. Of those, discrimination was only associated with high cholesterol.

“[Interventions] targeted at stress management or coping strategies could be incorporated into patient care to address the mental health and subsequent cardiovascular health of at-risk persons,” Turkson-Ocran told Healio. “Overall, as health care providers, it is important to address discrimination and potential sources of discrimination, including being aware of both our actions and preconceived biases, because they impact both the mental and physical health of others, especially persons of racial/ethnic minorities.”

Researchers stated that targeted, culturally appropriate interventions are needed to help decrease CVD risk in this population.

“Understanding and acknowledging the relationship between discrimination and heart disease outcomes is important, considering that African immigrants are vulnerable to suboptimal heart health because just like their African American counterparts, African immigrants are more likely to encounter discrimination in the health care settings,” Turkson-Ocran said in an interview. “This is a necessary first step to addressing bias within health care and may facilitate a culture of health, where health care providers care for others with cultural humility. Doing this may in turn impact African immigrants’ engagement with the health care system, participation in preventive care, heart-healthy lifestyle behaviors and, ultimately, (cardiovascular) health outcomes more positively.” – by Scott Buzby

Reference:

Turkson-Ocran RN, et al. Presentation Sa3062. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.

Disclosures: The authors report no relevant financial disclosures.

Ruth-Alma N. Turkson-Ocran

PHILADELPHIA — African immigrants who experience frequent discrimination have significantly elevated risk for CVD and high cholesterol, according to findings presented at the American Heart Association Scientific Sessions.

Researchers found that African immigrants who experienced frequent discrimination had elevated risk for CVD (adjusted OR = 1.82; 95% CI, 1.04-3.21) and high cholesterol (aOR = 2; 95% CI, 1.01-3.97) compared with individuals who did not.

“Discrimination is associated with negative health outcomes and contributes to health disparities including higher CVD risk and prevalence of CVD risk factors. It is notable that African immigrants similar to African Americans also experience the negative health impact of discrimination,” Ruth-Alma N. Turkson-Ocran, PhD, MPH, MSN, RN, FNP-BC, who during the conduct of the study was a PhD student in the Johns Hopkins School of Nursing and is now a postdoctoral fellow in the Johns Hopkins School of Medicine, told Healio. “Yet, little research has been conducted to advance our understanding of discrimination in African immigrants in this country who have the unique experience of being both black and immigrants.”

Researchers assessed 395 African immigrants (60% women; mean age, 48 years; 61% had at least a bachelor’s degree; 19% with income < $40,000; 47% lived in the U.S. at least 15 years) living in the Baltimore-Washington, D.C., area. The Everyday Discrimination Scale was used to assess exposure to discrimination; the sum of scores greater than 2 on each item indicated frequent experiences of discrimination. High CVD risk was defined as the presence of three or more risk factors including hypertension, diabetes, high cholesterol, overweight/obesity, tobacco use and poor diet.

Secondary outcomes included each of the six risk factors analyzed individually. Of those, discrimination was only associated with high cholesterol.

“[Interventions] targeted at stress management or coping strategies could be incorporated into patient care to address the mental health and subsequent cardiovascular health of at-risk persons,” Turkson-Ocran told Healio. “Overall, as health care providers, it is important to address discrimination and potential sources of discrimination, including being aware of both our actions and preconceived biases, because they impact both the mental and physical health of others, especially persons of racial/ethnic minorities.”

Researchers stated that targeted, culturally appropriate interventions are needed to help decrease CVD risk in this population.

“Understanding and acknowledging the relationship between discrimination and heart disease outcomes is important, considering that African immigrants are vulnerable to suboptimal heart health because just like their African American counterparts, African immigrants are more likely to encounter discrimination in the health care settings,” Turkson-Ocran said in an interview. “This is a necessary first step to addressing bias within health care and may facilitate a culture of health, where health care providers care for others with cultural humility. Doing this may in turn impact African immigrants’ engagement with the health care system, participation in preventive care, heart-healthy lifestyle behaviors and, ultimately, (cardiovascular) health outcomes more positively.” – by Scott Buzby

Reference:

Turkson-Ocran RN, et al. Presentation Sa3062. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Alanna Morris

    Alanna Morris

    These results are not surprising to me at all, and I applaud Turkson-Ocran and colleagues for undertaking this important investigation because analyses like this are critical to understand the multiple factors that underlie the disproportionate rates of CVD experienced by people of African ancestry in the U.S. The historical underpinnings of racism in the U.S. continue to inform microaggressions as well as overt experiences of prejudicial and unjust treatment that racial/ethnic minorities are subject to. Multiple other studies have shown us a mechanistic link between experiences of discrimination and unhealthy lifestyle behaviors, including smoking, poor sleep and poor diet in African Americans. However, the current analysis suggests that these experiences influence CVD risk patterns for African immigrants as well. Future studies should try to define the biochemical axes triggered by these experiences of discrimination, including inflammatory, oxidative stress and other biomarkers, as well as surrogate markers of vascular reactivity.

    • Alanna Morris, MD, MSc, FHFSA, FACC
    • Cardiology Today Next Gen Innovator
      Assistant Professor of Medicine, Division of Cardiology
      Emory University Clinical Cardiovascular Research Institute

    Disclosures: Morris reports no relevant financial disclosures.

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