Recent older immigrants at higher risk of heart disease

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An increasing number of uninsured, older immigrants are going to emergency rooms with strokes, heart attacks and other serious but preventable complications of cardiovascular disease, according to a recent study. Lack of health insurance may be to blame.

Older immigrants’ risk for cardiovascular disease may be higher among those who recently arrived in the United States, according to researchers contributing to the study published in the Journal of Nursing Scholarship. The finding contradicts the so-called “healthy immigrant effect,” which holds that immigrants initially tend to healthier than native-born Americans, with the advantage eroding over time they take on American ways, such as becoming more sedentary and eating less healthfully.

The study found that recent older immigrants had higher blood glucose levels, higher total cholesterol and triglycerides and lower HDL cholesterol values compared with long-term immigrants, suggesting that they could develop cardiovascular disease and would benefit from screening and preventive care.

Also, lifestyle factors like alcohol or tobacco use, language barriers, lower socioeconomic status, discrimination and lack of access to health care all adversely impact immigrant health, according to the American Society on Aging.

“Health insurance coverage can play an essential part in a comprehensive approach to mitigating cardiovascular risk for aging immigrants,” said lead author Tina Sadarangani, Ph.D., a nurse-practitioner and assistant professor at NYU Rory Meyers College of Nursing.

“The lack of health insurance coverage we observed among recent immigrants is especially concerning, given that their cardiovascular health is susceptible to deterioration as they adopt American lifestyles,” she said in a statement.

Prior studies confirm that having health insurance increases health care utilization. However, immigrants experience barriers to obtaining affordable coverage. In the majority of states, immigrants who meet federal poverty guidelines must wait at least five years to become eligible for Medicaid. Private health insurance plans may be unaffordable for older immigrants with limited incomes.

“When we think about affordable health insurance and access to health care we seldom think about the barriers that immigrants face,” co-author Deborah Chyun, Ph.D., R.N., dean of the School of Nursing, University of Connecticut, told UConn Today.

The researchers sought to understand the risk of cardiovascular disease among aging immigrants (age 50 and older) and analyzed whether health insurance plays a role in this risk. Using a nationally representative sample from the CDC’s National Health and Nutrition Examination Survey from 2007 to 2012, they looked at cardiovascular disease risk, health insurance coverage, and factors that may be barriers to health care for immigrants.

Of the 1,920 aging immigrants studied, the majority (1,607) had been in the U.S. for at least a decade, while the remainder were recent immigrants, having arrived in the U.S. within the past 10 years. Recent immigrants were more likely to have low incomes, limited English proficiency, and lack routine health care.

More than half of recent immigrants (54 percent) had no health insurance, more than twice the uninsured rate of long-term immigrants (22 percent). In comparison, 8.8 percent of the overall U.S. population and roughly 1 percent of those over 65 are uninsured.

“All of these factors challenge immigrants’ ability to access care at a time when risk factors for cardiovascular disease may emerge,” Sadarangani said in a statement. “This is compounded by unfamiliar and complex medical systems and fear around the cost of care, which may prevent many from seeking care until a health condition is serious and often more expensive to treat.”

Being uninsured was a greater contributor to cardiovascular disease risk than other factors restricting health care access, according to the authors. Health insurance acts as an “equalizer” of sorts, mitigating some of the effects of socioeconomic and language barriers, but immigrants these days are discouraged from using health care, according to Sadarangani.

Recent Trump administration changes to the public charge rule would further negatively impact immigrants, according to an analysis by the Kaiser Family Foundation. They concluded that “the changes would likely lead to broad decreases in participation in Medicaid and other programs among legal immigrant families and their primarily U.S.-born children beyond those directly affected by the changes Decreased participation in these programs would contribute to more uninsured individuals and negatively affect the health and financial stability of families.”

Cardiovascular Disease Risk Among Older Immigrants in the United States: A Comparison of Risk Measures” appeared in the November/December 2018 issue of Journal of Nursing Scholarship.

Resources & story angles

  • For a deeper dive into the history of immigrants and aging in the United States, check out this chapter in the International Handbook of Population Aging.
  • This report from the Center for an Urban Future found that “the growth in New York’s older immigrant population is far outpacing that of the U.S.-born senior population.” What’s happening in your city? Are stakeholders prepared to handle the issues and challenges that come with increasing older immigrant populations?
  • This article from Grantmakers in Aging looks at issues stakeholders should consider before funding future programs and services. What’s in place to help older immigrants in your community?

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