Elsevier

Canadian Journal of Cardiology

Volume 28, Issue 1, January–February 2012, Pages 20-26
Canadian Journal of Cardiology

Clinical research - prevention/rehabilitation
Cardiovascular Risk Factor Profiles of Recent Immigrants vs Long-term Residents of Ontario: A Multi-ethnic Study

https://doi.org/10.1016/j.cjca.2011.06.002Get rights and content

Abstract

Background

There is growing evidence that cardiovascular risk profiles differ markedly across Canada's 4 major ethnic groups, namely White, South Asian, Chinese, and Black; however, the impact of long-term Canadian residency on cardiovascular risk within and across these ethnic groups is unknown.

Methods

Using pooled data from Statistics Canada's National Population and Canadian Community Health Surveys (1996-2007), we compared the age- and sex-standardized prevalence of cardiovascular risk factors and diseases between recent immigrants (< 15 years in Canada) and long-term residents (immigrants who lived in Canada for ≥ 15 years or people born in Canada) among White, South Asian, Chinese, and Black ethnic groups living in Ontario. We also calculated ethnic-specific attributable fraction (AF), defined as the proportion of risk that can be attributed to long-term Canadian residency.

Results

For all ethnic groups, cardiovascular risk factor profiles (ie, the percentage of people with ≥ 2 major cardiovascular risk factors, ie, smoking, obesity, diabetes, and hypertension) were worse among those with longer duration of residency in Canada. The greatest change in recent immigrants vs long-term residents was observed in the Chinese group (2.2% vs 5.2%; AF 0.47) followed by the White (6.5% vs 10.3%; AF 0.36), Black (9.2% vs 12.1%; AF 0.17), and South Asian (7.7% vs 8.2%; AF 0.03) groups. The prevalence of cardiovascular disease did not differ significantly between recent immigrants and long-term residents, irrespective of ethnic group.

Conclusions

Our results suggest that cardiovascular disease prevention strategies must consider not only ethnicity, but also the level of acculturation within each ethnic group.

Résumé

Introduction

Il y a de plus en plus de preuves démontrant que les profils de risque cardiovasculaire diffèrent de façon marquée entre les 4 groupes ethniques majeurs du Canada, c'est-à-dire les Blancs, les Sud-Asiatiques, les Chinois et les Noirs. Cependant, l'incidence de la résidence canadienne à long terme sur le risque cardiovasculaire au sein et entre ces groupes ethniques est inconnue.

Méthodes

En utilisant les données groupées de l'Enquête nationale sur la santé de la population et l'Enquête sur la santé dans les collectivités canadiennes de Statistique Canada (1996-2007), nous avons comparé la prévalence standardisée selon l'âge et le sexe des facteurs de risque cardiovasculaire et des maladies entre des immigrants récents (< 15 ans au Canada) et des résidants à long terme (des immigrants qui ont vécu au Canada pour ≥ 15 ans ou des personnes qui sont nées au Canada) parmi les groupes ethniques de Blancs, de Sud-Asiatiques, de Chinois et de Noirs vivant en Ontario. Nous avons aussi calculé la fraction attribuable (FA) à la spécificité ethnique, définie comme la proportion de risque qui peut être attribuée à la résidence canadienne à long terme.

Résultats

Pour tous les groupes ethniques, les profils des facteurs de risque cardiovasculaire (c.-à-d. le pourcentage de personnes ayant ≥ 2 facteurs de risque cardiovasculaire, soit le tabagisme, l'obésité, le diabète et l'hypertension) ont été pires parmi ceux ayant résidé au Canada plus longuement. Le plus grand changement chez les immigrants récents par rapport aux résidants à long terme a été observé dans le groupe de Chinois (2,2 % vs 5,2 %; FA 0,47) suivi par les Blancs (6,5 % vs 10,3 %; FA 0,36), les Noirs (9,2 % vs 12,1 %; FA 0,17), et les Sud-Asiatiques (7,7 % vs 8,2 %; FA 0,03). La prévalence de la maladie cardiovasculaire n'a pas différé significativement entre les immigrants récents et les résidants à long terme, sans distinction de groupe ethnique.

Conclusions

Nos résultats suggèrent que les stratégies de prévention de la maladie cardiovasculaire doivent considérer non seulement l'ethnicité, mais aussi le niveau d'acculturation au sein de chacun des groupes ethniques.

Section snippets

Study population and variables

Data from the Statistics Canada's cross-sectional National Population Health Survey (NPHS) 1996 and Canadian Community Health Survey (CCHS) Cycles 1.1 (2001), 2.1 (2003), 3.1 (2005), and 4.1 (2007)12 were combined13 to create the study population. Details about the surveys are found in Online Appendix SI.

We analyzed people living in Ontario, who were aged 12 years or older and who identified themselves, when asked to which racial-cultural group they belonged, as ‘White,' ‘South Asian’ (ie,

Study population

This study included a total of 163,797 participants: 154,653 White, 3364 South Asian, 3038 Chinese, and 2742 Black. The mean age for each ethnic subgroup was approximately 42 years and 49.1% were male. More details about the sociodemographic characteristics of the study population can be found in Online Appendix SIV and Online Table S1.

Cardiovascular risk factors

Table 1 displays the age- and sex-standardized prevalence of major cardiovascular risk factors for recent immigrants and long-term residents in each of the 4

Discussion

In this population-based, multi-ethnic study in Ontario, we found that major cardiovascular risk factors were more prevalent among long-term residents than among recent immigrants. This negative acculturation effect was observed within all 4 ethnic groups examined, however, the largest effect was observed among the Chinese, followed by the White, Black, and South Asian groups. The changes in the Chinese and White groups were mainly driven by an increase in the prevalence of diabetes and the

Funding Sources

This study was supported by an operating grant from the Heart and Stroke Foundation of Ontario (HSFO) to the Institute for Clinical Evaluative Sciences (ICES), a Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award to Maria Chiu and a CIHR Team Grant in Cardiovascular Outcomes Research. ICES is funded by the Ontario Ministry of Health and Long-Term Care. Peter Austin is supported by a Career Investigator Award from the HSFO.

Disclosures

The authors have no conflicts of interest to disclose.

Acknowledgements

The authors acknowledge that the data used in this publication are from Statistics Canada's National Population Health Survey and Canadian Community Health Surveys. The authors thank all the participants of these surveys, as well as the staff from Statistics Canada who assisted in the collection and management of the survey data.

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