Immigration Status and Disparities in the Treatment of Cardiovascular Disease Risk Factors in the Hispanic Community Health Study/Study of Latinos (Visit 2, 2014-2017)

• Published in: American journal of public health (1971) 2020-09, Vol.110 (9), p.1397-1404
• Main Authors: Guadamuz, Jenny S, Durazo-Arvizu, Ramon A, Daviglus, Martha L, Perreira, Krista M, Calip, Gregory S, Nutescu, Edith A, Gallo, Linda C, Castaneda, Sheila F, Gonzalez, 2nd, Franklyn, Qato, Dima M
• Format: Article
• Language: English
• Subjects: Adult; Aged; AJPH Open-Themed Research; Antidiabetics; Antihypertensive Agents - therapeutic use; Antihypertensives; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - prevention & control; Cholesterol; Chronic Disease; Citizens; Confidence intervals; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus - drug therapy; Disease; Emigrants and Immigrants - statistics & numerical data; Female; Health care; Health care access; Health care industry; Health insurance; Health Policy; Health risks; Health services; Health Services Accessibility - statistics & numerical data; Hispanic Americans; Hispanic or Latino - statistics & numerical data; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypercholesterolemia - drug therapy; Hypertension; Hypertension - drug therapy; Hypoglycemic Agents - therapeutic use; Immigrants; Immigration; Insurance coverage; Latin American cultural groups; Male; Medical treatment; Middle Aged; Noncitizens; Prevention; Public health; Public relations; Race/Ethnicity; Risk analysis; Risk Factors; Statins; Statistical analysis; Statistical significance; Undocumented immigrants; Undocumented Immigrants - statistics & numerical data
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2020.305745

To estimate treatment rates of high cholesterol, hypertension, and diabetes among Hispanic/Latino immigrants by immigration status (i.e., naturalized citizens, documented immigrants, or undocumented immigrants). We performed a cross-sectional analyses of the Hispanic Community Health Study/Study of Latinos (visit 2, 2014-2017). We restricted our analysis to Hispanic/Latino immigrants with high cholesterol (n = 3974), hypertension (n = 3353), or diabetes (n = 2406); treatment was defined as use of statins, antihypertensives, and antidiabetics, respectively. When compared with naturalized citizens, undocumented and documented immigrants were less likely to receive treatment for high cholesterol (38.4% vs 14.1%; prevalence ratio [PR] = 0.37 [95% confidence interval [CI] = 0.27, 0.51] and 25.7%; PR = 0.67 [95% CI = 0.58, 0.76]), hypertension (77.7% vs 57.7%; PR = 0.74 [95% CI = 0.62, 0.89] and 68.1%; PR = 0.88 [95% CI = 0.82, 0.94]), and diabetes (60.3% vs. 50.4%; PR = 0.84 [95% CI = 0.68, 1.02] and 55.8%; PR = 0.93 [95% CI = 0.83, 1.03]); the latter did not reach statistical significance. Undocumented and documented immigrants had less access to health care, including insurance coverage or a usual health care provider, than naturalized citizens. Therefore, adjusting for health care access largely explained treatment disparities across immigration status. Preventing cardiovascular disease among Hispanic/Latino immigrants should focus on undertreatment of high cholesterol, hypertension, and diabetes by increasing health care access, especially among undocumented immigrants.