- Researchers have recently compared the incidence of cardiovascular-related deaths among Black people who live in the United States and were born either inside or outside of the country.
- Those born outside of the U.S. had lower rates of cardiovascular-related and all-cause mortality, compared with those born in the U.S.
- Understanding the various reasons for this requires further research.
According to the Department of Health and Human Services’ Office of Minority Health, Black Americans are 30% more likely to die from heart disease and 40% more likely to have high blood pressure than non-Hispanic white Americans.
Research has shown, however, that health outcomes vary between those who were born in the U.S. and elsewhere.
Immigrants in a country often have a health advantage over native populations, despite having a lower socioeconomic status and limited access to healthcare. Some researchers refer to this phenomenon as the “healthy immigrant effect.”
Whether the healthy immigrant effect relates to the cardiovascular health of Black people in the U.S. has been largely unclear. Research into the area may provide valuable information for preventive healthcare strategies.
In a recent study led by a team at Penn State University, researchers analyzed health and demographic data to assess health outcomes of Black people in the U.S. who had been born in or outside of the country.
They found that Black African-born individuals had lower rates of mortality from cardiovascular diseases and from all causes than Black individuals born in the U.S.
“Our finding that Black individuals who immigrated to the U.S. earlier (less than 5 years ago) and later (15 years ago or more) died at a lower rate than U.S.-born Black individuals was surprising, and our analysis could not explain this difference,“ says Dr. Alain Lekoubou Looti, an assistant professor at the Penn State Neuroscience Institute and lead author of the study.
“One potential explanation is the persistent ‘carryover’ effects from their country of birth, although this benefit fades with time,” he added.
The
The researchers looked at health information from 2000–2014, taken from the
Altogether, they analyzed data from 64,717 individuals aged 25–74 years who self-identified as Black. They then identified as being born in the U.S., the Caribbean, Central or South America, or Africa.
According to Pew Research Center, as of 2019, 10% of Black people in the U.S. were immigrants and 58% of Black foreign-born people living in the U.S. had immigrated in 2000 or later.
Over the study period, 2,549 people reported a stroke. Meanwhile, 4,329 deaths were recorded. Of these, 205 were attributed to stroke and 932 to cardiovascular disease.
After analyzing the data, the researchers found that at a 10-year follow-up, people born outside of the U.S. had lower overall rates of all-cause mortality and mortality caused by cardiovascular disease or stroke.
All-cause, cardiovascular disease, and stroke mortality occurred among:
- 12.6%, 2.8%, and 0.6% of individuals born in the U.S., respectively
- 6.1%, 1.6%, and 0.5%, of those born in the Caribbean, or Central or South America
- 3.2%, 0.5%, and 0.1% of those born in Africa
After controlling for demographic factors, the researchers found that people born in the Caribbean and Central or South America had lower rates of all-cause mortality and cardiovascular mortality than those born in the U.S., but similar stroke mortality rates.
And, after adjustments, the researchers still found that people born in Africa had lower all-cause mortality rates and tended to have lower cardiovascular mortality rates than people born in the U.S.
The team also noted that adjusting for smoking, body mass index, and time since migration did not significantly affect their findings.
As this study was observational, it does not explain the reasons behind the differences in health outcomes among Black people born inside or outside of the U.S.
When asked about the reasons for the results, Dr. Lekoubou Looti explained to Medical News Today that factors related to the so-called healthy immigrant effect may play a role:
“Those who migrate to the U.S. quite frequently have better health than those who stay behind in their home countries,“ Dr. Mercedes Carnethon told MNT. Dr. Carnethon is a professor of preventive medicine at Northwestern University Feinberg School of Medicine and was not involved in the study.
“Moving to another country requires financial resources and connections and good baseline health to withstand the challenges associated with travel and relocation. The findings from this study are consistent with prior studies that include immigrants from other countries,” she noted.
Dr. Stephen Juraschek, a clinician investigator at Beth Israel Deaconess Medical Center, who was also not involved in the study, told MNT:
“It should be noted that some migrants to other countries often do not reflect that countries’ population. In fact, from the perspective of education, African migrants to the U.S. are among the most well-educated. These types of factors, which are difficult to measure, may also influence health outcomes, particularly when compared to the population of American-born adults.”
“Another hypothesis is that individuals born within the U.S. into racial and ethnic groups that have been historically marginalized and discriminated against have a lifetime of experiences that take a toll on their health,” explained Dr. Carnethon.
“For example,” she continued, “limited economic opportunity within families can translate into restricted access to health-promoting resources, including communities to live and work [in] and constrained access to healthcare. Over time, these limitations can build up — to lead to worse health behaviors and worse health outcomes. Immigrants coming from other cultures may face fewer of these insults to health.”
Dr. Juraschek agreed with these points and added that shift work, inconsistent healthcare access, and lifestyle factors, such as high sodium in processed foods and insufficient physical activity, may also contribute to the worse health outcomes that the researchers observed.
“The differences between Caribbean [or] South American and African migrants is also noteworthy and may require some more work to understand the factors behind these differences,” he added.
The researchers conclude that foreign-born Black Americans generally have lower all-cause mortality and cardiovascular-related mortality rates than Black people born in the U.S.
Source: Medical News Today
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