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African Americans, African Immigrants, and Afro-Caribbeans Differ in Social Determinants of Hypertension and Diabetes: Evidence from the National Health Interview Survey

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Abstract

In the United States (U.S.), Blacks have higher morbidity and mortality from cardiovascular disease (CVD) than other racial groups. The Black racial group includes African Americans (AAs), African immigrants (AIs), and Afro-Caribbeans (ACs); however, little research examines how social determinants differentially influence CVD risk factors in each ethnic subgroup. We analyzed the 2010–2014 National Health Interview Survey, a cross-sectional, nationally representative survey of non-institutionalized civilians. We included 40,838 Blacks: 36,881 AAs, 1660 AIs, and 2297 ACs. Age- and sex-adjusted hypertension prevalence was 37, 22, and 21% in AAs, ACs, and AIs, respectively. Age- and sex-adjusted diabetes prevalence was 12, 10, and 7% in AAs, ACs, and AIs, respectively. In the multivariable logistic regression analyses, social determinants of hypertension and diabetes differed by ethnicity. Higher income was associated with lower odds of hypertension in AAs (aOR 0.86, 95% CI 0.77–0.96) and ACs (aOR 0.55, 95% CI 0.37–0.83). In AAs, those with some college education (aOR 0.79, 95% CI 0.68–0.92) and college graduates (aOR 0.62, 95% CI 0.53–0.73) had lower odds of hypertension than those with < high school education. In AIs, having health insurance was associated with higher odds of hypertension (aOR 1.59, 95% CI 1.04–2.42) and diabetes (aOR 3.22, 95% CI 1.29–8.04) diagnoses. We observed that the social determinants associated with hypertension and diabetes differed by ethnicity. Socioeconomic factors of health insurance and income were associated with a disparate prevalence of hypertension by ethnic group. Future research among Blacks should stratify by ethnicity to adequately address the contributors to health disparities.

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Funding

Yvonne Commodore-Mensah was supported by a Career Development Award through The Johns Hopkins Institute for Clinical and Translational Research (ICTR) 5KL2TR001077-05. Lisa A. Cooper was supported by a grant from the National Heart, Lung, and Blood Institute (K24HL083113).

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Authors and Affiliations

  1. Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 419, Baltimore, MD, 21205, USA

    Yvonne Commodore-Mensah & Cheryl Dennison Himmelfarb

  2. Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, USA

    Nadine Matthie, Jessica Wells, Sandra B. Dunbar & Rasheeta D. Chandler

  3. Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, 2024 E Monument, Baltimore, MD, 21205, USA

    Lisa A. Cooper

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  1. Yvonne Commodore-Mensah
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Correspondence to Yvonne Commodore-Mensah.

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This article does not contain any studies with human participants performed by any of the authors. We did not obtain ethics approval from our institution Ethical Review Board because de-identified and publicly available data was used from the National Center for Health Statistics in this study. There were no identifying data for participants in the dataset used in this study.

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Informed consent was obtained from all individual participants included in the study by the National Center for Health Statistics.

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Commodore-Mensah, Y., Matthie, N., Wells, J. et al. African Americans, African Immigrants, and Afro-Caribbeans Differ in Social Determinants of Hypertension and Diabetes: Evidence from the National Health Interview Survey. J. Racial and Ethnic Health Disparities 5, 995–1002 (2018). https://doi.org/10.1007/s40615-017-0446-x

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