Psychosocial and Demographic Factors Underlying Cardiovascular Risk in Chinese Americans

Abstract

Objective: To examine how stress, social capital, and socioeconomic status are related to cardiovascular risk in Chinese American immigrants.

Methods: 2,069 first-generation immigrants from mainland China were recruited in New York City for a cross sectional epidemiological study. Data collection included a brief physical exam and interview-administered questionnaires to assess socioeconomic status, social capital, medical history, and stress. Cardiovascular disease (CVD), including coronary heart disease, cerebrovascular events, peripheral artery disease, and heart failure risk was measured by the Framingham General Cardiovascular Risk score and the two scores developed by Barzi et al. (2007) based on an Asian cohort. The relationship between the Perceived Stress Scale (PSS), a Socioeconomic Status Index (SES), and multiple measures of social capital (social cohesion and social network index) to CVD risk was analyzed.

Results: Socioeconomic status, perceived stress, social cohesion and the social network index were negatively correlated with CVD risk. Multiple regression analysis associating SES, PSS, and social capital with Framingham General CVD risk found SES (b * = -0.15), PSS (b * = -0.17), social network index (b * = -0.13) and social cohesion (b * = -0.05) were statistically significant (p < 0.01), with similar results from the CVD risk scores developed based on Asian cohorts by Barzi et al. (2007). The overall R 2 ranged from 0.07 to 0.13. Mediation analysis found that stress did not mediate the impact of SES on CVD risk and that social capital did not mediate the impact of SES on CVD risk. Perceived stress was found to mediate the relationship between social cohesion and Framingham General CVD risk, with a direct effect of -0.18 and an indirect effect of -0.14, both significant at p < 0.05, with similar results from the CVD risk measures calculated based on Asian cohorts by Barzi et al. (2007). All results were consistent across all three measures of CVD risk.

Conclusions: The findings suggest that SES, PSS, and social capital need to be considered when addressing CVD risk in Chinese American immigrants. The inverse relationship between SES and CVD risk (i.e., higher socioeconomic status is associated with lower CVD risk) is consistent with earlier findings, suggesting that the risk association for Chinese American immigrants is more similar to non-immigrant populations in the U.S. than to the population in China. The inverse relationship between PSS and CVD risk is inconsistent with other research and may reflect unique dynamics in how stress is perceived and responded to in this Chinese American community. Social capital appears to be an important factor at both the individual and community level and should be further explored. The consistency of results between the two Barzi et al. (2007) Asian specific CVD risk scores and the Framingham General CVD risk measure suggests the Framingham General Cardiovascular Risk score can be used to estimate relative risk levels among this population. Further research to calibrate cardiovascular risk measures for Chinese Americans and to understand the negative relationship between perceived stress and CVD risk is needed.

KEYWORDS: cardiovascular disease; Chinese American; perceived stress; socioeconomic status; social capital