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Cardiovascular diseases and risk factors among Chinese immigrants

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Abstract

The aim of this study is to identify the prevalence of cardiovascular disease (CVD) and major CVD risk factors, including diabetes, hypertension, dyslipidemia, obesity and smoking among Chinese immigrants by a systematic review of studies from various countries. PubMed and the China National Knowledge Infrastructure databases were searched for studies of the prevalence of major CVDs and risk factors, and of CVD mortality among Chinese immigrants. The search identified 386 papers, 16 of which met the inclusion criteria for this review. In mainland China, there is a pattern of high stroke prevalence but low coronary heart disease (CHD) prevalence. Among Chinese immigrants, there is a much lower prevalence and mortality of stroke, but a higher prevalence and mortality of CHD, even though these are lower than the rates in immigrants of other ethnicities in the host country. The prevalence of CVD risk factors is also markedly different in immigrants. Compared with mainland Chinese, Chinese immigrants have a higher prevalence of diabetes and hypertension, higher serum cholesterol, poorer dietary patterns, and higher prevalence of obesity and smoking. Thus, the epidemiological pattern of CVD among Chinese immigrants changes compared with resident mainland Chinese. The less healthy environmental factor after immigration may be a major trigger in the adverse CVD status of Chinese immigrants. It is important for policy-makers to pay more attention to specific minority immigrant groups, and to implement more effective preventive measures to improve the health of immigrant populations.

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References

  1. World Health Organization (2014) Global status report on noncommunicable diseases

  2. GDB (2013) Mortality and causes of death collaborators. global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden Of Disease Study. Lancet 385(9963):117–171

  3. Yang G, Wang Y, Zeng Y et al (2013) Rapid health transition in china, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381(9882):1987–2015

    Article  PubMed  Google Scholar 

  4. Habib SH, Saha S (2010) Burden of non-communicable disease: global overview. Diabetes Metab Syndr 4(1):41–47

    Article  Google Scholar 

  5. Vineis P, Stringhini S, Porta M (2014) The environmental roots of non-communicable diseases (Ncds) and the epigenetic impacts of globalization. Environ Res 133:424–430

    Article  CAS  PubMed  Google Scholar 

  6. Mahalingam R, Rabelo VC (2013) Theoretical, methodological, and ethical challenges to the study of immigrants: perils and possibilities. New Dir Child Adolesc Dev 2013(141):25–41

    Article  PubMed  Google Scholar 

  7. Ko Y, Butcher R, Leong RW (2014) Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases. World J Gastroenterol 20(5):1238–1247

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dassanayake J, Gurrin L, Payne WR et al (2011) Cardiovascular disease risk in immigrants: what is the evidence and where are the gaps. Asia Pac J Public Health 23(6):882–895

    Article  PubMed  Google Scholar 

  9. Hoeffel EM, Rastogi S, Kim MO et al The Asian Population (2010) US Department Of Commerce, Economics And Statistics Administration, US Census Bureau

  10. Gryn T, Gambino C (2012) The foreign born from Asia: 2011. American Community Survey Briefs

  11. Tunstall-Pedoe H, Kuulasmaa K, Mahonen M et al (1999) Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 who MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 353(9164):1547–1557

    Article  CAS  PubMed  Google Scholar 

  12. Wu Z, Yao C, Zhao D et al (2001) Sino-MONICA Project: a Collaborative Study on trends and determinants in cardiovascular diseases in China, part I: morbidity and mortality monitoring. Circulation 103(3):462–468

    Article  CAS  PubMed  Google Scholar 

  13. Chen D, Roman GC, Wu GX et al (1992) Stroke in China (Sino-MONICA-Beijing Study) 1984–1986. Neuroepidemiology 11(1):15–23

    Article  CAS  PubMed  Google Scholar 

  14. Zhao D, Liu J, Wang W et al (2008) Epidemiological transition of stroke in china: twenty-one-year observational study from the Sino-MONICA-Beijing project. Stroke 39(6):1668–1674

    Article  PubMed  Google Scholar 

  15. Modesti PA, Bianchi S, Borghi C et al (2014) Cardiovascular health in migrants: current status and issues for prevention. a collaborative multidisciplinary task force report. J Cardiovasc Med 15(9):683–692

    Article  Google Scholar 

  16. Bhopal R (2000) What is the risk of coronary heart disease in South Asians? A review of UK research. J Public Health Med 22(3):375–385

    Article  CAS  PubMed  Google Scholar 

  17. Raza Q, Doak CM, Khan A et al (2013) Obesity and cardiovascular disease risk factors among the indigenous and immigrant Pakistani population: a systematic review. Obes Facts 6(6):523–535

    Article  PubMed  Google Scholar 

  18. Anand SS, Yusuf S, Vuksan V et al (2000) Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study Of Health Assessment And Risk In Ethnic Groups (SHARE). Lancet 356(9226):279–284

    Article  CAS  PubMed  Google Scholar 

  19. Zaninotto P, Mindell J, Hirani V (2007) Prevalence of cardiovascular risk factors among ethnic groups: results from the Health Surveys For England. Atherosclerosis 195(1):E48–E57

    Article  CAS  PubMed  Google Scholar 

  20. Chiu M, Austin PC, Manuel DG, Tu JV (2010) Comparison of cardiovascular risk profiles among ethnic groups using Population Health Surveys between 1996 and 2007. CMAJ 182(8):E301–E310

    Article  PubMed  PubMed Central  Google Scholar 

  21. Corlin L, Woodin M, Thanikachalam M et al (2014) Evidence for the healthy immigrant effect in older chinese immigrants: a cross-sectional study. BMC Public Health 14:603

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fang J, Madhavan S, Alderman MH (1999) Cardiovascular mortality of Chinese in New York City. J Urban Health 76(1):51–61

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sheth T, Nair C, Nargundkar M et al (1999) Cardiovascular and cancer mortality among Canadians of European, South Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths. CMAJ 161(2):132–138

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Jose PO, Frank AT, Kapphahn KI et al (2014) Cardiovascular disease mortality in Asian Americans. J Am Coll Cardiol 64(23):2486–2494

    Article  PubMed  PubMed Central  Google Scholar 

  25. Li N, Tuomilehto J, Dowse G et al (1992) Electrocardiographic abnormalities and associated factors in Chinese living in Beijing and in Mauritius. The Mauritius Non-Communicable Disease Study Group. BMJ 304(6842):1596–1601

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Harland JO, Unwin N, Bhopal RS et al (1997) Low levels of cardiovascular risk factors and coronary heart disease in a UK Chinese population. J Epidemiol Community Health 51(6):636–642

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Wang L (2014) Immigrant health, socioeconomic factors and residential neighbourhood characteristics: a comparison of multiple ethnic groups in Canada. Appl Geogr 52:90–98

    Article  Google Scholar 

  28. Dowse GK, Gareeboo H, Zimmet PZ et al (1990) High prevalence Of NIDDM and impaired glucose tolerance in Indian, CreoleAnd Chinese Mauritians. Diabetes 39(3):390–396

    Article  CAS  PubMed  Google Scholar 

  29. Kandula NR, Diez-Roux AV, Chan C et al (2008) Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care 31(8):1621–1628

    Article  PubMed  PubMed Central  Google Scholar 

  30. Veeranna V, Zalawadiya SK, Niraj A et al (2013) Association of novel biomarkers with future cardiovascular events is influenced by ethnicity: results from a multi-ethnic cohort. Int J Cardiol 166(2):487–493

    Article  PubMed  Google Scholar 

  31. Wang B, Wei DY, Wang CX et al (2010) A research on prevalence and risk factors of type 2 diabetes mellitus in the farmers and immigrants of Yi people on Liangshan, Sichuan province, China. Chin J Prev Med 44(6):510–515

    Google Scholar 

  32. Moran A, Diez RAV, Jackson SA et al (2007) Acculturation is associated with hypertension in a multiethnic sample. Am J Hypertens 20(4):354–363

    Article  PubMed  Google Scholar 

  33. Bin W, Chunxiu W, Daying W et al (2010) Prevalence and risk factors of essential hypertension in Yi people in Sichuan province, China. Chin J Public Health 26(4):472–473

    Google Scholar 

  34. Longde W, Ling Y, Yang H et al (2015) Fixed-dose combination treatment after stroke for secondary prevention in China: a National Community-Based Study. Stroke 46(5):1295–1300

    Article  PubMed  Google Scholar 

  35. Zhai Y, Wang WZ, Zhao WH et al (2009) The prevalence and onset of age of stroke in Chinese adults. Chin J Prev Med 43(12):1069–1072

    Google Scholar 

  36. Ministry of Health in China (2014) China Health And Family Planning Statistics Yearbook

  37. Chiu JF, Bell AD, Herman RJ et al (2010) Cardiovascular risk profiles and outcomes of Chinese living inside and outside China. Eur J Cardiovasc Prev Rehabil 17(6):668–675

    Article  PubMed  Google Scholar 

  38. Center for Health Statistic and Information (2009) An Analysis Report Of National Health Services Survey In China, 2008

  39. Hu D, Fu P, Xie J et al (2008) Increasing prevalence and low awareness, treatment and control of diabetes mellitus among Chinese adults: the InterASIA Study. Diabetes Res Clin Pract 81(2):250–257

    Article  PubMed  Google Scholar 

  40. Hu D, Sun L, Fu P et al (2009) Prevalence and risk factors for type 2 diabetes mellitus in the Chinese adult population: the InterASIA Study. Diabetes Res Clin Pract 84(3):288–295

    Article  CAS  PubMed  Google Scholar 

  41. Dong JJ, Lou NJ, Zhao JJ et al (2011) Evaluation of a risk factor scoring model in screening for undiagnosed diabetes in China population. J Zhejiang Univ Sci B 12(10):846–852

    Article  PubMed  PubMed Central  Google Scholar 

  42. Park PJ, Griffin SJ, Sargeant L, Wareham NJ (2002) The performance of a risk score in predicting undiagnosed hyperglycemia. Diabetes Care 25(6):984–988

    Article  CAS  PubMed  Google Scholar 

  43. Meisinger C, Strassburger K, Heier M et al (2010) Prevalence of undiagnosed diabetes and impaired glucose regulation in 35–59-year-old individuals in Southern Germany: the KORA F4 Study. Diabet Med 27(3):360–362

    Article  CAS  PubMed  Google Scholar 

  44. Yang W, Lu J, Weng J et al (2010) Prevalence Of diabetes among men and women in China. N Engl J Med 362(12):1090–1101

    Article  CAS  PubMed  Google Scholar 

  45. Unwin N, Harland J, White M et al (1997) Body mass index, waist circumference, waist-hip ratio, and glucose intolerance in Chinese and Europid adults in Newcastle, UK

  46. Eastern Stroke Coronary Heart Disease Collaborative Research Group (1998) Blood pressure, cholesterol, and stroke in eastern Asia. The Lancet 352(9143):1801–1807

    Article  Google Scholar 

  47. Li LM, Rao KQ, Kong LZ et al (2005) A description on the Chinese national nutrition and health survey in 2002. Zhonghua Liu Xing Bing Xue Za Zhi 26(7):478–484

    PubMed  Google Scholar 

  48. Hsu YH, Mao CL, Wey M (2010) Antihypertensive medication adherence among elderly Chinese Americans. J Transcult Nurs 21(4):297–305

    Article  PubMed  Google Scholar 

  49. Kramer H, Han C, Post W et al (2004) Racial/ethnic differences in hypertension and hypertension treatment and control in the multi-ethnic study of atherosclerosis (MESA). Am J Hypertens 17(10):963–970

    Article  PubMed  Google Scholar 

  50. Yang W, Xiao J, Yang Z et al (2012) Serum lipids and lipoproteins in Chinese Men and Women. Circulation 125(18):2212–2221

    Article  CAS  PubMed  Google Scholar 

  51. Wahlqvist ML (2002) Asian migration to Australia: food and health consequences. Asia Pac J Clin Nutr 11(Suppl 3):S562–S568

    Article  PubMed  Google Scholar 

  52. Klatsky AL, Armstrong MA (1991) Cardiovascular risk factors among Asian Americans living In northern California. Am J Public Health 81(11):1423–1428

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Narayan KM, Aviles-Santa L, Oza-Frank R et al (2010) Report of a National Heart, Lung, And Blood Institute Workshop: heterogeneity in cardiometabolic risk In Asian Americans in the US opportunities for research. J Am Coll Cardiol 55(10):966–973

    Article  PubMed  Google Scholar 

  54. Albrecht SS, Roux AVD, Kandula NR et al (2013) Immigrant assimilation and bmi and waist size: a longitudinal examination among hispanic and Chinese participants in the multi-ethnic study of atherosclerosis. Obesity 21(8):1695–1703

    Article  PubMed  PubMed Central  Google Scholar 

  55. Zhai F, Wang H, Du S et al (2007) Lifespan nutrition and changing socio-economic conditions in China. Asia Pac J Clin Nutr 16(Suppl 1):374–382

    PubMed  Google Scholar 

  56. Johnson CA, Xie B, Liu C et al (2006) Socio-demographic and cultural comparison of overweight and obesity risk and prevalence in adolescents in southern California and Wuhan, China. J Adolesc Health 39(6):925.E1–8

  57. Chiu M, Austin PC, Manuel DG, Tu JV (2012) Cardiovascular risk factor profiles of recent immigrants vs long-term residents of Ontario: a multi-ethnic study. Can J Cardiol 28(1):20–26

    Article  PubMed  Google Scholar 

  58. Zhou N, Cheah CS (2015) Ecological risk model of childhood obesity in Chinese immigrant children. Appetite 90:99–107

    Article  PubMed  Google Scholar 

  59. Au L, Kwong K, Chou JC et al (2009) Prevalence of overweight and obesity in Chinese American children in New York City. J Immigr Minor Health 11(5):337–341

    Article  PubMed  Google Scholar 

  60. Razak F, Anand SS, Shannon H et al (2007) Defining obesity cut points in a multiethnic population. Circulation 115(16):2111–2118

    Article  PubMed  Google Scholar 

  61. Pan WH, Flegal KM, Chang HY et al (2004) Body mass index and obesity-related metabolic disorders in taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. Am J Clin Nutr 79(1):31–39

    CAS  PubMed  Google Scholar 

  62. Lv N, Brown JL (2010) Chinese American family food systems: impact of western influences. J Nutr Educ Behav 42(2):106–114

    Article  PubMed  Google Scholar 

  63. Rosenthal T (2014) The effect of migration on hypertension and other cardiovascular risk factors: a review. J Am Soc Hypertens

  64. Li Q, Hsia J, Yang G (2011) Prevalence of smoking in China in 2010. N Engl J Med 364(25):2469–2470

    Article  CAS  PubMed  Google Scholar 

  65. Chen X, Unger JB, Johnson CA (1999) Is acculturation a risk factor for early smoking initiation among Chinese American minors?A Comparative Perspective. Tob Control 8(4):402–410

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Chen X, Unger JB, Cruz TB, Johnson CA (1999) Smoking patterns of Asian–American youth in California and their Relationship with acculturation. J Adolesc Health 24(5):321–328

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was sponsored by the National Science and Technology Pillar Program during the Twelfth Five-Year Plan Period of China (NO. 2011BAI08B01).

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Correspondence to Dong Zhao.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human and animals performed by any of the authors.

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Gong, Z., Zhao, D. Cardiovascular diseases and risk factors among Chinese immigrants. Intern Emerg Med 11, 307–318 (2016). https://doi.org/10.1007/s11739-015-1305-6

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