Comorbid conditions, access to care and health behaviors in adults with hypertension in New York City: Highlighting disparities in South Asian immigrants

Immigrants from South Asia (India, Pakistan, Bangladesh, Nepal, Burma) have been shown to have elevated cardiovascular disease morbidity and mortality compared to other racial/ethnic groups in both national and international research studies. The purpose of this analysis was to identify how demographic characteristics, comorbid conditions, access to care and health behaviors differed in South Asian immigrants with hypertension compared to other racial/ethnic groups. Data were from the New York City Community Health Survey combined over four survey waves from 2009 to 2012 (n=36,188; 461 South Asian immigrants). Age-adjusted prevalence of hypertension in South Asian immigrants was 26.6 (21.9, 32.0), compared to 22.9 (22.0, 23.8) in non-Hispanic whites; 37.1 (35.7, 38.5) in non-Hispanic blacks, and 31.1 (29.8, 32.4) in Hispanics. South Asian immigrants with hypertension were younger and much less likely to speak English at home compared to whites and blacks with hypertension. Mean body mass index was significantly lower in South Asian immigrants (25.3 kg/m²) compared to all other racial/ethnic groups (28.7, 30.3, 30.1 kg/m² in whites, blacks, Hispanics, respectively, p<0.001 all). South Asian immigrants had similar access to care and health behaviors (taking anti-hypertensive medication, never smoker, physical activity in last 30 days) as whites, but had lower mean daily fruit and vegetable consumption (2.0 vs. 2.6 servings/day in whites). After adjustment for age, sex, individual and neighborhood level poverty and education, the associations with body mass index and fruit and vegetable consumption persisted. South Asian immigrants have similar socioeconomic and access to care profiles as other racial/ethnic groups, however they appear to have hypertension at younger ages, and lower body mass index values. Further, despite some evidence suggesting a protective effect of immigration on dietary habits, South Asian immigrants with hypertension in our study were less likely to consume fruits and vegetables in their diets. The results of this study highlight important disparities in the South Asian immigrant community in an urban area and suggest opportunities for intervention at earlier ages and lower body mass index values than for other racial/ethnic groups.