Lack of health insurance may increase risk of cardiovascular disease among older immigrants

A study conducted by NYU researchers Rory Meyers College of Nursing increases the risk of cardiovascular disease among older immigrants, especially among those recently arrived in the United States. The results are published in the Journal of Nursing Scholarship.

"Health insurance coverage can play a vital role in a comprehensive approach to mitigating cardiovascular risk in older immigrants," said Tina Sadarangani, Ph.D., Nurse-in-Residence, ANP-C GNP-BC, Assistant Professor and NYU faculty member Rory Meyers College of Nursing. the main author of the study. "The lack of health insurance coverage we have seen among recent immigrants is of particular concern, as their cardiovascular health is likely to deteriorate as they adopt American lifestyles."

In the United States, an increasing number of uninsured older immigrants are visiting emergency rooms with stroke, heart attack and other serious but preventable complications of cardiovascular disease. This may surprise some previous research on the effect of the healthy immigrant, which reveals that immigrants are initially healthier than native-born Americans. However, this advantage erodes over time, as immigrants adopt American methods, such as becoming more sedentary and eating less healthily.

Research also shows that having health insurance increases the use of health care. However, immigrants face barriers to affordable coverage. In most states, immigrants who comply with federal poverty guidelines must wait at least five years to qualify for Medicaid, the result of welfare reform in the 1990s. Private health insurance is expensive and may be unaffordable for low-income older immigrants – who, for example, may come to the United States to care for their grandchildren.

In this study, researchers sought to understand the risk of cardiovascular disease among older immigrants (aged 50 and over) and to determine whether health insurance plays a role in this risk. With the help of a nationally representative sample of the National Health and Nutrition Survey conducted by the CDC from 2007 to 2012, they examined the risk of cardiovascular disease , health insurance coverage and factors that may be barriers to health care for immigrants. Of the 1,920 aging immigrants studied, the majority (1,607) had been in the United States for at least a decade, the remainder being recent immigrants who had arrived in the last 10 years.

The researchers found that recent immigrants had a lower overall risk of cardiovascular disease than long-term immigrants, consistent with previous studies on the effect of healthy immigrants, but may also explain by their slightly younger age. However, although they are younger and healthier, laboratory tests have shown that recent immigrants had higher plasma glucose, total cholesterol and triglyceride levels and lower HDL cholesterol long-time immigrants, suggesting that they could develop cardiovascular disease and would benefit from screening. and preventive care.

In addition, recent immigrants were much more socially disadvantaged than long-term immigrants. More than half of recent immigrants (54%) had no health insurance, which made them twice as likely to be uninsured as long-term immigrants (22%). These figures contrast sharply with the American population as a whole: 8.8% of the population and about 1% of those over 65 are uninsured. Recent immigrants were also more likely to have low incomes, limited proficiency in English and a lack of routine health care.

"All of these factors undermine immigrants' ability to access care at a time when risk factors for cardiovascular disease may appear," said Sadarangani. "This is compounded by unknown and complex medical systems and the fear of the cost of care, which can prevent many people from seeking care until their health is serious and often more expensive to treat. . "

One of the key findings of the study was that not being insured contributed to the risk of cardiovascular disease beyond other factors limiting access to health care. Although the risk of cardiovascular disease was generally lower among recent immigrants than among long-term immigrants, the risk of cardiovascular disease was particularly pronounced among uninsured individuals. immigrants. Insurance plays a critical role in expanding access to preventative services, including laboratory testing for inclusive lipid and glucose screening, which was high among recent immigrants.

"Many factors have an impact on access to health care, but the most powerful indicator we measured was whether immigrants were insured.For recent immigrants, insurance disease acts as an equalizer, mitigating the effects of lower socio-economic status and language barriers, "said Sadarangani. "Aging immigrants enter the United States at a precarious moment in their lives and are predisposed to the development of chronic diseases, yet they are discouraged from using health care for a variety of reasons, including recent efforts to adopt a "public liability" rule that would penalize immigrants for using Medicaid and other services, but better access to health insurance could actually reduce their risk of cardiovascular disease, which could prevent unnecessary use and costly health care. "