|Brown, Alison - TUFTS UNIVERSITY|
|Houser, Robert - TUFTS UNIVERSITY|
|Mattei, Josiemer - HARVARD UNIVERSITY|
|Mozaffarian, Dariush - TUFTS UNIVERSITY|
|Lichtenstein, Alice - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY|
|Folta, Sara - TUFTS UNIVERSITY|
Submitted to: Journal of Hypertension
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/28/2017
Publication Date: 12/1/2017
Citation: Brown, A.G., Houser, R., Mattei, J., Mozaffarian, D., Lichtenstein, A.H., Folta, S.C. 2017. Hypertension among US-born and foreign-born non-Hispanic Blacks: National Health and Nutrition Examination Survey 2003-2014 data. Journal of Hypertension. 35(12):2380-2387. https://doi.org/10.1097/HJH.0000000000001489.
DOI: https://doi.org/10.1097/HJH.0000000000001489 Interpretive Summary: Observational data suggest that Blacks in the U.S. experience the highest reported rates of high blood pressure worldwide. A major limitation of this epidemiological evidence is the lack of consideration of the ethnic and cultural heterogeneity within the U.S. Black population due to immigration trends over the past 50 years. We compared the rates of high blood pressure in U.S.-born versus foreign-born non-Hispanic Blacks. The data indicated that 43% of U.S.-born Blacks and 27% of foreign-born Blacks reported or presented high blood pressure. Foreign-born Blacks were 40% less likely to have high blood pressure than their U.S.-born counterparts when taking into consideration relevant differences in demographic characteristics (e.g. age, body weight,) behaviors, and health risk factors associated with elevated blood pressures. Length of U.S. residency was not significantly associated with high blood pressure among foreign-born Blacks. These data suggest that factoring in place of birth among U.S. Blacks in observational and public health research studies may improve the accuracy of characterizing health disparities and facilitate the development of targeted interventions to reduce elevated blood pressure rates in this diverse population.
Technical Abstract: BACKGROUND: Blacks in the U.S. experience among the highest reported prevalence of hypertension (44%) worldwide. However, this does not consider the heterogeneity of Blacks within the U.S., particularly comparing US-born to long-standing or recent immigrants. METHODS: We assessed the prevalence of hypertension among U.S.-born versus foreign-born (immigrant) non-Hispanic Blacks, based on pooled nationally representative data (2003-2014) for U.S.-born (n=4,733) vs. immigrant (n=538) adults aged 22-79y; as well by length of U.S. residency among immigrants. Multivariable-adjusted logistic regression was used to investigate the association between nativity and odds for hypertension, defined as self-reported physician-diagnosed hypertension plus use of medication, or directly measured elevated blood pressure >/=140/90mmHg. RESULTS: Nearly half (42.8%) of U.S.-born Blacks but only 27.4% of foreign-born Blacks had hypertension. After adjusting for major demographic, behavioral, and health risk factors, foreign-born Blacks were 40.0% less likely (OR 0.60 95% CI 0.48, 0.76) to have hypertension than their U.S.-born counterparts. Among foreign-born Blacks, length of U.S. residency was not significantly associated with risk of hypertension: [present results/uncertainty]. CONCLUSIONS: Foreign-born versus U.S.-born non-Hispanic Blacks have substantially lower prevalence of hypertension. Considering place of birth among U.S. Blacks in research and public health efforts may improve accuracy of characterizing health disparities and facilitate development of targeted interventions to reduce hypertension rates in this diverse population.