Immigration Status and Medication Use for Cardiovascular Disease Prevention in the United States
thesisposted on 2020-08-01, 00:00 authored by Jenny S Guadamuz
The adult immigrant population has doubled from approximately 19 million in 1990 to 42 million in 2017, accounting for 17% of all US adults. However, noncitizens, which account for half of all immigrants, encounter significant barriers to healthcare access. For example, noncitizens without documentation (or undocumented immigrants) are ineligible for publicly funded health insurance, as are many documented immigrants, their eligibility depends on their specific visa status. Noncitizens also disproportionately face structural factors, such as poverty and residence in segregated, underserved communities, that adversely impact health and healthcare access. Therefore, immigration status, conceptualized using both citizenship and documentation status, may contribute to disparities in cardiovascular disease (CVD), the leading cause of morbidity and mortality in this population. Despite the critical role of immigration status and community characteristics on CVD risk factors and their treatment and control, these determinants have largely been ignored in immigrant health research. The dissertation attempts to fill this knowledge gap by investigating: (1) the association between immigration status and the prevalence, treatment, and control of CVD risk factors, (2) the relationship between living in Latino noncitizen communities and preventative cardiovascular medication use, and (3) individual and community level factors that confound these relationships. Using nationally representative data, I found that high cholesterol, hypertension, and diabetes were commonly prevalent among immigrants regardless of citizenship status yet, noncitizens are less likely to be treated or achieve control of these CVD risk factors. Using a population-based cohort of Latino immigrants, I found that undocumented immigrants are less likely to be treated for CVD risk factors. Finally, using all-payer administrative claims in New York City, Los Angeles, and Chicago, I found that living in Latino communities with a greater proportion of noncitizens (i.e., noncitizen communities) is associated with greater nonadherence to statins. Differences in the treatment of CVD risk factors may lead to disparities in CVD morbidity and mortality as immigrants age in the US, therefore, these studies have important implications for policies that intend to reduce the CVD burden among immigrants. More importantly, this research has the potential to shift the line of questioning in immigrant health, a field that has mainly focused on the influence of racial/ethnic, cultural, or behavioral differences. Instead, this work acknowledges the influence of immigration status as a structural factor that can deeply influence health inequities, regardless of these factors. I hope this work broadens the focus of immigrant health research as policymakers need to understand the root causes of disparities in order to design effective interventions.