New research shows American-born Black adults are more likely to die from cardiovascular disease than Black immigrants

For years, research has suggested that immigrants in the United States have better health outcomes than those who are born here, partially because immigrants tend to already have healthier lifestyles. However, physicians also believe this good health probably fades the longer immigrants stayed in the U.S., where cheap, highly processed foods are widely available and consumed.

New research presented in February at the 2022 American Stroke Association (ASA) International Stroke Conference muddies these beliefs. Study author Dr. Alain Lekoubou Looti, a neurologist at Penn State Health Milton S. Hershey Medical Center and assistant professor of neurology and public health sciences at Penn State College of Medicine, found that both recent Black immigrants and those who had been in the U.S. for 15 years or longer were less likely to die earlier in general and from cardiovascular disease than Black adults born in the U.S.

“Even after adjusting for multiple covariates, such as socioeconomic status and education levels, these results were really surprising to us,” Lekoubou said. “To see that persistent gap between Black people born elsewhere and those who were born here — we don’t have any clear or solid explanation.”

The researchers examined data on almost 65,000 Black adults aged 25 to 74 from the CDC’s National Health Interview Survey (NHIS) from 2000 to 2014, with linked mortality files through 2015. Almost 4% of the individuals were African immigrants and 8% were from the Caribbean and Central and Latin America.

During the studied years, there were 4,329 deaths, with 935 caused by cardiovascular disease and 205 from stroke. In every case, mortality was significantly lower among immigrants, even those who had lived in the U.S. for longer than 15 years — immigrants had 54% lower death rates overall and 40% lower death rates from cardiovascular disease. While the stroke information was self-reported — a potential limitation of the study — Lekoubou said fellow physicians at the ASA conference shared his amazement by what they found.

“Everyone was surprised that foreign-born Black people have that advantage over U.S.-born people, even after 15 years of being here,” Lekoubou said. “I don’t think there was any skepticism, but this emphasizes the need for further research.”

Lekoubou said one of biggest takeaways from this study is the need to stop assuming Black patients are a homogenous group.

“I think we have to be careful when we use race to identify patients because, as this research shows, when we are talking about ‘Black people’ and their risk of cardiovascular disease, it may not the same for everyone,” he said. “There are probably some differences within these groups that need to be accounted for when we are talking to those patients.”

Important questions remain

The next steps are to clinically assess whether the “immigrant effect” is real when not self-reported, and if it is, then to figure out what is causing it. Is it health screenings prior to immigration? Underreporting health conditions because of lack of access to care? Is it self-selection among those who choose to immigrate? Or could there be other factors that improve Black immigrants’ heart health, despite the stressors of immigration and racism in the U.S.?

“The hope is that research in this area may ultimately help us discover ways to reduce heart disease and stroke for all people in the U.S., regardless of place of birth,” Lekoubou Looti said, noting the benefit of continuing his research in Pennsylvania. “We have a very diverse population here and a large number of both Black Americans and immigrants, so I think there’s an opportunity for us to try to tap into that population.”