Cardiovascular health among Chinese immigrants in Australia

Abstract

Coronary heart disease (CHD) is a major health issue for immigrants in Western countries. However, little is known about cardiovascular health among Chinese immigrants, the largest non-English speaking group in Australia. This thesis aims to explore cardiovascular risk among Chinese immigrants. Firstly, the incidence of CHD and outcome after first CHD diagnosis was determined through systematic review and meta-analysis. Secondly, survey data from the 45 and Up Study examined prevalence of CHD and risk factors among Chinese immigrants compared to other Australians, and acculturation effects on their cardiovascular risk. Finally, a family-centred descriptive, qualitative study explored socio-ecological influences on Chinese immigrants’ engagement with CHD prevention. The systematic review and meta-analysis found Chinese immigrants in Western countries had lower CHD incidence compared with Whites (OR=0.29; P<0.001), yet had higher short-term mortality after CHD events compared with Whites (OR=1.34; P<0.05). The 45 and Up Study data showed higher prevalence of cardiovascular risk factors among Chinese Australians, including higher prevalence of current smoking, physical inactivity and diabetes and worse cardiovascular risk profiles. Those who migrated as either a child or adolescent were particularly at risk for diabetes and overweight/obesity. The qualitative findings identified important barriers and facilitators for effective CHD prevention and care among Chinese immigrants. Barriers included individual factors such as health knowledge deficits, widespread non-adherence to primary prevention medication and low English proficiency. The cardiovascular health of Chinese immigrants is influenced by complex individual, environmental and contextual exposure during their life course, both in their country of origin and in their new country. This thesis identifies important gaps in CHD prevention and calls for culturally-specific preventive programs.