Understanding immigrants' cardiovascular disease utilization: An epidemiological and system dynamics approach

PROJECT SUMMARY Cardiovascular disease (CVD) is one of the leading causes of mortality for most racial and ethnic groups in the U.S. When immigrants first arrive in the U.S., they have better CVD risk factor profiles than the U.S.-born, but within 5 to 15-years of living in the U.S., they experience a worsening of their CVD risk factor profiles.

Immigrants of color, specifically some Black, Latinx and Afro-Latinx immigrants, have lower screening, monitoring, and treatment of CVD risk factors than U.S.-born populations. Lower preventive care utilization likely contributes to their worsening cardiovascular health. Eliminating disparities in CVD preventive care

utilization is necessary to improve the cardiovascular health trajectory of immigrants of color and lessen the burden of CVD mortality in the U.S. The research objective of this career development award is to use epidemiologic, system dynamics, and community-engaged methods to understand how individual and multiple

components of the sociopolitical environment affect Black and Latinx immigrants’ CVD preventive care utilization. This research will also address current gaps in immigrant health research by focusing on CVD preventive care utilization outcomes, including Black immigrants in the study population, and using objectively

measured, longitudinal electronic health record data (EHR). The research objective will be achieved through three novel aims. Aim 1 is to estimate trends and associations between state and county-level immigration enforcement rates (e.g., community arrests), hate crimes rates, and CVD preventive care utilization among

Black and Latinx immigrant adults using electronic health record data from a nationwide network of community health centers. Aim 2 is to develop a system map with community stakeholders that graphically depicts hypothesized causal relationships and feedback loops within the sociopolitical environment that affect

immigrants’ CVD preventive care utilization. Aim 3 is to develop a system dynamics simulation model to estimate improvements in CVD preventive care utilization as different components of the immigrant-related sociopolitical environment are manipulated. This multidisciplinary research plan directly addresses NHLBI’s

critical challenge to advance methods of assessing and characterizing exposures to understand differences in health among populations. The research aims are complemented with a training plan that builds upon the candidate’s expertise as social epidemiologist to develop the candidate’s expertise in the (1) measurement and

quantification of non-policy components of the sociopolitical environment, (2) analysis of longitudinal EHR data, (3) use of system dynamics simulation methods, and (4) use of community-engaged research and community- based system dynamics methods. Together, the research and training plans will prepare the candidate to

become an interdisciplinary, independent research investigator whose career is aimed at improving the cardiovascular health trajectories of immigrants of color in the U.S.