Hispanics and Chinese: Acculturation and Kidney Dysfunction
Hispanics and Chinese: Acculturation and Kidney Dysfunction
Background. Acculturation affects health, but it has never been studied with kidney disease.
Methods. We studied the association of language spoken at home, generation and birth place with kidney function among Hispanics and Chinese in the Multi-Ethnic Study of Atherosclerosis (n = 2999). Kidney function was determined by cystatin C (eGFRcys) and albumin/creatinine ratio (ACR). We evaluated mediators in models: Model 1 = age, sex, income, education; Model 2 = Model 1 + behaviors; and Model 3 = Model 1 + comorbidities.
Results. Among Hispanics, speaking mixed Spanish/English was significantly associated with lower eGFRcys (−2.83 mL/min/1.73 m, −5.69–0.04) and higher ACR (RD 40%, 17–68%) compared with speaking Spanish only; this was mildly attenuated by behaviors (−2.29, −5.33–0.75; RD 42%, 18–72%) but not comorbidities (−3.04, −5.83 to −0.23); RD 35%, 14–59%). US-born Hispanics had lower eGFRcys compared with foreign-born Hispanics [1.83 mL/min/1.73 m lower (0.97–1.31) for Generation 1; 1.37 mL/min/1.73 m lower (0.75–1.57) for Generation ≥ 2].
In contrast, Chinese who spoke any English had higher eGFRcys (2.53, 95% CI: −1.70–6.78), but similar ACR (RD −5%, 95% CI: −26–23%) compared with those speaking Chinese only, but associations were not statistically significant.
Conclusion. Higher acculturation was associated with worse kidney function in Hispanics, mediated perhaps by behavioral factors but not comorbidities. Associations may be in the opposite direction among Chinese. Future studies are needed to elucidate these mechanisms.
Chronic kidney disease (CKD) is a major public health problem in the USA, which is reported to affect 13% of adults. The impact of CKD and its complications is higher among certain racial/ethnic groups. Hispanics have ~yy2-fold higher incidence of end-stage renal disease (ESRD) and Asians have a 1.3-fold higher incidence compared with non-Hispanic whites in the USA. These observations have not been explained by differences in the prevalence of traditional CKD risk factors or differences in socioeconomic status. Despite the increasing numbers of persons of Hispanic or Asian descent affected by kidney disease, studies of risk factors for CKD among Hispanics and Asians in the USA are limited.
One major challenge in the study of CKD risk factors within these groups is that adults who are categorized as Hispanic or Asian in epidemiological studies may actually be quite heterogenous, possibly leading to differences in disease risk. One source of variability within immigrant groups is the degree of adoption of US culture, referred to as level of acculturation. Acculturation refers to the modification of the culture, behavior, beliefs and values of individuals and groups as they borrow or adapt to another culture. Different immigrant groups may acculturate to different degrees, and acculturation may also vary by gender or age. Moreover, acculturation may have differing associations with disease in different groups. Higher levels of acculturation have been shown to be independently associated with higher rates of traditional CKD risk factors such as diabetes, atherosclerotic heart disease and hypertension among Chinese and non-Mexican American Hispanics in the USA. Evidence also suggests that the health consequences of greater acculturation are not always adverse. The association of acculturation with kidney disease has not been previously studied.
We used data from the Multi-Ethnic Study of Atherosclerosis (MESA) to investigate whether acculturation is associated with kidney dysfunction and albuminuria among Hispanic and Chinese participants. We also investigated whether a potential association between acculturation and kidney dysfunction was explained by differences in traditional kidney disease risk factors or differences in behavioral factors. We hypothesized that higher levels of acculturation would be associated with decreased kidney function and increased albuminuria, and that these associations would be primarily mediated by differences in the prevalence of diabetes and hypertension.
Abstract and Introduction
Abstract
Background. Acculturation affects health, but it has never been studied with kidney disease.
Methods. We studied the association of language spoken at home, generation and birth place with kidney function among Hispanics and Chinese in the Multi-Ethnic Study of Atherosclerosis (n = 2999). Kidney function was determined by cystatin C (eGFRcys) and albumin/creatinine ratio (ACR). We evaluated mediators in models: Model 1 = age, sex, income, education; Model 2 = Model 1 + behaviors; and Model 3 = Model 1 + comorbidities.
Results. Among Hispanics, speaking mixed Spanish/English was significantly associated with lower eGFRcys (−2.83 mL/min/1.73 m, −5.69–0.04) and higher ACR (RD 40%, 17–68%) compared with speaking Spanish only; this was mildly attenuated by behaviors (−2.29, −5.33–0.75; RD 42%, 18–72%) but not comorbidities (−3.04, −5.83 to −0.23); RD 35%, 14–59%). US-born Hispanics had lower eGFRcys compared with foreign-born Hispanics [1.83 mL/min/1.73 m lower (0.97–1.31) for Generation 1; 1.37 mL/min/1.73 m lower (0.75–1.57) for Generation ≥ 2].
In contrast, Chinese who spoke any English had higher eGFRcys (2.53, 95% CI: −1.70–6.78), but similar ACR (RD −5%, 95% CI: −26–23%) compared with those speaking Chinese only, but associations were not statistically significant.
Conclusion. Higher acculturation was associated with worse kidney function in Hispanics, mediated perhaps by behavioral factors but not comorbidities. Associations may be in the opposite direction among Chinese. Future studies are needed to elucidate these mechanisms.
Introduction
Chronic kidney disease (CKD) is a major public health problem in the USA, which is reported to affect 13% of adults. The impact of CKD and its complications is higher among certain racial/ethnic groups. Hispanics have ~yy2-fold higher incidence of end-stage renal disease (ESRD) and Asians have a 1.3-fold higher incidence compared with non-Hispanic whites in the USA. These observations have not been explained by differences in the prevalence of traditional CKD risk factors or differences in socioeconomic status. Despite the increasing numbers of persons of Hispanic or Asian descent affected by kidney disease, studies of risk factors for CKD among Hispanics and Asians in the USA are limited.
One major challenge in the study of CKD risk factors within these groups is that adults who are categorized as Hispanic or Asian in epidemiological studies may actually be quite heterogenous, possibly leading to differences in disease risk. One source of variability within immigrant groups is the degree of adoption of US culture, referred to as level of acculturation. Acculturation refers to the modification of the culture, behavior, beliefs and values of individuals and groups as they borrow or adapt to another culture. Different immigrant groups may acculturate to different degrees, and acculturation may also vary by gender or age. Moreover, acculturation may have differing associations with disease in different groups. Higher levels of acculturation have been shown to be independently associated with higher rates of traditional CKD risk factors such as diabetes, atherosclerotic heart disease and hypertension among Chinese and non-Mexican American Hispanics in the USA. Evidence also suggests that the health consequences of greater acculturation are not always adverse. The association of acculturation with kidney disease has not been previously studied.
We used data from the Multi-Ethnic Study of Atherosclerosis (MESA) to investigate whether acculturation is associated with kidney dysfunction and albuminuria among Hispanic and Chinese participants. We also investigated whether a potential association between acculturation and kidney dysfunction was explained by differences in traditional kidney disease risk factors or differences in behavioral factors. We hypothesized that higher levels of acculturation would be associated with decreased kidney function and increased albuminuria, and that these associations would be primarily mediated by differences in the prevalence of diabetes and hypertension.
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