Psychosocial factors related to cardiovascular disease risk in UK South Asian men: A preliminary study
Corresponding Author
Emily D. Williams
University College London, UK
Correspondence should be addressed to Emily D. Williams, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK (e-mail: [email protected]).Search for more papers by this authorCorresponding Author
Emily D. Williams
University College London, UK
Correspondence should be addressed to Emily D. Williams, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK (e-mail: [email protected]).Search for more papers by this authorAbstract
Objective. To compare the exposure to psychosocial factors associated with cardiovascular risk in UK South Asian and white European men.
Design. Interview study of 63 healthy UK South Asian and 42 white European men aged 35–75 years, randomly selected from a larger study group in West London. Interviews were administered in Punjabi and English. Measures of psychosocial and cardiovascular risk factors were obtained.
Setting. Ealing Hospital, West London.
Results. The South Asian men had lived in the UK for an average of 27.9 (SD 11.6) years, and had higher educational attainment than the white Europeans. Compared with the white Europeans, the South Asian men lived in significantly more crowded homes, experienced lower job control, greater financial strain, lower neighbourhood social cohesion and more racial harassment. They received less emotional support, and were more depressed and less optimistic on standard questionnaires. These men also had higher waist/hip ratios and were more sedentary, but there were no significant ethnic differences in biological risk factors.
Conclusions. South Asian men living in London showed a higher risk profile in psychosocial factors thought to contribute to cardiovascular disease risk. This preliminary investigation is consistent with the possibility that psychosocial adversity contributes to increased vulnerability to coronary heart disease in South Asians resident in the UK.
References
- Agyemang, C., Bhopal, R. S. Is the blood pressure of South Asian adults in the UK higher or lower than that in European white adults? A review of cross-sectional data Journal of Human Hypertension 16 739–751 2002.
- Balarajan, R. Ethnicity and variations in the nation's health Health Trends 27 114–119 1995.
- Berkman, L. F., Leo-Summers, L., Horwitz, R. I. Emotional support and survival after myocardial infarction Annals of Internal Medicine 117 1003–1009 1992.
- Bhopal, R. What is the risk of coronary heart disease in South Asians? A review of UK research Journal of Public Health Medicine 22 375–385 2000.
- Bhopal, R. Glossary of terms relating to ethnicity and race, for reflection and debate Journal of Epidemiology and Community Health 58 441–445 2004.
- Bhopal, R., Hayes, L., White, M., Unwin, N., Harland, J., Ayis, S. et al. Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians Journal of Public Health Medicine 24 95–105 2002.
- Bhopal, R., Vettini, A., Hunt, S., Wiebe, S., Hanna, L., Amos, A. Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups British Medical Journal 328 76–80A 2004.
- Bosma, H., Marmot, M. G., Hemingway, H., Nicholson, A. C., Brunner, E., Stansfeld, S. A. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study British Medical Journal 314 558–565 1997.
- Chambers, J. C., Eda, S., Bassett, P., Karim, Y., Thompson, S. G., Gallimore, J. R. et al. C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in South Asians from the United Kingdom compared with European whites Circulation 104 145–150 2001.
- Chambers, J. C., Obeid, O. A., Refsum, H., Ueland, P., Hackett, D., Hooper, J. et al. Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men Lancet 355 523–527 2000.
- Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., Gwaltney, J. M. Social ties and susceptibility to the common cold Journal of American Medical Association 277 1940–1944 1997.
- Diez Roux, A. V., Merkin, S. S., Arnett, D., Chambless, L., Massing, M., Nieto, F. J. et al. Neighborhood of residence and incidence of coronary heart disease New England Journal of Medicine 345 99–106 2001.
- Eaker, E. D., Pinsky, J., Castelli, W. P. Myocardial infarction and coronary death among women, psychosocial predictors from a 20-year follow-up of women in the Framingham study American Journal of Epidemiology 135 854–864 1992.
- Evans, G. W., Kantrowitz, E. Socioeconomic status and health, the potential role of environmental risk exposure Annual Review of Public Health 23 303–331 2002.
- Executive summary of the third report of the national cholesterol education program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) Journal of American Medical Association 285 2486–2497 2001.
- Feldman, P. J., Steptoe, A. How neighborhoods and physical functioning are related, the roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors Annals of Behavioral Medicine 27 91–99 2004.
- Fischbacher, C. M., Hunt, S., Alexander, L. How physically active are South Asians in the United Kingdom? A literature review Journal of Public Health 26 250–258 2004.
- Fischbacher, C. M., White, M., Bhopal, R. S., Unwin, N. C. Self-reported work strain is lower in South Asian than European people, cross-sectional survey Ethnicity and Health 10 279–292 2005.
- Forouhi, N. G., Sattar, N., McKeigue, P. M. Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians International Journal of Obesity 25 1327–1331 2001.
- Giltay, E. J., Kamphuis, M. H., Kalmijn, S., Zitman, F. G., Kromhout, D. Dispositional optimism and the risk of cardiovascular death, the Zutphen elderly study Archives of Internal Medicine 166 431–436 2006.
- Gupta, M., Singh, N., Verma, S. South Asians and cardiovascular risk: What clinicians should know Circulation 113 e924–e929 2006.
- Harding, S. Social mobility and self-reported limiting long-term illness among West Indian and South Asian migrants living in England and Wales Social Science and Medicine 56 355–361 2003.
- Hemingway, H., Kuper, H., Marmot, M. Psychosocial factors in the primary and secondary prevention of coronary heart disease, an updated systematic review of prospective cohort studies R. Yusuf, J. A. Cairns, A. J. Camm, E. L. Fallen, B. J. Gersh Evidence-based cardiology 2nd ed. 181–218 London: BMJ Books 2003.
- Hemingway, H., Whitty, C. J., Shipley, M., Stansfeld, M. S., Brunner, E., Fuhrer, R. et al. Psychosocial risk factors for coronary disease in White, South Asian and Afro-Caribbean civil servants, the Whitehall II study Ethnicity and Disease 11 391–400 2001.
- Horsten, M., Mittleman, M. A., Wamala, S. P., Schenck-Gustafsson, K., Orth-Gomer, K. Social relations and the metabolic syndrome in middle-aged Swedish women Journal of Cardiovascular Risk 6 391–397 1999.
- Huxley, R., Barzi, F., Woodward, M. Excess risk of fatal coronary heart disease associated with diabetes in men and women, meta-analysis of 37 prospective cohort studies British Medical Journal 32 73–78 2006.
- Jafar, T. H., Jafary, F. H., Jessani, S., Chaturvedi, N. Heart disease epidemic in Pakistan: Women and men at equal risk American Heart Journal 150 221–226 2005.
- R. A. Karasek, T. Theorell Healthy work New York: Basic Books 1990.
- Karlsen, S., Nazroo, J. Y. Relation between racial discrimination, social class, and health among ethnic minority groups American Journal of Public Health 92 624–631 2002.
- Katbamna, S., Ahmad, W., Bhakta, P., Baker, R., Parker, G. Do they look after their own? Informal support for South Asian carers Health and Social Care in the Community 12 398–406 2004.
- Kooner, J. S. Coronary heart disease in UK South Asians, the potential for reducing mortality Heart 78 530–532 1997.
- McKeigue, P. M., Shah, B., Marmot, M. G. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians Lancet 337 382–386 1991.
- Nazroo, J. Y. South Asian people and heart disease, an assessment of the importance of socioeconomic position Ethnicity and Disease 11 401–411 2001.
- Pearlin, L. I., Menaghan, E. G., Lieberman, M. A., Mullan, J. T. The stress process Journal of Health and Social Behavior 22 337–356 1981.
- Phinney, J. S., Ong, A., Madden, T. Cultural values and intergenerational value discrepancies in immigrant and non-immigrant families Child Development 71 528–539 2000.
- Pollard, T. M., Carlin, E., Bhopal, R., Unwin, N., White, M., Fischbacher, C. Social networks and coronary heart disease risk factors in South Asians and Europeans in the UK Ethnicity and Health 8 263–275 2003.
- Radloff, L. S. The CES-D scale: A self-report depression scale for research in the general population Applied Psychological Assessment 1 385–401 1977.
- Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A. et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study), case-control study Lancet 364 953–962 2004.
- Rosengren, A., Wilhelmsen, L., Orth-Gomer, K. Coronary disease in relation to social support and social class in Swedish men. A 15 year follow-up in the study of men born in 1933 European Heart Journal 25 56–63 2004.
- Rozanski, A., Blumenthal, J. A., Kaplan, J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy Circulation 99 2195–2217 1999.
- Sampson, R. J., Raudenbush, S. W., Earls, F. Neighborhoods and violent crime, a multilevel study of collective efficacy Science 277 918–924 1997.
- Scheier, M. F., Carver, C. S. Effects of optimism on psychological and physical well-being, theoretical overview and empirical update Cognitive Therapy and Research 16 201–228 1992.
- Scheier, M. F., Matthews, K. A., Owens, J. F., Schulz, R., Bridges, M. W., Magovern, G. J. et al. Optimism and rehospitalization after coronary artery bypass graft surgery Archives of Internal Medicine 159 829–835 1999.
- Sheth, T., Nair, C., Nargundkar, M., Anand, S., Yusuf, S. Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993, an analysis of 1.2 million deaths Canadian Medical Association Journal 161 132–138 1999.
- Sonuga-Barke, E. J., Mistry, M. The effect of extended family living on the mental health of three generations within two Asian communities British Journal of Clinical Psychology 39 129–141 2000.
- S. A. Stansfeld, M. G. Marmot Stress and the heart, psychosocial pathways to coronary heart disease London: BMJ Books 2002.
- Steptoe, A., Ayers, S. Stress, health and illness S. Sutton, A. Baum, M. Johnston Sage handbook of health psychology 169–196 London: Sage 2004.
- Steptoe, A., Kunz-Ebrecht, S., Owen, N., Feldman, P. J., Rumley, A., Lowe, G. D. et al. Influence of socioeconomic status and job control on plasma fibrinogen responses to acute mental stress Psychosomatic Medicine 65 137–144 2003.
- Steptoe, A., Willemsen, G. The influence of low job control on ambulatory blood pressure and perceived stress over the working day in men and women from the Whitehall II cohort Journal of Hypertension 22 915–920 2004.
- Troxel, W. M., Matthews, K. A., Bromberger, J. T., Sutton-Tyrrell, K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women Health Psychology 22 300–309 2003.
- Veenstra, G. Social capital, SES and health, an individual-level analysis Social Science Medicine 50 619–629 2000.
- Webster, R. A., Thompson, D. R., Mayou, R. A. The experiences and needs of Gujarati Hindu patients and partners in the first month after a myocardial infarction European Journal of Cardiovascular Nursing 1 69–76 2002.
- Whitty, C. J., Brunner, E. J., Shipley, M. J., Hemingway, H., Marmot, M. G. Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study Atherosclerosis 142 279–286 1999.
- Williams, R., Hunt, K. Psychological distress among British South Asians, the contribution of stressful situations and subcultural differences in the West of Scotland Twenty-07 Study Psychological Medicine 27 1173–1181 1997.