Research Highlights:

  • A new study found Black adults born in the U.S. had a higher risk of death from cardiovascular disease and other causes compared to Black U.S. immigrants.
  • These findings highlight the need for health care professionals to obtain detailed information about the region of origin and cultural differences among people from diverse racial and ethnic backgrounds in order to increase health equity across all people.

Embargoed until 4 a.m. CT/5 a.m. ET Thursday, Feb. 3, 2022

NEW ORLEANS, Feb. 3, 2022 — Black adults born in the U.S. had a higher rate of death from cardiovascular diseases and all causes compared to Black adults who were born in other countries, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2022, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health to be held in person in New Orleans and virtually, Feb. 8-11, 2022.

Black adults in the U.S. are at higher risk for heart attack, stroke and other cardiovascular diseases compared to white Americans. However, the risk of death from stroke and other types of cardiovascular disease, as well as all causes of death, may vary among Black adults born in the U.S. versus those who are born elsewhere. The researchers note their study is one of the first large, population-based, epidemiological studies to examine the impact of migration and assimilation on death among Black individuals.

“Previous reports have suggested that despite having low socio-economic status and limited access to health care, immigrants around the world are generally healthier than the host population [in the country to which they have migrated], a benefit that tends to dissipate the longer they live in the host country,” said study author Alain Lekoubou Looti, M.D., M.S., an assistant professor of neurology and public health sciences at Penn State College of Medicine at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania. “How region of origin and acculturation affect death from cardiovascular disease, stroke and all causes among Black immigrants remains largely unknown and may provide valuable information for studies on stroke prevention and outcomes for the public, health care professionals and health care stakeholders.”

In 2019, 10% of the Black population in the U.S. was estimated to be born elsewhere, an increase of 3% from 2000, when about 7% of the U.S. Black population was born outside the U.S., according to statistics from the Pew Research Center.

In this study, researchers evaluated the association between country of birth and stroke prevalence using health information on more than 64,700 Black adults in the U.S., ages 25 to 74 years, from the National Health Interview Service data 2000-2014 of the U.S. Centers for Disease Control and Prevention (CDC). Among those who reported surviving a stroke, researchers compared overall death rates, as well as death rates specifically due to stroke and cardiovascular diseases, among Black adults born in the U.S. and Black adults born in the Caribbean, South and Central America, and Africa. The researchers also analyzed the potential effect of time since migration on these parameters.

The analysis found:

  • Of those studied, 2,549 had a self-reported history of a stroke.
  • There were 4,329 deaths (including 205 attributed to a stroke and 932 deaths from cardiovascular disease) recorded during the study period.
  • Compared to U.S.-born Black adults, African-born Black adults who reported having had a stroke had 50% lower death from all causes and trended toward having lower cardiovascular death rates.
  • At the 10-year follow-up, the incidence of death for U.S.-born Black adults from all causes was 12.6%; 2.76% from cardiovascular disease; and 0.6% from stroke. Among Black adults who were born in the Caribbean, South and Central America, the incidence of death from all causes was about 6.1%; 1.6% from cardiovascular disease; and 0.45% from stroke. For Black adults born in Africa, the incidence of death from all causes was 3.15%; 0.54% from cardiovascular disease; and 0.08% from stroke.
  • Compared to U.S.-born Black adults, the rates of death among Black individuals born in the Caribbean, South and Central America from all causes were 54% lower and 40% lower from cardiovascular disease, respectively, however, rates of death from stroke were similar.
  • Time since migration did not significantly affect death rates among Black adults born outside the U.S.

“Our finding that Black individuals who immigrated to the U.S. earlier (less than five years ago) and later (15 years ago and more) died at a lower rate than U.S.-born Black individuals was surprising, and our analysis could not explain this difference. One potential explanation is the persistent ‘carryover’ effects from their country of birth, although this benefit fades with time,” Lekoubou Looti said.

A potential study limitation is that stroke was self-reported by the study participants.

“This study provides important additional information as we continue to investigate the various factors that may affect cardiovascular disease death and stroke incidence among people born in the U.S. compared to people who migrate to the U.S.,” said Mercedes R. Carnethon, Ph.D., FAHA, an American Heart Association volunteer expert and Circulation Associate Editor and an epidemiologist and vice chair of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, Illinois. “Continued research in this area will ultimately help us reduce heart disease and stroke for all people in the U.S. regardless of place of birth.”

Co-authors of the study are Bruce Ovbiagele, M.D., M.S., M.A.S.; Daniela Markovic, M.S.; and Amytis Towfighi, M.D. The list of authors’ disclosures is available in the abstract.

The study was funded by the James and Dorothy Williams Stroke Scholarship.

Statements and conclusions of studies that are presented at the American Stroke Association and American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2022 will be held in person in New Orleans and virtually, Feb. 8-11, 2022. The three-day conference will feature more than 1,500 compelling presentations in 17 categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC22.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. Connect with us on, Facebook, Twitter or by calling 1-888-4STROKE.


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