Abstract P333: Asian-Specific BMI Cutoffs as a Predictor for Mortality Risk

Introduction: Prior studies have found a U-shaped association between body mass index (BMI) and mortality. The WHO has recommended Asian-specific BMI guidelines to better screen for BMI-related diseases among Asians. Little is known about patterns between BMI and mortality rates in Asian subgroups. We used Asian-specific BMI cutpoints to determine whether BMI was associated with mortality among disaggregated Asian subgroups.

Methods: A sample of Asians (n=26,831) was obtained from the 1999-2018 National Health Interview Survey (NHIS) linked to the National Death Index. BMI was calculated with self-reported height and weight. Individuals were grouped into 4 BMI classes by Asian-specific BMI cutpoints: underweight (BMI <18.5), normal (BMI >18.5-22.9), overweight (BMI > 23-24.9), and obese (BMI ≥ 25) categories. Using Poisson models, we calculated the age-standardized mortality rate (ASMR) per 1,000 person years (PY) for All Asian adults and specific sub-groups (Asian Indian, Chinese, Filipino, Other Asian) with normal weight as a reference.

Results: Our sample was comprised of 20.6% Chinese (n=5517), 22.8% Filipino (n=6111), 19.5% Asian Indian (n=5232), and 37.2% Other Asian (n=9971). Compared to normal BMI, underweight individuals had significantly higher ASMR among all Asians and more specifically among Chinese, Filipinos, and Asian Indians, but not among Other Asians. Compared to normal BMI, risk of mortality was not significantly different among overweight or obese individuals across any Asian subgroup.

Conclusion: We found that low BMI was consistently associated with increased mortality among all Asian subgroups. In contrast to what has been described in Non-Hispanic White adults, we found that overweight or obesity was not associated with increased mortality among Asian American subgroups utilizing Asian-specific cutpoints.

Disentangling contributions of demographic, family, and socioeconomic factors on associations of immigration status and health in the United States

BACKGROUND

In the United States, immigration policy is entwined with health policy, and immigrants' legal statuses determine their access to care. Yet, policy debates rarely take into account the health needs of immigrants and potential health consequences of linking legal status to healthcare. Confounding from social and demographic differences and lack of individual-level data with sensitive immigration variables present challenges in this area of research.

METHODS

This article used the restricted California Health Interview Survey (CHIS) to assess differences in self-rated health, obesity, and severe psychological distress. Between US-born citizens, naturalised citizens, lawful permanent residents (LPR), undocumented immigrants, and temporary visa holders living in California.

RESULTS

Results show that while immigrant groups appear to have poorer health on the surface, these differences were explained predominantly by older age among naturalised citizens and by lower-income and education among LPRs and undocumented immigrants. Favourable family characteristics acted as protective factors for immigrants' health, especially among disadvantaged immigrants.

CONCLUSION

Immigration policy that limits access to healthcare and family support may further widen the health disadvantage among immigrants with less legal protection.

Pre-acculturation as a risk factor for obesity: Findings from the Health of Philippine Emigrants Study (HoPES)

Immigrants to the United States may have an advantage in terms of healthier weight, but tend to gain excessive weight after arrival, and may suffer from obesity and related health conditions. Acculturation theory suggests that this increase in obesity risk is due to adoption of unhealthy western dietary behaviors, and assumes that "eastern/traditional" dietary behaviors prior to migration are healthier. While this assumption is supported by studies conducted several decades ago, the phenomenon of globalization that has risen since the 1990s has increased exposure to western ideas and behaviors in communities worldwide. Hence, today's immigrants are more likely to have already adopted less healthy behaviors that increase obesity risk prior to their arrival in the U.S., a phenomenon we term "pre-acculturation." The present study investigates the role of pre-acculturation in obesity development among immigrants from the Philippines. Data come from the Health of Philippine Emigrants Study, fielded in 2017 (n = 1632). Pre-acculturation was measured with English proficiency, preparation to migrate, receiving care packages, texting, telephone, or internet contact with friends/family in the U.S. Outcomes included the body mass index (BMI, kg/m2), waist circumference (WC, cm), waist-to-height ratio (WHtR) and waist-to-hip-ratio (WHR). Covariates included age, gender, education, financial strain, physical activity, and diet. Migrants reported greater English proficiency, preparation, and a slightly lower WHtR than non-migrants, but did not differ on BMI, WC, or WHR. Preparation was associated with greater BMI, WC, and WHtR, and the effects of preparation status differed by migration status. Among migrants, more preparation was associated with greater BMI, WC, and WtHR. Further, among non-migrants, texting and telephone communications was related to lower BMI, WC, and WHR. In summary, pre-acculturation may be a risk factor for obesity in the Philippines, suggesting that binary notions of "Western" versus "eastern/traditional" cultures may be too simplistic.