Pilot 1
Malavika Subramanyam, MD, MPH, DSc
University of Michigan
Biography
Malavika A Subramanyam received her DSc in Social Epidemiology from Harvard University in 2009, and is currently a Research Fellow at the Center for Integrative Approaches to Health Disparities (CIAHD), University of Michigan. Malavika has an interest in examining the role of socioeconomic context at multiple levels on health and has been working with Dr. Ana Diez-Roux since 2009. She has studied the association of subjective social status and cardiovascular risk factors among African-Americans in the Jackson Heart Study (JHS) and is currently wrapping up a project testing the John Henryism Hypothesis in the JHS. As part of her doctoral dissertation, Malavika used data from the United States and India and examined the association between relative deprivation and self-rated health among adults in the United States using data from the Current Population Surveys. Her India papers investigated trends in social disparities in undernutrition, and the association of economic growth of a state with the risk of childhood undernutrition. Her other areas of interest are neighborhood effects on health and outcomes relevant to both developed and developing countries such as insulin resistance, obesity, diabetes, and tobacco use.
Research Abstract
Socioeconomic patterning of cardiovascular disease risk factors among Asian Indians: a cross cultural comparison of the United States and India
Asian Indians (AIs) are the third-largest and one of the fastest growing ethnic minorities in the United States (U.S.) AIs are disproportionately burdened by the highest ethnic-specific prevalence of cardiovascular disease (CVD). The greater risk of CVD among AIs is attributed to a higher prevalence of insulin resistance and diabetes compounded by higher central adiposity at lower body mass index (BMI) (the ‘Yudkin-Yajnik’ paradox), and a greater risk of diabetes and metabolic syndrome even at a healthy BMI. However, despite their growing numbers and elevated CVD risk, there are limited epidemiological studies of this minority population in the U.S. Social factors such as socioeconomic status (SES) and acculturation to a Western lifestyle are well-established determinants of CVD risk factors. However, research on the socioeconomic pattern in CVD risk among Asian Indians is currently lacking. Contrary to the myth of AIs as the ‘model minority’, there is great socioeconomic and cultural diversity within this group. Hence, an investigation into the socioeconomic determinants of CVD risk in Asian Indians can provide avenues for interventions aimed at both reducing CVD burden among AIs and reducing ethnic disparities in CVD. Using recent data from the Diabetes among Indian Americans (DIA) Survey, the only large community-based study of Asian Indians in the U.S., we propose to examine the socioeconomic patterning of CVD risk factors and the influence of acculturation on this patterning. The DIA Survey also includes data from India allowing us to compare the socioeconomic patterning of CVD in the Asian Indian diaspora (immigrant Asian Indians) in the U.S. with that among Indians in urban and rural India. This will allow us to contrast a range of exposure to Westernization (U.S. versus urban India versus rural India) in three sub-samples of a high-risk population while controlling for potential genetic pre-disposition to diabetes and CVD. Additionally, the results of this comparison will add to the small body of literature on the socioeconomic disparities in CVD risk in the Indian context, which has recently generated a debate. We will be guided by the following three specific aims: Specific Aim 1: To assess the socioeconomic patterning of CVD risk factors among Asian Indians in the U.S. The following CVD risk factors will be examined: BMI, waist circumference, systolic and diastolic blood pressure, hemoglobin A 1C (HbA1C), total serum cholesterol, serum low density lipoprotein (LDL), serum high density lipoprotein (HDL), and prevalence of Type 2 diabetes (DM). Socioeconomic status (SES) will be measured using income and education. Specific Aim 2: To investigate whether the associations of SES with CVD risk factors (Specific Aim 1) vary by levels of acculturation to Western lifestyle among Asian Indians in the U.S. The CVD risk factors examined in Specific Aim 1 will be the focus. Acculturation measured using a scale, as well as proxy measures such as duration of residence in the U.S., language of preference, and ethnic self-identity will be used. . Specific Aim 3: To compare the socioeconomic patterning of CVD risk factors among Asian Indians in the U.S. with rural Indians and urban Indians living in India. The following CVD risk factors will be used for the cross-cultural comparison: BMI, waist circumference, systolic and diastolic BP, total cholesterol, LDL, and HDL. SES measures will be transformed to ensure comparability across countries.