‘Place’ Matters: Heart Disease and Stroke Less Common Among Foreign-Born Than Native-Born U.S. Adults

Eduardo Sanchez photoEduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Center for Health Metrics and Evaluation, American Heart Association

When it comes to heart disease and stroke risk, it’s about “location, location, location.”

In a national survey reported today in the Journal of the American Heart Association, heart disease and stroke were less common among foreign-born than native-born adults in the United States.

We often think of “place” as our residential environment, but the data from 2006-14 suggest that “place” also refers to country of birth.

In the survey of nearly 260,000 adults, 16 percent were foreign-born, grouped into six birthplace regions: Mexico, Central America and the Caribbean; South America; Europe (including Russia and the Middle East); Africa; Indian subcontinent; and Asia (including Southeast Asia).

Key findings (Figure 1) include:

  • More than 8 percent (8.2) of U.S.-born men reported having coronary heart disease (CHD), compared to 5.5 percent of foreign-born men.
  • Almost 5 percent (4.8) of U.S.-born women reported having CHD, compared to 4.1 percent of foreign-born women.
  • The percentage of U.S.-born men and women living with stroke was 2.7 percent, compared to 2.1 percent for foreign-born men and 1.9 percent for foreign-born women.

Figure 1: Self-reported Prevalence of Coronary Heart Disease and Stroke (* denotes statistically significant findings).

Figure 1: Self-reported Prevalence of Coronary Heart Disease and Stroke (* denotes statistically significant findings).


The “healthy immigrant effect” could help explain the lower levels of CHD and stroke among foreign-born adults. People who immigrate to another country are usually healthier than those who stay behind, because of self-selection or physical or legal barriers to entering the destination country.

Another important finding was that the risk for CHD and stroke varied by region of birth. Compared to U.S.-born people, existence of CHD was lower among people born in Asia, Mexico, Central America or the Caribbean. Existence of stroke was lowest among men born in South America or Africa and women from Europe. This is consistent with prior research that suggests wide variation in cardiovascular risk factors (such as obesity, diabetes and high blood pressure) among immigrants in the United States, depending on country of origin.

Prior research has also documented an increase in cardiovascular risk factors as time living in the United States increased. However, this study didn’t find a relationship between years of living in the United States and risk of CHD or stroke after adjusting for demographic and health characteristics.

It also found that when race/ethnicity was factored in, the “protective” effect of being foreign-born became weaker. This could be related to racial/ethnic differences in cardiovascular health, which are supported by ample evidence.

As our overall population grows and becomes more diverse, knowing which groups have higher risk of disease can help guide our efforts to give all Americans – regardless of their birthplace, race, ethnicity or other descriptive characteristics – the same opportunity to improve their health and prevent disease. That’s the core of health equity and the heart of our mission to build healthier lives, free of cardiovascular diseases and stroke.