Abstract Body: Introduction: Environmental pollution is a risk factor for cardiovascular disease. Few environmental justice studies have examined the burden of pollution among Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) subgroups. The California Environmental Protection Agency CalEnviroScreen is an environmental justice mapping tool that identifies disadvantaged communities with a high burden of multiple pollutants.
Methods: The study included 562,538 AANHPI and 1,891,203 non-Hispanic White adults aged ≥30 years who received health care from Kaiser Permanente Northern California during 2012-2022 and had no prior cardiovascular disease. We linked the CalEnviroScreen 2.0 score to the census tract of each person in the study at baseline. CalEnviroScreen designates “disadvantaged communities” as the census tracts with the highest statewide quartile of the score. Atherosclerotic cardiovascular disease (ASCVD) events were ascertained through 2023 using discharge diagnosis codes and death certificates. We fit Cox proportional hazards models to examine the association between statewide quartiles of the CalEnviroScreen score with incident ASCVD, adjusting for age, sex, AANHPI subgroups, diabetes, hypertension, dyslipidemia, chronic kidney disease severity, body mass index, and current and former tobacco use.
Results: CalEnviroScreen scores differed by AANHPI subgroups (p-value <0.0001). The Southeast Asian subgroup had the highest percentage of adults living in a CalEnviroScreen disadvantaged community (23.0%), followed by Native Hawaiian/Pacific Islander (12.9%), Vietnamese (11.7%), and Filipino (8.5%; Figure). In contrast, only 6.9% of non-Hispanic White adults lived in a CalEnviroScreen disadvantaged community. Living in a disadvantaged community was associated with a 23% increased risk of incident ASCVD (adjusted hazard ratio 1.23, 95%CI 1.19-1.27) compared to the lowest quartile of the CalEnviroScreen score, adjusting for demographics and clinical cardiovascular risk factors.
Conclusions: In a large, community-based AANHPI cohort in California, we found differences in the burden of pollution across AANHPI subgroups. Living in a community with a high pollution burden was associated with an increased adjusted risk of incident ASCVD. Environmental pollution may be a factor contributing to disparities in ASCVD among AANHPI subgroups.