A Multilevel Framework to Investigate Cardiovascular Health Disparities among South Asian Immigrants in the United States.

Prior studies of cardiovascular health (CVH) disparities among immigrants of South Asian-origin in the United States (U.S.) have examined South Asians as one homogenous group, focused primarily on Indian-origin immigrants, and examined risk at the individual level. We present current knowledge and evidence gaps about CVH in the three largest South Asian-origin populations in the U.S.- Bangladeshi, Indian, and Pakistani- and draw on socioecological and lifecourse frameworks to propose a conceptual framework for investigating multilevel risk and protective factors of CVH across these groups. The central hypothesis is that CVH disparities among South Asian populations exist due to differences in structural and social determinants, including lived experiences like discrimination, and that acculturation strategies and resilience resources (e.g. neighborhood environment, education, religiosity, social support) ameliorate stressors to act as health protective factors. Our framework advances conceptualization of the heterogeneity and drivers of cardiovascular disparities in diverse South Asian-origin populations. We present specific recommendation to inform the design of future epidemiologic studies on South Asian immigrant health and the development of multilevel interventions to reduce CVH disparities and promote well-being.