The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001–2008 National Health and Nutrition Examination Survey
Greater acculturation has been linked to increased risk of cardiovascular disease in Hispanics. C-reactive protein (CRP), a marker of inflammation, is known to be associated with an increased risk of cardiovascular disease morbidity and mortality. Whether acculturation is associated with CRP levels in Hispanics has not been established. We examined the association between acculturation and CRP in 11,858 Hispanic-American adults participating in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2008. Acculturation was measured by the Short Acculturation Scale (SAS), a validated language-based scale. We used multivariate linear regression to examine the independent association between acculturation and CRP after adjusting for clinical and demographic covariates and appropriate sampling weights. We back-transformed the beta coefficients into relative differences (RDs). Higher acculturation was independently associated with higher CRP levels in Hispanics. Compared to those less acculturated, the RD in CRP levels was 52% higher (p = 0.003) for more acculturated Hispanics. Other significant predictors of CRP in Hispanics included a higher body mass index (RD 139% higher per 5 kg/m(2)), female gender (RD 36% higher), education level (RD 19% higher levels for at least a high school education, p <0.001), being insured (RD 27% higher CRP level, p = 0.006), having hypertension (RD 40% higher CRP levels, p <0.001), and statin use (RD 22% lower CRP levels, p = 0.002). In conclusion, higher acculturation was associated with increased CRP levels in Hispanics in a nationally representative population survey. Inflammation may play an important role in explaining the association between acculturation and increased cardiovascular risk.