Examination of the Association Between Latent Variables for Social Determinants of Health and Blood Pressure Control in Immigrants using Structural Equation Modeling

Background: Hypertension is responsible for about 12.8% of deaths around the world. Immigrants' risk of developing hypertension increases with length of residency. There is limited work on the role of social determinants of health and blood pressure control in immigrants. We created a theory-based conceptual model for immigrant-specific and general social determinants variables and their relationship to blood pressure. Purpose: Use a theory-based model to identify latent variables for immigrant-specific social determinants using confirmatory factor analysis (CFA) and structural equation modeling (SEM) to test theoretical validity and relationship with blood pressure (BP). Methods: CFA was used to identify latent variables for global socioeconomic status, stressors of immigration, adaptation to immigration, acculturation, and burden of disease. SEM was used to test the structural relationships between latent variables and BP. Results: 181 immigrants were included in the analysis. The final model (chi2 (68, n = 181) = 149.87, p < 0.001, RMSEA = 0.055, CFI = 0.94, TLI = 0.91, CD = 0.99) found burden of disease was significantly related to BP (r = 0.35, p < 0.001). Conclusions: One latent variable measuring need was significantly associated with BP in an immigrant sample. This suggests that interventions targeting burden of disease are likely to be effective in controlling blood pressure in immigrants.