Aging immigrants’ risk for cardiovascular disease may be heightened by their lack of health insurance, particularly among those who arrived in the United States recently, say researchers at New York University and the University of Connecticut.

The study, published in the Journal of Nursing Scholarship, found a growing number of uninsured, older immigrants go to U.S. emergency rooms with strokes, heart attacks, and other serious but preventable complications of cardiovascular disease.

The new information is counter to prior research on the healthy immigrant effect, which finds that immigrants are initially healthier than native-born Americans. However, this advantage erodes over time as immigrants take on American ways, such as becoming more sedentary and eating less healthfully, researchers say.

“This study highlights the high risk of cardiovascular disease, the leading cause of death around the world, in this vulnerable segment of our population,” says Deborah Chyun, professor and dean of the School of Nursing, and a study co-author. “It also serves as a call to action to lower multiple risk factors in order to prevent cardiovascular disease and cardiac-related mortality.”

Research also shows that having health insurance increases healthcare utilization. However, immigrants experience barriers to obtaining affordable coverage.

In the majority of states, immigrants who meet federal poverty guidelines must wait at least five years to be eligible for Medicaid, a result of welfare reform in the 1990s. In addition, private health insurance plans are costly and may be unaffordable for older immigrants with limited incomes – who, for instance, may be coming to the U.S. to care for their grandchildren.

“When we think about affordable health insurance and access to health care we seldom think about the barriers that immigrants face,” says Chyun.

Using a nationally representative sample from the CDC’s National Health and Nutrition Examination Survey from 2007 to 2012, the researchers looked at cardiovascular disease risk, health insurance coverage, and factors that may be barriers to health care for immigrants.

Of the 1,920 aging immigrants studied, the vast majority (1,607) had been in the U.S. for at least a decade, while the remainder were recent immigrants, having arrived in the U.S. within the past 10 years.

The researchers found that recent immigrants had an overall lower risk for cardiovascular disease than long-term immigrants, which is consistent with prior studies of the healthy immigrant effect, but may also be explained by their slightly younger age.

However, despite being younger and healthier, laboratory testing found that recent immigrants had higher plasma glucose levels, total cholesterol, and triglycerides, and lower HDL cholesterol values compared to long-term immigrants, suggesting that they could develop cardiovascular disease and would benefit from screening and preventive care.

In addition, recent immigrants were far more socially disadvantaged than long-term immigrants. Fifty-four percent of recent immigrants, and 22 percent of long-term immigrants had no health insurance.

These figures are a stark contrast to the overall U.S. population: 8.8 percent of the population and roughly 1 percent of people over 65 years are uninsured. Recent immigrants were also more likely to have low incomes, limited English proficiency, and lack routine health care.

“All of these factors challenge immigrants’ ability to access care at a time when risk factors for cardiovascular disease may emerge,” says Tina Sadarangani, assistant professor and faculty fellow at NYU Rory Meyers College of Nursing and the study’s lead author. “This is compounded by unfamiliar and complex medical systems and fear around the cost of care, which may prevent many from seeking care until a health condition is serious and often more expensive to treat.”

A key finding of the study was that being uninsured contributed to cardiovascular disease risk beyond other factors that restrict healthcare access. While recent immigrants overall had a lower risk for cardiovascular disease than long-term immigrants, cardiovascular disease risk was particularly pronounced among uninsured recent immigrants.

“Increasing access to health insurance might actually lower their cardiovascular disease risk, which could prevent unnecessary and costly healthcare utilization,” says Sadarangani.

Study authors included Chau Trinh-Shevrin of NYU School of Medicine, and Gary Yu and Christine Kovner of NYU Meyers.

The research was supported by the National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar Award Program, the National Institute on Minority Health and Health Disparities (U54 MD000538), and the Centers for Disease Control and Prevention (U48 DP005008).