Not one enclave: Disaggregation and cardiometabolic health in Asian ethnic enclaves

Many Asian American (AA) subgroups experience disproportionate rates of cardiometabolic (CMB) conditions, yet the contextual drivers of these disparities remain unclear. Little is known about the role of Asian residential segregation, often conceptualized as Asian enclaves, with limited prior work largely ignoring region of origin and nativity. Using six years of cross-sectional survey data from New York City (N = 6686 AAs) linked with multiple sources of community data, we examine how residence in ethnicity-specific enclaves relates to CMB risks (obesity, hypertension, and diabetes), whether these associations differ by nativity, and the extent to which neighborhood socioeconomic conditions, the built environment, social cohesion, and institutional support account for observed associations. Our combined concentration-based and spatial clustering analysis identified five East Asian enclaves and six South Asian enclaves, with no geographic overlap between the two. Multilevel logistic regression analyses show that residence in an East Asian enclave was associated with lower odds of obesity (OR=0.60; 95%CI=0.38, 0.95), while residence in a South Asian enclave was linked to higher odds of diabetes (OR=1.36; 95%CI=1.02, 1.82) and hypertension (OR=1.44; 95%CI=1.07, 1.95). These associations were present only among foreign-born individuals. After adjusting for neighborhood characteristics, the association between East Asian enclaves and obesity persisted, while those of South Asian enclaves with diabetes and hypertension were partly attenuated. Both suggest a role for unmeasured enclave factors, including cultural and food environments. Our findings challenge the view that Asian enclaves are monolithically health-promoting and redirect scholarly attention toward disaggregated approaches to investigating AA health disparities.