Title: Comparison of cardiovascular disease risk factors among FiLWHEL (2014-2016), NNS
(2013), and KNHANES (2013-2015) women
Version: 2 Date: 06 Sep 2022
Reviewer's report:
The goal of this paper is to assess the cardiovascular diseases (CVDs) risk factors among women
living in the Philippines, Korea and in the United States. This is a worthwhile topic to explore.
However, I have following concerns.
There is no rationale provided for the choice of the sample. What is the motivation for studying
Filipino migrants in South Korea? How does studying Filipino women build on what is known
about the health of Filipino women in residing in countries outside of the Philippines? Second,
the interest in including women in the United States (U.S.) has not been provided. While
comparing across Filipino women in the Philippines, Filipino women in South Korea and women
of Korean nationals can be justified conceptually, inclusion of U.S. women is hard to understand.
Additionally, it is not clear who are these U.S. women. It appeared that U.S. women included
Filipino immigrants in the U.S. as well as White women in the U.S. I may well be wrong.
Nonetheless, the point is that it is unclear.
Authors do touch upon socioeconomic and cultural (dietary) factors. They could have been
much better developed. There is a quite a bit of literature on comparing immigrant and non-
immigrant groups and the transitions that immigrants have been seen to make. For example, in
the U.S. research on Hispanic population has led to what is called ‘immigrant health paradox’
or alternatively as ‘healthy migrant effect’, ‘immigrant health advantage’ or ‘epidemiological
paradox’.  Evidence indicates that recent immigrants report better health outcomes despite lower
socioeconomic status.
The results could have been better substantiated. For instance, the plausible reasons for the
finding that Filipino women in Korea perform better that those in the Philippines have not
been provided. Also, the authors and rightly so, given that obesity is linked to incidence of
cardiovascular diseases, point out variations in the obesity level. There is research indicating the
link between obesity levels and socioeconomic status (Kulkarni et al. 2017 ).
(Kulkarni, Vani S., Veena Kulkarni and Raghav Gaiha. 2017. ‘Double Burden of Malnutrition’:
Reexamining the Coexistence of Undernutrition and Overweight among Women in
India’, International Journal of Health Services, 47:108-113).
The information on the number of observations warrants clarification. The authors mention that
the sample size across all the data sets is 504 and the method used is matching with age on a
ratio of 1: 1. What does matching with age 1: 1 mean and how does that yield the same sample
size across the different data sets? Further, sample sizes for tables 3 through 6 are different. It
would be beneficial for readers to know the reason for that.
Finally, a minor editorial point is on the language. The authors employ the term indigenous (for
example, page 3, page 15) people to refer to what I guess is native born women. Indigenous
is not a label that is used in the literature to identify native born people. The term indigenous
usually has a specific connotation to indicate historically present-original people of that world.