Cardiovascular mortality of Chinese in New York City

International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe

Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.

Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States

OBJECTIVE

The Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S.

METHODS

: Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup.

RESULTS

: Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed.

CONCLUSION

: We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.

Non-communicable diseases in migrants: an expert review

BACKGROUND

Non-communicable diseases (NCDs) remain a major challenge in the 21st century. High-income countries (HICs) populations are ethnically and culturally diverse due to international migration. Evidence suggests that NCDs rates differ between migrants and the host populations in HICs. This paper presents a review of NCDs burden among migrant groups in HICs in Europe, North America and Australia with a major focus on cardiovascular diseases (CVDs), cancer and diabetes.

METHODS

We performed a narrative review consisting of scholarly papers published between 1960 until 2018.

RESULTS

CVD risk differs by country of origin, country of destination and duration of residence. For example, stroke is more common in sub-Sahara African and South-Asian migrants, but lower in North African and Chinese migrants. Chinese migrants, however, have a higher risk of haemorrhagic stroke despite the lower rate of overall stroke. Coronary heart disease (CHD) is more common in South-Asian migrants, but less common in sub-Saharan and north African migrants although the lower risk of CHD in these population is waning. Diabetes risk is higher in all migrants and migrants seem to develop diabetes at an earlier age than the host populations. Migrants in general have lower rates of overall cancer morbidity and mortality than the host populations in Europe. However, migrants have a higher infectious disease-related cancers than the host populations in Europe. In North America, the picture is more complex. Data from cross-national comparisons indicate that migration-related lifestyle changes associated with the lifestyle of the host population in the country of settlement may influence NCDs risk among migrants in a very significant way.

CONCLUSION

With exception of diabetes, which is consistently higher in all migrant groups than in the host populations, the burden of NCDs among migrants seems to depend on the migrant group, country of settlement and NCD type. This suggests that more work is needed to disentangle the key migration-related lifestyle changes and contextual factors that may be driving the differential risk of NCDs among migrants in order to assist prevention and clinical management of NCDs in these populations.

An association between autosomal-dominant polycystic kidney disease and the risk of acute myocardial infarction in Asian population - results of a nationwide study

Cardiovascular complications are the leading causes of death in patients with autosomal-dominant polycystic kidney disease (ADPKD) in the Western countries. However, theprevalence and risk of acute myocardial infarction (AMI) in patients with ADPKD remain unknown, especially in Asian population. We utilized the data from Taiwan National Health Insurance Research Database (NHIRD) to perform a population-based cohort study (1997-2008). A total of 2062 patients with ADPKD were selected from one million of general population after excluding those patients with age less than 18 years old, receiving renal replacement therapy, and concomitant diagnoses of AMI. Additionally, we set up those patients without ADPKD as comparison group by matching study cohort with age, gender, income and urbanization with 1:10 ratio (n=20620). The results showed that although the prevalence of AMI in ADPKD patients in Taiwan was lower than those in the United States (2.91% v.s. 6%, p=0.0567), the Taiwanese ADPKD group had significantly higher prevalence of AMI as compared with the non-ADPKD group (2.91% v.s. 0.97%, p<0.0001). In addition, Kaplan-Meier analysis demonstrated that cumulative incidence of AMI was significantly higher in ADPKD than in the non-ADPKD group (all p<0.001). After adjusting for age, gender and comorbidities by multivariate and sensitivity analysis, ADPKD patients had 2.43-fold greater risk for developing AMI as compared with non-ADPKD patients (95% CI 1.8 to 3.29, p<0.0001). In conclusion, Taiwanese patients with ADPKD have lower prevalence of AMI as compared to Americans, whereas ADPKD per se remains independently predictive of AMI in Asian population.

Cardiometabolic disease in South Asians: A global health concern in an expanding population

Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.

Social support and networks: cardiovascular responses following recall on immigration stress among Chinese Americans

Social support has been shown to act as a buffer for cardiovascular responses to stress. However, little is known about how social support and networks are related to cardiovascular responses to immigration stress recall. The current study evaluated the impact of structural and functional support on cardiovascular reaction following immigrant stress recall provocation as well as the moderation effect of interdependent self-construal among first-generation Chinese immigrants. One hundred fifty Chinese immigrants were recruited in the New York Chinatown area. Participants completed questionnaires assessing their levels of social support and networks, and interdependent self-construal. Following adaptation, participants recalled a recent post-immigration stress-provoking situation. Cardiovascular measures were taken during adaptation, stressor task, and recovery period. Hierarchical multiple regression analysis was performed. Social network size and type, as well as perceived emotional support were positively predictive of systolic blood pressure (SBP) reactivity changes. Instrumental support seeking was a positive predictor of SBP and diastolic blood pressure (DBP) reactivity. The moderation effect between instrumental support seeking and interdependent self-construal were significantly predictive of DBP reactivity and recovery, suggesting that perceptions about themselves in relation to others is a crucial factor for determining whether support seeking is beneficial or not. Social support was not a direct buffer on cardiovascular responses to stress among Chinese immigrants. Chinese values of interdependence and collectivism may partly explain the disconfirming results. Still, when interdependent self-construal was taken into account, Chinese immigrants who had less interdependent self-construal, but solicited more instrumental support, had faster adaptation to stress over the long term.

Cardiovascular diseases and risk factors among Chinese immigrants

The aim of this study is to identify the prevalence of cardiovascular disease (CVD) and major CVD risk factors, including diabetes, hypertension, dyslipidemia, obesity and smoking among Chinese immigrants by a systematic review of studies from various countries. PubMed and the China National Knowledge Infrastructure databases were searched for studies of the prevalence of major CVDs and risk factors, and of CVD mortality among Chinese immigrants. The search identified 386 papers, 16 of which met the inclusion criteria for this review. In mainland China, there is a pattern of high stroke prevalence but low coronary heart disease (CHD) prevalence. Among Chinese immigrants, there is a much lower prevalence and mortality of stroke, but a higher prevalence and mortality of CHD, even though these are lower than the rates in immigrants of other ethnicities in the host country. The prevalence of CVD risk factors is also markedly different in immigrants. Compared with mainland Chinese, Chinese immigrants have a higher prevalence of diabetes and hypertension, higher serum cholesterol, poorer dietary patterns, and higher prevalence of obesity and smoking. Thus, the epidemiological pattern of CVD among Chinese immigrants changes compared with resident mainland Chinese. The less healthy environmental factor after immigration may be a major trigger in the adverse CVD status of Chinese immigrants. It is important for policy-makers to pay more attention to specific minority immigrant groups, and to implement more effective preventive measures to improve the health of immigrant populations.

A Chinese Immigrant Paradox? Low Coronary Heart Disease Incidence but Higher Short-Term Mortality in Western-Dwelling Chinese Immigrants: A Systematic Review and Meta-Analysis

BACKGROUND

Chinese form a large proportion of the immigrant population in Western countries. There is evidence that Chinese immigrants experience an increased risk of coronary heart disease (CHD) after immigration in part due to cultural habits and acculturation. This is the first systematic review and meta-analysis that aims to examine the risk of CHD in people of Chinese ethnicity living in Western countries, in comparison with whites and another major immigrant group, South Asians.

METHODS AND RESULTS

Literature on the incidence, mortality, and prognosis of CHD among Chinese living in Western countries was searched systematically in any language using 6 electronic databases up to December 2014. Based on the meta-analysis, Chinese had lower incidence of CHD compared with whites (odds ratio 0.29; 95% CI: 0.24-0.34) and South Asians (odds ratio 0.37; 95% CI: 0.24-0.57) but higher short-term mortality after first hospitalization for acute myocardial infarction compared with whites (odds ratio 1.34; 95% CI, 1.04-1.73) and South Asians (odds ratio 1.82; 95% 1.33-2.50). There was no significant difference between Chinese immigrants and whites in long-term outcomes (mortality and recurrent events) after acute myocardial infarction.

CONCLUSIONS

These findings provide an important focus for resource planning to enhance early secondary prevention of CHD to improve short-term survival outcomes among Western-dwelling Chinese immigrants.

Racial/ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern California 2010-2012

BACKGROUND

Hypertension (HTN) is a known major cardiovascular disease risk factor, but prevalence, treatment, and control of HTN among rapidly growing minority groups such as Asian Americans and Hispanics are unknown largely due to either underrepresentation in epidemiologic studies or aggregation of Asian American subgroups.

METHODS

A three-year cross-section (2010-2012) of patients from a large ambulatory care setting in northern California was examined in the following subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Mexicans, non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs). We defined HTN as two separate nonemergent office visit blood pressure measurements ≥140/90 mm Hg, physician diagnosis of HTN, or use of antihypertensive medications.

RESULTS

A total of 208,985 patients were included in the study. Age-adjusted HTN prevalence ranged from 30.0% in Chinese women to 59.9% in Filipino men. Most minority subgroups had lower or similar odds of having HTN compared with NHWs, except for Filipinos and NHBs whose odds were significantly higher after adjusting for patient demographic and clinical characteristics. Asian Americans and NHBs were more likely to be treated for HTN compared with NHWs. Achievement of blood pressure control was lower among Filipino women (odds ratio = 0.82, 99% confidence interval 0.70-0.96) and NHB men (odds ratio = 0.73, 99% confidence interval 0.58-0.91), compared with NHW women and men.

CONCLUSIONS

Substantial racial/ethnic variation in HTN prevalence, treatment, and control was found in our study population. Filipino and NHB women and men are at especially high risk for HTN and may have more difficulty in achieving adequate blood pressure control.

Cardiovascular disease mortality in Asian Americans

BACKGROUND

Asian Americans are a rapidly growing racial/ethnic group in the United States. Our current understanding of Asian-American cardiovascular disease mortality patterns is distorted by the aggregation of distinct subgroups.

OBJECTIVES

The purpose of the study was to examine heart disease and stroke mortality rates in Asian-American subgroups to determine racial/ethnic differences in cardiovascular disease mortality within the United States.

METHODS

We examined heart disease and stroke mortality rates for the 6 largest Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) from 2003 to 2010. U.S. death records were used to identify race/ethnicity and cause of death by International Classification of Diseases-10th revision coding. Using both U.S. Census data and death record data, standardized mortality ratios (SMRs), relative SMRs (rSMRs), and proportional mortality ratios were calculated for each sex and ethnic group relative to non-Hispanic whites (NHWs).

RESULTS

In this study, 10,442,034 death records were examined. Whereas NHW men and women had the highest overall mortality rates, Asian Indian men and women and Filipino men had greater proportionate mortality burden from ischemic heart disease. The proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every Asian-American subgroup compared with NHWs.

CONCLUSIONS

The heterogeneity in cardiovascular disease mortality patterns among diverse Asian-American subgroups calls attention to the need for more research to help direct more specific treatment and prevention efforts, in particular with hypertension and stroke, to reduce health disparities for this growing population.

Is country of birth a risk factor for acute hospitalization for cardiovascular disease in Victoria, Australia?

International mortality studies show that some subgroups of migrants have a higher risk of Cardiovascular Disease (CVD) than the native-born. To investigate whether country of birth increases the risk for acute myocardial infarction (AMI) and cerebral infarction (stroke) hospitalization in Victoria, Australia. A retrospective analysis of Victorian AMI (ICD-10-AM codes I21 and I22) and stroke (ICD-10-AM I63 and I64) discharges from routinely collected hospital data in 2001-2002 was conducted. The outcome measures were directly age standardized rate ratios (RRs) of AMI and stroke hospitalization, calculated using 2001 Australian census data, with the Australian-born as the reference group. Males from 4 ethnic groups--USSR/Baltic; Southern Asia; Middle East; and Eastern Europe, displayed higher risk for AMI hospitalization than Australian-born men, whereas males and females from Southeast Asia and Northeast Asia were at lower risk. Furthermore, males from Western Europe and females from the Pacific were also at lower risk. Females from the Middle East, Southern Asia, and Southern Europe were at higher risk of stroke hospitalization than Australian-born women; in contrast, males from Eastern Europe, NorthAsia, Southern Asia, Southern Europe, and the United Kingdom and Ireland were at lower risk. Risk for AMI and stroke hospitalization varies by country of birth in comparison with the Australian-born population. It will be import to identify the factors associated with these varying risks in order to target preventive strategies aimed at reducing risk of AMI and stroke.

Social Stigma, Social Capital Reconstruction and Rural Migrants in Urban China: A Population Health Perspective

In this study, we examine migrant stigma and its effect on social capital reconstruction among rural migrants who possess legal rural residence but live and work in urban China. After a review of the concepts of stigma and social capital, we report data collected through in-depth interviews with 40 rural migrant workers and 38 urban residents recruited from Beijing, China. Findings from this study indicate that social stigma against rural migrants is common in urban China and is reinforced through media, social institutions and their representatives, and day-to-day interactions. As an important part of discrimination, stigma against migrant workers creates inequality, undermines trust, and reduces opportunities for interpersonal interactions between migrants and urban residents. Through these social processes, social stigma interferes with the reconstruction of social capital (including bonding, bridging and linking social capital) for individual rural migrants as well as for their communities. The interaction between stigma and social capital reconstruction may present as a mechanism by which migration leads to negative health consequences. Results from this study underscore the need for taking measures against migrant stigma and alternatively work toward social capital reconstruction for health promotion and disease prevention among this population.

Cardiovascular disease risk in immigrants: what is the evidence and where are the gaps?

OBJECTIVES

This study systematically reviewed the peer-reviewed literature to establish morbidity and mortality from myocardial infarction (MI) and stroke among immigrant populations.

METHODS

The review considered only studies published between 1986 and 2008 that provided data on MI or stroke morbidity/mortality among first-generation immigrants. A prespecified search strategy identified 58 studies for possible inclusion. Of these, 12 met the inclusion criteria.

RESULTS

Immigrant MI mortality and morbidity varied by host country with no consistent pattern from one country or region. However, there was an overall trend for increasing risk of MI among immigrants worldwide. Chinese and African immigrants had consistently higher stroke mortality.

CONCLUSION

MI and stroke incidence and prevalence among first-generation immigrants are related to both genetic and environmental factors, but the relative contribution of each is unclear. Prospective studies are needed to identify genetic and behavioral characteristics associated with stroke among Chinese immigrant populations.

Ethnic and sex differences in the incidence of hospitalized acute myocardial infarction: British Columbia, Canada 1995-2002

Background

As populations in Western countries continue to change in their ethnic composition, there is a need for regular surveillance of diseases that have previously shown some health disparities. Earlier data have already demonstrated high rates of cardiovascular mortality among South Asians and relatively lower rates among people of Chinese descent. The aim of this study was to describe the differences in the incidence of hospitalized acute myocardial infarction (AMI) among the three largest ethnic groups in British Columbia (BC), Canada.

Methods

Using hospital administrative data, we identified all patients with incident AMI in BC between April 1, 1995, and March 31, 2002. Census data from 2001 provided the denominator for the entire BC population. Ethnicity was determined using validated surname analysis and applied to the census and hospital administrative datasets. Direct age standardization was used to compare incidence rates.

Results

A total of 34,848 AMI cases were identified. Among men, South Asians had the highest age standardized rate of AMI hospitalization at 4.97/1000 population/year, followed by Whites at 3.29, and then Chinese at 0.98. Young South Asian men, in particular, showed incidence rates that were double that of young Whites and ten times that of young Chinese men. South Asian women also had the highest age-standardized rate of AMI hospitalization at 2.35/1000 population/year, followed by White women (1.53) and Chinese women (0.49).

Conclusions

South Asians continue to have a higher incidence of hospitalized AMI while incidence rates among Chinese remain low. Ethnic differences are most notable among younger men.

The relationship between higher blood pressure and ischaemic, haemorrhagic stroke among Chinese and Caucasians: meta-analysis

BACKGROUND AND PURPOSE

Previous studies have suggested that blood pressure is a particularly important risk factor for stroke in Chinese, and that the magnitude of the effect may be greater than in Caucasians. We performed a meta-analysis in order to define the magnitude of the risk of stroke associated with hypertension among Chinese, and to compare the magnitude of this risk with Caucasians.

METHODS

We searched Medline from 1966 to 2004, plus Chinese Medical Literature databases from 1977 to 2003 for Caucasian and Chinese studies. Results were pooled using the random effects model, and heterogeneity and publication bias were checked.

RESULTS

For a 10 mmHg increase in systolic blood pressure, the pooled risk ratio was 1.44 [95% confidence interval (CI)] 1.39-1.51 for ischaemic stroke, and 1.5 (95% CI 1.45-1.57) for haemorrhagic stroke in Chinese, versus 1.19 (95% CI 1.15-1.23) for total stroke in Caucasians. The pooled odds ratio for hypertension measured dichotomously (defined as > or =160/95 mmHg) was 5.8 (95% CI 4.7-7.2) among Chinese versus 1.93 (95% CI 1.7-2.2) among Caucasians for ischaemic stroke; and 7.2 (95% CI 5.3-9.7) in Chinese versus 3.1 (95% CI 2.5-3.9) in Caucasians for haemorrhagic stroke.

CONCLUSION

The risk of stroke associated with hypertension is consistently and significantly greater in Chinese than Caucasians. This may help genetic epidemiologists to dissect the cause of stroke, and emphasizes the particular importance of hypertension control in the Chinese population.

Stroke Risk among Chinese Immigrants in New York City

BACKGROUND

Little is known of risk factors for stroke among Chinese immigrants to the United States. We have conducted a case-control study to identify risk factors for stroke among foreign-born Chinese in New York City.

METHODS

From September 2000 to June 2003, 187 sequential stroke cases (44 hemorrhagic) and 204 controls matched on age, gender, and years since immigration were recruited from New York Downtown Hospital, which was located next to New York City Chinatown. Risk factor status was assessed by questionnaire interview and medical chart review, which included clinical factors, sociodemographic characteristics, personal and family histories, and behavior and lifestyle factors, as well as behavioral changes after immigration to the United States.

RESULTS

For cases and controls, mean ages were 74.8 and 74.7 years, 47.3% of cases and 47.5% of controls were male, and mean years since immigration to the United States were 26.7 and 26.8, respectively. Sociodemographic characteristics and behavioral pattern including cigarette smoking, exercise, and usage of special diet or dietary supplements were similar between cases and controls. However, stroke patients were more likely to have hypertension (76% vs. 59%, p<or/=0.001), increased blood pressure (165/84 mmHg vs. 140/74 mmHg, p<or=0.001) and left ventricular hypertrophy (LVH) (10.1% vs. 4.3%, p<or=0.05), and less likely to consume poultry (odds ratio 0.80, 95% confidence interval (CI) 0.59-1.00); fish (0.70, 95% CI 0.42-0.96), fruit and vegetable juice (0.83, 95% CI 0.70-0.95), and grains (0.79, 95% CI 0.62-0.96) than were controls.

CONCLUSION

Among Chinese immigrants in New York City, as in general population, poor controlled hypertension was related to the risk of stroke. Therefore, Chinese immigrants presenting with hypertension and/or a family history of hypertension should be detected and followed up regularly to monitor the blood pressure level. In addition, difference in food intake between stroke and control patients may present an opportunity for behavior intervention to prevent stroke.

Incidence of Stroke and Stroke Subtypes in Malmö, Sweden, 1990–2000

BACKGROUND AND PURPOSE

The proportion of immigrants has increased in Sweden markedly during the last decades, as in many other Western countries. Incidence of stroke has increased during this period. However, it is primarily unknown whether incidence of stroke and stroke subtypes in Sweden is related to country of birth.

METHODS

Incidence of first-ever stroke was followed during 10 years in a cohort consisting of all 40- to 89-year-old inhabitants in the city of Malmö, Sweden (n=118,134). Immigrants from 12 different countries were compared with native-born Swedes.

RESULTS

Adjusted for age, sex, marital status, and socioeconomic indicators, the incidence of stroke (all subtypes) was significantly higher among immigrants from former Yugoslavia (relative risk [RR], 1.31; 95% CI, 1.1 to 1.6) and Hungary (RR, 1.33; CI, 1.02 to 1.7). A significantly increased incidence of intracerebral hemorrhage was observed in immigrants from Peoples Republic of China or Vietnam (RR, 4.2; CI, 1.7 to 10.4) and the former Soviet Union (RR, 2.7; CI, 1.01 to 7.3). Immigrants from Finland had a significantly higher incidence of subarachnoid hemorrhage (RR, 2.8; CI, 1.1 to 6.8). A significantly lower incidence of stroke was observed in the group from Romania (RR, 0.14; CI, 0.04 to 0.6). Immigrants from Denmark, Norway, Germany, Chile, Czechoslovakia, and Poland had approximately the same risk as citizens born in Sweden.

CONCLUSIONS

In this urban population from Sweden, there are substantial differences in stroke incidence and stroke subtypes between immigrants from different countries. To what extent this could be accounted for by exposure to biological risk factors remains to be explored.

Coronary heart disease mortality for six ethnic groups in California, 1990–2000

PURPOSE

To investigate ethnic variations in coronary heart disease death in California, the authors examined total and CHD-specific mortality among non-Hispanic white (white), Hispanic, non-Hispanic black (black), Chinese, Japanese, and Asian Indian Americans. Deaths were identified in the California Mortality Database and population information was derived from the 1990 and 2000 censuses.

METHODS

Age-standardized death rates per 100,000 population were calculated for ages 25 to 84 years from 1990 to 2000. Proportional mortality ratios (PMRs) for each sex and age group were calculated by dividing the proportion of deaths due to CHD in each ethnic group by the proportion of deaths due to CHD in the total population.

RESULTS

Blacks had the highest all-cause age-standardized death rates among men (1614) and women (1014). Blacks had the highest CHD death rates among men (272) and women (190). PMRs for CHD were highest in Asian Indian men (161) and women (144), reflective of the higher percentage of CHD deaths compared with all cause deaths in this group. All sex-ethnic groups showed a decline in all cause and CHD mortality compared with the period between 1985 and 1990, except Asian Indian women, who experienced a 16% increase in all cause mortality and 5% increase in CHD mortality.

CONCLUSIONS

There is considerable heterogeneity in CHD mortality among ethnic subgroups, and additional research is needed to guide treatment and prevention efforts. Blacks and Asian Indians in California are identified as particularly high risk populations.