Hospitalization for heart disease, stroke, and diabetes mellitus among Indian-born persons: a small area analysis

Does mortality vary between Asian subgroups in New Zealand: an application of hierarchical Bayesian modelling

The aim of this paper was to see whether all-cause and cause-specific mortality rates vary between Asian ethnic subgroups, and whether overseas born Asian subgroup mortality rate ratios varied by nativity and duration of residence. We used hierarchical Bayesian methods to allow for sparse data in the analysis of linked census-mortality data for 25-75 year old New Zealanders. We found directly standardised posterior all-cause and cardiovascular mortality rates were highest for the Indian ethnic group, significantly so when compared with those of Chinese ethnicity. In contrast, cancer mortality rates were lowest for ethnic Indians. Asian overseas born subgroups have about 70% of the mortality rate of their New Zealand born Asian counterparts, a result that showed little variation by Asian subgroup or cause of death. Within the overseas born population, all-cause mortality rates for migrants living 0-9 years in New Zealand were about 60% of the mortality rate of those living more than 25 years in New Zealand regardless of ethnicity. The corresponding figure for cardiovascular mortality rates was 50%. However, while Chinese cancer mortality rates increased with duration of residence, Indian and Other Asian cancer mortality rates did not. Future research on the mechanisms of worsening of health with increased time spent in the host country is required to improve the understanding of the process, and would assist the policy-makers and health planners.

Clinical decision support system: risk level prediction of heart disease using weighted fuzzy rules and decision tree rules

The development of medical domain applications has been one of the most active research areas recently. One example of a medical domain application is a detection system for heart disease based on computer-aided diagnosis methods, where the data is obtained from some other sources and is evaluated by computer based applications. Up to now, computers have usually been used to build knowledge based clinical decision support systems which used the knowledge from medical experts, and transferring this knowledge into computer algorithms was done manually. This process is time consuming and really depends on the medical expert’s opinion, which may be subjective. To handle this problem, machine learning techniques have been developed to gain knowledge automatically from examples or raw data. Here, a weighted fuzzy rule-based clinical decision support system (CDSS) is presented for the diagnosis of heart disease, automatically obtaining the knowledge from the patient’s clinical data. The proposed clinical decision support system for risk prediction of heart patients consists of two phases, (1) automated approach for generation of weighted fuzzy rules and decision tree rules, and, (2) developing a fuzzy rule-based decision support system. In the first phase, we have used the mining technique, attribute selection and attribute weightage method to obtain the weighted fuzzy rules. Then, the fuzzy system is constructed in accordance with the weighted fuzzy rules and chosen attributes. Finally, the experimentation is carried out on the proposed system using the datasets obtained from the UCI repository and the performance of the system is compared with the neural network-based system utilizing accuracy, sensitivity and specificity.

Stroke in young in India

Stroke in young has special significance in developing countries. This is so because some etiologies like cardioembolic infections are more common than in developed countries, and the affection of economically productive group adds further to the overall disease burden. The paper discusses the burden of stroke in young and its implications in a developing country like India along with an approach to identifying different causes that are known to occur in this age group.

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.

Comparison of the perforation rate for acute appendicitis between nationals and migrants in Taiwan, 1996-2001

OBJECTIVE

Immigrant populations have grown rapidly in recent years in many countries. Immigrant-related healthcare issues have thus become more and more important. The aim of this study was to assess any possible disparity in access to care between migrants and nationals under the national health insurance (NHI) system in Taiwan.

STUDY DESIGN

Retrospective population-based observational study.

METHODS

National population-based data on patients aged ≥20 years in Taiwan under the NHI programme were studied. The frequency of use and expenditure on ambulatory care, inpatient care and emergency care were analysed separately. Ruptured appendicitis was also analysed as an outcome indicator for access to care. Logistic regression and two-part models were applied.

RESULTS

Overall, migrants had a lower rate of healthcare utilization than nationals, and this gap remained consistent from 1996 to 2001. However, using ruptured appendicitis as the outcome indicator, no significant overall difference in access to care was found between nationals and migrants under the NHI programme in Taiwan (odds ratio 1.01, 95% confidence interval 0.93∼1.11).

CONCLUSION

This study found that although migrants had a lower rate of healthcare utilization than nationals, their rate of adverse outcome was similar to nationals when they faced an acute, non-selective emergency condition such as appendicitis. The findings suggest that the use of more dimensional indicators may help to avoid possible misleading inferences on the variation in access to health care in Taiwan.

Health of foreign-born people in the United States: a review

This paper identifies the overarching patterns of immigrant health in the US. Most studies indicate that foreign-born individuals are in better health than native-born Americans, including individuals of the same race/ethnicity. They tend to have lower mortality rates and are less likely to suffer from circulatory diseases, overweight/obesity, and some cancers. However, many foreign-born groups have higher rates of diabetes, some infections, and occupational injuries. There is heterogeneity in health among immigrants, whose health increasingly resembles that of natives with duration of US residence. Prospective studies are needed to better understand migrant health and inform interventions for migrant health maintenance.