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Tran K, Shon H, Phan J, Cheng T, Kim GS, Jamal A, Srinivasan M, Palaniappan LP, Nguyen L, Huang RJ. Leading causes of death in Vietnamese Americans: An ecological study based on national death records from 2005-2020. PLoS One 2024; 19:e0303195. [PMID: 38787829 PMCID: PMC11125458 DOI: 10.1371/journal.pone.0303195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Disaggregated data is a cornerstone of precision health. Vietnamese Americans (VietAms) are the fourth-largest Asian subgroup in the United States (US), and demonstrate a unique burden of disease and mortality. However, most prior studies have aggregated VietAms under the broader Asian American category for analytic purposes. This study examined the leading causes of death among VietAms compared to aggregated Asian Americans and non-Hispanic Whites (NHWs) during the period 2005-2020. METHODS Decedent data, including underlying cause of death, were obtained from the National Center for Health Statistics national mortality file from 2005 to 2020. Population denominator estimates were obtained from the American Community Survey one-year population estimates. Outcome measures included proportional mortality, age-adjusted mortality rates per 100,000 (AMR), and annual percent change (APC) in mortality over time. Data were stratified by sex and nativity status. Due to large differences in age structure, we report native- and foreign-born VietAms separately. FINDINGS We identified 74,524 VietAm decedents over the study period (71,305 foreign-born, 3,219 native-born). Among foreign-born VietAms, the three leading causes of death were cancer (26.6%), heart disease (18.0%), and cerebrovascular disease (9.0%). Among native-born VietAms the three leading causes were accidents (19.0%), self-harm (12.0%), and cancer (10.4%). For every leading cause of death, VietAms exhibited lower mortality compared to both aggregated Asians and NHWs. Over the course of the study period, VietAms witnessed an increase in mortality in every leading cause. This effect was mostly driven by foreign-born, male VietAms. CONCLUSIONS AND RELEVANCE While VietAms have lower overall mortality from leading causes of death compared to aggregated Asians and NHWs, these advantages have eroded markedly between 2005 and 2020. These data emphasize the importance of racial disaggregation in the reporting of public health measures.
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Affiliation(s)
- Khoa Tran
- Department of Humanities, New York University, Abu Dhabi, United Arab Emirates
| | - HyeYuong Shon
- Department of Psychology, University of California, Berkeley, CA, United States of America
| | - Jonathan Phan
- Department of Bioengineering, University of California, Los Angeles, CA, United States of America
| | - Tina Cheng
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Gloria S. Kim
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Armaan Jamal
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Malathi Srinivasan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Latha P. Palaniappan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Linda Nguyen
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Robert J. Huang
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States of America
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Liu Y, Wolkin AF, Kresnow MJ, Schroeder T. Addressing health disparities using multiply imputed injury surveillance data. Int J Equity Health 2023; 22:126. [PMID: 37400819 DOI: 10.1186/s12939-023-01940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Assessing disparities in injury is crucial for injury prevention and for evaluating injury prevention strategies, but efforts have been hampered by missing data. This study aimed to show the utility and reliability of the injury surveillance system as a trustworthy resource for examining disparities by generating multiple imputed companion datasets. METHODS We employed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for the period 2014-2018. A comprehensive simulation study was conducted to identify the appropriate strategy for addressing missing data limitations in NEISS-AIP. To evaluate the imputation performance more quantitatively, a new method based on Brier Skill Score (BSS) was developed to assess the accuracy of predictions by different approaches. We selected the multiple imputations by fully conditional specification (FCS MI) to generate the imputed companion data to NEISS-AIP 2014-2018. We further assessed health disparities systematically in nonfatal assault injuries treated in U.S. hospital emergency departments (EDs) by race and ethnicity, location of injury and sex. RESULTS We found for the first time that significantly higher age-adjusted nonfatal assault injury rates for ED visits per 100,000 population occurred among non-Hispanic Black persons (1306.8, 95% Confidence Interval [CI]: 660.1 - 1953.5), in public settings (286.3, 95% CI: 183.2 - 389.4) and for males (603.5, 95% CI: 409.4 - 797.5). We also observed similar trends in age-adjusted rates (AARs) by different subgroups for non-Hispanic Black persons, injuries occurring in public settings, and for males: AARs of nonfatal assault injury increased significantly from 2014 through 2017, then declined significantly in 2018. CONCLUSIONS Nonfatal assault injury imposes significant health care costs and productivity losses for millions of people each year. This study is the first to specifically look at health disparities in nonfatal assault injuries using multiply imputed companion data. Understanding how disparities differ by various groups may lead to the development of more effective initiatives to prevent such injury.
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Affiliation(s)
- Yang Liu
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Amy F Wolkin
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcie-Jo Kresnow
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Schroeder
- Division of Hazard and Injury Data Systems, U.S. Consumer Product Safety Commission, Bethesda, MD, USA
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Leading causes of death in Asian Indians in the United States (2005–2017). PLoS One 2022; 17:e0271375. [PMID: 35947608 PMCID: PMC9365163 DOI: 10.1371/journal.pone.0271375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
Asian Indians are among the fastest growing United States (US) ethnic subgroups. We characterized mortality trends for leading causes of death among foreign-born and US-born Asian Indians in the US between 2005–2017.
Study design and setting
Using US standardized death certificate data, we examined leading causes of death in 73,470 Asian Indians and 20,496,189 non-Hispanic whites (NHWs) across age, gender, and nativity. For each cause, we report age-standardized mortality rates (AMR), longitudinal trends, and absolute percent change (APC).
Results
We found that Asian Indians’ leading causes of death were heart disease (28% mortality males; 24% females) and cancer (18% males; 22% females). Foreign-born Asian Indians had higher all-cause AMR compared to US-born (AMR 271 foreign-born, CI 263–280; 175.8 US-born, CI 140–221; p<0.05), while Asian Indian all-cause AMR was lower than that of NHWs (AMR 271 Indian, CI 263–278; 754.4 NHW, CI 753.3–755.5; p<0.05). All-cause AMR increased for foreign-born Asian Indians over time, while decreasing for US-born Asian Indians and NHWs.
Conclusions
Foreign-born Asian Indians were 2.2 times more likely to die of heart disease and 1.6 times more likely to die of cancer. Asian Indian male AMR was 49% greater than female on average, although AMR was consistently lower for Asian Indians when compared to NHWs.
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Shah NS, Xi K, Kapphahn KI, Srinivasan M, Au T, Sathye V, Vishal V, Zhang H, Palaniappan LP. Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups. Circ Cardiovasc Qual Outcomes 2022; 15:e008651. [PMID: 35535589 PMCID: PMC9117444 DOI: 10.1161/circoutcomes.121.008651] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. METHODS Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. RESULTS Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). CONCLUSIONS There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.
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Affiliation(s)
- Nilay S Shah
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Cardiology) (N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Preventive Medicine (N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kevin Xi
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | | | - Malathi Srinivasan
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Primary Care and Population Health) (M.S., L.P.P.), Stanford University School of Medicine, CA
| | - Timothy Au
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Vedant Sathye
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Vaibhav Vishal
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Han Zhang
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Latha P Palaniappan
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Primary Care and Population Health) (M.S., L.P.P.), Stanford University School of Medicine, CA
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Tripathi O, He Y, Han BY, Paragas DG, Sharp N, Dan S, Srinivasan M, Palaniappan LP, Thompson CA. Cancer Mortality in U.S.-Born versus Foreign-Born Asian American Groups (2008-2017). Cancer Epidemiol Biomarkers Prev 2022; 31:58-65. [PMID: 34697057 PMCID: PMC8767961 DOI: 10.1158/1055-9965.epi-21-0359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Asian Americans (AA) are the fastest growing ethnic group in the United States with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. U.S.-born). METHODS Ninety-eight thousand eight hundred and twenty-six AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from U.S. death certificates (2008-2017) were analyzed. Thirteen cancers that contribute significantly to Asian-American cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet-/obesity-related, and infection-related. Ten-year age-adjusted mortality rates [AAMR; 95% confidence interval (CI); per 100,00] and standardized mortality ratios (SMR; 95% CI) using foreign-born as the reference group were calculated. RESULTS Overall, foreign-born AAs had higher mortality rates than U.S.-born. Japanese U.S.-born males had the highest tobacco-related mortality rates [foreign-born AAMR: 43.02 (38.72, 47.31); U.S.-born AAMR: 55.38 (53.05, 57.72)]. Screen-detected death rates were higher for foreign-born than U.S.-born, except for among Japanese males [SMR 1.28 (1.21-1.35)]. Diet-/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than U.S.-born; the highest rates were foreign-born males-Korean [AAMR 41.54 (39.54, 43.53)] and Vietnamese [AAMR 41.39 (39.68, 43.09)]. CONCLUSIONS We observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than U.S.-born AAs. IMPACT Disaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.
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Affiliation(s)
- Osika Tripathi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
- San Diego State University School of Public Health, San Diego, California
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
| | - Yuelin He
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Computational and Systems Biology, University of California, Los Angeles, Westwood, California
| | - Bridgette Y Han
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Darynn G Paragas
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- College of Architecture, Arts and Humanities, Clemson University, Clemson, South Carolina
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Nora Sharp
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Computational and Systems Biology, University of California, Los Angeles, Westwood, California
| | - Shozen Dan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
| | - Malathi Srinivasan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Department of Medicine, Stanford Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Department of Medicine, Stanford Medicine, Stanford University, Stanford, California
| | - Caroline A Thompson
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California.
- San Diego State University School of Public Health, San Diego, California
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Iyer DG, Shah NS, Hastings KG, Hu J, Rodriguez F, Boothroyd DB, Krishnan AV, Falasinnu T, Palaniappan L. Years of Potential Life Lost Because of Cardiovascular Disease in Asian-American Subgroups, 2003-2012. J Am Heart Assoc 2020; 8:e010744. [PMID: 30890022 PMCID: PMC6509739 DOI: 10.1161/jaha.118.010744] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Asian‐American subgroups (Asian‐Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display varied cardiovascular disease mortality patterns, especially at younger ages. This study aims to examine the years of potential life lost because of ischemic heart disease and cerebrovascular disease among the 6 largest Asian‐American subgroups compared with non‐Hispanic whites. Methods and Results We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012 to calculate race‐specific life expectancy, mean years of potential life lost, and years of potential life lost per 100 000 population for each Asian subgroup and non‐Hispanic whites. Asian‐American subgroups display heterogeneity in cardiovascular disease burden. Asian‐Indians had a high burden of ischemic heart disease; Asian‐Indian men lost 724 years per 100 000 population in 2012 and a mean of 17 years to ischemic heart disease. Respectively, Vietnamese and Filipino men and women lost a mean of 17 and 16 years of life to cerebrovascular disease; Filipino men lost 352 years per 100 000 population in 2012. All Asian subgroups for both sexes had higher years of life lost to cerebrovascular disease compared with non‐Hispanic whites. Conclusions Cardiovascular disease burden varies among Asian subgroups, and contributes to greater premature mortality in certain subgroups. Asian‐Indian and Filipino populations have the highest years of life lost because of ischemic heart disease and Filipino and Vietnamese have the highest years of life lost because of cerebrovascular disease. Analysis of risk factors and development of subgroup‐specific interventions are required to address these health disparities.
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Affiliation(s)
- Divya G Iyer
- 1 University of Connecticut School of Medicine Farmington CT
| | - Nilay S Shah
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Katherine G Hastings
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Jiaqi Hu
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Fatima Rodriguez
- 3 Division of Cardiovascular Medicine Stanford University Stanford CA
| | - Derek B Boothroyd
- 4 Quantitative Sciences Unit Stanford University School of Medicine Stanford CA
| | - Aruna V Krishnan
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Titilola Falasinnu
- 5 Division of Epidemiology Department of Health Research & Policy Stanford University School of Medicine Stanford CA
| | - Latha Palaniappan
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
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Young JC, Conover MM, Jonsson Funk M. Measurement Error and Misclassification in Electronic Medical Records: Methods to Mitigate Bias. CURR EPIDEMIOL REP 2018; 5:343-356. [PMID: 35633879 PMCID: PMC9141310 DOI: 10.1007/s40471-018-0164-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW We sought to: 1) examine common sources of measurement error in research using data from electronic medical records (EMR), 2) discuss methods to assess the extent and type of measurement error, and 3) describe recent developments in methods to address this source of bias. RECENT FINDINGS We identified eight sources of measurement error frequently encountered in EMR studies, the most prominent being that EMR data usually reflect only the health services and medications delivered within the specific health facility/system contributing to the EMR data. Methods for assessing measurement error in EMR data usually require gold standard or validation data, which may be possible using data linkage. Recent methodological developments to address the impact of measurement error in EMR analyses were particularly rich in the multiple imputation literature. SUMMARY Presently, sources of measurement error impacting EMR studies are still being elucidated, as are methods for assessing and addressing them. Given the magnitude of measurement error that has been reported, investigators are urged to carefully evaluate and rigorously address this potential source of bias in studies based in EMR data.
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