Nativity and prevalence of cardiometabolic diseases among U.S. Asian immigrants.

AIMS: Acculturation has been shown to be an important factor for immigrants' health in the United States. We investigate whether nativity is associated with a greater risk for cardiometabolic diseases among Asian Americans (Asians) vs. non-Hispanic whites (whites). METHODS: Based on data from the U.S. National Health Interview Survey in 2006-2015, 146,862 Asians and whites aged ≥30 years were evaluated. Nativity as a proxy for acculturation was defined using a combination of birthplace and the duration of U.S. residency. Cardiometabolic diseases were defined based on self-reported diagnoses of diabetes, prediabetes, or cardiovascular diseases (CVD). Using 10-year pooled data accounting for complex sampling designs and weights, multiple logistic regression models were used to assess associations. Four Asian subgroups, including Chinese, Filipinos, Asian Indians and other Asians, were evaluated in subgroup analyses. RESULTS: Compared to U.S.-born whites, prevalent type 2 diabetes and prediabetes were higher among Asians depending on nativity. However, the prevalence of CVD was lower among Asians than among whites regardless of nativity (OR≥15 years = 0.5 [95% CI:0.5-0.6], ORU.S-born = 0.7 [95% CI:0.6-0.8]). In addition, compared to U.S.-born whites, prevalent type 2 diabetes and prediabetes increased with an increasing length of U.S. residency for foreign-born Asians among Asians overall (≥15 years: ORdiabetes = 1.5 [95% CI:1.3-1.7]; ORprediabetes = 1.3 [95% CI:1.2-1.6]) and Asian Indians and Filipinos. Furthermore, a significant graded association between prediabetes and length of U.S. residency was found among foreign-born Asians. CONCLUSIONS: The prevalence of diabetes and prediabetes is higher among Asian immigrants who have spent more years in the U.S., than those in U.S.-born whites. Monitoring and prevention efforts for diabetes should target this group.

Trends in the prevalence of type 2 diabetes and its association with mortality rates in Asians vs. Whites: Results from the United States National Health Interview Survey from 2000 to 2014.

AIMS: To identify the prevalence and mortality of type 2 diabetes in Asian Americans (Asians) vs. non-Hispanic whites (Whites). METHODS: We analyzed a nationally representative sample of 237,354 U.S. adults aged ≥30 years using National Health Interview Survey data from 2000 to 2014 to estimate the prevalence and trends of type 2 diabetes. Additionally, 144,638 Asians and Whites represented in surveys from 2000 to 2009 were included in the mortality analysis with follow-up to 2011. RESULTS: Type 2 diabetes was higher in Asians than Whites (7.0-11.2 vs. 5.6-8.3%) and increased over time. Prevalence rates increased from 8.1 (2000-2002) to 9.6% (2012-2014) in Asians and from 6.0 (2000-2002) to 7.9% (2012-2014) in Whites (both P < 0.05). The age-standardized mortality rates were 72.7 and 138.8 per 1000 person-years in Asians and Whites with diabetes, respectively, and 58.1 and 77.8 per 1000 person-years, respectively, in those without diabetes. Among Asians and Whites with diabetes, hazard ratios for total and CVD mortality were 0.7 (95% CI: 0.5-0.9) and 0.3 (95% CI: 0.1-0.6), respectively, with no difference in cancer mortality. Asians and Whites without diabetes exhibited no differences in total or cause-specific mortality. CONCLUSIONS: Type 2 diabetes was more prevalent in Asians, with a significant upward trend since 2000, but overall mortality was lower in Asians than Whites with diabetes. Asians are susceptible to type 2 diabetes; thus, prevention programs are still needed.

Ethnic differences in barriers and referral to cardiac rehabilitation among women hospitalized with coronary heart disease.

Important gender differences in cardiac rehabilitation utilization are well established, yet few studies have documented whether reported barriers and referrals vary by ethnicity. This is a cross-sectional study to determine whether barriers and referrals to participation in cardiac rehabilitation differed by race/ethnicity in 304 women (52% ethnic minorities) hospitalized with coronary heart disease. Nearly all subjects (92%) strongly agreed that physician referral was important to participation in rehab, but only 22% of subjects reported physician instruction to attend. Whites were more likely than minorities to report instruction to attend cardiac rehabilitation, and minorities were more likely to report financial barriers when compared with whites. These disparities need to be addressed because minority women have a worse prognosis following hospitalization for coronary heart disease, and cardiac rehabilitation has been shown to improve survival.

The association between educational level and risk of cardiovascular disease fatality among women with cardiovascular disease.

BACKGROUND: The inverse relation of socioeconomic status with incident cardiovascular diseases (CVDs) has been well established. However, few data are available describing this relation among ethnically diverse women with prevalent CVD. Using education as a proxy for socioeconomic status, we examined its relation to CVD mortality among women with established CVD. SUBJECTS: Data from 2,157 women with CVD at baseline, who participated in nine long-term U.S. cohort studies, were pooled. METHODS: Cox regression models adjusted for history of diabetes mellitus, total cholesterol, systolic and diastolic blood pressure, body mass index, smoking, race/ethnicity, and age at baseline were used to estimate hazard ratios for CVD mortality between non-high school graduates and high school graduates. RESULTS: During a mean follow-up time of 11.5 years, 615 CVD deaths were observed. There was an age-dependent (p = .003) inverse association between education and CVD mortality among women with CVD. At age 60, the risk of dying due to CVD among non-high school graduates was more than twice greater than that of high school graduates (hazard ratio = 2.34; 95% CI 1.27-4.29). At age 65, the hazard ratio decreased to 1.31 (95% CI 1.00-1.71). By age 70, there was no difference in the hazard of dying between high school graduates and nongraduates (hazard ratio = 1.01; 95% CI .85-1.21). CONCLUSIONS: Our results show that among women with CVD, educational level was a significant, and age-dependent, predictor of fatal CVD independent of other traditional risk factors. These women are an important high-risk population to target secondary prevention and educational efforts.