Impacts of Long-Term Obesity on the Health Status of Samoan and Tongan Men in the United States: Results from the Pacific Islander Health Study.

OBJECTIVE: To examine the impacts of long-standing obesity (BMIs ≥ 30.0 kg/m(2)) on health outcomes among Samoan and Tongan men (aged ≥ 18 years) in California using a life course perspective. DESIGN: Cross-sectional analysis of 103 males from the Pacific Islander Health Study (PIHS), a probability sample modeled after the National Health Interview Survey (NHIS). SETTING: Urban residential neighborhoods in San Mateo and Los Angeles counties using a multistage, cluster sample design. MAIN OUTCOME MEASURES: BMI, diabetes, hypertension, total cholesterol, smoking, drinking, arthritis, gout and migraines. RESULTS: Bivariate analysis shows high rates of poor health outcomes distributed throughout the obese and non-obese sample. Logistic analysis finds that being obese does not significantly increase observed negative health outcomes. After controlling for socio-demographic characteristics, the presence of obesity results in non-significant findings for hypertension (OR=1.02; CI: .21, 4.91), and high cholesterol (OR=.52; CI: .10, 2.73), while obesity significantly reduces the risk of diabetes by 60% (OR=.40; CI: .14, 1.17). When applying disease counts, obese men have a significantly lower risk of reporting multiple health conditions (OR=.72; CI: .52, 1.00). CONCLUSION: Overall, the health of Samoan and Tongan males in California is uniformly poor and obesity alone does not significantly increase risks of poor health outcomes. Using a life course perspective, the analysis offers new insights on the basic health of this understudied population.

Mortality patterns of Native Hawaiians across their lifespan: 1990-2000.

OBJECTIVES: We examined mortality patterns across the lifespan of Native Hawaiians and compared mortality disparities across races. METHODS: We determined the age-specific and age-adjusted mortality rates of Native Hawaiians from 1990 to 2000 by using national census and vital registration data. RESULTS: Among Native Hawaiians aged younger than 1 year, expected deaths were 15% lower than for Blacks and 50% higher than for Whites. Among older adults, Native Hawaiians had higher rates of mortality compared with the general population, particularly in 1990 and 1995. Crude death rates for Native Hawaiians were similar to those for Blacks in 1990 and 1995 but were 20% lower than those for Blacks by 2000. Crude death rates for Native Hawaiians were 30% higher than for Whites in 1990 and 1995 and more than 40% higher than for Whites in 2000. CONCLUSIONS: Compared with Whites, Native Hawaiians and Blacks face similar challenges regarding infant and early-life mortality and increasing risks of mortality in mid-life and early old age. Our analyses document a need for renewed efforts to identify the determinants of ill health and commitment to address them.

A multiple imputation approach to disclosure limitation for high-age individuals in longitudinal studies.

Disclosure limitation is an important consideration in the release of public use data sets. It is particularly challenging for longitudinal data sets, since information about an individual accumulates with repeated measures over time. Research on disclosure limitation methods for longitudinal data has been very limited. We consider here problems created by high ages in cohort studies. Because of the risk of disclosure, ages of very old respondents can often not be released; in particular, this is a specific stipulation of the Health Insurance Portability and Accountability Act (HIPAA) for the release of health data for individuals. Top-coding of individuals beyond a certain age is a standard way of dealing with this issue, and it may be adequate for cross-sectional data, when a modest number of cases are affected. However, this approach leads to serious loss of information in longitudinal studies when individuals have been followed for many years. We propose and evaluate an alternative to top-coding for this situation based on multiple imputation (MI). This MI method is applied to a survival analysis of simulated data, and data from the Charleston Heart Study (CHS), and is shown to work well in preserving the relationship between hazard and covariates.

Health, widowhood, and family support in the North and South Pacific: a comparative study.

This paper compares the impacts of health and widowhood on the level of support received by elderly women living in small island communities within the Philippines and Fiji. Using a theoretical perspective of ongoing reciprocal exchange as opposed to altruistic support within household economies, this paper reviews the impacts of disability and economic contributions on the level of support an elderly female receives. It is hypothesized that as the health of the widow declines her access to care will also diminish due to an inability to contribute to the household economies of the extended family. This paper extends existing work on health and family support of widowed females in the developing world by performing a cross-national comparative analysis as well as by explicitly testing the assumptions of altruism that are a central assumption of most models of long-term care in underdeveloped nations.