Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study
Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study
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DOI：
10.1186/s12889-019-7683-3
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发表时间：
2019-11-25
影响因子：
4.5
通讯作者：
Lo, Joan C.
中科院分区：
文献类型：
--
作者：
Gordon, Nancy P.;Lin, Teresa Y.;Lo, Joan C.
很少有大型队列研究调查了主要亚裔美国人族群和夏威夷/太平洋岛民（PI）中老年人糖尿病（DM）、高血压（HTN）、冠状动脉疾病（CAD）、肥胖和吸烟的患病率。本研究的目的是评估这些疾病的患病率和风险因素在亚裔美国人和PI种族群体中的差异，并与所有亚裔美国人种族群体进行比较。方法本研究使用了一组140万45至84岁的成年人，他们是2016年期间Kaiser Permanente北方加州健康计划的成员。该队列包括约274，910名亚裔美国人（中国人，菲律宾人，日本人，韩国人，东南亚人，南亚人，其他），8450名PI，795，080名非西班牙裔白人，107，200名黑人和210，050名拉丁美洲人。我们使用电子健康记录数据，对所有种族/民族亚组中的男性和女性进行DM、HTN、CAD、肥胖（使用标准和亚洲阈值）和吸烟的年龄标准化患病率估计，并将这些亚组与汇总的全亚裔美国种族组以及白人、黑人和拉丁美洲人进行比较。结果我们发现亚裔美国人的健康负担有很大的差异。对于男性和女性来说，糖尿病和高血压的最低和最高患病率之间分别有16和> 22个百分点的差异。亚洲人群中的肥胖患病率（基于亚洲BMI ≥ 27.5 kg/m2的阈值），女性为14%至39%，男性为21%至45%。妇女吸烟率为1%至4%，男子为5%至14%。在所有疾病和风险因素中，亚裔美国人和PI种族组的患病率估计值与全亚裔美国人组显著不同。一般而言，菲律宾人和PI的健康负担大于所有亚洲人，患病率估计接近黑人。结论：在北方加州健康计划成员的中老年人群中，我们发现亚裔美国人群体之间以及亚裔美国人群体与所有亚裔种族群体之间的慢性心血管疾病、肥胖和吸烟患病率存在实质性差异。我们的研究证实，亚裔美国人种族群体的报告统计数据掩盖了亚裔美国人种族群体健康的有意义的差异。
Background Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group. Methods This study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos. Results We found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI >= 27.5 kg/m(2) threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks. Conclusions In a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.