Disaggregating Asian American and Pacific Islander Health Data: Multilevel Analysis of Neighborhood Context and Cardiovascular Health using the Medicare Health Outcomes Survey

项目摘要/摘要 心血管疾病(CVD)是美国、亚裔美国人和太平洋地区的主要死亡原因 岛民(AAPI)65岁及以上的成年人。在非西班牙裔人群中，心血管疾病的患病率已经有了很好的记录 白人、非裔美国人和西班牙裔美国人。然而，心血管疾病的发病率和死亡率不成比例 影响居住在美国的AAPI和特定种族亚群(例如亚裔印第安人、 中国人、菲律宾人、日本人、韩国人、越南人、夏威夷原住民和太平洋岛民) 准确地描述了。缺乏关于AAPI亚组的数据导致无法准确地 估计心血管疾病的发病率和患病率，并制定适当的临床指南和建议 心血管疾病研究的优先事项。此外，传统的心血管疾病危险因素(如高血压、体重指数和 糖尿病)在AAPI亚组之间分布不均，以及这些心血管疾病风险的相对重要性 影响因素尚不清楚。社区背景(例如，家庭收入中位数、社区贫困和 农村/城市状况)已被确定为健康状况的重要决定因素和#年的潜在因素 健康差距。然而，AAPI社区环境与心血管疾病健康的关系 人们对亚群的理解还不够深入。AAPI代表了40多种起源的文化和100种不同的语言 预计到2050年将成为美国增长最快的种族群体。AAPI老年人也将成为 美国老年人口中增长最快的群体。大多数AAPI老年人是在外国出生的，而且是最近出生的 移民到美国，他们通常受教育程度低，英语水平有限，贫困程度高 费率。AAPI老年人是一个特别脆弱的群体，因为他们面临着 少数群体地位和老年问题。此外，这些当前的问题因缺乏 AAPIs在研究中。本研究的主要目的是确定心血管疾病的患病率和决定因素。 在AAPI子组中，并确定社区环境和个人健康状况之间的关联 在AAPI中，通过对美国人口普查局数据和联邦医疗保险健康计划的二级数据分析，对老年人进行调查 结果调查(HOS)。我们提出了多水平回归分析居屋(N=1,017,500)，一个全国性的 由医疗保险和医疗补助服务中心管理的代表性调查。居屋是独一无二的 2011年开始收集扩大的族裔和种族数据的数据集，包括4个西班牙裔和11个 AAPI来源类别，允许对AAPI亚组进行分类分析(44,705自报和 AAPI亚组)。居屋计划将与地理层面的人口普查数据挂钩，以调查邻里因素 这会影响健康状况的个体差异。我们希望这些调查结果将建立一个更好的 AAPI亚组及邻区和交界点心血管病患病率的调查 心血管疾病和种族/民族。拟议的研究将为改善心血管疾病健康的文化相关战略提供信息。 在高危人群中，管理心血管疾病危险因素，降低不同老年人的心血管疾病发病率和死亡率。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of mortality in the US and for Asian Americans and Pacific Islander (AAPIs) adults age 65 and older. The prevalence of CVD has been well documented for non-Hispanic white, African American, and Hispanic populations. However, CVD morbidity and mortality disproportionately impacts AAPIs living in the US and the true magnitude of CVD by specific racial subgroup (e.g. Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Native Hawaiian and Pacific Islander) has not been accurately characterized. The paucity of data on AAPI subgroups has resulted in the inability to precisely estimate CVD incidence and prevalence and develop appropriate clinical guidelines and recommendations for CVD research priorities. Moreover, traditional CVD risk factors (e.g. hypertension, body mass index, and diabetes) are unequally distributed across AAPI subgroups and the relative importance of these CVD risk factors is unclear. Neighborhood context (e.g. median household income, neighborhood deprivation, and rural/urban status) has been identified as an important determinant of health status and underlying factor in health disparities. However, the relationship between neighborhood context and CVD health in AAPI subgroups is not well understood. AAPIs represent more than 40 cultures of origin and 100 different languages and are projected to be the fastest growing racial group in the US by 2050. AAPI older adults will also be the fastest growing group in the US elderly population. Most AAPI older adults are foreign-born and recent immigrants to the US, and typically have low education levels, limited English proficiencies, and high poverty rates. AAPI older adults are a particularly vulnerable population as they face the compounding effects of minority group status and older age. Furthermore, these current issues are exacerbated by the absence of AAPIs in research. The primary objectives of this study are to identify the prevalence and determinants of CVD in AAPI subgroups and determine the associations between neighborhood context and individual health status in AAPI older adults through secondary data analysis of US Census Bureau data and the Medicare Health Outcomes Survey (HOS). We propose multilevel regression analysis of the HOS (N=1,017500), a nationally representative survey administered by the Centers for Medicare & Medicaid Services. The HOS is a unique dataset that began collecting expanded ethnic and racial data in 2011, including 4 Hispanic-origin and 11 AAPI-origin categories, which allows for disaggregated analysis of AAPI subgroups (44,705 self-reported an AAPI subgroup). The HOS will be linked to geographic-level census data to investigate neighborhood factors that impact individual differences in health status. We expect that the findings will establish a better understanding of the CVD prevalence in AAPI subgroups and the intersections between neighborhood and CVD and race/ethnicity. The proposed research will inform culturally relevant strategies to improve CVD health in high-risk groups, manage CVD risk factors, and reduce CVD morbidity and mortality in diverse older adults.