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

分解亚裔美国人和太平洋岛民的健康数据：使用医疗保险健康结果调查对社区环境和心血管健康进行多层次分析

基本信息

批准号：
9755319
负责人：
Lan N Doan
金额：
$ 6.54万
依托单位：
OREGON STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2020-07-31
项目状态：
已结题

项目摘要

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.

项目总结/摘要心血管疾病（CVD）是美国以及亚裔美国人和太平洋裔美国人死亡的主要原因岛民（AAPI）65岁及以上的成年人。CVD的患病率在非西班牙裔人群中有充分的记录白色、非裔美国人和西班牙裔人群。然而，CVD发病率和死亡率不成比例地对生活在美国的AAPI的影响以及特定种族亚组（例如亚洲印度人，中国人、菲律宾人、日本人、韩国人、越南人以及夏威夷原住民和太平洋岛民）准确地描述。由于缺乏关于AAPI亚组的数据，估计CVD发病率和患病率，并制定适当的临床指南和建议， CVD研究优先事项。此外，传统的心血管疾病风险因素（如高血压、体重指数和糖尿病）在AAPI亚组中的分布不均匀，这些CVD风险的相对重要性因素尚不清楚。邻里背景（例如，家庭收入中位数、邻里贫困和农村/城市状况）被确定为健康状况的一个重要决定因素，健康差距。然而，在AAPI中，邻里环境与CVD健康之间的关系子组不太清楚。AAPI代表了40多种起源文化和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老年人也将是美国老年人口中增长最快的群体。大多数亚太裔老年人是在外国出生的，移民到美国，通常教育水平低，英语水平有限，贫困程度高 rates. AAPI老年人是一个特别脆弱的群体，因为他们面临着以下因素的复合影响：少数群体地位和老年人。此外，这些问题由于缺乏 AAPI在研究中。本研究的主要目标是确定心血管疾病的患病率和决定因素并确定邻里环境与个人健康状况之间的关联通过对美国人口普查局数据和医疗保险健康的二级数据分析，成果调查。我们提出了HOS（N= 1，017500）的多层次回归分析，由医疗保险和医疗补助服务中心管理的代表性调查。居屋是一个独特的 2011年开始收集扩大的种族和民族数据的数据集，包括4个西班牙裔和11个 AAPI来源类别，可对AAPI亚组进行分类分析（44，705名自我报告的 AAPI亚组）。居屋计划将与地理层面的人口普查数据挂钩，以调查邻里因素影响健康状况的个体差异。我们希望这些发现将建立一个更好的了解AAPI亚组的CVD患病率以及邻居和 CVD和种族/民族。拟议的研究将为改善CVD健康的文化相关策略提供信息在高危人群中，管理CVD危险因素，并降低不同老年人的CVD发病率和死亡率。