Single ‘Asian’ category masks heart disease risk in Indian Americans, finds new study

iNDICA News Bureau-

A large-scale, retrospective study of data from the past 20 years has revealed wide divergence in death rates from cardiovascular diseases in the U.S. among people from various Asian ethnic subgroups.

Death rate trends stagnated in some subgroups and increased in others, according to the research that was published earlier this week in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed journal of the American Heart Association.

Asian Americans constitute the fastest growing racial/ethnic group in the U.S., rising 81% from 11 million to 19 million between 2000 and 2019 and projected to go up to 36 million by 2060, according to the Pew Research Center.

Yet public health and clinical data have commonly combined them into one ‘Asian’ category, obscuring health outcomes (including death rates) and risks such as high blood pressure, obesity, Type 2 diabetes and smoking for the various subgroups.

The Asian American population is diverse in how the subgroups experience health outcomes, said study lead author Nilay S Shah, MD, MPH, assistant professor of cardiology and preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago and an affiliated global faculty member at Stanford University’s Center for Asian Health Research and Education.

Dr Shah said it is important to recognize that evidence-based strategies that work for one section of the population may not necessarily work for people in another group.

He said the study revealed tremendous opportunity to improve health for Asian Americans by focusing and tailoring research and care to the unique needs and cultural characteristics of these communities.

Examining U.S. death certificates from 2003 to 2017 available from the National Center for Health Statistics, researchers analyzed death rates for ischemic heart disease (also known as coronary heart disease); heart failure; and cerebrovascular disease, which includes stroke.

Data was compiled and stratified among Asian adults who reported their subgroup as Asian Indian, Chinese, Filipino, Japanese, Korean or Vietnamese, which are the Asian categories available on U.S. death certificates since 2003. Health information about these various subgroups of Asian Americans was compared to the death certificates of White and Hispanic people.

Comparing deaths of more than 600,000 Asian Americans with more than 30 million White and more than 2 million Hispanic people, researchers made some important findings.

  1. Death rates from ischemic heart disease significantly decreased between 2003 and 2017 in all women, significantly decreased in Chinese, Filipino, Japanese, Korean, White and Hispanic men, but remained stagnant in Asian Indian and Vietnamese men. Asian Indian women had the highest death rates for ischemic heart disease in 2017.
  2. Death rates from heart failure were unchanged in Chinese, Korean and White women and Chinese and Vietnamese men between 2003 and 2017 but increased significantly among Filipino, Asian Indian and Japanese individuals, Vietnamese women and Korean men. Asian Indian people had the highest heart failure death rates of all Asian American subgroups in 2017 (14 per 100,000 in women, 15 per 100,000 in men).
  3. Cerebrovascular disease death rates decreased among Chinese, Filipino and Japanese women and men but did not shift among Asian Indian, Korean and Vietnamese women and men. Vietnamese people had the highest cerebrovascular disease death rates in 2017.

For a long time, because Asian Americans were grouped into one category, it appeared that Asian people in the U.S. did not have as high a risk for heart and vascular diseases compared with other groups, Dr Shah said.

“Our findings indicate this is inaccurate,” he said. “By separating Asian subgroups, we can identify populations and communities that are at higher cardiovascular disease risk, and they may benefit from enhanced heart disease prevention and treatment strategies.”

The study’s assessment of death rates relied on administrative codes for causes of death, which may sometimes misclassify the cause. Despite the potential limitations of misclassification, the researchers noted the data still provides the most comprehensive national surveillance of cardiovascular and cerebrovascular death rates among people from diverse racial and ethnic backgrounds.

An accompanying editorial by Monica Parks, MD; Brahmajee Nallamothu, MD, MPH; and P Michael Ho, MD, PhD, noted that while this manuscript is an important contribution to the information available on this topic, it only scratches the surface of needed research. Nallamothu is editor-in-chief of Circulation: Cardiovascular Quality and Outcomes while Dr Ho is deputy editor of the journal.

The editorial noted that the U.S. Department of Health and Human Services (HHS) first added Asian American subgroups of Asian Indian, Chinese, Filipino, Japanese, Korean and Vietnamese to birth and death certificates in 2003.

In 2010, the Affordable Care Act mandated that all health surveys sponsored by the HHS must also include these subgroups and classifications. It was through these mandates that the study by Dr Shah and his team was possible.

It is increasingly clear that not only has the ethnic makeup of the U.S. population changed, but the aggregate living experiences of these communities have evolved and may drive wildly different interactions with the healthcare system. Simple checking a box next to White or Asian American is insufficient to capture such complexity, they wrote.

Dr Shah’s co-authors are Kevin Xi, BS; Kristopher I Kapphahn, MS; Malathi Srinivasan, MD; Timothy Au, BS; undergraduate students Vedant Sathye, Vaibhav Vishal and Han Zhang; and Latha P Palaniappan, MD, MS.

The study was funded by the National Institute on Minority Health and Health Disparities and the National Heart, Lung, and Blood Institute, both of which are divisions of the National Institutes of Health.