Race and Medicine

Race and Medicine

Disclosures: The study and editorial authors report no relevant financial disclosures.
May 10, 2022
3 min read
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CV, cerebrovascular death trends vary across Asian American subgroups

Disclosures: The study and editorial authors report no relevant financial disclosures.
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U.S. death data show the burden of ischemic heart disease, cerebrovascular disease and HF deaths vary significantly across Asian American subgroups, emphasizing the importance of tailoring CVD prevention and management strategies.

A retrospective analysis of death certificate data from 2003 to 2017 showed several Asian American subgroups experienced stagnant age-standardized mortality rates, including Asian Indian and Vietnamese American men for ischemic heart disease, and Asian Indian, Korean and Vietnamese American women and men for cerebrovascular disease. HF age-standardized mortality rates increased for both sexes across several Asian American subgroups.

Graphical depiction of data presented in article
Nilay S. Shah, MD, MPH, assistant professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and affiliated global faculty at the Stanford Center for Asian Health Research and Education.

“These findings show the importance of evaluating Asian American groups in health research individually, instead of grouped in a single ‘Asian’ category,” Nilay S. Shah, MD, MPH, assistant professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and affiliated global faculty at the Stanford Center for Asian Health Research and Education, told Healio. “Our results show that several Asian American subgroups are experiencing worrisome trends in death rates from CVD. For example, Asian Indians have the highest mortality rates from ischemic heart disease. Mortality from HF increased among several Asian American groups, including Filipino, Asian Indian and Japanese women and men.”

Assessing U.S. death data

Using U.S. death certificate data from 2003 to 2017 from the National Center for Health Statistics, Shah and colleagues assessed age-standardized mortality rates, average annual percent change of age-standardized mortality rate and proportional mortality ratios of ischemic heart disease, HF and cerebrovascular disease, calculated by sex, for non-Hispanic Asian American subgroups, defined as Chinese, Filipino, Asian Indian, Japanese, Korean and Vietnamese (n = 618,004), as well as white (n = 30,267,178) and Hispanic adults (n = 2,292,257).

The findings were published in Circulation: Cardiovascular Quality and Outcomes.

Across groups, age-standardized mortality rates from ischemic heart disease fell among all subgroups of Asian American women and among white and Hispanic women; significantly decreased among Chinese, Filipino, Japanese and Korean men and white and Hispanic men, but remained stagnant for Asian Indian and Vietnamese men. The highest 2017 age-standardized mortality rates from ischemic heart disease among Asian American decedents were in Asian Indian women, at 77 per 100,000, and Asian Indian men, at 133 per 100,000.

HF age-standardized mortality rates remained stagnant for Chinese, Korean and white women, as well as for Chinese and Vietnamese men. HF age-standardized mortality rates increased in both sexes for Filipino, Asian Indian and Japanese adults, as well as for Vietnamese women and Korean men, with the highest 2017 age-standardized mortality rates among Asian American subgroups in Asian Indian women, at 14 per 100,000, and Asian Indian men, at 15 per 100,000.

Cerebrovascular disease age-standardized mortality rates decreased among Chinese, Filipino and Japanese women and men from 2003 to 2017, but remained stagnant for Asian Indian, Korean and Vietnamese women and men. The highest cerebrovascular disease age-standardized mortality rates among Asian American subgroups in 2017 was for Vietnamese women, at 46 per 100,000, and Vietnamese men, at 47 per 100,000.

“CVD prevention is important for everyone,” Shah told Healio. “These findings should prompt us to give particular attention to enhancing CV prevention efforts for people who identify with subgroups that are disproportionately affected among the Asian American population, such as Asian Indian and Filipino Americans.”

Shah said future research should investigate why there are differences in CVD outcomes between Asian subgroups, what the unique social determinants of CV health and disease are within each Asian subgroup, and how to adapt and implement evidence-based CVD prevention strategies for patients in individual Asian subgroups.

‘Substantial heterogeneity’ across Asian subgroups

In a related editorial, Monica Parks, MD, a cardiology fellow at the University of Colorado Anschutz Medical Campus, and colleagues wrote that despite decades of research describing Asian Americans as an aggregate and the persistent stereotype of Asian Americans as a “model minority,” studies demonstrate substantial heterogeneity in CVD prevalence and outcomes across Asian American subgroups, with a notably increased disease burden among Filipinos and Asian Indians.

“[The authors’] findings invite us to look deeper into the so-called model minorities, which may not always reveal a pretty picture,” Parks and colleagues wrote. “While we have focused our discussion on Asian Americans in the United States, this approach also applies to studies of health care outcomes in other racial and ethnic groups. We invite scientists and clinicians alike to reflect on not just what research questions remain unanswered, but also those that have not yet been asked.”

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For more information:

Nilay S. Shah, MD, MPH, can be reached at nilay.shah@northwestern.edu.