Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California

• Published in: BMC public health Vol. 23; no. 1; p. 885
• Main Authors: Waitzfelder, Beth, Palaniappan, Latha, Varga, Alexandra, Frankland, Timothy B, Li, Jiang, Daida, Yihe G, Kaholokula, Joseph Keawe'aimoku, Bacong, Adrian Matias, Rawlings, Andreea M, Chung, Sukyung, Howick, Connor, Fortmann, Stephen P
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-05-2023; BioMed Central; BMC
• Subjects: Adult; Asian; Asian American Native Hawaiian and Pacific Islander - statistics & numerical data; Asian Americans; Asian people; California - epidemiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - ethnology; Census of Population; Confidence intervals; Coronary artery disease; Demographic aspects; Electronic health records; Estimates; Ethnicity; Filipino; Hawaii - epidemiology; Health aspects; Health disparities; Heart diseases; Hispanic people; Humans; Minority & ethnic groups; Native Hawaiian; Oceanians; Pacific Islander; Pacific Islander people; Patients; Population studies; Populations; Prevalence; Primary care; Public health; Race; Regression analysis; Regression models; Risk factors; Statistical analysis; Stroke; Subgroups; Subpopulations; Vascular diseases; Hawaii; California; United States > US; Alaska; Cardiovascular disease; Filipino; Native Hawaiian; Stroke; Pacific Islander; Asian
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-023-15795-5

Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations.
The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups.
The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos).
Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.