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      Leading Causes of Death among Asian American Subgroups (2003–2011)

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          Abstract

          Background

          Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups.

          Methods and Findings

          We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer’s disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs.

          Conclusions

          Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.

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          Most cited references35

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          Cardiovascular disease mortality in Asian Americans.

          Asian Americans are a rapidly growing racial/ethnic group in the United States. Our current understanding of Asian-American cardiovascular disease mortality patterns is distorted by the aggregation of distinct subgroups.
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            Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S.

            Objectives We report cancer incidence, mortality, and stage distributions among Asians and Pacific Islanders (API) residing in the U.S. and note health disparities, using the cancer experience of the non-Hispanic white population as the referent group. New databases added to publicly available SEER*Stat software will enable public health researchers to further investigate cancer patterns among API groups. Methods Cancer diagnoses among API groups occurring from 1 January 1998 to 31 December 2002 were included from 14 Surveillance, Epidemiology, and End Results (SEER) Program state and regional population-based cancer registries covering 54% of the U.S. API population. Cancer deaths were included from the seven states that report death information for detailed API groups and which cover over 68% of the total U.S. API population. Using detailed racial/ethnic population data from the 2000 decennial census, we produced incidence rates centered on the census year for Asian Indians/Pakistanis, Chinese, Filipinos, Guamanians, Native Hawaiians, Japanese, Kampucheans, Koreans, Laotians, Samoans, Tongans, and Vietnamese. State vital records offices do not report API deaths separately for Kampucheans, Laotians, Pakistanis, and Tongans, so mortality rates were analyzed only for the remaining API groups. Results Overall cancer incidence rates for the API groups tended be lower than overall rates for non-Hispanic whites, with the exception of Native Hawaiian women (All cancers rate = 488.5 per 100,000 vs. 448.5 for non-Hispanic white women). Among the API groups, overall cancer incidence and death rates were highest for Native Hawaiian and Samoan men and women due to high rates for cancers of the prostate, lung, and colorectum among Native Hawaiian men; cancers of the prostate, lung, liver, and stomach among Samoan men; and cancers of the breast and lung among Native Hawaiian and Samoan women. Incidence and death rates for cancers of the liver, stomach, and nasopharynx were notably high in several of the API groups and exceeded rates generally seen for non-Hispanic white men and women. Incidence rates were lowest among Asian Indian/Pakistani and Guamanian men and women and Kampuchean women. Asian Indian and Guamanian men and women also had the lowest cancer death rates. Selected API groups had less favorable distributions of stage at diagnosis for certain cancers than non-Hispanic whites. Conclusions Possible disparities in cancer incidence or mortality between specific API groups in our study and non-Hispanic whites (referent group) were identified for several cancers. Unfavorable patterns of stage at diagnosis for cancers of the colon and rectum, breast, cervix uteri, and prostate suggest a need for cancer control interventions in selected groups. The observed variation in cancer patterns among API groups indicates the importance of monitoring these groups separately, as these patterns may provide etiologic clues that could be investigated by analytic epidemiological studies.
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              Call to action: cardiovascular disease in Asian Americans: a science advisory from the American Heart Association.

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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 April 2015
                2015
                : 10
                : 4
                : e0124341
                Affiliations
                [1 ]Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America
                [2 ]Sutter Health Medical Foundation, Department of Cardiology, Davis, California, United States of America
                [3 ]Columbia University School of Nursing, New York, New York, United States of America
                [4 ]Palo Alto Medical Foundation Research Institute, Palo Alto, California, United States of America
                [5 ]Stanford University, Shorenstein Asia-Pacific Research Center, Stanford, California, United States of America
                California Department of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KGH POJ KIK ATHF. Analyzed the data: KIK BAG. Contributed reagents/materials/analysis tools: KIK BAG CAT. Wrote the paper: KGH POJ KIK ATHF BAG CAT KE MRC LPP. Designed the figures: KGH, KIK. Designed and populated tables: KGH. Designed and performed sensitivity analyses: KIK CAT. Provided critical edits after first draft and subsequent drafts: KE MRC LPP.

                Article
                PONE-D-14-51831
                10.1371/journal.pone.0124341
                4411112
                25915940
                ade3013d-331d-4c33-8332-f2469584e3a8
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 24 November 2014
                : 2 March 2015
                Page count
                Figures: 1, Tables: 6, Pages: 18
                Funding
                This study was supported by a grant from the National Institute on Minority Health and Health Disparities (1 R01 MD 007012-01 CAUSES: Causes of Asian American mortality Understood by Socio-Economic Status). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                All data underlying the authors' findings in this study are freely available in a public repository, regulated by the National Center for Health Statistics (NCHS). The authors have obtained individual county-level characteristic data from NCHS for their analyses, thus its public use is restricted. Readers that are interested in requesting this data may contact Robert Anderson MD, MPH, Chief of the Mortality Statistics at NCHS, by email at rnanderson@ 123456cdc.gov .

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