Hastings Katherine G, Jose Powell O, Kapphahn Kristopher I, Frank Ariel T H, Goldstein Benjamin A, Thompson Caroline A, Eggleston Karen, Cullen Mark R, Palaniappan Latha P
Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America.
Sutter Health Medical Foundation, Department of Cardiology, Davis, California, United States of America.
PLoS One. 2015 Apr 27;10(4):e0124341. doi: 10.1371/journal.pone.0124341. eCollection 2015.
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.
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.
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.
目前我们对亚裔美国人死亡模式的理解因死亡证明上不同亚洲亚群体的历史汇总而被扭曲，掩盖了各亚群体主要死因的重要差异。在本分析中，我们旨在通过报告按亚裔美国人亚群体细分的主要死因，填补亚裔美国人健康方面的一个重要知识空白。
我们研究了2003年至2011年六个最大的亚洲亚群体（印度裔、华裔、菲律宾裔、日裔、韩裔、越南裔）和非西班牙裔白人（NHWs）的全国死亡记录，并对主要死因进行了排名。我们计算了全因和特定病因的年龄调整率、年百分比变化的时间趋势以及按种族/族裔和性别的率比。排名显示，作为一个汇总群体，癌症是亚裔美国人的主要死因。细分后，存在显著的异质性。在女性中，除印度裔外，癌症是每个群体的主要死因。在男性中，癌症是华裔、韩裔和越南裔男性的主要死因，而心脏病是印度裔、菲律宾裔和日裔男性的主要死因。印度裔男性因心脏病死亡的比例几乎是癌症的两倍（31%对18%）。时间趋势显示，2003年至2011年期间，印度裔和越南裔的癌症和糖尿病死亡率上升；印度裔中风死亡率上升；韩裔自杀死亡率上升；所有种族/族裔群体的阿尔茨海默病死亡率上升。全因率比显示，与非西班牙裔白人相比，亚裔美国人的总体死亡率较低。
我们的研究结果显示了亚裔美国人亚群体主要死因的异质性。进一步的研究应侧重于在这些日益多样化的人群中预防和治疗特定疾病的具有文化适应性和成本效益的方法。
