Unraveling Differences in CVD Outcomes Among Asian-American Subgroups Reveal Disparities

photo of Yosef M. Khan, M.D., M.P.H., Ph.D.Yosef M. Khan, M.D., M.P.H., Ph.D., Director, Health Informatics and Analytics, Centers for Health Metrics and Evaluation

The burden of cardiovascular disease among Asian-Americans varies by subgroup and contributes to greater premature death, according to new research published in the Journal of the American Heart Association.

The study provides the first calculation, based on national-level mortality data, of years of potential life lost from CVD among Asian-Americans — the fastest-growing racial/ethnic group in the United States that’s expected to reach 34 million by 2050.

Based on 2003-12 data of Asian-Americans that include Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese:
  • Asian Indians and Filipinos lost the most years of life due to heart disease.
  • Filipinos and Vietnamese lost the most years of life lost due to stroke.
  • All Asian-American subgroups had the most years of life lost from stroke, compared to whites.

Previous research suggested that CVD may contribute to premature death among Asian-American subgroups because they have been observed to develop CVD risk factors and have the onset of first heart attack at younger ages.

This study’s calculation of years of potential life lost, which is based on a comparison of age at death with average life expectancy, helps quantify premature death. The metric of years of potential life lost is particularly valuable to clinicians, who can estimate the impact of CVD life expectancy of each ethnic subgroup.

This is especially relevant for Asian Indians, who have higher death rates and at younger ages from CVD accounting for a decade or more of years lost — which may be due in part to a high prevalence of cardiometabolic abnormalities among normal-weight individuals and a relatively early onset of Type 2 diabetes.

 

The value of disaggregated data

It wasn’t until 2003 that national death surveys reported data separately for the six largest Asian-American subgroups examined in this study. This paved the way for researchers to unmask subgroup differences in disease patterns, such as the variation in leading causes of death among subgroups.

The study results also indicate that evaluating Asian-Americans as a whole — often done in research studies — underestimates their burden of CVD. This emphasizes the need to understand determinants of health and evaluate health outcomes of Asian-Americans by subgroups, which have different immigration histories, acculturation levels, risk factors, genetic markers and cultural practices related to lifestyle behaviors and health care. Understanding these differences can help paint a more detailed picture about disparities in CVD outcomes among subgroups.

Now that we can attach real numbers to the toll that CVD takes on different Asian-American populations, we can better direct and shape efforts — whether research, education, clinical care or advocacy — to help prevent and treat CVD disparities leading to an increase in life years. Continued assessment of subgroup-specific outcomes will help us evaluate changes in risk factors that coincide with interventions such as educational campaigns or environmental and policy changes tailored to specific subgroups.

 
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