Despite seeing yearly improvements in cardiovascular disease mortality rates among non-Hispanic whites, Asian-American subgroups have not attained similar rates of improvements, according to a study published Dec. 8 in the Journal of the American College of Cardiology, suggesting that messages pertaining to prevention and management of cardiovascular disease are not effectively reaching this particular population.

As the fastest growing racial-ethnic group in the U.S., Asians are projected to reach 40 million by the year 2050. In spite of this considerable growth, ethnic-specific research among Asians on a national level has been limited, partly due to the lack of specificity of the term “Asian,” which was recently modified to include the major Asian-American subgroups of Chinese, Japanese, Korean, Filipino, Asian Indian and Vietnamese Americans. With a lack of national mortality statistics for cardiovascular disease among Asian Americans, recommending research agendas, creating public health policy, and offering appropriate clinical guidelines has proven difficult.

Using these six subgroups, principal investigator Powell Jose, MD, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and his colleagues examined heart disease and stroke mortality rates to determine racial/ethnic differences in cardiovascular disease mortality within the U.S. Combing through more than 10 million death records from 2003-2010, using U.S. Census and death record data, standardized mortality ratios, relative standardized mortality ratios, and proportional mortality ratios calculated for each sex and ethnic group relative to non-Hispanic whites, results showed that while non-Hispanic men and women had the highest overall mortality rates, Asian Indian men and women and Filipino men had greater proportionate morality burden from ischemic heart disease. The data also showed that the proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every Asian-American subgroup compared to non-Hispanic whites.

The authors conclude that, “using disaggregated mortality data, this analysis demonstrates differences in cardiovascular disease mortality among diverse Asian-American subgroups. These findings stress the importance of increasing efforts in prevention, health education and community outreach to help target the highest risk groups.”

Mirroring this sentiment, Russell de Souza, SCD, RD and Sonia Anand, MD, PhD, McMaster University, Hamilton, ON, Canada, write in a commenting editorial that “the data presented by Jose et al. provide a public health basis for the U.S. Census decision to expand the ‘Asian’ category of race, and underscore the need to look beyond the traditional five-category race classification to understand and reduce health care discrepancies. This work provides justification for ethnic-specific public health efforts tailored to specific risk profiles for heterogeneous groups. Up-to-date surveillance data at the national, state and local levels are important for the design, implementation and evaluation of programs designed to reduce these health care disparities.”

Keywords: Asian Americans, Asian Continental Ancestry Group, Censuses, Cerebrovascular Disorders, Community-Institutional Relations, Cost of Illness, Death Certificates, Ethnic Groups, European Continental Ancestry Group, Health Education, Health Policy, Healthcare Disparities, Hispanic Americans, Myocardial Ischemia, Public Health, Stroke

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