Nilay S Shah1,2, Cecily Luncheon3,4, Namratha R Kandula5,6, Pyone Cho7, Fleetwood Loustalot3, Jing Fang3. 1. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. nilay.shah@northwestern.edu. 2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. nilay.shah@northwestern.edu. 3. Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. 4. IHRC, Inc., Atlanta, GA, USA. 5. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 6. Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 7. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Abstract
BACKGROUND: Diabetes mellitus (DM) is a leading contributor to morbidity and mortality in the United States (US). Prior DM prevalence estimates in Asian Americans are predominantly from Asians aggregated into a single group, but the Asian American population is heterogenous. OBJECTIVE: To evaluate self-reported DM prevalence in disaggregated Asian American subgroups to inform targeted management and prevention. DESIGN: Serial cross-sectional analysis. PARTICIPANTS: Respondents to the US Behavioral Risk Factor Surveillance System surveys who self-identify as non-Hispanic Asian American (NHA, N=57,001), comprising Asian Indian (N=11,089), Chinese (N=9458), Filipino (N=9339), Japanese (N=10,387), and Korean Americans (N=2843), compared to non-Hispanic White (NHW, N=2,143,729) and non-Hispanic Black (NHB, N=215,957) Americans. MAIN MEASURES: Prevalence of self-reported DM. Univariate Satterthwaite-adjusted chi-square tests compared the differences in weighted DM prevalence by sociodemographic and health status. KEY RESULTS: Self-reported fully adjusted DM prevalence was 8.7% (95% confidence interval 8.2-9.3) in NHA, compared to 14.3% (14.0-14.6) in NHB and 10.0% (10.0-10.1) in NHW (p<0.01 for difference). In NHA subgroups overall, DM prevalence was 14.4% (12.6-16.3) in Filipino, 13.4% (10.9-16.2) in Japanese, 10.7% (9.6-11.8) in Asian Indian, 5.1% (4.2-6.2) in Chinese, and 4.7% (3.4-6.3) in Korean Americans (p<0.01). Among those aged ≥65 years, DM prevalence was highest in Filipino (35.0% (29.4-41.2)) and Asian Indian (31.5% (25.9-37.8)) Americans. Adjusted for sex, education, and race/ethnicity-specific obesity category, NHA overall had a 21% higher DM prevalence compared to NHW (prevalence ratio 1.21 [1.14-1.27]), while prevalence ratios were 1.42 (1.24-1.63) in Filipinos and 1.29 (1.14-1.46) in Asian Indians. CONCLUSIONS: Adjusted self-reported DM prevalence is higher in NHA compared with NHW. Disaggregating NHA reveals heterogeneity in self-reported DM prevalence, highest in Filipino and Asian Indian Americans.
BACKGROUND: Diabetes mellitus (DM) is a leading contributor to morbidity and mortality in the United States (US). Prior DM prevalence estimates in Asian Americans are predominantly from Asians aggregated into a single group, but the Asian American population is heterogenous. OBJECTIVE: To evaluate self-reported DM prevalence in disaggregated Asian American subgroups to inform targeted management and prevention. DESIGN: Serial cross-sectional analysis. PARTICIPANTS: Respondents to the US Behavioral Risk Factor Surveillance System surveys who self-identify as non-Hispanic Asian American (NHA, N=57,001), comprising Asian Indian (N=11,089), Chinese (N=9458), Filipino (N=9339), Japanese (N=10,387), and Korean Americans (N=2843), compared to non-Hispanic White (NHW, N=2,143,729) and non-Hispanic Black (NHB, N=215,957) Americans. MAIN MEASURES: Prevalence of self-reported DM. Univariate Satterthwaite-adjusted chi-square tests compared the differences in weighted DM prevalence by sociodemographic and health status. KEY RESULTS: Self-reported fully adjusted DM prevalence was 8.7% (95% confidence interval 8.2-9.3) in NHA, compared to 14.3% (14.0-14.6) in NHB and 10.0% (10.0-10.1) in NHW (p<0.01 for difference). In NHA subgroups overall, DM prevalence was 14.4% (12.6-16.3) in Filipino, 13.4% (10.9-16.2) in Japanese, 10.7% (9.6-11.8) in Asian Indian, 5.1% (4.2-6.2) in Chinese, and 4.7% (3.4-6.3) in Korean Americans (p<0.01). Among those aged ≥65 years, DM prevalence was highest in Filipino (35.0% (29.4-41.2)) and Asian Indian (31.5% (25.9-37.8)) Americans. Adjusted for sex, education, and race/ethnicity-specific obesity category, NHA overall had a 21% higher DM prevalence compared to NHW (prevalence ratio 1.21 [1.14-1.27]), while prevalence ratios were 1.42 (1.24-1.63) in Filipinos and 1.29 (1.14-1.46) in Asian Indians. CONCLUSIONS: Adjusted self-reported DM prevalence is higher in NHA compared with NHW. Disaggregating NHA reveals heterogeneity in self-reported DM prevalence, highest in Filipino and Asian Indian Americans.
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