Latha Palaniappan MD, MS, is an internist and clinical researcher. Her research has focused on the study of diverse populations, chronic disease and prevention. Dr. Palaniappan specifically seeks to address the gap in knowledge of health in Asian subgroups and other understudied racial/ethnic minorities (PACS 5R01DK081371, CASPER R01HL126172, and CAUSES R01MD007012). During her time at Palo Alto Medical Foundation (PAMF), she led the organization-wide initiative to collect patient race/ethnicity and language information, enabling PAMF researchers to conduct disparities research using electronic health records. She was the co-founder of PRANA (along with Dr. Ronesh Sinha), a South Asian Wellness program. Her current work examines the clinical effectiveness of structured physical activity programs for diabetes management (Initiate and Maintain Physical Activity in Clinics - IMPACT, 5R18DK096394), as well as best exercise regimens for normal-weight diabetics (Strength Training Regimen for Normal Weight Diabetics - STRONG-D, 2R01DK081371). She is currently working on implementation of evidence based genetic and pharmacogenetic testing in Primary Care Clinics as the Scientific Director of Precision Genomics and Pharmacogenomics in Primary Care ( with Dr. Megan Mahoney). She also co-leads the Stanford GenePool (founded by Dr. Thomas Quertermous in 2014) at Stanford, a population based biobank designed to accelerate genetic and other -omics discovery.
- Internal Medicine
Scientific Director of Precision Genomics and Pharmacogenomics in Primary Care, Stanford Division of Primary Care and Population Health (2017 - Present)
Medical Director of Clinical Research, Palo Alto Medical Foundation Research Institute (2012 - 2014)
Adjunct Clinical Associate Professor, Stanford University School of Medicine (2010 - 2014)
Associate Investigator, Palo Alto Medical Foundation Research Institute (2009 - 2014)
Clinical Assistant Professor, University of California, San Francisco (2008 - 2011)
Adjunct Clinical Assistant Professor, Stanford University School of Medicine (2006 - 2010)
Assistant Investigator, Palo Alto Medical Foundation Research Institute (2006 - 2009)
Attending Physician, Preventive Cardiology Clinic (2002 - 2008)
Honors & Awards
Asian American Faculty Award, Stanford University (2016)
Healthcare Hero Award, Silicon Valley Business Journal (2013)
Fellow, American College of Cardiology (2012)
Fellow, American College of Physicians (2009)
"Top Physician", Consumers Research Council of America (2007-2009)
Fellow, American Heart Association (2006)
BIRCWH (Building Interdisciplinary Research Careers in Womens Health) Scholar., NIH Career Development Award (K12) (2003 - 2006)
Fellow, American College of Epidemiology (2003)
Katherine McCormick Award, Stanford University (2003)
Fellow, American Heart Association 27th Ten-Day Seminar on the Epidemiology and Prevention of Heart Disease (2001)
Individual NIH National Research Service Award (F-32), National Heart, Lung, and Blood Institute (2000-2003)
Kughn Clinical Research Center Grant, University of Michigan Medical Center (1996)
Boards, Advisory Committees, Professional Organizations
Senior Fellow, Stanford Center for Innovation in Global Health (2015 - Present)
Medical Education:University of Michigan School of Medicine (1996) MI
Board Certification: Internal Medicine, American Board of Internal Medicine (1999)
M.S., Stanford University, Epidemiology (2001)
B.A./M.D., University of Michigan, Integrated Premedical-Medical (1996)
Community and International Work
Doctors Without Borders, East Timor
East Timorese Refugees
Opportunities for Student Involvement
Current Research and Scholarly Interests
Latha Palaniappan MD, MS, is an internist and clinical researcher. Her research has focused on the study of diverse populations, chronic disease and prevention. Dr. Palaniappan specifically seeks to address the gap in knowledge of health in Asian subgroups and other understudied racial/ethnic minorities (PACS 5R01DK081371, CASPER R01HL126172, and CAUSES R01MD007012). During her time at Palo Alto Medical Foundation (PAMF), she led the organization-wide initiative to collect patient race/ethnicity and language information, enabling PAMF researchers to conduct disparities research using electronic health records. She was the co-founder of PRANA (along with Dr. Ronesh Sinha), a South Asian Wellness program. Her current work examines the clinical effectiveness of structured physical activity programs for diabetes management (Initiate and Maintain Physical Activity in Clinics - IMPACT, 5R18DK096394), as well as best exercise regimens for normal-weight diabetics (Strength Training Regimen for Normal Weight Diabetics - STRONG-D, 2R01DK081371).
Initiate and Maintain Physical Activity in Clinics: The IMPACT Diabetes Study
The Initiate and Maintain Physical Activity in Clinics (IMPACT) study will determine the optimal and feasible level of frequency of structured contact needed in a clinical setting for adult patients with Type 2 Diabetes Mellitus to initiate and maintain physical activity recommendations long-term.
Strength Training Regimen for Normal Weight Diabetics
The Strength Training Regimen in Normal Weight Diabetics (STRONG-D) study will examine the effectiveness of different exercise regimen types in controlling diabetes for the normal weight type 2 diabetes population.
Master's Program Advisor
Disaggregation of Cause-Specific Cardiovascular Disease Mortality Among Hispanic Subgroups.
Hispanics are the largest minority group in the United States and face a disproportionate burden of risk factors for cardiovascular disease (CVD) and low socioeconomic position. However, Hispanics paradoxically experience lower all-cause mortality rates compared with their non-Hispanic white (NHW) counterparts. This phenomenon has been largely observed in Mexicans, and whether this holds true for other Hispanic subgroups or whether these favorable trends persist over time remains unknown.To disaggregate a decade of national CVD mortality data for the 3 largest US Hispanic subgroups.Deaths from CVD for the 3 largest US Hispanic subgroups-Mexicans, Puerto Ricans, and Cubans-compared with NHWs were extracted from the US National Center for Health Statistics mortality records using the underlying cause of death based on coding from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (I00-II69). Mortality data were evaluated from January 1, 2003, to December 31, 2012. Population estimates were calculated using linear interpolation from the 2000 and 2010 US Census reports. Data were analyzed from November 2015 to July 2016.Mortality due to CVD.Participants included 688 074 Mexican, 163 335 Puerto Rican, 130 397 Cuban, and 19 357 160 NHW individuals (49.0% men and 51.0% women; mean [SD] age, 75  years). At the time of CVD death, Mexicans (age, 67  years) and Puerto Ricans (age, 68  years) were younger compared with NHWs (age, 76  years). Mortality rates due to CVD decreased from a mean of 414.2 per 100 000 in 2003 to 303.3 per 100 000 in 2012. Estimated decreases in mortality rate for CVD from 2003 to 2012 ranged from 85 per 100 000 for all Hispanic women to 144 per 100 000 for Cuban men, but rate differences between groups vary substantially, with Puerto Ricans exhibiting similar mortality patterns to NHWs, and Mexicans experiencing lower mortality. Puerto Ricans experienced higher mortality rates for ischemic and hypertensive heart disease compared with other subgroups, whereas Mexicans experienced higher rates of cerebrovascular disease deaths.Significant differences in CVD mortality rates and changes over time were found among the 3 largest Hispanic subgroups in the United States. Findings suggest that the current aggregate classification of Hispanics masks heterogeneity in CVD mortality reporting, leading to an incomplete understanding of health risks and outcomes in this population.
View details for DOI 10.1001/jamacardio.2016.4653
View details for PubMedID 28114655
Dyslipidemia in Special Ethnic Populations.
Endocrinology and metabolism clinics of North America
2016; 45 (1): 205-216
This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.
View details for DOI 10.1016/j.ecl.2015.09.013
View details for PubMedID 26893006
- Executive Summary: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016; 133 (4): 447-454
Dyslipidemia in special ethnic populations.
2015; 33 (2): 325-333
This article reviews racial/ethnic differences in dyslipidemia-prevalence of dyslipidemia, its relation to coronary heart disease (CHD) and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. Asian Indians, Filipinos, and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher CHD mortality rates in these groups. Statins may have greater efficacy for Asians, but the data are mixed. Lifestyle modifications are recommended. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.
View details for DOI 10.1016/j.ccl.2015.01.005
View details for PubMedID 25939303
- Leading Causes of Death among Asian American Subgroups (2003-2011) PLOS ONE 2015; 10 (4)
Comparative effectiveness of early versus delayed metformin in the treatment of type 2 diabetes
DIABETES RESEARCH AND CLINICAL PRACTICE
2015; 108 (1): 170-178
The purpose of this study was to evaluate the effectiveness of early versus delayed initiation of metformin in type 2 diabetes.We identified 2925 new users of metformin with type 2 diabetes between 2005 and 2012 in the electronic health records of an integrated health system in Northern California. Patients were matched 1:1 on the propensity for receiving early treatment (defined as ≤6 months from first evidence of diabetes). We evaluated the effectiveness of early versus delayed metformin treatment on intermediate clinical outcomes indicated by changes in hemoglobin A1c (HbA1c) and body mass index (BMI), as well as the incidence of therapy intensification (addition or substitution of a second antihyperglycemic agent).A total of 2144 propensity-score matched patients were included in the early or delayed treatment group (n=1072, in each). Early treatment was associated with significantly larger decreases in HbA1c (-0.36%; 95% confidence intervals [CI]: -0.44 to -0.27%; P<0.001) and BMI (-0.46kg/m(2); 95% CI: -0.64 to -0.29kg/m(2); P<0.001) relative to delayed treatment. Patients receiving early treatment also had a greater likelihood of attaining an HbA1c<7% (<53mmol/mol) (odds ratio: 2.00; 95% CI: 1.63-2.45; P<0.001) and a reduced risk of therapy intensification (hazard ratio: 0.72; 95% CI: 0.61-0.85; P<0.001).Treatment with metformin earlier in the course of type 2 diabetes is associated with better glycemic control, more pronounced weight reduction, and a lower risk for therapy intensification than delayed treatment. Antihyperglycemic therapy should be initiated early after diagnosis to achieve optimal outcomes.
View details for DOI 10.1016/j.diabres.2014.12.019
View details for Web of Science ID 000352274900031
View details for PubMedID 25661984
- Heart Disease and Stroke Statistics-2015 Update A Report From the American Heart Association CIRCULATION 2015; 131 (4): E29-E322
- Executive Summary: Heart Disease and Stroke Statistics-2015 Update A Report From the American Heart Association CIRCULATION 2015; 131 (4): 434-441
Leading Causes of Death among Asian American Subgroups (2003-2011).
2015; 10 (4)
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.
View details for DOI 10.1371/journal.pone.0124341
View details for PubMedID 25915940
- Diabetes Prevention and Weight Loss with a Fully Automated Behavioral Intervention by Email, Web, and Mobile Phone: A Randomized Controlled Trial Among Persons with Prediabetes. Journal of medical Internet research 2015; 17 (10)
Cardiovascular Disease Mortality in Asian Americans
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
2014; 64 (23): 2486-2494
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.The purpose of the study was to examine heart disease and stroke mortality rates in Asian-American subgroups to determine racial/ethnic differences in cardiovascular disease mortality within the United States.We examined heart disease and stroke mortality rates for the 6 largest Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) from 2003 to 2010. U.S. death records were used to identify race/ethnicity and cause of death by International Classification of Diseases-10th revision coding. Using both U.S. Census data and death record data, standardized mortality ratios (SMRs), relative SMRs (rSMRs), and proportional mortality ratios were calculated for each sex and ethnic group relative to non-Hispanic whites (NHWs).In this study, 10,442,034 death records were examined. Whereas NHW men and women had the highest overall mortality rates, Asian Indian men and women and Filipino men had greater proportionate mortality burden from ischemic heart disease. The proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every Asian-American subgroup compared with NHWs.The heterogeneity in cardiovascular disease mortality patterns among diverse Asian-American subgroups calls attention to the need for more research to help direct more specific treatment and prevention efforts, in particular with hypertension and stroke, to reduce health disparities for this growing population.
View details for DOI 10.1016/j.jacc.2014.08.048
View details for Web of Science ID 000345962400007
View details for PubMedID 25500233
- Patient and Provider Characteristics Associated with Colorectal, Breast, and Cervical Cancer Screening among Asian Americans CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION 2014; 23 (11): 2208-2217
Racial/Ethnic differences in the prevalence of proteinuric and nonproteinuric diabetic kidney disease.
2013; 36 (5): 1215-1221
OBJECTIVE To examine racial/ethnic differences in the prevalence of diabetic kidney disease (DKD), with and without proteinuria, in an outpatient health care organization. RESEARCH DESIGN AND METHODS We examined electronic health records for 15,683 persons of non-Hispanic white (NHW), Asian (Asian Indian, Chinese, and Filipino), Hispanic, and non-Hispanic black (NHB) race/ethnicity with type 2 diabetes and no prior history of kidney disease from 2008 to 2010. We directly standardized age- and sex-adjusted prevalence rates of proteinuric DKD (proteinuria with or without low estimated glomerular filtration rate [eGFR]) or nonproteinuric DKD (low eGFR alone). We calculated sex-specific odds ratios of DKD in racial/ethnic minorities (relative to NHWs) after adjustment for traditional DKD risk factors. RESULTS Racial/ethnic minorities had higher rates of proteinuric DKD than NHWs (24.8-37.9 vs. 24.8%) and lower rates of nonproteinuric DKD (6.3-9.8 vs. 11.7%). On adjusted analyses, Chinese (odds ratio 1.39 for women and 1.56 for men), Filipinos (1.57 for women and 1.85 for men), Hispanics (1.46 for women and 1.34 for men), and NHBs (1.50 for women) exhibited significantly (P < 0.01) higher odds of proteinuric DKD than NHWs. Conversely, Chinese, Hispanic, and NHB women and Hispanic men had significantly lower odds of nonproteinuric DKD than NHWs. CONCLUSIONS We found novel racial/ethnic differences in DKD among patients with type 2 diabetes. Racial/ethnic minorities were more likely to have proteinuric DKD and less likely to have nonproteinuric DKD. Future research should examine diverse DKD-related outcomes by race/ethnicity to inform targeted prevention and treatment efforts and to explore the etiology of these differences.
View details for DOI 10.2337/dc12-0951
View details for PubMedID 23238659
Incorporation of whole, ancient grains into a modern Asian Indian diet to reduce the burden of chronic disease
2011; 69 (8): 479-488
Refined carbohydrates, such as white rice and white flour, are the mainstay of the modern Asian Indian diet, and may contribute to the rising incidence of type 2 diabetes and cardiovascular disease in this population. Prior to the 1950s, whole grains such as amaranth, barley, brown rice, millet, and sorghum were more commonly used in Asian Indian cooking. These grains and other non-Indian grains such as couscous, quinoa, and spelt are nutritionally advantageous and may be culturally acceptable carbohydrate substitutes for Asian Indians. This review focuses on practical recommendations for culturally sensitive carbohydrate modification in a modern Asian Indian diet to reduce type 2 diabetes and cardiovascular disease in this population.
View details for DOI 10.1111/j.1753-4887.2011.00411.x
View details for Web of Science ID 000293176900005
View details for PubMedID 21790614
Shared Medical Appointments: Promoting Weight Loss in a Clinical Setting
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
2011; 24 (3): 326-328
Shared medical appointments (SMAs) are 90-minute group appointments for patients with similar medical complaints. SMAs include components of a traditional office visit but provide further emphasis on health education. The effectiveness of SMAs on weight-loss in an outpatient setting has not been studied.Weight-loss SMAs were offered by one physician at the Palo Alto Medical Foundation. Teaching content included Diabetes Prevention Program materials. This analysis includes patients who attended at least one SMA (n = 74) compared with patients in the same physician's practice who had at least one office visit and a body mass index ≥ 25 kg/m(2) (n = 356).The SMA group had a higher proportion of women than the comparison group (76% vs 64%) and were older (mean, 52.4 years; SD, 13.1 years vs mean, 47.0 years; SD, 13.3 years). SMA patients on average lost 1.0% of their baseline weight. Patients in the comparison group on average gained 0.8% of their baseline weight.SMAs may be a viable option for physicians to promote weight loss in the clinical setting.
View details for DOI 10.3122/jabfm.2011.03.100220
View details for Web of Science ID 000290384100016
View details for PubMedID 21551406
Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index
INTERNATIONAL JOURNAL OF OBESITY
2011; 35 (3): 393-400
To examine the relationship between body mass index (BMI) and metabolic syndrome for Asian Americans and non-Hispanic Whites (NHWs), given that existing evidence shows racial/ethnic heterogeneity exists in how BMI predicts metabolic syndrome.Electronic health records of 43,507 primary care patients aged 35 years and older with self-identified race/ethnicity of interest (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese or NHW) were analyzed in a mixed-payer, outpatient-focused health-care organization in the San Francisco Bay Area.Metabolic syndrome prevalence is significantly higher in Asians compared with NHWs for every BMI category. For women at the mean age of 55 and BMI of 25 kg m(-2), the predicted prevalence of metabolic syndrome is 12% for NHW women compared with 30% for Asians; similarly for men, the predicted prevalence of metabolic syndrome is 22% for NHWs compared with 43% of Asians. Compared with NHW women and men with a BMI of 25 kg m(-2), comparable prevalence of metabolic syndrome was observed at BMI of 19.6 kg m(-2) for Asian women and 19.9 kg m(-2) for Asian men. A similar pattern was observed in disaggregated Asian subgroups.In spite of the lower BMI values and lower prevalence of overweight/obesity than NHWs, Asian Americans have higher rates of metabolic syndrome over the range of BMI. Our results indicate that BMI ranges for defining overweight/obesity in Asian populations should be lower than for NHWs.
View details for DOI 10.1038/ijo.2010.152
View details for Web of Science ID 000288486300010
View details for PubMedID 20680014
- Call to Action: Cardiovascular Disease in Asian Americans A Science Advisory From the American Heart Association CIRCULATION 2010; 122 (12): 1242-1252
- Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135 (10): e146-e603
Social and clinically-relevant cardiovascular risk factors in Asian Americans adults: NHANES 2011-2014.
Little evidence exists examining cardiovascular risk factors among Asian Americans and how social determinants such as nativity status and education pattern risk in the United States (U.S.) context. We used the National Health and Nutrition Examination Survey, which purposely oversampled Asian Americans from 2011 to 2014, and examined prevalence of Type II diabetes, smoking and obesity for Asian Americans (n=1363) and non-Latino Whites (n=4121). We classified Asian Americans as U.S. or foreign-born and by years in the U.S. Obesity status was based on standard body mass index (BMI) cut points of ≥30kg/m(2) and Asian-specific cut points (BMI≥25kg/m(2)) that may be more clinically relevant for this population. We fit separate logistic regression models for each outcome using complex survey design methods and tested for the joint effect of race, nativity and education on each outcome. Diabetes and obesity prevalence (applying Asian-specific BMI cut points) were higher among Asian Americans when compared to non-Latino Whites but smoking prevalence was lower. These patterns remained in fully adjusted models and showed small increases with longer duration in the U.S. Joint effects models showed higher odds of prevalent Type II diabetes and obesity (Asian-specific) for foreign-born Asians, regardless of years in the U.S. and slightly higher risk for low education, when compared to non-Latino Whites with high education. Smoking models showed significant interaction effects between race and education for non-Latino Whites only. Our study supports the premise that social as well as clinical factors should be considered when developing health initiatives for Asian Americans.
View details for DOI 10.1016/j.ypmed.2017.02.016
View details for PubMedID 28219784
Cardiovascular Disease Risk Score: Results from the Filipino-American Women Cardiovascular Study.
Journal of racial and ethnic health disparities
2017; 4 (1): 25-34
Although cardiovascular disease (CVD) is a leading cause of morbidity and mortality of Filipino-Americans, conventional CVD risk calculators may not be accurate for this population. CVD risk scores of a group of Filipino-American women (FAW) were measured using the major risk calculators. Secondly, the sensitivity of the various calculators to obesity was determined.This is a cross-sectional descriptive study that enrolled 40-65-year-old FAW (n = 236), during a community-based health screening study. Ten-year CVD risk was calculated using the Framingham Risk Score (FRS), Reynolds Risk Score (RRS), and Atherosclerotic Cardiovascular Disease (ASCVD) calculators. The 30-year risk FRS and the lifetime ASCVD calculators were also determined.Levels of predicted CVD risk varied as a function of the calculator. The 10-year ASCVD calculator classified 12 % of participants with ≥10 % risk, but the 10-year FRS and RRS calculators classified all participants with ≤10 % risk. The 30-year "Hard" Lipid and BMI FRS calculators classified 32 and 43 % of participants with high (≥20 %) risk, respectively, while 95 % of participants were classified with ≥20 % risk by the lifetime ASCVD calculator. The percent of participants with elevated CVD risk increased as a function of waist circumference for most risk score calculators.Differences in risk score as a function of the risk score calculator indicate the need for outcome studies in this population. Increased waist circumference was associated with increased CVD risk scores underscoring the need for obesity control as a primary prevention of CVD in FAW.
View details for DOI 10.1007/s40615-015-0196-6
View details for PubMedID 27294770
Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study.
Preventive medicine reports
2016; 4: 608-613
The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women (n = 382), 40-65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6-0.7). The universal WC threshold of ≥ 35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥ 31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m(2) threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cut-off of ≥ 0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.
View details for PubMedID 27882291
View details for PubMedCentralID PMC5118592
Cross-national comparisons of increasing suicidal mortality rates for Koreans in the Republic of Korea and Korean Americans in the USA, 2003-2012.
Epidemiology and psychiatric sciences
Korea has the highest suicide rate of developed countries, two times higher than the USA. Suicide trends among Koreans Americans living in the USA during the same period have not yet been described. We report suicide mortality rates and trends for four groups: (1) Korean Americans, (2) non-Hispanic White (NHW) Americans, (3) selected Asian American subgroups and (4) Koreans living in the Republic of Korea.We used US national (n = 18 113 585) and World Health Organization (WHO) (n = 232 919 253) mortality records for Korea from 2003 to 2012 to calculate suicide rates, all expressed per 100 000 persons. We assessed temporal trends and differences in age, gender and race/ethnicity using binomial regression.Suicide rates are highest in Koreans living in the Republic of Korea (32.4 for men and 14.8 for women). Suicide rates in Korean Americans (13.9 for men and 6.5 for women) have nearly doubled from 2003 to 2012 and exceed rates for all other Asian American subgroups (5.4-10.7 for men and 1.6-4.2 for women). Suicide rates among NHWs (21.0 for men and 5.6 for women) remain high. Among elders, suicide in Korean Americans (32.9 for men and 15.4 for women) is the highest of all examined racial/ethnic groups in the USA.Suicide in Korean Americans is higher than for other Asian Americans and follows temporal patterns more similar to Korea than the USA. Interventions to prevent suicide in Korean American populations, particularly among the elderly, are needed.
View details for PubMedID 27830639
Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011.
2016; 6 (10)
With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations.We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003-2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported.We examined a total of 10 458 849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts.Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities.
View details for DOI 10.1136/bmjopen-2016-012201
View details for PubMedID 27793837
View details for PubMedCentralID PMC5093623
The Burden of Cancer in Asian Americans: A Report of National Mortality Trends by Asian Ethnicity
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
2016; 25 (10): 1371-1382
Asian Americans (AA) are the fastest growing U.S. population, and when properly distinguished by their ethnic origins, exhibit substantial heterogeneity in socioeconomic status, health behaviors, and health outcomes. Cancer is the second leading cause of death in the United States, yet trends and current patterns in the mortality burden of cancer among AA ethnic groups have not been documented.We report age-adjusted rates, standardized mortality ratios, and modeled trends in cancer-related mortality in the following AA ethnicities: Asian Indians, Chinese, Filipinos, Japanese, Koreans, and Vietnamese, from 2003 to 2011, with non-Hispanic whites (NHW) as the reference population.For most cancer sites, AAs had lower cancer mortality than NHWs; however, mortality patterns were heterogeneous across AA ethnicities. Stomach and liver cancer mortality was very high, particularly among Chinese, Koreans, and Vietnamese, for whom these two cancer types combined accounted for 15% to 25% of cancer deaths, but less than 5% of cancer deaths in NHWs. In AA women, lung cancer was a leading cause of death, but (unlike males and NHW females) rates did not decline over the study period.Ethnicity-specific analyses are critical to understanding the national burden of cancer among the heterogeneous AA population.Our findings highlight the need for disaggregated reporting of cancer statistics in AAs and warrant consideration of tailored screening programs for liver and gastric cancers. Cancer Epidemiol Biomarkers Prev; 25(10); 1371-82. ©2016 AACR.
View details for DOI 10.1158/1055-9965.EPI-16-0167
View details for Web of Science ID 000385642800002
View details for PubMedID 27694108
View details for PubMedCentralID PMC5218595
First Trimester Hemoglobin A1c Prediction of Gestational Diabetes.
American journal of perinatology
2016; 33 (10): 977-982
Objective The objective of this study is to examine whether a first trimester hemoglobin A1c (A1C) of 5.7 to 6.4% predicts an abnormal second trimester oral glucose tolerance test (OGTT). Methods We conducted a retrospective cohort study of all women screened with A1C through 13 (6/7) weeks' gestation between January 1, 2011, and December 31, 2012. Prediabetic women (A1C of 5.7-6.4%) were compared with women with a normal first trimester A1C (< 5.7%). The primary outcome was an abnormal 2-hour, 75-g OGTT as defined by the International Association of Diabetes and Pregnancy Study Groups. Results There were 2,812 women who met inclusion criteria of whom 6.7% (n = 189) were prediabetic. Women with prediabetes were more likely to have gestational diabetes mellitus (GDM) even after adjusting for potential confounders (29.1 vs. 13.7%; adjusted relative risk, 1.48; 95% confidence interval, 1.15-1.89). There were no statistically significant differences in secondary outcomes except that women with prediabetes had less excessive gestational weight gain. A prediabetic-range A1C in the first trimester was associated with a 13% sensitivity and a 94% specificity for predicting GDM Conclusion Although women with prediabetes by first trimester A1C are significantly more likely to have GDM, the low sensitivity of an A1C in this range renders it a poor test to identify women who will develop GDM.
View details for DOI 10.1055/s-0036-1581055
View details for PubMedID 27120479
- Dyslipidemia in Special Ethnic Populations ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA 2016; 45 (1): 205-?
- Clocks Moving at Different Speeds Cultural Variation in the Satisfaction With Wait Time for Outpatient Care MEDICAL CARE 2016; 54 (3): 269-276
Clocks Moving at Different Speeds: Cultural Variation in the Satisfaction With Wait Time for Outpatient Care.
2016; 54 (3): 269-276
To explore racial/ethnic differences in satisfaction with wait time of scheduled office visits by comparing electronic health record (EHR)-based, patient-reported, and patient satisfaction with wait time: A large multispecialty ambulatory care organization in Northern California. Patient experience surveys were collected between 2010 and 2014. Surveys were mailed after randomly selected nonurgent visits. Returned survey data were linked to EHR data for surveyed visits.Observational, retrospective study designed to assess differences in patient-reported wait time, wait-time satisfaction, and actual EHR-recorded wait time with respect to self-reported race/ethnicity. Multivariate regression models with provider random effects were used to evaluate differences.Asian subgroups (Chinese, Asian Indian, Filipino, Japanese, Korean, and Vietnamese) and Latinos gave poorer ratings for wait time than non-Hispanic whites (NHWs). The average wait time reported by Asians was longer than that reported by NHWs. On the basis of EHR data, however, no minority group was likely to wait longer, and all, except for Japanese (10%), were more likely to be late for the appointment (16%: Filipino and 23%: Asian Indian), than NHWs (13%).Given actual wait times, Asians perceive longer wait time and were less satisfied with wait times. Asians may have different expectations about wait time at the clinic.
View details for DOI 10.1097/MLR.0000000000000473
View details for PubMedID 26683779
- Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016; 133 (4): e38-e360
Improving diet, activity and wellness in adults at risk of diabetes: randomized controlled trial.
Nutrition & diabetes
2016; 6 (9)
The purpose of this analysis is to examine the effect of an algorithm-driven online diabetes prevention program on changes in eating habits, physical activity and wellness/productivity factors.The intervention, Alive-PD, used small-step individually tailored goal setting and other features to promote changes in diet and physical activity. A 6-month randomized controlled trial was conducted among patients from a healthcare delivery system who had confirmed prediabetes (n =339). Change in weight and glycemic markers were measured in the clinic. Changes in physical activity, diet and wellness/productivity factors were self-reported. Mean age was 55 (s.d. 8.9) years, mean body mass index was 31 (s.d. 4.4) kg m(-2), 68% were white and 69% were male.The intervention group increased fruit/vegetable consumption by 3.71 (95% confidence interval (CI) 2.73, 4.70) times per week (effect size 0.62), and decreased refined carbohydrates by 3.77 (95% CI 3.10, 4.44) times per week both significantly (P<0.001) greater changes than in the control group. The intervention group also reported a significantly greater increase in physical activity than in the control group, effect size 0.49, P<0.001. In addition, the intervention group reported a significant increase in self-rated health, in confidence in ability to make dietary changes and in ability to accomplish tasks, and a decrease in fatigue, compared with the control group. These changes paralleled the significant treatment effects on glycemic markers and weight.In addition to promoting improvements in weight and glycemic markers, the Alive-PD program appears to improve eating habits and physical activity, behaviors important not just for diabetes prevention but for those with diagnosed diabetes or obesity. The improvements in wellness/productivity may derive from the diet and activity improvements, and from the satisfaction and self-efficacy of achieving goals.
View details for DOI 10.1038/nutd.2016.42
View details for PubMedID 27643726
Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions.
World journal of cardiology
2015; 7 (12): 938-947
To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients.We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate.These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence.The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence.
View details for DOI 10.4330/wjc.v7.i12.938
View details for PubMedID 26730300
Racial/Ethnic Differences in Gestational Diabetes Prevalence and Contribution of Common Risk Factors
PAEDIATRIC AND PERINATAL EPIDEMIOLOGY
2015; 29 (5): 436-443
The White House, the American Heart Association, the Agency for Healthcare Research and Quality, and the National Heart, Lung and Blood Institute have all recently acknowledged the need to disaggregate Asian American subgroups to better understand this heterogeneous racial group. This study aims to assess racial/ethnic differences in relative contribution of risk factors of gestational diabetes mellitus (GDM) among Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese), Hispanics, non-Hispanic blacks, and non-Hispanic whites.Pregnant women in 2007-2012 were identified through California state birth certificate records and linked to the electronic health records in a large mixed-payer ambulatory care organisation in Northern California (n = 24 195). Relative risk and population attributable fraction (PAF) for specific racial/ethnic groups were calculated to assess the contributions of advanced maternal age, overweight/obesity (Centers for Disease Control and Prevention (CDC) standards and World Health Organization (WHO)/American Diabetes Association (ADA) body mass index cut-offs for Asians), family history of type 2 diabetes, and foreign-born status.GDM was most prevalent among Asian Indians (19.3%). Relative risks were similar across all race/ethnic groups. Advanced maternal age had higher PAFs in non-Hispanic whites (22.5%) and Hispanics (22.7%). Meanwhile family history (Asian Indians 22.6%, Chinese 22.9%) and foreign-borne status (Chinese 40.2%, Filipinos 30.2%) had higher PAFs in Asian subgroups. Overweight/obesity was the most important GDM risk factor for non-Hispanic whites, Hispanics, Asian Indians, and Filipinos when the WHO/ADA cut-off points were applied. Advanced maternal age was the only risk factor studied that was modified by race/ethnicity, with non-Hispanic white and Hispanic women being more adversely affected than other racial/ethnic groups.Overweight/obesity, advanced maternal age, family history of type 2 diabetes, and foreign-borne status are important risk factors for GDM. The relative contributions of these risk factors differ by race/ethnicity, mainly due to differences in population prevalence of these risk factors.
View details for DOI 10.1111/ppe.12209
View details for Web of Science ID 000359633400009
View details for PubMedID 26201385
Impact of Education on Weight in Newly Diagnosed Type 2 Diabetes: Every Little Bit Helps
2015; 10 (6)
Highly structured, intensive behavioral lifestyle interventions have been shown to be efficacious in research settings for type 2 diabetes management and weight loss. We sought to evaluate the benefit of participation in more limited counseling and/or education among individuals with newly diagnosed type 2 diabetes in more modest real-world clinical settings.Electronic Health Records of newly diagnosed type 2 diabetes patients age 35-74 from a large ambulatory group practice were analyzed (n = 1,314). We examined participation in clinic-based lifestyle counseling/education and subsequent weight loss.Of the total cohort, 599 (45.6%) patients received counseling/education with (26.2%) and without (19.4%) medication, 298(22.7%) patients received a prescription for medication alone, and 417(31.7%) patients were only monitored. On average, those who participated in counseling/education attended 2.5 sessions (approximately 2-3 hours). The average weight loss of patients who received counseling/education alone during the follow-up period (up to three years post-exposure to participation) was 6.3 lbs. (3.3% of body weight), and, if received with medication prescription, 8.1 lbs. (4.0% of body weight) (all at P<0.001). The weight loss associated with medication was only 3.5 lbs. (P<0.001). No significant weight change was observed in the monitoring only group.While efforts to improve both the short-term and long-term effectiveness of behavioral lifestyle interventions in real-world settings are ongoing, it is important for clinicians to continue to utilize less intensive, existing resources. Even relatively small "doses" of health education may help in promoting weight loss and may potentially reduce cardiometabolic risk.
View details for DOI 10.1371/journal.pone.0129348
View details for Web of Science ID 000355955300121
View details for PubMedID 26052698
Racial/Ethnic differences in hypertension prevalence, treatment, and control for outpatients in northern california 2010-2012.
American journal of hypertension
2015; 28 (5): 631-639
Hypertension (HTN) is a known major cardiovascular disease risk factor, but prevalence, treatment, and control of HTN among rapidly growing minority groups such as Asian Americans and Hispanics are unknown largely due to either underrepresentation in epidemiologic studies or aggregation of Asian American subgroups.A three-year cross-section (2010-2012) of patients from a large ambulatory care setting in northern California was examined in the following subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Mexicans, non-Hispanic Blacks (NHBs), and non-Hispanic Whites (NHWs). We defined HTN as two separate nonemergent office visit blood pressure measurements ≥140/90mm Hg, physician diagnosis of HTN, or use of antihypertensive medications.A total of 208,985 patients were included in the study. Age-adjusted HTN prevalence ranged from 30.0% in Chinese women to 59.9% in Filipino men. Most minority subgroups had lower or similar odds of having HTN compared with NHWs, except for Filipinos and NHBs whose odds were significantly higher after adjusting for patient demographic and clinical characteristics. Asian Americans and NHBs were more likely to be treated for HTN compared with NHWs. Achievement of blood pressure control was lower among Filipino women (odds ratio = 0.82, 99% confidence interval 0.70-0.96) and NHB men (odds ratio = 0.73, 99% confidence interval 0.58-0.91), compared with NHW women and men.Substantial racial/ethnic variation in HTN prevalence, treatment, and control was found in our study population. Filipino and NHB women and men are at especially high risk for HTN and may have more difficulty in achieving adequate blood pressure control.
View details for DOI 10.1093/ajh/hpu189
View details for PubMedID 25352230
- Dyslipidemia in Special Ethnic Populations CARDIOLOGY CLINICS 2015; 33 (2): 325-?
Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men
TRANSLATIONAL BEHAVIORAL MEDICINE
2015; 5 (1): 37-44
While group interventions for weight management have been shown to be efficacious, adherence is often low, especially among men. This pilot study seeks to test whether group interventions using web-based group video conferencing (VC) technology is effective for weight loss. We adapted a 12-week curriculum based on the Diabetes Prevention Program, and delivered this intervention to a small group of men (BMI ≥30 kg/m(2)), using web-based group VC. Participants were randomized to intervention (n = 32) or delayed-intervention control group (n = 32). The intervention group lost 3.5 % (95 % CI 2.1 %, 4.9 %) of their initial body weight. Difference in mean weight loss was 3.2 kg (p = 0.0002) and mean BMI decrease was 1.0 kg/m(2) (p = 0.0010) between the two groups. Virtual small groups may be an effective means of allowing face-to-face group interaction, while overcoming some barriers to access.
View details for DOI 10.1007/s13142-014-0296-6
View details for Web of Science ID 000356788400004
View details for PubMedID 25729451
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Primary care diabetes
2015; 9 (1): 23-30
We examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US.Data were extracted from electronic health records (EHR) for active patients ≥35 years in a multispecialty, multiclinic ambulatory care organization with 1000 providers. New onset type 2 diabetes and subsequent treatment were identified using lab, diagnosis, medication prescription, and service use data. Time from the first evidence of diabetes until initial treatment, either medication or education/counseling, was examined using a Kaplan-Meier hazards curve. Potential predictors of initial treatment were examined using multinomial logistic models accounting for physician random effects.Of 2258 patients with incident diabetes, 55% received either medication or education/counseling (20% received both) during the first year. Of the treated patients, 68% received a treatment within the first four weeks, and 13% after initial 16 weeks. Strong positive predictors (P<0.01) of combined treatment were younger age, higher fasting glucose at diagnosis, obesity, and visits with an endocrinologist.Among insured patients who have a primary care provider in a multispecialty health care system, incident diabetes is treated only half the time. Improved algorithms for identifying incident diabetes from the EHR and team approach for monitoring may help treatment initiation.
View details for DOI 10.1016/j.pcd.2014.04.005
View details for PubMedID 24810147
- Initiation of treatment for incident diabetes: Evidence from the electronic health records in an ambulatory care setting. Primary care diabetes 2015; 9 (1): 23-30
A Fully Automated Diabetes Prevention Program, Alive-PD: Program Design and Randomized Controlled Trial Protocol.
JMIR research protocols
2015; 4 (1)
In the United States, 86 million adults have pre-diabetes. Evidence-based interventions that are both cost effective and widely scalable are needed to prevent diabetes.Our goal was to develop a fully automated diabetes prevention program and determine its effectiveness in a randomized controlled trial.Subjects with verified pre-diabetes were recruited to participate in a trial of the effectiveness of Alive-PD, a newly developed, 1-year, fully automated behavior change program delivered by email and Web. The program involves weekly tailored goal-setting, team-based and individual challenges, gamification, and other opportunities for interaction. An accompanying mobile phone app supports goal-setting and activity planning. For the trial, participants were randomized by computer algorithm to start the program immediately or after a 6-month delay. The primary outcome measures are change in HbA1c and fasting glucose from baseline to 6 months. The secondary outcome measures are change in HbA1c, glucose, lipids, body mass index (BMI), weight, waist circumference, and blood pressure at 3, 6, 9, and 12 months. Randomization and delivery of the intervention are independent of clinic staff, who are blinded to treatment assignment. Outcomes will be evaluated for the intention-to-treat and per-protocol populations.A total of 340 subjects with pre-diabetes were randomized to the intervention (n=164) or delayed-entry control group (n=176). Baseline characteristics were as follows: mean age 55 (SD 8.9); mean BMI 31.1 (SD 4.3); male 68.5%; mean fasting glucose 109.9 (SD 8.4) mg/dL; and mean HbA1c 5.6 (SD 0.3)%. Data collection and analysis are in progress. We hypothesize that participants in the intervention group will achieve statistically significant reductions in fasting glucose and HbA1c as compared to the control group at 6 months post baseline.The randomized trial will provide rigorous evidence regarding the efficacy of this Web- and Internet-based program in reducing or preventing progression of glycemic markers and indirectly in preventing progression to diabetes.ClinicalTrials.gov NCT01479062; http://clinicaltrials.gov/show/NCT01479062 (Archived by WebCite at http://www.webcitation.org/6U8ODy1vo).
View details for DOI 10.2196/resprot.4046
View details for PubMedID 25608692
- AGING & HEALTH Medicare Annual Preventive Care Visits: Use Increased Among Fee-For-Service Patients, But Many Do Not Participate HEALTH AFFAIRS 2015; 34 (1): 11-20
Engaging South Asian women with type 2 diabetes in a culturally relevant exercise intervention: a randomized controlled trial.
BMJ open diabetes research & care
2015; 3 (1)
We examined the efficacy of a culturally relevant exercise program in improving glycated hemoglobin (HbA1c) among South Asian women with type 2 diabetes, compared with usual care.This was a randomized controlled 8-week pilot study of Bollywood dance among South Asian women with type 2 diabetes. The intervention consisted of 1 h Bollywood dance classes offered twice per week. The primary outcome was change in HbA1c. The effect of attendance on this outcome was also examined.The intervention group demonstrated a decrease in HbA1c from baseline (-0.18% (0.2%); p=0.018) compared with a non-significant increase in the usual care group (+0.03% (0.2%)); p value for difference between groups was 0.032. Participants attending at least 10 of 16 sessions had a statistically significant reduction in weight (-0.69 kg (0.76 kg)) compared with those attending fewer sessions (+0.86 kg (0.71 kg)).These results support culturally relevant dance as a successful exercise intervention to promote HbA1c control, compared with usual care.NCT02061618.
View details for DOI 10.1136/bmjdrc-2015-000126
View details for PubMedID 26566446
Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.
2015; 34 (1): 11-20
Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services.
View details for DOI 10.1377/hlthaff.2014.0483
View details for PubMedID 25561639
- Reconsidering the Age Thresholds for Type II Diabetes Screening in the U.S. AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2014; 47 (4): 375-381
Reconsidering the age thresholds for type II diabetes screening in the U.S.
American journal of preventive medicine
2014; 47 (4): 375-381
Type II diabetes and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent.To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines.Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007-2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014.NNS, under universal screening, drops sharply at age 35 years, from 80 (30-34-year-olds) to 31 (35-39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield an NNS of 15, translating to $66 per positive test. Among people aged 35-44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive test cases being missed (5,508,164 cases nationwide).Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.
View details for DOI 10.1016/j.amepre.2014.05.012
View details for PubMedID 25131213
Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States A Science Advisory From the American Heart Association
2014; 130 (7): 593-625
This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.
View details for DOI 10.1161/CIR.0000000000000071
View details for Web of Science ID 000340681000018
View details for PubMedID 25098323
Racial/Ethnic Differences in Dyslipidemia Patterns
2014; 129 (5): 570-579
No studies have comprehensively examined the prevalence of dyslipidemia, a major risk factor for cardiovascular disease, among diverse racial/ethnic minority groups. The primary aim of this study was to identify racial/ethnic differences in dyslipidemia among minorities including Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean or Vietnamese), Mexican Americans, and African Americans compared to Non-Hispanic Whites (NHWs).Using a three-year cross-section (2008-2011), we identified 169,430 active primary care patients (35 years or older) from an outpatient health care organization in Northern California. Age-standardized prevalence rates were calculated for three dyslipidemia subtypes: high TG (fasting lab ≥150 mg/dL), low HDL-C (fasting lab <40 [men] and <50 [women] mg/dL), and high LDL-C (fasting lab ≥130mg/dL or taking LDL-lowering agents). Odds ratios were calculated using multivariable logistic regression, adjusting for patient characteristics (age, measured BMI, smoking). Compared to NHWs, every minority subgroup had increased prevalence of high TGs, except African Americans. Most minority groups had increased prevalence of low HDL-C, except for Japanese and African Americans. The prevalence of high LDL-C was increased among Asian Indians, Filipinos, Japanese, and Vietnamese, compared to NHWs.Minority groups, except for African Americans, were more likely to have high TG/low HDL-C dyslipidemia. Further research is needed to determine how racial/ethnic differences in dyslipidemia affect racial/ethnic differences in cardiovascular disease rates.
View details for DOI 10.1161/CIRCULATIONAHA.113.005757
View details for Web of Science ID 000330583300013
View details for PubMedID 24192801
The Obesity Paradox in Diabetes
CURRENT CARDIOLOGY REPORTS
2014; 16 (2)
Overweight or obese adults have demonstrated a survival advantage compared with leaner adults in several population-based samples. This counterintuitive association has been termed the obesity paradox. Evidence for an obesity paradox among persons with diabetes has been less consistent. In the present review, we identified 18 longitudinal studies conducted in cohort studies, patient registries and clinical trial populations that tested the associations between obesity and survival in patients with diabetes. The majority of these studies reported that mortality was lowest in overweight and obese persons, and that leaner adults had the highest relative total and cardiovascular mortality. Some of these studies observed the patterns most strongly in older (age > 65 years) adults. To date, little research has been conducted to identify mechanisms that could explain elevated mortality in leaner adults with diabetes, or to identify strategies for diabetes management or mitigation of elevated mortality risk.
View details for DOI 10.1007/s11886-013-0446-3
View details for Web of Science ID 000345084500003
View details for PubMedID 24408674
Mobile Applications for Weight Management Theory-Based Content Analysis
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
2013; 45 (5): 583-589
The use of smartphone applications (apps) to assist with weight management is increasingly prevalent, but the quality of these apps is not well characterized.The goal of the study was to evaluate diet/nutrition and anthropometric tracking apps based on incorporation of features consistent with theories of behavior change.A comparative, descriptive assessment was conducted of the top-rated free apps in the Health and Fitness category available in the iTunes App Store. Health and Fitness apps (N=200) were evaluated using predetermined inclusion/exclusion criteria and categorized based on commonality in functionality, features, and developer description. Four researchers then evaluated the two most popular apps in each category using two instruments: one based on traditional behavioral theory (score range: 0-100) and the other on the Fogg Behavioral Model (score range: 0-6). Data collection and analysis occurred in November 2012.Eligible apps (n=23) were divided into five categories: (1) diet tracking; (2) healthy cooking; (3) weight/anthropometric tracking; (4) grocery decision making; and (5) restaurant decision making. The mean behavioral theory score was 8.1 (SD=4.2); the mean persuasive technology score was 1.9 (SD=1.7). The top-rated app on both scales was Lose It! by Fitnow Inc.All apps received low overall scores for inclusion of behavioral theory-based strategies.
View details for DOI 10.1016/j.amepre.2013.07.005
View details for Web of Science ID 000325910800007
View details for PubMedID 24139771
Festival Foods in the Immigrant Diet
JOURNAL OF IMMIGRANT AND MINORITY HEALTH
2013; 15 (5): 953-960
Dietary acculturation for immigrant groups has largely been attributed to the "Westernization" of indigenous diets, as characterized by an increased consumption of unhealthy American foods (i.e., fast foods, hamburgers). However, acculturation and adoption of western dietary habits may not fully explain new dietary patterns among racial/ethnic minority immigrants. The immigrant diet may change in such a way that it elaborates on specific ethnic traditions in addition to the incorporation of Western food habits. In this paper, we explore the role that festival foods, those foods that were once eaten a few times a year and on special occasions, play in the regular diet of immigrants to the US. This paper will focus on the overconsumption of ethnic festival foods, which are often high in carbohydrates, animal protein, sugar and fat, as opposed to Western "junk" food, as an explanation for the increased risk of cardiometabolic disorders among new immigrant groups.
View details for DOI 10.1007/s10903-012-9705-4
View details for Web of Science ID 000323757500013
View details for PubMedID 22968231
Gender and ethnic differences in the prevalence of type 2 diabetes among Asian subgroups in California
JOURNAL OF DIABETES AND ITS COMPLICATIONS
2013; 27 (5): 429-435
AIMS: To investigate gender and ethnic type 2 diabetes (DM) prevalences among California Asian subgroups versus other ethnic groups and if risk factors explain these differences. METHODS: We identified the prevalence of DM and associated risk factors, stratified by gender, among Chinese, Filipino, South Asian, Japanese, Korean, Vietnamese, Mexican, Other Hispanic, African-American, Caucasian, and Native American adults in a large survey conducted in 2009 (n=46,091, projected n=26.6 million). RESULTS: The highest age-adjusted DM prevalence was seen in Native Americans (32.4%), Filipinos (15.8%), and Japanese (11.8%) among men and in Native Americans (16.0%) and African-Americans (13.3%) among women. Caucasian and Mexican men had higher DM prevalences than women. Age and risk factor-adjusted logistic regression showed DM more likely (relative to Caucasians) among women in Koreans (OR=4.6, p<0.01), Native Americans (OR=3.0, p<0.01), and Other Hispanics (OR 2.9, p<0.01) and among men in Filipinos (OR=7.0, p<0.01), South Asians (OR=4.7, p<0.01), and Native Americans (OR=4.7, p<0.01). No specific risk factors accounted for the gender differences. CONCLUSIONS: Ethnic and gender differences in DM prevalence persist, even after adjusting for lifestyle and other risk factors; prevalence is high among certain Asian American subgroups. Different diabetes prevention approaches may be needed across ethnic/gender groups.
View details for DOI 10.1016/j.jdiacomp.2013.01.002
View details for Web of Science ID 000325299700004
View details for PubMedID 23743139
- American heart association guide for improving cardiovascular health at the community level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation 2013; 127 (16): 1730-1753
DIFFERENCES IN CORONARY HEART DISEASE MORTALITY RATES AMONG ASIAN AMERICAN SUBGROUPS: RESULTS FROM THE CAUSES STUDY (CAUSES OF ASIAN AMERICAN MORTALITY AS UNDERSTOOD BY SOCIO-ECONOMIC STATUS)
62nd Annual Scientific Session of the American-College-of-Cardiology
ELSEVIER SCIENCE INC. 2013: E1560–E1560
View details for Web of Science ID 000316555201665
Racial/ethnic differences in control of cardiovascular risk factors among type 2 diabetes patients in an insured, ambulatory care population
JOURNAL OF DIABETES AND ITS COMPLICATIONS
2013; 27 (1): 34-40
This paper examines differences in cardiovascular disease risk factor control among racial/ethnic minorities (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hispanic/Latino, Black/African Americans) with type 2 diabetes compared to Non-Hispanic Whites with type 2 diabetes in an insured, outpatient setting.A three-year, cross-sectional sample of 15,826 patients with type 2 diabetes was studied between 2008 and 2010. Goal attainment rates for three cardiovascular disease risk factors (HbA1c, BP, LDL) were estimated. Logistic regression was used to determine the association between patient characteristics and control of risk factors.Only one fifth (21.1%) of patients achieved simultaneous goal attainment (HbA1c, BP, LDL). After adjustment for patient characteristics and treatment, Black/African American women and men, and Filipino and Hispanic/Latino men were significantly less likely to simultaneously achieve all three goals, compared to Non-Hispanic Whites. Of the three goals, patients were more likely to achieve HbA1c goals (68.7%) than BP (45.7%) or LDL (58.5%) goals. Racial/ethnic differences were more apparent in risk factors that were under better control (i.e. HbA1c).Cardiovascular risk factor control in type 2 diabetes is suboptimal, even in an insured population. Special attention may be required for specific racial/ethnic/gender groups.
View details for DOI 10.1016/j.jdiacomp.2012.08.006
View details for Web of Science ID 000314329100009
View details for PubMedID 23062328
Finger millet (Ragi, Eleusine coracana L.): a review of its nutritional properties, processing, and plausible health benefits.
Advances in food and nutrition research
2013; 69: 1-39
Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses on its antiquity, consumption, nutrient composition, processing, and health benefits. Of all the cereals and millets, finger millet has the highest amount of calcium (344mg%) and potassium (408mg%). It has higher dietary fiber, minerals, and sulfur containing amino acids compared to white rice, the current major staple in India. Despite finger millet's rich nutrient profile, recent studies indicate lower consumption of millets in general by urban Indians. Finger millet is processed by milling, malting, fermentation, popping, and decortication. Noodles, vermicilli, pasta, Indian sweet (halwa) mixes, papads, soups, and bakery products from finger millet are also emerging. In vitro and in vivo (animal) studies indicated the blood glucose lowering, cholesterol lowering, antiulcerative, wound healing properties, etc., of finger millet. However, appropriate intervention or randomized clinical trials are lacking on these health effects. Glycemic index (GI) studies on finger millet preparations indicate low to high values, but most of the studies were conducted with outdated methodology. Hence, appropriate GI testing of finger millet preparations and short- and long-term human intervention trials may be helpful to establish evidence-based health benefits.
View details for DOI 10.1016/B978-0-12-410540-9.00001-6
View details for PubMedID 23522794
Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome
JOURNAL OF SLEEP RESEARCH
2012; 21 (5): 535-545
Women with severe premenstrual syndrome report sleep-related complaints in the late-luteal phase, but few studies have characterized sleep disturbances prospectively. This study evaluated sleep quality subjectively and objectively using polysomnographic and quantitative electroencephalographic measures in women with severe premenstrual syndrome. Eighteen women with severe premenstrual syndrome (30.5 ± 7.6 years) and 18 women with minimal symptoms (controls, 29.2 ± 7.3 years) had polysomnographic recordings on one night in each of the follicular and late-luteal phases of the menstrual cycle. Women with premenstrual syndrome reported poorer subjective sleep quality when symptomatic in the late-luteal phase compared with the follicular phase (P < 0.05). However, there were no corresponding changes in objective sleep quality. Women with premenstrual syndrome had more slow-wave sleep and slow-wave activity than controls at both menstrual phases (P < 0.05). They also had higher trait-anxiety, depression, fatigue and perceived stress levels than controls at both phases (P < 0.05) and mood worsened in the late-luteal phase. Both groups showed similar menstrual-phase effects on sleep, with increased spindle frequency activity and shorter rapid eye movement sleep episodes in the late-luteal phase. In women with premenstrual syndrome, a poorer subjective sleep quality correlated with higher anxiety (r = -0.64, P = 0.005) and more perceived nighttime awakenings (r = -0.50, P = 0.03). Our findings show that women with premenstrual syndrome perceive their sleep quality to be poorer in the absence of polysomnographically defined poor sleep. Anxiety has a strong impact on sleep quality ratings, suggesting that better control of mood symptoms in women with severe premenstrual syndrome may lead to better subjective sleep quality.
View details for DOI 10.1111/j.1365-2869.2012.01007.x
View details for Web of Science ID 000309402400008
View details for PubMedID 22417163
Problems With the Collection and Interpretation of Asian-American Health Data: Omission, Aggregation, and Extrapolation
ANNALS OF EPIDEMIOLOGY
2012; 22 (6): 397-405
Asian-American citizens are the fastest growing racial/ethnic group in the United States. Nevertheless, data on Asian American health are scarce, and many health disparities for this population remain unknown. Much of our knowledge of Asian American health has been determined by studies in which investigators have either grouped Asian-American subjects together or examined one subgroup alone (e.g., Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese). National health surveys that collect information on Asian-American race/ethnicity frequently omit this population in research reports. When national health data are reported for Asian-American subjects, it is often reported for the aggregated group. This aggregation may mask differences between Asian-American subgroups. When health data are reported by Asian American subgroup, it is generally reported for one subgroup alone. In the Ni-Hon-San study, investigators examined cardiovascular disease in Japanese men living in Japan (Nippon; Ni), Honolulu, Hawaii (Hon), and San Francisco, CA (San). The findings from this study are often incorrectly extrapolated to other Asian-American subgroups. Recommendations to correct the errors associated with omission, aggregation, and extrapolation include: oversampling of Asian Americans, collection and reporting of race/ethnicity data by Asian-American subgroup, and acknowledgement of significant heterogeneity among Asian American subgroups when interpreting data.
View details for DOI 10.1016/j.annepidem.2012.04.001
View details for Web of Science ID 000304846300003
View details for PubMedID 22625997
Clinically Identified Postpartum Depression in Asian American Mothers
JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING
2012; 41 (3): 408-416
To identify the clinical diagnosis rate of postpartum depression (PPD) in Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) compared to non-Hispanic Whites.Cross-sectional study using electronic health records (EHR).A large, outpatient, multiservice clinic in Northern California.A diverse clinical population of non-Hispanic White (N = 4582), Asian Indian (N = 1264), Chinese (N = 1160), Filipino (N = 347), Japanese (N = 124), Korean (N = 183), and Vietnamese (N = 147) mothers.Cases of PPD were identified from EHRs using physician diagnosis codes, medication usage, and age standardized for comparison. The relationship between PPD and other demographic variables (race/ethnicity, maternal age, delivery type, marital status, and infant gender) were examined in a multivariate logistic regression model.The PPD diagnosis rate for all Asian American mothers in aggregate was significantly lower than the diagnosis rate in non-Hispanic White mothers. Moreover, of the six Asian American subgroups, PPD diagnosis rates for Asian Indian, Chinese, and Filipino mothers were significantly lower than non-Hispanic White mothers. In multivariate analyses, race/ethnicity, age, and cesarean were significant predictors of PPD.In this insured population, PPD diagnosis rates were lower among Asian Americans, with variability in rates across the individual Asian American subgroups. It is unclear whether these lower rates are due to underreporting, underdiagnosis, or underutilization of mental health care in this setting.
View details for DOI 10.1111/j.1552-6909.2012.01352.x
View details for Web of Science ID 000306476800010
View details for PubMedID 22536783
A LARGE-SCALE MULTI ETHNIC STUDY OF A DIRECT MEASURE OF INSULIN SENSITIVITY DEMONSTRATES THAT SOUTH ASIANS ARE THE MOST INSULIN RESISTANT ETHNIC GROUP IN THE US
61st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC)/Conference on ACC-i2 with TCT
ELSEVIER SCIENCE INC. 2012: E1792–E1792
View details for Web of Science ID 000302326702003
Accuracy of Data Entry of Patient Race/Ethnicity/Ancestry and Preferred Spoken Language in an Ambulatory Care Setting
HEALTH SERVICES RESEARCH
2012; 47 (1): 228-240
To describe data collection methods and to audit staff data entry of patient self-reported race/ethnicity/ancestry and preferred spoken language (R/E/A/L) information.Large mixed payer outpatient health care organization in Northern California, June 2009.Secondary analysis of an audit planned and executed by the Department of Clinical Services.We analyzed concordance between patient written responses and staff data entry.The data entry accuracy rate across questions was high, ranging from 92 to 97 percent. Inaccuracies were due to human error (62 percent), flaws in system design (2 percent), or some combination of both (35 percent).This study highlights the high accuracy of patient self-reported R/E/A/L data entry and identifies some areas for improvement in staff training and technical system design to facilitate further progress.
View details for DOI 10.1111/j.1475-6773.2011.01305.x
View details for Web of Science ID 000299040600014
View details for PubMedID 22092342
Underdiagnosis of Hypertension Using Electronic Health Records
AMERICAN JOURNAL OF HYPERTENSION
2012; 25 (1): 97-102
Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incident hypertension cases in a large outpatient healthcare system, examine the diagnosis rates of prevalent and incident hypertension, and identify clinical and demographic factors associated with appropriate hypertension diagnosis.We analyzed a 3-year, cross-sectional sample of 251,590 patients aged ≥18 years using patient EHRs. Underlying hypertension was defined as two or more abnormal blood pressure (ABP) readings ≥140/90 mm Hg and/or pharmaceutical treatment. Appropriate hypertension diagnosis was defined by the reporting of ICD-9 codes (401.0-401.9). Factors associated with hypertension diagnosis were assessed through multivariate analyses of patient clinical and demographic characteristics.The prevalence of hypertension was 28.7%, and the diagnosis rate was 62.9%. The incidence of hypertension was 13.3%, with a diagnosis rate of 19.9%. Predictors of diagnosis for prevalent hypertension included older age, Asian, African American, higher body mass index (BMI), and increased number of ABP readings. Predictors for incident hypertension diagnosis were similar. In patients with two or more ABP readings, hypertension diagnosis was associated with significantly higher medication treatment rates (92.6% vs. 15.8%, P < 0.0001).Outpatient EHR diagnosis rates are suboptimal, yet EHR diagnosis of hypertension is strongly associated with treatment. Targeted efforts to improve diagnosis should be a priority.
View details for DOI 10.1038/ajh.2011.179
View details for Web of Science ID 000298264800019
View details for PubMedID 22031453
"All of Those Things We Don't Eat": A Culture-Centered Approach to Dietary Health Meanings for Asian Indians Living in the United States
2012; 27 (8): 818-828
This article applies a culture-centered approach to analyze the dietary health meanings for Asian Indians living in the United States. The data were collected as part of a health promotion program evaluation designed to help Asian Indians reduce their risk of chronic disease. Community members who used two aspects of the program participated in two focus groups to learn about their health care experiences and to engage them in dialogue about how culture impacts their overall health. Using constructionist grounded theory, we demonstrate that one aspect of culture, the discourses around routine dietary choice, is an important, but underrecognized, aspect of culture that influences community members' experiences with health care. We theorize community members' dietary health meanings operate discursively through a dialectic tension between homogeneity and heterogeneity, situated amid culture, structure, and agency. Participants enacted discursive homogeneity when they affirmed dietary health meanings around diet as an important means through which members of the community maintain a sense of continuity of their identity while differentiating them from others. Participants enacted discursive heterogeneity when they voiced dietary health meanings that differentiated community members from one another due to unique life-course trajectories and other membership affiliations. Through this dialectic, community members manage unique Asian Indian identities and create meanings of health and illness in and through their discourses around routine dietary choice. Through making these discursive health meanings audible, we foreground how community members' agency is discursively enacted and to make understandable how discourses of dietary practice influence the therapeutic alliance between primary care providers and members of a minority community.
View details for DOI 10.1080/10410236.2011.651708
View details for Web of Science ID 000307953200009
View details for PubMedID 22364189
Type 2 diabetes: Identifying high risk Asian American subgroups in a clinical population
DIABETES RESEARCH AND CLINICAL PRACTICE
2011; 93 (2): 248-254
We compared the prevalence and treatment of type 2 diabetes across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and Non-Hispanic Whites (NHWs) in a Northern California healthcare system.A three-year, cross-sectional sample of patient electronic health records was accessed to compare diabetes prevalence in 21,816 Asian and 73,728 NHWs aged 35+ years. Diabetes was classified through ICD-9 codes, abnormal laboratory values, or use of oral anti-diabetic medication. Multivariate adjusted prevalence rates for each Asian subgroup, and adjusted odds ratios (OR) relative to NHWs, were compared.Age-adjusted prevalence ranged from 5.8% to 18.2% (women) and 8.1 to 25.3% (men). Age-adjusted ORs of Asian subgroups ranged 1.11-3.94 (women) and 1.14-4.56 (men). The odds of diabetes were significantly higher in Asian Indians (women OR 3.44, men OR 3.54) and Filipinos (women OR 3.94, men OR 4.56), compared to NHWs. Results for Asian Indians and Filipinos were similar with age-and-BMI adjustment. Treatment rates across subgroups were 59.7-82.0% (women) and 62.9-79.4% (men).Heterogeneity exists in the prevalence of diabetes across Asian subgroups, independent of obesity prevalence. Asian Indian and Filipino subgroups had particularly high prevalence of diabetes when compared to NHWs. Future studies should explore these clinically important differences among Asian subgroups.
View details for DOI 10.1016/j.diabres.2011.05.025
View details for Web of Science ID 000293825400027
View details for PubMedID 21665315
Spectrum of Cardiovascular Diseases in Asian-American Racial/Ethnic Subgroups
ANNALS OF EPIDEMIOLOGY
2011; 21 (8): 608-614
To compare the prevalence of coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD) across Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and non-Hispanic white (NHW) subjects in a mixed-payer, outpatient health care organization in California.Electronic health records from 2007 to 2010 were examined for 94,423 Asian and NHW patients. Age-adjusted prevalence rates of CHD, stroke, and PVD, defined by physician International Classification of Diseases, Version 9, codes, were directly standardized to the NHW population. Age-adjusted odds ratios were calculated by the use of logistic regression for each Asian subgroup, by sex, compared with NHWs.The range of age-adjusted prevalence rates were: CHD (1.7%-5.2%), stroke (0.3%-1.8%), and PVD (0.9%-3.4%). The adjusted odds ratios of CHD were significantly higher for Filipino women (1.66; 95% confidence interval; 1.13-2.43) and men (1.47, 1.05-2.06) and Asian Indian men (1.77, 1.43-2.21), and significantly lower for Chinese women (0.72, 0.55-0.94) and men (0.78, 0.65-0.93), compared with NHWs. The odds of stroke were significantly greater for Filipino women (2.02, 1.22-3.34). The odds of PVD were generally lower for all Asian subgroups.There is considerable heterogeneity across Asian subgroups for prevalent CHD, stroke, and PVD. Future research should disaggregate Asian subgroups and cardiovascular outcomes to inform targeted prevention and treatment efforts.
View details for DOI 10.1016/j.annepidem.2011.04.004
View details for Web of Science ID 000292808800007
View details for PubMedID 21737048
Racial and Ethnic Variation in Lipoprotein (a) Levels among Asian Indian and Chinese Patients.
Journal of lipids
2011; 2011: 291954-?
Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA. Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW. Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age ≥18 y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at the P < .0001 level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes. Results. Both Asian Indians (36 nmol/L) and NHW (29 nmol/L) had higher median Lp(a) levels than Chinese (22 nmol/L, P ≤ .0001 and P = .0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH: P = .001, NHW v CH: P = .0018) but were not statistically significant in the 1130 women (AI v CH: P = .0402, NHW v CH: P = .0761). Asian Indians (OR = 2.0) and Chinese (OR = 4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR = 1.4), but no relationship was statistically significant. Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA.
View details for DOI 10.1155/2011/291954
View details for PubMedID 21660301
Population Colorectal Cancer Screening Estimates: Comparing Self-Report to Electronic Health Record Data in California.
International journal of cancer prevention
2011; 4 (1)
INTRODUCTION: Population-based surveys are used to assess colorectal cancer (CRC) screening rates, but may be subject to self-report biases. Clinical data from electronic health records (EHR) are another data source for assessing screening rates and self-report bias; however, use of EHR data for population research is relatively new. We sought to compare CRC screening rates from a self-report survey, the 2007 California Health Interview Survey (CHIS), to EHR data from Palo Alto Medical Foundation (PAMF), a multi-specialty healthcare organization serving three counties in California. METHODS: Ever- and up-to-date CRC screening rates were compared between CHIS respondents (N=18,748) and PAMF patients (N=26,283). Both samples were limited to English proficient subjects aged 51-75 with health insurance and a physician visit in the past two years. PAMF rates were age-sex standardized to the CHIS population. Analyses were stratified by racial/ethnic group. RESULTS: EHR data included PAMF internally completed tests (84%), and patient-reported externally completed tests which were either confirmed (7%) or unconfirmed (9%) by a physician. When excluding unconfirmed tests, PAMF screening rates were 6-14 percentage points lower than CHIS rates, for both ever- and up-to-date CRC screening among Non-Hispanic White, Black, Hispanic/Latino, Chinese, Filipino and Japanese subjects. When including unconfirmed tests, differences in screening rates between the two data sets were minimal. CONCLUSION: Comparability of CRC screening rates from survey data and clinic-based EHR data depends on whether or not unconfirmed patient-reported tests in EHR are included. This indicates a need for validated methods of calculating CRC screening rates in EHR data.
View details for PubMedID 21857818
Using Name Lists to Infer Asian Racial/Ethnic Subgroups in the Healthcare Setting
2010; 48 (6): 540-546
Many clinical data sources used to assess health disparities lack Asian subgroup information, but do include patient names.This project validates Asian surname and given name lists for identifying Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) in clinical records.We used 205,000 electronic medical records from the Palo Alto Medical Foundation, a multipayer, outpatient healthcare organization in Northern California, containing patient self-identified race/ethnicity information.Name lists were used to infer racial/ethnic subgroup for patients with self-identified race/ethnicity data. Using self-identification as the "gold standard," sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of classification by name were calculated. Clinical outcomes (obesity and hypertension) were compared for name-identified versus self-identified racial/ethnic groups.With classification using surname and given name, the overall sensitivities ranged from 0.45 to 0.76 for the 6 racial/ethnic groups when no race data are available, and 0.40 to 0.79 when the broad racial classification of "Asian" is known. Specificities ranged from 0.99 to 1.00. PPV and NPV depended on the prevalence of Asians in the population. The lists performed better for men than women and better for persons aged 65 and older. Clinical outcomes were very similar for name-identified and self-identified racial/ethnic groups.In a clinical setting with a high prevalence of Asian Americans, name-identified and self-identified racial/ethnic groups had similar clinical characteristics. Asian name lists may be a valid substitute for identifying Asian subgroups when self-identification is unavailable.
View details for DOI 10.1097/MLR.0b013e3181d559e9
View details for Web of Science ID 000278191900008
View details for PubMedID 20421828
Does the Frequency of Pay-for-Performance Payment Matter?-Experience from a Randomized Trial
HEALTH SERVICES RESEARCH
2010; 45 (2): 553-564
To examine the effects of incentive payment frequency on quality measures in a physician-specific pay-for-performance (P4P) experiment.A multispecialty physician group practice.In 2007, all primary care physicians (n=179) were randomized into two study arms differing by the frequency of incentive payment, either four quarterly bonus checks or a single year-end bonus (maximum of U.S.$5,000/year for both arms).Data were extracted from electronic health records. Quality measure scores between the two arms over four quarters were compared.There was no difference between the two arms in average quality measure score or in total bonus amount earned.Physicians' responses to a P4P program with a small maximum bonus do not differ by frequency of bonus payment.
View details for DOI 10.1111/j.1475-6773.2009.01072.x
View details for Web of Science ID 000275335900012
View details for PubMedID 20059568
Report of a National Heart, Lung, and Blood Institute Workshop: Heterogeneity in Cardiometabolic Risk in Asian Americans in the US Opportunities for Research
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
2010; 55 (10): 966-973
The Asian and Pacific Islander population (Asian Americans) in the U.S. has increased dramatically in the last few decades. Yet, data on cardiovascular disease (CVD) in this population are scarce. The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health conducted an Expert Workshop to: 1) assess the importance of studying CVD in Asian Americans in the U.S.; and 2) consider strategic options for further investigations of CVD in this population. There is considerable geographical, ethnic, cultural, and genetic diversity within this population. Limited data also suggest striking differences in the risk of CVD, obesity, type 2 diabetes mellitus, and other CVD risk factors across the Asian-American population. The Asian-American population is a new diverse pool with less contemporary genetic and cultural admixture relative to groups that have lived in the U.S. for generations, plus it is diverse in lifestyle including culture, diet, and family structure. This diversity provides a window of opportunity for research on genes and gene-environment interactions and also to investigate how acculturation/assimilation to U.S. lifestyles affects health and CVD risk among relatively homogenous groups of recent immigrants. Given the heterogeneity in body weight, body size, and CVD risk, the Asian-American population in the U.S. offers a unique model to study the interaction and relationships between visceral adiposity and adipose tissue distribution and beta cell function, insulin resistance, and atherosclerosis.
View details for DOI 10.1016/j.jacc.2009.07.075
View details for Web of Science ID 000275143200002
View details for PubMedID 20202512
Effect of Physician-Specific Pay-for-Performance Incentives in a Large Group Practice
AMERICAN JOURNAL OF MANAGED CARE
2010; 16 (2): E35-E42
To assess the effect of a physician-specific pay-for-performance program on quality-of-care measures in a large group practice.In 2007, Palo Alto Medical Clinic, a multispecialty physician group practice, changed from group-focused to physician-specific pay-for-performance incentives. Primary care physicians received incentive payments based on their quarterly assessed performance.We examined 9 reported and incentivized clinical outcome and process measures. Five reported and nonincentivized measures were used for comparison purposes. The quality score of each physician for each measure was the main dependent variable and was calculated as follows: Quality Score = (Patients Meeting Target / Eligible Patients) x 100. Differences in scores between 2006 and 2007 were compared with differences in scores between 2005 and 2006. We also compared the performance of Palo Alto Medical Clinic with that of 2 other affiliated physician groups implementing group-level incentives.Eight of 9 reported and incentivized measures showed significant improvement in 2007 compared with 2006. Three measures showed an improvement trend significantly better than the previous year's trend. A similar improvement trend was observed in 1 related measure that was reported but was nonincentivized. However, the improvement trend of Palo Alto Medical Clinic was not consistently different from that of the other 2 physician groups.Small financial incentives (maximum, $5000/year) based on individual physicians' performance may have led to continued or enhanced improvement in well-established ambulatory care measures. Compared with other quality improvement programs having alternative foci for incentives (eg, increasing support for staff hours), the effect of physician-specific incentives was not evident.
View details for Web of Science ID 000274590800009
View details for PubMedID 20148608
LEADING CAUSES OF MORTALITY OF ASIAN INDIANS IN CALIFORNIA
ETHNICITY & DISEASE
2010; 20 (1): 53-57
Asian Indians had one of the highest population growth rates in California between 1990 and 2000. However, few studies have examined common causes of death in this ethnic group in California. We examined leading causes of mortality in Asian Indians in California and analyzed differences across age and sex.Linear interpolation of 1990 and 2000 US Census data were used to calculate population sizes. California mortality data were examined to determine total number of Asian Indian deaths, and analyzed to determine causes of death across age (25-44, 45-64, > or = 65) and sex subgroups.International Classification of Diseases, 9th and 10th revision codes were used to aggregate causes of mortality into disease categories of cardiovascular diseases, cancers, diabetes, traumas/accidents/suicides, infections, and other conditions.Cardiovascular diseases were the leading cause of death for both sexes. Cancers were the second leading cause of death for both sexes. Diabetes and traumas/accidents/suicides were the next most common cause of mortality for females and males respectively. However, differences were found between age groupings across the sexes.This analysis confirms leading causes of death found in other densely-populated Asian Indian regions. It also sheds light on emerging conditions in this population in California. Although contributors to causes of mortality are discussed, more research is needed to understand the unique biological and socio-cultural determinants of disease in Asian Indians. Translation of this research into intervention strategies will reduce the burden of these diseases in this rapidly-growing population in California and the United States.
View details for Web of Science ID 000274057600011
View details for PubMedID 20178183
Collecting Patient Race/Ethnicity and Primary Language Data in Ambulatory Care Settings: A Case Study in Methodology
HEALTH SERVICES RESEARCH
2009; 44 (5): 1750-1761
To collect patient race/ethnicity and language (r/e/l) in an ambulatory care setting.The Palo Alto Medical Foundation (PAMF), December 2006-May 2008.Three pilot studies: (1) Comparing mail versus telephone versus clinic visit questionnaire distribution; (2) comparing the front desk method (FDM) versus exam room method (ERM) in the clinic visit; and (3) determining resource allocation necessary for data entry.Studies were planned and executed by PAMF's Quality and Planning division.Collecting r/e/l data during clinic visits elicited the highest response rate. The FDM yielded higher response rate than the ERM. One full-time equivalent is initially necessary for data entry.Conducting sequential studies can help guide r/e/l collection in a short time frame.
View details for DOI 10.1111/j.1475-6773.2009.00992.x
View details for Web of Science ID 000269494600018
View details for PubMedID 19555396
Examining Racial/Ethnic Differences in Lipoprotein(a) Levels
Joint Nutrition, Physical Activity and Metabolism Conference/49th Cardiovascular Disease Epidemiology and Prevention of the American-Heart-Association
LIPPINCOTT WILLIAMS & WILKINS. 2009: E345–E345
View details for Web of Science ID 000264243700361
Asian Americans Have a Greater Prevalence of Metabolic Syndrome Despite Lower Body Mass Index
Joint Nutrition, Physical Activity and Metabolism Conference/49th Cardiovascular Disease Epidemiology and Prevention of the American-Heart-Association
LIPPINCOTT WILLIAMS & WILKINS. 2009: E363–E363
View details for Web of Science ID 000264243700442
Ethnic differences in the relationship between adiponectin and insulin sensitivity in south Asian and Caucasian women
2008; 31 (4): 798-801
To assess whether lower adiponectin concentrations in South Asian Indians may be responsible for their greater degree of insulin resistance.Insulin-mediated glucose uptake and plasma total and high molecular weight (HMW) adiponectin concentrations were quantified in 52 women of South Asian (SA) and Caucasian (CAU) ancestry and compared.Mean +/- SD total (2,965 +/- 1,278 vs. 4,235 +/- 160 ng/ml) and HMW (1,001 +/- 352 vs. 1,591 +/- 854 ng/ml) adiponectin were lower in SAs than CAUs (P < 0.005). Insulin-resistant CAUs (CAU-IR) had lower total (2,665 +/- 1,040 vs. 5,133 +/- 1,086 ng/ml) and HMW (987 +/- 479 vs. 1,935 +/- 838 ng/ml) adiponectin than insulin-sensitive CAUs (CAU-IS) (P < 0.01), but there were no significant differences between insulin-resistant (SA-IR) and insulin-sensitive (SA-IS) SAs. HMW adiponectin did not differ between SA-IR and CAU-IR, but SA-IS had significantly lower adiponectin concentrations than CAU-IS.Insulin resistance status is not associated with significantly lower levels of adiponectin in these SA women, in contrast to the CAU women.
View details for DOI 10.2337/dc07-1781
View details for Web of Science ID 000254591900033
View details for PubMedID 18202246
Clinical experience with a relatively low carbohydrate, calorie-restricted diet improves insulin sensitivity and associated metabolic abnormalities in overweight, insulin resistant South Asian Indian women
ASIA PACIFIC JOURNAL OF CLINICAL NUTRITION
2008; 17 (4): 669-671
South Asian Indians are at increased risk for cardiovascular disease associated with insulin resistance and a dyslipidemia characterized by high triglyceride and low high-density lipoprotein cholesterol concentrations. The purpose of this study is to determine the effects of a calorie-restricted, relatively low carbohydrate diet on weight loss, insulin sensitivity, and associated cardiovascular disease risk factors in overweight, insulin resistant, but apparently healthy, South Asian Indian women. Twenty-three, overweight, insulin resistant, apparently healthy, South Asian Indian women were advised on a calorie-restricted diet containing 40 percent carbohydrate for 3 months. Change in weight, insulin sensitivity (quantified by the steady state plasma glucose concentration during the insulin suppression test), and associated cardiovascular disease risk factors were measured. Weight fell from 75.5 to 70.5 kg (p<0.001), associated with significant decreases in diastolic blood pressure, plasma concentrations (mg/dL) of steady state plasma glucose (217 to 176, p<0.001), triglycerides (137 to 101, p = 0.003), and glucose (98 to 92, p = 0.005). A calorie-restricted diet, moderately lower in carbohydrate, can lead to weight loss, decreased insulin resistance, and reduction in several cardiovascular disease risk factors in overweight, insulin resistant, apparently healthy, South Asian Indian women.
View details for Web of Science ID 000262520400020
View details for PubMedID 19114407
Lipoprotein abnormalities are associated with insulin resistance in South Asian Indian women
METABOLISM-CLINICAL AND EXPERIMENTAL
2007; 56 (7): 899-904
South Asian Indians are at increased risk of coronary heart disease (CHD), possibly related to dyslipidemia characterized by high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations. The importance of differences in insulin resistance as compared to abdominal obesity in the development of this atherogenic lipoprotein profile is not clear, and the current cross-sectional study was initiated to examine this issue. Consequently, we defined the relationship between differences in insulin-mediated glucose uptake (IMGU), abdominal obesity, and various measures of lipoprotein metabolism known to increase CHD risk in 52 apparently healthy women of South Asian Indian ancestry. IMGU was quantified by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test and abdominal obesity was assessed by measurement of waist circumference (WC), and the population was divided into tertiles on the basis of their SSPG results. Results indicated that although there were significant differences in SSPG, TG, and HDL-C values, there were no differences in age, blood pressure, total cholesterol, low-density lipoprotein cholesterol, body mass index, or WC between the highest and lowest tertiles. SSPG concentrations were significantly correlated with both log TG (r = 0.44, P = .001) and HDL-C (r = -0.44, P < .001) concentration, whereas TG and HDL-C concentrations were not significantly related to WC. Furthermore, the relationships between SSPG concentration and TG and HDL-C remained significant when adjusted for age and WC. Finally, a more extensive lipoprotein analysis indicated that the most insulin resistant tertile had higher TG concentrations, lower concentrations of HDL-C and HDL-C subclasses, and smaller and denser low-density lipoprotein particles than the most insulin sensitive tertile, despite the 2 groups not being different in age, BMI, or WC. These results indicate that a highly atherogenic lipoprotein profile seen in South Asian Indian women is significantly associated with insulin resistance independent of differences in WC.
View details for DOI 10.1016/j.metabol.2007.01.020
View details for Web of Science ID 000247542300007
View details for PubMedID 17570249
Sociocultural factors that affect pregnancy outcomes in two dissimilar immigrant groups in the United States
JOURNAL OF PEDIATRICS
2006; 148 (3): 341-346
To compare perinatal risks and outcomes in foreign- and U.S.-born Asian-Indian and Mexican women.We evaluated 6.4 million U.S. vital records for births during 1995-2000 to white, foreign- and U.S.-born Asian-Indian and Mexican women. Risks and outcomes were compared by use of chi2 and logistic regression.With the exception of increased teen pregnancy and tobacco use, the favorable sociodemographic profile and increased rate of adverse outcomes seen in foreign-born Asian Indians persisted in their U.S.-born counterparts. In contrast, foreign-born Mexicans had an adverse sociodemographic profile but a low incidence of low birth weight (LBW), whereas U.S.-born Mexicans had an improved sociodemographic profile and increased LBW, prematurity and neonatal death.Perinatal outcomes deteriorate in U.S.-born Mexican women. In contrast, the paradoxically increased incidence of LBW persists in U.S.-born Asian-Indian women. Further research is needed to identify the social and biologic determinants of perinatal outcome.
View details for DOI 10.1016/j.peds.2005.11.028
View details for Web of Science ID 000236718700015
View details for PubMedID 16615964
Coronary heart disease mortality for six ethnic groups in California, 1990-2000
ANNALS OF EPIDEMIOLOGY
2004; 14 (7): 499-506
To investigate ethnic variations in coronary heart disease death in California, the authors examined total and CHD-specific mortality among non-Hispanic white (white), Hispanic, non-Hispanic black (black), Chinese, Japanese, and Asian Indian Americans. Deaths were identified in the California Mortality Database and population information was derived from the 1990 and 2000 censuses.Age-standardized death rates per 100,000 population were calculated for ages 25 to 84 years from 1990 to 2000. Proportional mortality ratios (PMRs) for each sex and age group were calculated by dividing the proportion of deaths due to CHD in each ethnic group by the proportion of deaths due to CHD in the total population.Blacks had the highest all-cause age-standardized death rates among men (1614) and women (1014). Blacks had the highest CHD death rates among men (272) and women (190). PMRs for CHD were highest in Asian Indian men (161) and women (144), reflective of the higher percentage of CHD deaths compared with all cause deaths in this group. All sex-ethnic groups showed a decline in all cause and CHD mortality compared with the period between 1985 and 1990, except Asian Indian women, who experienced a 16% increase in all cause mortality and 5% increase in CHD mortality.There is considerable heterogeneity in CHD mortality among ethnic subgroups, and additional research is needed to guide treatment and prevention efforts. Blacks and Asian Indians in California are identified as particularly high risk populations.
View details for DOI 10.1016/j.annepidem.2003.12.001
View details for Web of Science ID 000223407900009
View details for PubMedID 15310526
Depression and the metabolic syndrome in young adults: Findings from the third national health and nutrition examination survey
2004; 66 (3): 316-322
Previous reports have suggested that depression may lead to the development of cardiovascular disease through its association with the metabolic syndrome; however, little is known about the relationship between depression and the metabolic syndrome. The aim of this study was to establish an association between depression and the metabolic syndrome in a nationally representative sample.The Third National Health and Nutrition Examination Survey is a population-based health survey of noninstitutionalized US citizens completed between 1988 and 1994. Three thousand one hundred eighty-six men and 3003 women, age 17 to 39, free of coronary heart disease and diabetes, completed the depression module from the Diagnostic Interview Schedule and a medical examination that provided clinical data needed to establish the presence of the metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults.Women with a history of a major depressive episode were twice as likely to have the metabolic syndrome compared with those with no history of depression. The relationship between depression and metabolic syndrome remained after controlling for age, race, education, smoking, physical inactivity, carbohydrate consumption, and alcohol use. Men with a history of depression were not significantly more likely to have the metabolic syndrome.The prevalence of the metabolic syndrome is elevated among women with a history of depression. It is important to better understand the role depression may play in the effort to reduce the prevalence of the metabolic syndrome and its health consequences.
View details for DOI 10.1097/01.psy.0000124755.91880.f4
View details for Web of Science ID 000221548300005
View details for PubMedID 15184689
Predictors of the incident metabolic syndrome in adults - The Insulin Resistance Atherosclerosis Study
2004; 27 (3): 788-793
To prospectively investigate predictors of the incident metabolic syndrome in nondiabetic adults.This analysis included 714 white, black, and Hispanic participants in the Insulin Resistance Atherosclerosis Study (IRAS) who were free of the metabolic syndrome at baseline; 139 of these developed the metabolic syndrome in the subsequent 5 years. We examined measures of glucose (fasting and 2 h), insulin (fasting and 2 h, acute insulin response, insulin sensitivity [Si], and proinsulin), lipids (HDL and triglycerides), blood pressure (systolic and diastolic), waist circumference, and baseline physical activity (total energy expenditure) as predictors of the metabolic syndrome. Logistic regression models were adjusted for age, sex, study site, ethnicity, and impaired glucose tolerance. Signal detection analysis was used to identify the characteristics of the highest risk group.The best predictors of incident metabolic syndrome were waist circumference (odds ratio [OR] 1.7 [1.3-2.0] per 11 cm), HDL cholesterol (0.6 [0.4-0.7] per 15 mg/dl), and proinsulin (1.7 [1.4-2.0] per 3.3 pmol/l). Signal detection analysis identified waist circumference (>89 cm in women, >102 cm in men) as the optimal predictor.These findings suggest that obesity may precede the development of other metabolic syndrome components. Interventions that address obesity and reduce waist circumference may reduce the incidence of the metabolic syndrome in nondiabetic adults.
View details for Web of Science ID 000189307400025
View details for PubMedID 14988303
Risk factors for progression to incident hyperinsulinemia: The Atherosclerosis Risk in Communities Study, 1987-1998
AMERICAN JOURNAL OF EPIDEMIOLOGY
2003; 158 (11): 1058-1067
Hyperinsulinemia is a marker of insulin resistance, a correlate of the metabolic syndrome, and an established precursor of type 2 diabetes. This US study investigated the role of risk factors associated with hyperinsulinemia in cross-sectional studies in progression to incident hyperinsulinemia. Nondiabetic participants from the Atherosclerosis Risk in Communities Study (n = 9,020) were followed from 1987 to 1998 for the development of hyperinsulinemia (fasting serum insulin > or = 90th percentile, 19.1 micro U/ml). After adjustment for demographic characteristics, all risk factors simultaneously, and baseline insulin value, the risk of progressing to hyperinsulinemia increased per standard deviation increase in baseline uric acid (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.2, 1.4; per 1.4 mg/dl) and waist/hip ratio (OR = 1.4, 95% CI: 1.2, 1.5; per 0.08) and was inversely associated with high density lipoprotein cholesterol (OR = 0.8, 95% CI: 0.7, 0.9; per 0.4 mmol/liter). Starting to smoke (OR = 1.5, 95% CI: 1.2, 2.0) and becoming obese (OR = 2.4, 95% CI: 1.8, 3.1) during the study were also associated with increased risk. The associations were similar across race and gender groups. These data suggest that, in addition to weight gain, hyperuricemia, dyslipidemia, and smoking can be detected prior to development of hyperinsulinemia.
View details for DOI 10.1093/aje/kwg260
View details for Web of Science ID 000186896800006
View details for PubMedID 14630601
Association between microalbuminuria and the metabolic syndrome: NHANES III
AMERICAN JOURNAL OF HYPERTENSION
2003; 16 (11): 952-958
We investigated whether microalbuminuria was associated with the metabolic syndrome by comparing the strength of the association between microalbuminuria and the syndrome as a whole and its individual components. This investigation included 5659 women and men aged 20 to 80 years from the cross-sectional, nationally representative, Third National Health and Nutrition Examination Survey (NHANES III: 1988-1994). Metabolic syndrome was defined as any three of the following: increased waist circumference, increased triglycerides, decreased HDL cholesterol, increased blood pressure, or high fasting glucose. Microalbuminuria was defined as urinary albumin/creatinine ratio of 30 to 300 mg/g. Microalbuminuria was present in 7.8% of women and 5.0% of men. Log linear analysis revealed a significant association between the metabolic syndrome and microalbuminuria in both genders (women chi(2) = 44.1; men chi(2) = 59.6; P <.0001 for both). Microalbuminuria was more common in both women (odds ratio [OR] = 2.2; 95% confidence interval [CI] 1.44, 3.34) and men (OR = 4.1; 95% CI 2.45, 6.74) with metabolic syndrome compared to those without it; 34% of women and 42% of men with microalbuminuria also had metabolic syndrome. After adjusting for other components of the metabolic syndrome, hypertension demonstrated the strongest association with microalbuminuria in both women (OR = 3.34; 95% CI 2.45, 4.55) and men (OR = 2.51; 95% CI 1.63, 3.86). Microalbuminuria and metabolic syndrome are associated in a large, nationally representative cohort, possibly due to early renal effects of hypertension, and it may be useful to consider microalbuminuria as a component of the metabolic syndrome.
View details for DOI 10.1016/S0895-7061(03)01009-4
View details for Web of Science ID 000186098500010
View details for PubMedID 14573334
Association of dietary protein intake and microalbuminuria in healthy adults: Third National Health and Nutrition Examination Survey
AMERICAN JOURNAL OF KIDNEY DISEASES
2003; 41 (3): 580-587
The relationship between dietary protein intake (DPI) and microalbuminuria (MA) is unclear. We investigated whether DPI was associated with urinary albumin level in a population sample of persons with normal kidney function.We addressed this question in adults aged 20 to 80 years from the Third National Health and Nutrition Examination Survey (n = 12,422). DPI was assessed from a 24-hour dietary recall and quantified as percentage of total energy intake. MA is defined as urinary albumin-creatinine ratio 30 mg/g (3 mg/mmol) or greater.In multivariable logistic regression models adjusted for sociodemographic characteristics and coronary heart disease risk factors, DPI was not associated with MA in normotensive or nondiabetic persons. In crude models, odds ratios (ORs) for MA were 1.9 (95% confidence interval, 1.2 to 3.0) in persons with hypertension (n = 3,433) and 2.4 (95% confidence interval, 1.1 to 5.2) in those with diabetes (n = 1,165) in the highest (>19%) versus lowest (<11.7%) quintile of DPI. However, in models adjusted for the concurrent prevalence of diabetes or hypertension, this association attenuated to nonsignificance. Persons in the highest quintile of DPI who had both hypertension and diabetes (n = 634) had a significantly elevated OR for MA (3.3; 95% confidence interval, 1.4 to 7.8) compared with those in the lowest quintile.DPI is not associated with MA in healthy persons or those with isolated hypertension or diabetes. However, in persons with both conditions, high DPI is associated with increased prevalence of MA. These findings suggest the need for further research on weight-loss strategies for high-risk persons.
View details for DOI 10.1053/ajkd.2003.50119
View details for Web of Science ID 000181324000008
View details for PubMedID 12612981
The metabolic syndrome - Prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994
ARCHIVES OF INTERNAL MEDICINE
2003; 163 (4): 427-436
The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.Metabolic syndrome-associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P =.86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.
View details for Web of Science ID 000181207900005
View details for PubMedID 12588201
Risk functions for prediction of cardiovascular disease in elderly Australians: the Dubbo Study
MEDICAL JOURNAL OF AUSTRALIA
2003; 178 (3): 113-116
To evaluate a Framingham risk function for coronary heart disease in an elderly Australian cohort and to derive a risk function for cardiovascular disease (CVD) in elderly Australians.Analysis of data from a prospective cohort study (the Dubbo Study) in a semi-urban town (population, 34 000).2805 men and women 60 years and older living in the community, first assessed in 1988, and a subcohort of 2102 free of CVD at study entry.Incidence of CVD (myocardial infarction, coronary death or stroke) over 5 and 10 years.A Framingham risk function assessing "hard" coronary heart disease (ie, myocardial infarction or coronary death) accurately predicted 10-year incidence in men and women aged 60-79 years who were free of prevalent CVD or diabetes at study entry. In a multiple logistic model, CVD incidence was significantly predicted by age, sex, taking antihypertensive medication, blood pressure, smoking, total cholesterol level and diabetes. For a given age and cholesterol level, CVD risk over 5 years was doubled in the presence of antihypertensive medication or diabetes, increased by 50% with cigarette smoking, and halved in women compared with men.We have derived a simple CVD risk function specifically for elderly Australians that employs risk factors readily accessible to all medical practitioners.
View details for Web of Science ID 000183668000004
View details for PubMedID 12558481
Comparison of usefulness of systolic, diastolic, and mean blood pressure and pulse pressure as predictors of cardiovascular death in patients >/=60 years of age (The Dubbo Study).
American journal of cardiology
2002; 90 (12): 1398-1401
View details for PubMedID 12480056
Comparison of usefulness of systolic, diastolic, and mean blood pressure and pulse pressure as predictors of cardiovascular death in patients not greater than or equal to 60 years of age (The Dubbo Study)
AMERICAN JOURNAL OF CARDIOLOGY
2002; 90 (12): 1398-?
View details for Web of Science ID 000180004000023
Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults - The atherosclerosis risk in communities study: 1987-1998
2002; 25 (8): 1358-1364
In this study, we tested the hypothesis that fasting serum insulin is higher in nonobese black adults than in white adults and that high fasting insulin predicts type 2 diabetes equally well in both groups.At the baseline examination (1987-1989) of the Atherosclerosis Risk in Communities Study, fasting insulin and BMI were measured in 13,416 black and white men and women without diabetes. Participants were examined at years 3, 6, and 9 for incident diabetes based on fasting glucose and American Diabetes Association criteria.Fasting insulin was 19.7 pmol/l higher among nonobese (BMI <30 kg/m(2)) black women compared with white women (race and obesity interaction term, P < 0.01). There were no differences among men. Among nonobese women, the relative risk for developing diabetes was similar between racial groups: 1.4 (95% CI 1.2-1.5) and 1.3 (1.2-1.4) per 60 pmol/l increase in insulin (P < 0.01) for black and white women, respectively (interaction term, P = 0.6). Findings were similar among men. Adjusting for established risk factors did not attenuate this association.Nonobese black women have higher fasting insulin levels than nonobese white women, and fasting insulin is an equally strong predictor of diabetes in both groups. These results suggest one mechanism to explain the excess incidence of diabetes in nonobese black women but do not explain the excess among black men. Future research should evaluate additional factors: genetic, environmental, or the combination of both, which might explain higher fasting insulin among black women when compared with white women.
View details for Web of Science ID 000185504100016
View details for PubMedID 12145235
Heterogeneity in the relationship between ethnicity, BMI, and fasting insulin
2002; 25 (8): 1351-1357
To determine whether the association of BMI and fasting insulin is modified by ethnicity.Non-Hispanic black (black), non-Hispanic white (white), and Mexican-American men and women aged 20-80 years from the Third National Health and Nutrition Examination Survey (1988-1994) were included in this study. Linear regression models with an interaction term were used to test whether ethnicity modified the association between BMI and fasting insulin.Fasting insulin was 19, 26, 20, and 19% higher in black women than white women with BMI levels of <22, 22-24, 25-27, and 28-30 kg/m(2), respectively. These differences between black and white women converged at BMI levels >30 kg/m(2). Mexican-American women had fasting insulin levels that were 17, 22, 20, and 16% higher than those of white women at BMI levels of 25-27, 28-30, 31-33, and >34 kg/m(2), respectively, but were not different in individuals with BMI levels <25 kg/m(2). Adjusting for established risk factors did not attenuate these associations in women. Differences in fasting insulin among men were not as apparent.These findings suggest that the effect of obesity on insulin sensitivity is different for Americans in ethnic minorities. In black subjects, fasting insulin is higher at lean weight when compared with white and Mexican-American subjects. In Mexican-American subjects, fasting insulin is higher in overweight individuals when compared with white and black subjects. These findings are more pronounced in women than in men. This result reinforces the importance of designing prevention programs that are tailored to meet the needs of specific populations. Investigation of possible explanations for these differences seems warranted.
View details for Web of Science ID 000185504100015
View details for PubMedID 12145234
Cardiovascular risk factors in ethnic minority women aged <= 30 years
AMERICAN JOURNAL OF CARDIOLOGY
2002; 89 (5): 524-529
Men and women of African and South Asian ancestry in the United States are increasingly recognized as being at greater risk for coronary heart disease (CHD) than Caucasians of European ancestry. Relatively little data on the genetic and lifestyle risk factors that predispose women to CHD in these ethnic minorities are available. We compared coronary risk factors in a volunteer sample of African-American, Asian Indian American, and Caucasian American women of college age. Life style, dietary, hemodynamic and anthropometric parameters, and laboratory data were sought from 70 subjects in each ethnic group. African-American women were found to have lower triglyceride levels and higher apolipoproten A-1, high-density lipoprotein (HDL), lipoprotein (a) (Lp(a)), fibrinogen, and fasting insulin levels. They also consumed more fat and cholesterol than their peers, had a higher percentage of body fat, body weight, and body mass indexes, and reported less physical activity than Caucasians. Asian Indian American women had higher Lp(a), HDL, and fibrinogen levels than Caucasian American women, and also reported less physical activity. Thus, young African- American and Asian Indian American women have several modifiable risk factors as well as some nontraditional lipid risk factors that warrant consideration for explaining the increased prevalence of CHD in these ethnic groups. The tendency toward peripheral insulin insensitivity and increased body fat in this age group of African-American women suggests diet and exercise may reduce the risk of subsequent CHD.
View details for Web of Science ID 000174140900007
View details for PubMedID 11867035
Analysis of CYP21 coding polymorphisms in three ethnic populations: Further evidence of nonamplifying CYP21 alleles among whites
2000; 5 (1): 47-52
Adrenal steroid 21-hydroxylase is essential for the synthesis of both mineralocorticoids and glucocorticoids. The gene for this enzyme, CYP21, contains several frequent coding polymorphisms. Because of its essential function in steroid synthesis, polymorphisms in this enzyme might influence a variety of disease processes. However, before disease-association studies are performed, it is important to understand the frequency of these polymorphisms among normal individuals.Using polymerase chain reaction (PCR) with restriction enzyme digestion or size length polymorphism analysis, we measured the frequencies of the +Leu(10), Arg102Lys, and Ser268Thr polymorphisms in CYP21 in healthy whites, blacks, and Indian Americans. The subjects were all young female college students participating in a study of relative risks for cardiovascular disease in these populations.The frequency of each polymorphism among whites, blacks, and Indian Americans were as follows: +Leu(10), 0.55, 0.96, 0.75; Arg102, 0.63, 0.97, 0.82; and Ser268, 0.92, 0.68, 0.79, respectively. With the exception of the frequencies of the Ser268Thr polymorphism among blacks and Indian Americans, there were significantly different frequencies of each polymorphism among all groups (P<.05). Among whites, the distribution of genotypes for the +Leu(10) and Arg102Lys polymorphisms deviated significantly from expected Hardy-Weinberg values because of an excess of homozygotes.Among the ethnic groups, there are statistically significant differences in the frequencies of these common coding polymorphisms in CYP21 that need to be considered in disease-association studies. Deviation from Hardy-Weinberg distributions might be explained by allelic dropout during PCR, a phenomenon previously reported at this locus.
View details for Web of Science ID 000087211200013
View details for PubMedID 10837089