Leading Causes of Death among Asian American Subgroups (2003-2011).
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America.
Katherine G
KG
Hastings
Sutter Health Medical Foundation, Department of Cardiology, Davis, California, United States of America.
Powell O
PO
Jose
Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America.
Kristopher I
KI
Kapphahn
Columbia University School of Nursing, New York, New York, United States of America.
Ariel T H
AT
Frank
Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America.
Benjamin A
BA
Goldstein
Palo Alto Medical Foundation Research Institute, Palo Alto, California, United States of America.
Caroline A
CA
Thompson
Stanford University, Shorenstein Asia-Pacific Research Center, Stanford, California, United States of America.
Karen
K
Eggleston
Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America.
Mark R
MR
Cullen
Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, California, United States of America.
Latha P
LP
Palaniappan
D001213:Asian / Q000208:ethnology*; D002423:Cause of Death / Q000639:trends*; D002561:Cerebrovascular Disorders / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data