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PubMed1999

Smoking patterns of Asian-American youth in California and their relationship with acculturation.

PURPOSE: To examine patterns of smoking behavior among subgroups of Asian-American youth in California and their relationship with acculturation status. METHODS: Data were from the 1990-1996 California Tobacco Survey and the California Youth Tobacco Survey, which assessed smoking-related attitudes and behaviors among California youth in grades 7-12. Among the 20,482 respondents, 1,810 were Asian-Americans. Variables assessed included lifetime smoking prevalence, 30-day smoking prevalence, and age of smoking onset. Acculturation status was assessed with measures of English usage, language spoken at home, and age at immigration to the United States. RESULTS: Of the 1,810 Asian-Americans (52% male), 19% were Chinese, 33% Filipino, 8% Japanese, 13% Korean, and 26% other Asian-Americans. Lifetime smoking prevalence was 16.1% for Asians and 26.1% for non-Asians. The 30-day smoking rate was 6.9% for Asians and 14.2% for non-Asians. Subgroup-specific analyses revealed differences in lifetime smoking prevalence (18.9% for Filipinos, 17.3% for Japanese, 16.3 % for Koreans, 11.0% for Chinese, and 13.7% for other Asian-Americans) and 30-day smoking rate (8.6% for Filipinos, 8.3% for Koreans, 7.4% for Japanese, 2.8% for Chinese, and 7.2% for other Asian-Americans). Gender differences in lifetime smoking prevalence varied by Asian subgroup; smoking prevalence was higher among males than among females for Chinese and Koreans, but smoking prevalence was higher among females than among males for Japanese and other Asians. The average age of smoking onset was 12.9 years for Asians and 12.8 years for non-Asians. Age of smoking onset differed among Asian-American subgroups but did not differ by gender. In addition, smoking behaviors of the Asian respondents were significantly associated with their acculturation status. CONCLUSIONS: Asian-American youth have relatively lower smoking rates and later age of smoking onset than non-Asian youth in California. In addition, subgroups of Asian-American youth vary widely in their smoking behavior. High levels of acculturation among Asian-American youth are associated with higher smoking prevalence rates and earlier age of smoking onset.

Acculturation↗
PubMed1994

Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect?

OBJECTIVES: To compare the prevalence of diabetes, hyperinsulinaemia, and associated metabolic abnormalities in immigrant Asians, Asians in India, and native white British men. DESIGN: Case control study. SETTING: Wythenshawe Hospital, Manchester, United Kingdom, and Maulana Azad Medical School, New Delhi, India. SUBJECTS: Men with angiographically proved coronary artery disease; 83 British Asians, 87 white men, and 30 Indian Asians with age matched controls. INTERVENTIONS: Fasting lipid concentrations, serum glucose, and total insulin concentrations were measured in the fasting state and one and two hours after a 75 g glucose load by mouth. All subjects had a physical examination by the same observer. RESULTS: Asians in the United Kingdom and in India had a higher prevalence of diabetes and impaired glucose tolerance than the white British men. Patients in all three ethnic groups had higher total insulin concentrations than their controls in the fasting state and after the glucose load. British Asian and Indian Asian patients and controls had higher total insulin concentrations than the white men in the fasting state and after the glucose load. Total insulin concentrations were similar in British and Indian Asians, though fasting concentrations were higher in British Asians than Indian Asians. White men had similar cholesterol, lower triglyceride, and higher high density lipoprotein cholesterol concentrations than Asians in the United Kingdom and in India. British Asian patients had higher cholesterol concentrations and British Asian controls had higher triglyceride concentrations than the Indian Asian groups. Asian patients and controls were more active. British and Indian Asian patients had higher waist to hip ratios than controls. The waist to hip ratio was positively correlated with insulin and triglyceride concentrations and negatively correlated with the high density lipoprotein cholesterol concentration. Fasting insulin and high density lipoprotein concentrations were independent predictors of coronary artery disease in white men, whereas in British Asians the waist to hip ratio was the strongest independent predictor. In Indian Asians the waist to hip ratio and high density lipoprotein concentration were independent predictors of coronary artery disease. CONCLUSIONS: Central obesity in the subgroups of Asians studied showed a close association with hyperinsulinaemia and the risk of coronary artery disease. A predisposition to insulin resistance and its metabolic abnormalities in this group of Asians seems to be genetically determined, environmental changes after migration having only a small additional effect.

Asia↗
PubMed2002

Advanced presentation of lung cancer in Asian immigrants: a case-control study.

STUDY OBJECTIVES: To determine if Asian immigrants to the United States present with more advanced lung cancer compared to non-Asians. DESIGN: A 5-year retrospective case-control study (January 1, 1992, to December 31, 1996) of patients with lung cancer identified using the New England Medical Center cancer center database. A 2-year follow up was obtained in all subjects. SETTING: A tertiary level care hospital providing all levels of medical care to the local Asian population in the Boston area. PATIENTS: Forty-two Asian immigrants with lung cancer diagnosed over the study period were matched for age and sex with 42 non-Asian control subjects. RESULTS: Asians presented more frequently with advanced stage (stage III or IV) and less frequently with early stage (stage I or II) lung cancer compared with the non-Asian control group (p < 0.05). Asians were more likely to present with hemoptysis or constitutional symptoms (p < 0.01) and had a longer duration of symptoms prior to presentation (p < 0.01) compared with non-Asians. There was no difference in the length of time elapsed between diagnosis and start of treatment (approximation of workup time) between the two groups. The utilization of tests and procedures for clinical disease staging was not significantly different between the two groups. The incidence of large cell carcinoma (p < 0.05) was higher in Asians compared with non-Asians. Asians were more likely to receive radiotherapy and less likely to receive combination therapy compared with non-Asians (p < 0.05). The treatment of stage I and II lung cancer did not differ between the two groups. The median 2-year survival was significantly reduced in Asians compared with non-Asians: Asians, 7 months (95% confidence interval [CI], 3.1 to 10.9); non-Asians, 15 months (95% CI, 12.0 to 17.5) [p < 0.001]. CONCLUSIONS: Asian immigrants with lung cancer appear to present with more advanced stage of disease, have more prolonged symptomatology, and have reduced survival compared with non-Asians. These data suggest that ethnicity may play a role in the presentation and outcome of lung cancer in the Asian immigrant population.

Aged↗
PubMed2005

English language proficiency and smoking prevalence among California's Asian Americans.

The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.

Acculturation↗
PubMed2002

Indo-Asian experience of renal transplantation in Yorkshire: results of a 10-year survey.

BACKGROUND: There is a significant Indo-Asian community in Yorkshire. The rate of end-stage renal failure is disproportionately high in this ethnic group. There have not been any large studies of this ethnic minority's access to and outcome after cadaveric renal transplantation. METHODS: Three local cohorts were studied: 846 adult patients (9.1% Asian) who started renal replacement therapy 1990-1994, 822 adult patients (11.4% Asian) registered on the transplant waiting list 1985-1994; and 608 adult patients (8.6% Asian) transplanted 1985-1994. RESULTS: At 1 year from the start of dialysis, 34% of Asian and 31% of non-Asian patients were registered onto the waiting list. After adjustment for age in a multifactorial model, Asian patients were less likely to be listed (relative risk, 0.68), although this did not reach statistical significance (P=0.06). There was a significant difference in graft rate between the groups: at 3 years 72% of non-Asians versus 55% of Asians had been transplanted from the waiting list (P<0.001). For those transplanted, HLA matching was superior for white patients: 34% versus 20% of pairings achieved a 000 mismatched or favorably matched graft (P<0.05). Transplant survival at 5 years was 71% in the non-Asian and 58% in the Asian patients (P=0.07). Asian cadaveric donation was identified in 2 of 608 transplants during a 10-year period. CONCLUSION: Asian patients gained access to the transplant waiting list at a similar rate to the non-Asian white majority. Because of difficulties with HLA matching, Asian patients were significantly disadvantaged in receiving a transplant once listed, and there was a trend towards reduced posttransplant survival. Cadaveric donation was uncommon from within the Asian community; the reasons for which are likely to be complex.

ABO Blood-Group System↗
PubMed1996

Differences in bone mineral in young Asian and Caucasian Americans may reflect differences in bone size.

Bone mineral content (BMC) and areal bone mineral density (BMD) have been reported to be lower in Asian than in Caucasian adults. To determine if racial differences in bone mass are present in younger subjects and whether they reflect differences in estimated volumetric bone density or in bone size, we compared measurements of bone mineral in healthy young Asian- and Caucasian-American males and females. Bone mineral was measured at the lumbar spine (L2-L4), femoral neck (FN), and whole body (WB) by dual-energy X-ray absorptiometry (DXA) in 99 Asians (49 females, 50 males) and 103 Caucasians (54 females, 49 males) ages 9-26 years. Results were expressed as BMC, BMD, and apparent density (BMAD), an estimate of volumetric bone density that reduces the effect of bone size. Subjects were compared on the basis of chronological age as well as by Tanner stage to correct for potential differences in the timing of puberty. Habitual dietary intake and physical activity were also assessed and correlated with bone mineral. The Asian and Caucasian cohorts differed in body size, diet, and physical activity. Asian females were shorter than the Caucasian females at all stages of puberty and weighed less at pre-/early puberty (p < 0.05). Asian males were older than Caucasians at midpuberty (p < 0.01) and weighed less than the Caucasian males at pubertal maturity (p = 0.001). Asian youths also consumed less calcium and reported less weight-bearing activity. Racial differences were most apparent when comparing BMC data. Asian males had greater spine BMC at midpuberty and lower WB BMC at maturity (p < 0.05). Asian females had lower FN BMC through midpuberty and lower WB BMC in pre-/early puberty (p < 0.05). WB BMD and WB BMC/height values were significantly lower in mature Asian versus Caucasian males. No significant racial differences in BMAD were observed. Multivariate regression analysis indicated that the differences in BMD and BMAD between Asian and Caucasian subjects were largely attributable to differences in weight and pubertal stage, and, at the FN, in weight-bearing activity. Further, the explanatory variables were less strongly associated with BMAD than with BMD. In summary, no significant differences in BMD were found between Asian and Caucasian youths through midpuberty; however, WB BMD and WB BMC/height values were lower in Asian males at sexual maturity. We conclude that observed differences in bone mineral between Asians and Caucasians may be partially attributed to the smaller bone size of Asians.

Absorptiometry, Photon↗
PubMed1993

Ethnic differences in psychiatric diagnosis among Asian American adolescents.

This is the first investigation of the psychiatric diagnosis of Asian American adolescents using data from the Los Angeles County Department of Mental Health. It was hypothesized that Asian American adolescents receive different diagnoses than Caucasian adolescents, and furthermore, that there are intra-Asian differences in diagnosis among the Asian subgroups. Asian American adolescents were categorized in the following subgroups: Chinese, Japanese, Korean, Filipino, Vietnamese, and other Asians (i.e., Southeast Asians and Pacific Islanders). Separate comparisons were made for male and female adolescents. The findings strongly support the presence of ethnic differences between Asian and Caucasian adolescents and also among Asian subgroups in both male and female groups. In the Asian-Caucasian comparison, Asian males and females received significantly more nonpsychiatric diagnosis than Caucasians. Asian males were more often diagnosed with nonpsychiatric disorder and less often with affective disorders than Caucasian males. Asian females were more frequently diagnosed with major depression and nonpsychiatric disorder than Caucasian females. Among Asian American adolescents, Chinese and Japanese adolescents received similar diagnoses while Korean and Vietnamese also showed similar patterns in diagnosis. The implications of intra-Asian differences are discussed.

Adjustment Disorders↗
PubMed1999

Screening for Type 2 diabetes mellitus in the UK Indo-Asian population.

AIMS: Type 2 diabetes mellitus (DM) has a high prevalence in Asian subjects. A simple method of screening using self-testing for postprandial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population. We examined its effectiveness in Asian subjects. METHODS: Caucasian and Indo-Asian subjects aged 35-70 years in two general practices in Leicester (n=9896 (6198=Asian subjects, 3698=Caucasian)) were screened. Those known to have diabetes were excluded. Subjects were asked to self-test for glycosuria 1 h after their main meal. Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects, depending on age and surname. RESULTS: Response rate was 34.4% in Asian subjects compared to 54.0% in Caucasian subjects. Prevalence of glycosuria was 8.2% in Asian subjects and 3.2% in Caucasian subjects. Two hundred and thirty-nine subjects recorded glycosuria and 202 (84.5% of the total, 86.9% of Asian subjects, 78.1% of Caucasian) attended for oral glucose tolerance test (OGTT). Sixty-three (31.2%) were found to have diabetes (46, 73% Asian), 29 (14.4%) impaired glucose tolerance (24, 82.8% Asian) and 110 (54.4%) normal glucose tolerance (82, 74.6% Asian). Thus 30% of Asian subjects and 34% of Caucasian subjects had diabetes on OGTT. The prevalence of diabetes in 35-70 years in the total population after screening was 5.6% (6.8% in Asian subjects, 3.6% in Caucasian) and in the screened population was 12.7% (17.9% in Asian subjects, 6.3% in Caucasian). CONCLUSIONS: Screening for diabetes using this method, in terms of response rate, is not as effective in a large city setting, particularly in the Asian population. However, the yield of diabetes in the age group 35-64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified.

Adult↗
PubMed2005

Growth and lung function in Asian patients with cystic fibrosis.

BACKGROUND: The incidence of cystic fibrosis (CF) in Asians is rare. How these patients fare in terms of morbidity and mortality in the UK compared to their non-Asian peers is not well documented. AIMS: To retrospectively study annual reviews of 31 Asian CF patients from three London paediatric CF centres. METHODS: Disease severity was assessed by lung function, age at first infection with Pseudomonas aeruginosa, and body mass index (BMI). The Asian children were compared with 143 matched non-Asian patients with CF. Matching criteria used were same sex and treatment centre as the Asian index patient. In addition, the controls were matched so that their date of birth, date of diagnosis, and date at annual review were within 12 months of the index patient. RESULTS: There was no significant difference in age at diagnosis or age at annual review between the Asian and non-Asian children. Mean Z-scores for FEV1 and FVC were significantly lower for the Asian girls. There was no significant difference in Z-scores for BMI between the Asian children and their controls. Age at first isolation of Pseudomonas aeruginosa in Asian girls was significantly later than for their controls (8.3 years compared to 5.6 years for non-Asian girls). CONCLUSIONS: While the Asian boys' lung function seems comparable with that of their non-Asian peers, the Asian girls emerge as a potentially vulnerable group and more work is required to discover why this is the case.

Adolescent↗
PubMed1989

First myocardial infarctions in Asian and white men.

OBJECTIVE: To compare the presentation and natural course of first myocardial infarctions in immigrant Asians and the indigenous white population in Britain and the subsequent risk states of the two groups. DESIGN: Prospective ethnic comparison of consecutive patients with first myocardial infarctions. SETTING: Secondary referrals to a coronary care unit of a district general hospital. PATIENTS: 128 Men (77 white, 54 Asian) presenting consecutively with a first myocardial infarction diagnosed on the basis of clinical, biochemical, and electrocardiographic findings. END POINT: Identification of mechanisms accounting for the increased rate of ischaemic heart disease in Asians. MEASUREMENTS AND MAIN RESULTS: Infarct size was assessed by measuring the release of creatine phosphokinase (all patients), radionuclide ventriculography (50), and contrast ventriculography (103). Risk states after infarction were assessed from the degree of ventricular dysfunction as determined by exercise electrocardiography (82 patients) and from the extent of coronary atheroma as determined by coronary arteriography (103). Glucose state was measured in fasting venous blood samples. Overall the relative rate of infarction was 4.9 times higher in Asians (95% confidence interval 3.4 to 6.9) than in the white population. Moreover, the relative rate of infarction was higher in Asians in all 10 year age groups, the greatest difference being in 30-39 year olds. The mean age of the Asian denominator population was 47.1 years compared with 49.5 years in the white population. Age at infarction was less in Asians (50.2 years) than in white patients (55.5 years; mean difference 5.5 years (95% confidence interval 2.5 to 7.1]. In Asians the mean creatine phosphokinase activity was 777 (95% confidence interval 155 to 1399) U/1 higher, radionuclide ejection fraction 8.9% (1.0% to 16.9%) lower, and left ventricular fractional shortening 4.8% (1.4% to 8.2%) lower than in white patients. The extent of coronary atheroma was significantly greater in Asians. The mean numbers of plaques in vessels not associated with infarction were 3.66 (median 3.0, range 0-10) in Asians compared with 1.97 (median 2.0, range 0-6) in white patients (p less than 0.001), and a higher proportion of Asians had three vessel coronary artery disease (p less than 0.001). Asians with diabetes or impaired glucose tolerance did not differ from those with normal blood glucose values. CONCLUSIONS: Atherogenesis arises earlier in Asians, contributing to premature first myocardial infarctions. The increased incidence of diabetes in Asians may not in itself be relevant in the greater propensity to coronary atheroma in Asians.

Adult↗
PubMed2001

Insulin resistance and elevated levels of tissue plasminogen activator in first-degree relatives of South Asian patients with ischemic cerebrovascular disease.

BACKGROUND AND PURPOSE: South Asians in the United Kingdom suffer from an increased mortality from cerebrovascular disease compared with whites. Evidence suggests that the relatives of white stroke patients are at increased risk of vascular disease. The aim of this study was to investigate atherothrombotic risk factors in the first-degree relatives of South Asian patients suffering from ischemic cerebrovascular disease and to compare them with South Asian subjects free from clinically detectable cerebrovascular disease. METHODS: We compared 143 relatives of South Asians with ischemic stroke (South Asian relatives group) with 146 South Asian control subjects from West Yorkshire, UK. RESULTS: The ages and ethnic and sex distributions of South Asian relatives and South Asian controls were similar. There were no significant differences in body mass index, waist-hip ratio, number of current smokers, and past medical history of hypertension, diabetes mellitus, or myocardial infarction between the 2 groups. Fasting blood glucose, glycosylated hemoglobin (HbA(1c)), total cholesterol, triglycerides, and HDL cholesterol were similar in the 2 groups. Fasting insulin (South Asian relatives, 12.0; South Asian controls, 8.5 mU/L; P<0.0001) (independent of tissue plasminogen activator) and insulin resistance (derived by Homeostasis Model Assessment) (South Asian relatives, 2.7; South Asian controls, 1.9; P=0.001) were significantly raised in stroke relatives. Stroke relatives showed elevated levels of tissue plasminogen activator (South Asian relatives, 11.6; South Asian controls, 8.4 ng/mL; P<0.0001), which was independent of plasma insulin. There were no differences in plasminogen activator inhibitor antigen or activity between the groups. CONCLUSIONS: South Asians stroke relatives exhibit hyperinsulinemia, increased insulin resistance, and increased tissue plasminogen activator levels. These observations might account for increased susceptibility to atherothrombotic disease in this ethnic group.

Adolescent↗
PubMed2002

Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects.

BACKGROUND: Coronary artery disease affects a significantly larger proportion of Canadians of South Asian origin than Canadians of other ethnic origins. We compared differences in presentation, risk factors and management of myocardial infarction (MI) between South Asian Canadians and matched control subjects. METHODS: We reviewed the charts of 553 South Asian patients and 553 non-South Asian matched control subjects presenting with acute MI (International Classification of Diseases code 410) to 2 hospitals in Canada from January 1994 to April 1999. We identified South Asian subjects by their surnames and first names, and by using self-reported ethnicity and country of birth when available. Patients of Southeast Asian and Middle Eastern origin were excluded. The remaining patients were classified as non-South Asian. Subjects were matched by age within 5 years, sex, discharge date within 6 months and hospital of admission. Presentation characteristics, risk factors and major complications were compared between the 2 groups. RESULTS: The median time from symptom onset to presentation with acute MI was significantly longer among the South Asian subjects than among the control subjects (3.92 v. 3.08 hours) (p = 0.04). The South Asians were more likely than the control subjects to have diabetes mellitus (43.4% v. 28.2%) (p < 0.001) despite having a significantly lower mean body mass index (25.7 v. 28.0) (p = 0.05) but were less likely to have hyperlipidemia (36.2% v. 42.7%, p = 0.05), to smoke (29.3% v. 67.8%) (p < 0.001) or to have pre-existing vascular disease (49.4% v. 55.0%, p = 0.04). Treatment of acute MI was similar between the South Asian and matched control groups. Also similar were the in-hospital outcomes, including mortality (9.6% and 7.8%, p = 0.27). INTERPRETATION: There are clear differences in the risk factor profile between Canadians of South Asian origin and those of non-South Asian origin who have acute MI. Despite the higher incidence of cardiovascular disease in the South Asian population, our results indicate that the in-hospital case-fatality rate for MI is the same for South Asian and non-South Asian Canadians.

Asia, Southeastern↗
PubMed2005

Self-reported work strain is lower in South Asian than European people: cross-sectional survey.

OBJECTIVE: Jobs with high levels of demand and low levels of control have been linked to the risk of coronary heart disease (CHD). Limited evidence is available about the contribution of job characteristics to the increased risk of CHD in UK South Asian people. We aimed to describe psychosocial work characteristics in South Asian compared with European people. DESIGN: Cross-sectional study in Newcastle upon Tyne, UK, using self-reported measures of job demand, decision latitude, skill utilisation and social support at work in an age and sex stratified representative population sample of 652 adults of European (391) and South Asian (261) ethnic origin. RESULTS: Compared to European people, fewer South Asian men (57% vs 47%) but more South Asian women (22% vs 48%) were employed. South Asian people were more likely than European people to be self-employed (33% vs 7% among men). Employed South Asian people were better educated and had higher income than European people. Compared to European men, more South Asian men had high job control (42% vs 35%) but similar proportions had high job demand (42% vs 41%). Fewer South Asian men had jobs that allowed a high use of skill, but more had high decision latitude. These differences were partly explained by higher rates of self-employment among South Asian people. South Asian people were more likely to be in low demand/high control jobs, while European people occupied a wider range of jobs, in low control and in high demand/high control occupations. More detailed sub-group analyses were not reliable because of small numbers. CONCLUSION: In a representative population sample the overall balance of job demand and control was similar in South Asian and European people, though South Asian people tended to be in jobs characterised by low skill and high decision latitude. These findings do not support the suggestion that increased work strain contributes to the increased risk of CHD in UK South Asian people.

Adult↗
PubMed2004

Cancer occurrence in Southeast Asian children in California.

OBJECTIVES: To estimate misclassification of ethnicity and cancer incidence in Southeast Asian children using the population-based California Cancer Registry. METHODS: Asian race/ethnicity was evaluated using lists of Asian surnames. Average annual incidence rates (per million) for 1988 to 1992 were calculated for non-Hispanic white, black, Hispanic, and Asian children (age <15 years). Proportional incidence ratios (PIRs) for 1988 to 1995 were used to compare Southeast Asian children to non-Hispanic white children. RESULTS: Of the Asian children, 4.2% (30/722) were misclassified by subgroup, predominantly Hmong listed as Laotian. The Asian cancer rate was 134.2 versus 159.2 for non-Hispanic whites. The germ cell tumor rate was higher in Asians (9.9) than in non-Hispanic whites (4.8), but the Wilms tumor rate was two-thirds lower (3.1 vs. 9.2). The rates of Hodgkin lymphoma and central nervous system tumors were lower (2.8 vs. 5.6 and 20.0 vs. 33.8) in Asians than non-Hispanic whites. Compared with non-Hispanic whites, the PIR for Wilms tumor in Southeast Asian children was reduced (PIR = 0.1). Southeast Asian children had increased PIRs for Burkitt lymphoma (PIR = 2.6) and leukemias not classified as acute lymphocytic leukemia or acute nonlymphocytic leukemia (PIR = 3.5). CONCLUSIONS: Accurate race/ethnicity classification of Southeast Asian children is a concern. Marked differences were found in the incidence and PIRs of specific cancers among Southeast Asian children, other Asian children, and other children in California.

Adolescent↗
PubMed2003

Asian ethnicity-related differences in gastric cancer presentation and outcome among patients treated at a canadian cancer center.

PURPOSE: Differences in stage-stratified survival have been reported between Asian and Western populations with gastric cancer. This study examines differences in presentation and outcomes among Asian and non-Asian patients evaluated and treated at a Canadian institution. PATIENTS AND METHODS: We reviewed 2,043 patients (159 Asians and 1,884 non-Asians) with gastric adenocarcinoma treated between 1978 and 1997. Overall survival was examined by the Kaplan-Meier method, and multivariable analysis by Cox proportional hazards was used to identify whether Asian ethnicity had independent prognostic significance for survival. RESULTS: Median survival was 13.1 months for Asians and 11.1 months for non-Asians (P =.0016). Asian patients were younger and had a greater proportion of signet ring cell histology but were less likely to have proximal disease. Signet ring cell histology did not adversely affect survival. By multivariable analysis, proximal location, poor differentiation, and extent of disease were independently associated with worse survival. Survival was improved with curative resection, palliative resection, and palliative chemotherapy. Asian ethnicity was not independently associated with survival (hazard ratio, 0.89; 95% confidence interval, 0.74 to 1.08). Although a similar proportion of patients underwent curative resection, an interaction was observed between Asian ethnicity and efficacy of resection, with Asians achieving a greater benefit as compared with non-Asians even when adjusted for age and location. CONCLUSION: The disparity between Eastern and Western gastric cancer survival is not explained by the hypothesis of ethnicity-related differences in tumor biology. Although it is not an independent predictor of survival, Asian ethnicity is associated with distinct characteristics at presentation and more favorable outcomes after curative surgery.

Adenocarcinoma↗
PubMedDate not supplied

Racial variation in risk factors and occurrence of acute myocardial infarction: comparison between Arab and South Asian men in Kuwait.

BACKGROUND: There are little data available on the rates of occurrence, risk factors and mortality due to acute myocardial infarction among the various ethnic groups living in Middle-East countries. Therefore, we did a study to compare Arabs and South Asians living in Kuwait. METHODS AND RESULTS: The data for this retrospective study were collected from the computerized database of the Coronary Care Unit at the Mubarak Al-Kabeer Hospital (a 476-bed teaching hospital) and the 1997-2000 Census data for the State of Kuwait. Arab and South Asian men above 25 years admitted between September 1997 and August 2000 with a diagnosis of acute myocardial infarction were included in the study A total of 866 Arabs and 277 South Asian men were admitted. The rate of admission for the entire patient population was two-fold higher among Arabs as compared with South Asians (6.7/1000 population and 3.3/1,000, respectively). Diabetes mellitus was present in 453 Arabs (52.3%) and 109 South Asians (39.4%) (p< or = 0.001) of those >25 years of age. Hypertension was recorded in 247 Arabs (28.5%) and 57 South Asians (20.6%) (p < or = 0.01). Among patients <55 years of age (454 Arabs and 226 South Asians); the rate of admission was 4.0/1,000 in Arabs and 3.5/1,000 in South Asians (not significant). Hypertension was present in 97 Arabs (21.3%) and 43 South Asians (19%) (not significant). Diabetes mellitus was present in 202 Arabs (44.5%) and 80 South Asians (35.4%) (p < or = 0.05). Smoking was recorded in 353 Arabs (77.8%) and 160 South Asians (70.8%) (notsignificant). Hypercholesterolemia was presentin 182 (40.1%) and 88 (39%), respectively (not significant). While in hospital, 11 Arabs and 9 South Asians died (not significant). CONCLUSIONS: Among men >55 and <75 years of age, Arabs had a higher rate of admission with acute myocardial infarction compared with men of South Asian origin. The incidence of diabetes and hypertension was significantly higher among Arabs in this age group. In younger patients (<55 years), the rate of acute myocardial infarction was not different between the two groups; however, diabetes was present more often among Arabs. The smoking rate is very high in both groups and is an important risk factor for both Arab and South Asian men living in the Middle East.

Adult↗
PubMed1996

Menstrual and reproductive factors and risk of breast cancer in Asian-Americans.

We conducted a population-based case-control study of breast cancer among Chinese-, Japanese- and Filipino-American women in Los Angeles County Metropolitan Statistical Area (MSA), San Francisco-Oakland MSA and Oahu, Hawaii. One objective of the study was to quantify breast cancer risks in relation to menstrual and reproductive histories in migrant and US-born Asian-Americans and to establish whether the gradient of risk in Asian-Americans can be explained by these factors. Using a common study design and questionnaire in the three study areas, we successfully conducted in-person interviews with 597 Asian-American women diagnosed with incident, primary breast cancer during the period 1983-87 (70% of those eligible) and 966 population-based controls (75% of those eligible). Controls were matched to cases on age, ethnicity and area of residence. In the present analysis, which included 492 cases and 768 controls, we observed a statistically non-significant 4% reduction in risk of breast cancer with each year delay in onset of menstruation. Independent of age at menarche risk of breast cancer was lower (odds ratio; OR=0.77) among women with menstrual cycles greater than 29 days. Parous Asian-American women showed a significantly lower risk of breast cancer then nulliparous women (OR=0.54). An increasing number of livebirths and a decreasing age at first livebirth were both associated with a lower risk of breast cancer, although the effect of number of livebirths was no longer significant after adjustment for age at first livebirth. Women with a pregnancy (spontaneous or induced abortions) but no livebirth had a statistically non-significant increased risk (OR=1.84), but there was no evidence that one type of abortion was particularly harmful. A positive history of breastfeeding was associated with non-significantly lower risk of breast cancer (OR=.78). There are several notable differences in the menstrual and reproductive factors between Asian-Americans in this study and published data on US whites. US-born Asian Americans had an average age at menarche of 12.12 years-no older than has been found in comparable studies of US whites, but 1.4 years earlier than Asian women who migrated to the US. Asian-American women, particularly those born in the US and those who migrated before age 36, also had a later age at first birth and fewer livebirths than US whites. A slightly higher proportion of Asian-American women breastfed, compared with US whites. The duration of breastfeeding was similar in US-born Asians and US whites, but was longer in Asian migrants, especially those who migrated at a later age. Menstrual and reproductive factors in Asian-American women are consistent with their breast cancer rates being at least as high as in US whites, and they are. However, the effects of these menstrual and reproductive factors were small and the ORs for migration variables changed only slightly after adjustment for these menstrual and reproductive factors. These results suggest that the lower rates of breast cancer in Asians must be largely as a result of other environmental/lifestyle factors.

Adult↗
PubMed2001

Liver transplantation in patients with hepatitis B virus infection: outcome in Asian versus white patients.

Previous studies have found that Asian patients transplanted for hepatitis B virus (HBV) infection had worse outcomes than white patients. The aim of this study was to compare outcomes in Asian and white patients listed for liver transplantation for HBV infection. Data of all patients with HBV infection listed for liver transplantation between January 1996 and June 1998 from 20 centers in North America were collected using a survey. Total patients enrolled were 325 (171 whites, 126 Asians, 28 other races). There was no difference in demographics, liver biochemistry, and HBV replicative status between Asians and whites at the time of listing. More Asians had hepatocellular carcinoma and fewer Asians had hepatitis C or D virus coinfection. At the time of this survey, 70 Asians (55%) and 99 whites (58%) had been transplanted. Actuarial 2-year survival posttransplantation for Asians (88%) and whites (92%) was similar. Recurrent HBV infection occurred in 8 (11%) Asians and 12 (12%) whites. Five patients with recurrent HBV infection died, 4 of whom were Asian. Actuarial 2-year survival for Asians versus whites with recurrent HBV infection was 60% versus 90% (P =.04). In this large cohort of patients, overall survival and recurrent HBV infection posttransplantation were comparable between Asians and whites. However, Asians with recurrent HBV infection posttransplantation had significantly higher mortality.

Antiviral Agents↗