Graduate Thesis Or Dissertation
 

Disaggregating Asian American, Native Hawaiian and Pacific Islander Health Data: Cardiovascular Health, Neighborhood Factors, and Socioeconomic Disadvantage Among Older Adults

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  • Cardiovascular disease (CVD) is the leading cause of mortality in the United States (US) and research suggests that CVD morbidity and mortality disproportionately impacts Asian American and Native Hawaiian and Pacific Islander (NHPI) older adults. However, the prevalence on CVD and underlying mechanisms for CVD disparities among disaggregated Asian American and NHPI ethnic groups is not well known. Research has demonstrated the association between socioeconomically deprived neighborhoods and higher CVD mortality. Health-related quality of life (HRQOL) and neighborhood socioeconomic factors may help explain discrepant CVD rates across this diverse population. Guided by the ecosocial theory and theory of health services utilization, this dissertation is composed of three empirical papers on CVD among Asian American and NHPI older adults. The first paper examined the prevalence and determinants of CVD risk factors (obesity, diabetes, smoking status and hypertension) and CVD conditions (coronary artery disease, congestive heart failure, myocardial infarction, other heart conditions, and stroke) among 10 disaggregated Asian American and NHPI ethnic groups and white adults. Data were from the 2011-2015 Medicare Health Outcomes Survey (HOS), a panel survey of adults aged 65 and older enrolled in Medicare Advantage health plans. The prevalence of overweight and obesity, diabetes and hypertension was higher among most Asian American and NHPI ethnic groups than white adults. There was substantial variation in the prevalence of CVD risk factors across ethnic groups. After adjustment, the majority of Asian American ethnic groups had lower odds of all CVD conditions compared to their white counterparts. The second paper assessed the relationship between CVD and HRQOL among 10 disaggregated Asian American and NHPI ethnic groups compared to white adults. Data were from the 2011-2015 Medicare HOS. Overall, adults who self-reported a CVD condition had worse physical health and worse mental health than adults without CVD. There were marked differences in physical and mental health across disaggregated Asian American and NHPI ethnic groups. After adjustment, compared to white adults, Asian American and NHPI ethnic groups had better physical health but worse mental, though the differences were not statistically significant for all ethnic groups. Furthermore, race/ethnicity moderated the relationship between CVD and HRQOL. The third paper investigated the relationship between neighborhood socioeconomic disadvantage and CVD in Asian American and NHPI older adults. Data came from the 2011-2015 Medicare HOS and Neighborhood Atlas 2015 US Area Deprivation Index. Neighborhoods were defined as more disadvantaged and less disadvantaged. Overall, about 8% of respondents lived in more disadvantaged neighborhoods. Respondents living in more disadvantaged neighborhoods reported higher rates of diabetes, hypertension, smoking, and obesity. Residence in more disadvantaged neighborhoods ranged from 2% among Japanese to 22% in Other Pacific Islander adults. Adults residing in more disadvantaged neighborhoods had greater odds of any CVD diagnosis, coronary artery disease, congestive heart failure, other heart conditions, and stroke compared to adults in less disadvantaged neighborhoods. These associations were not statistically significant after adjustment. Our findings of greater prevalence of overweight and obesity, diabetes and hypertension as well as worse mental health among disaggregated Asian American and NHPI adults suggest there are still improvements to be made in prevention efforts for these groups. These papers highlight the importance of individual- and neighborhood-level factors as possible areas to prevent CVD as well as improve overall well-being for Asian American and NHPI adults in the US.
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  • Pending Publication
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  • 2020-06-04 to 2022-07-05

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