Abstract
Background: Asian Indians (AI) in the US are known to have a high prevalence of atherosclerotic diseases and diabetes mellitus (DM). However, it is not known if these two cluster as causes of death in AI compared to the rest of US population. Methods: Using 2017 Multiple Cause-of-Death Data from the National Centre for Health Statistics, we included deaths at age ≥ 45 years among US residents where AI vs not-AI could be ascertained (n = 7940 AI; n = 2.6 million not-AI). DM (ICD-10 range: E10-E14) and any atherosclerosis (either of: ischemic heart disease, ischemic stroke, atherosclerosis; ICD-10 range: I20-I25, I69, I70, respectively) as contributing causes of death were identified in AI and not-AI. We calculated dichotomous tetrachoric correlation (Rho) between DM and atherosclerosis as co-occurring contributing causes. To examine whether this association differed by age decade and sex, we calculated the difference in fraction of deaths with DM in those with atherosclerosis versus those without atherosclerosis as a co-occurring cause of death. Results: There were 114,210 atherosclerosis deaths and 24,331 DM deaths in 2017 in the sample. DM and atherosclerosis as contributing causes correlated more strongly in AI (Rho = 0.36, p < 0.001) as compared to not-AI (Rho = 0.31, p < 0.001; difference between groups, p < 0.001). The excess fraction of deaths due to DM when atherosclerosis also contributed vs when atherosclerosis did not contribute was higher in AI men of all ages and in most ages for AI women, except for a group where AI death numbers were smaller (Figure). Conclusion: Our findings highlight the increased burden of co-occurring DM and atherosclerotic disease together contributing as causes of death in AI compared to not-AI in the US. Public health strategies targeted to AI should focus on prevention and clinical treatment of both conditions jointly, in both men and women, especially during young adulthood and middle age.
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