Disparities in 2020 Life Expectancy by Race and Ethnicity in Hawai'i.

The Challenge of Providing Culturally Competent Services

This study sought to identify racial and ethnic differences in rates of alcohol-related advice given to veterans treated in Veterans Affairs (VA) facilities. This was a cross-sectional analysis of data from the VA Survey of the Healthcare Experiences of Patients (SHEP). Participants were 255,522 veterans treated in VA ambulatory clinics in fiscal year 2005. SHEP measures included alcohol consumption questions from the Alcohol Use Disorders Identification Test and an item inquiring whether a VA clinician had given advice about drinking. Logistic regression was used to examine relationships between race and ethnicity categories and receipt of alcohol-related advice. Covariate measures included demographic characteristics and physical and mental component summary scores from the Veterans RAND Health Survey (VR-12). Among veterans who consumed any alcohol, compared with veterans from the other racial or ethnic groups, Asian, Native Hawaiian, or Pacific Islander veterans were less likely to be in the medium and highest alcohol consumption categories and non-Hispanic white veterans were less likely to be in the highest alcohol consumption category (p<.001). In a model adjusting for demographic characteristics, physical and mental health status, and alcohol consumption category, among veterans who consumed any alcohol, those who were non-Hispanic black (odds ratio [OR]=1.65, 95% confidence interval [CI]=1.47-1.84), Hispanic (OR=1.56, CI=1.35-1.80), or non-Hispanic American Indian or Alaska Native (OR=1.56, CI=1.06-2.29) were more likely to report receiving alcohol-related advice, compared with non-Hispanic white veterans. The results suggest that veterans from certain minority groups are more likely than white veterans to report receiving alcohol-related advice in the VA, after the model is adjusted for demographic characteristics, health status, and alcohol consumption. Further research is needed to understand the underlying reasons for observed differences in receipt of alcohol-related advice and the potential clinical implications.

An Institute of Medicine report titled U.S. Health in International Perspective: Shorter Lives, Poorer Health documents the decline in the health status of Americans relative to people in other high-income countries, concluding that “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”1 The report blames many factors, “adverse economic and social conditions” among them. In an editorial in Science discussing the findings of the Institute of Medicine report, Bayer et al2 call for a national commission on health “to address the social causes that have put the USA last among comparable nations.” Although mortality from cardiovascular disease (CVD) in the United States has been on a linear decline since the 1970s, the burden remains high. It accounted for 31.9% of deaths in 2010.3 There is general agreement that the decline is the result, in equal measure, of advances in prevention and advances in treatment. These advances in turn rest on dramatic successes in efforts to understand the biology of CVD that began in the late 1940s.4,5 It has been assumed that the steady downward trend in mortality will continue into the future as further breakthroughs in biological science lead to further advances in prevention and treatment. This view of the future may not be warranted. The prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.6 This change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. Although there is no consensus on the precise causes of the obesity epidemic, a dramatic change in the underlying biology of Americans is …

Life expectancy by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Please click here to download the map associated with this article. People's life expectancies are closely linked to health and deprivation and highlight inequalities. Life expectancy in England continues to rise, while at the same time known differences between the social classes persist. Little is known about life expectancy of various ethnic groups living in England, even though statistics from other countries suggest pronounced differences in life expectancies between ethnic or race groups. In the absence of mortality figures for ethnic groups in England, we estimate life expectancies through surrogate information: health. In this paper we visualise these unique estimates in population cartograms, linking ethnic with geographical information. As well as detecting evident variations in life expectancy between ethnic groups, we also find the North-South gradient which divides England apparent within each group. Life expectancy at birth decreases by about one year for every 100 km further North. We display the spatial variation in life expectancy with population cartograms to give prominence to metropolitan areas where ethnic minority groups are concentrated. Conventional maps would hide the story that our cartograms tell.

Evidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for all states by racial and ethnic groups were estimated. To quantify trends in MMRs (maternal deaths per 100 000 live births) by state for 5 mutually exclusive racial and ethnic groups using a bayesian extension of the generalized linear model network. Observational study using vital registration and census data from 1999 to 2019 in the US. Pregnant or recently pregnant individuals aged 10 to 54 years were included. MMRs. In 2019, MMRs in most states were higher among American Indian and Alaska Native and Black populations than among Asian, Native Hawaiian, or Other Pacific Islander; Hispanic; and White populations. Between 1999 and 2019, observed median state MMRs increased from 14.0 (IQR, 5.7-23.9) to 49.2 (IQR, 14.4-88.0) among the American Indian and Alaska Native population, 26.7 (IQR, 18.3-32.9) to 55.4 (IQR, 31.6-74.5) among the Black population, 9.6 (IQR, 5.7-12.6) to 20.9 (IQR, 12.1-32.8) among the Asian, Native Hawaiian, or Other Pacific Islander population, 9.6 (IQR, 6.9-11.6) to 19.1 (IQR, 11.6-24.9) among the Hispanic population, and 9.4 (IQR, 7.4-11.4) to 26.3 (IQR, 20.3-33.3) among the White population. In each year between 1999 and 2019, the Black population had the highest median state MMR. The American Indian and Alaska Native population had the largest increases in median state MMRs between 1999 and 2019. Since 1999, the median of state MMRs has increased for all racial and ethnic groups in the US and the American Indian and Alaska Native; Asian, Native Hawaiian, or Other Pacific Islander; and Black populations each observed their highest median state MMRs in 2019. While maternal mortality remains unacceptably high among all racial and ethnic groups in the US, American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states where these inequities had not been previously highlighted. Median state MMRs for the American Indian and Alaska Native and Asian, Native Hawaiian, or Other Pacific Islander populations continue to increase, even after the adoption of a pregnancy checkbox on death certificates. Median state MMR for the Black population remains the highest in the US. Comprehensive mortality surveillance for all states via vital registration identifies states and racial and ethnic groups with the greatest potential to improve maternal mortality. Maternal mortality persists as a source of worsening disparities in many US states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis.

The study of inequality in life expectancy by socio-economic groups has been receiving more and more attention with the rise in inequality. The present study investigates the prevailing situation in Bangladesh by using the age-specific mortality data available from various sources like the Sample Vital Registration System(SVRS) of the BBS and the Bangladesh Maternal Mortality Survey. The BBS, however, has been presenting a life table by sex, and there is a disparity in life expectancy in favour of females presently by three years. Rural life expectancy was lower in Bangladesh from 1981-to 2014, after which it exhibited that the difference in rural and urban life expectancy is being narrowed down. In India, the life expectancy at birth is slightly more than one year higher in urban areas than in rural areas. Life expectancy at birth was computed for seven regions (administrative divisions) using the age-specific mortality rates given in SVRS reports. For the year 2016, the highest value of life expectancy at birth (73.9 years) was found for the Rajshahi division, followed by Khulna division(73.5 years), Rangpur(73.0 years), Barisal(72.8 years), Sylhet(72.6 years) and the lowest for Chattogram division(72.1 years). We also compared the life expectancy and Household average income of the administrative divisions as obtained in the HIES 2016. No systematic relationship between household income and life expectancy was observed. Analysing the mortality of BMMCHS between 2010 and 2016, the life expectancy increased with the increase in wealth quintile for both males and females. The difference in life expectancy between the richest and poorest quintile of the male was 3.37 years, and for females, it was 1.34 years. But the much higher difference in life expectancy at birth between the richest and poorest quintile has been observed in other countries like India, the United Kingdom, the United States and Norway.

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Rates of early-onset (before 50 years of age) colorectal cancer (EOCRC) are increasing, with notable differences across racial and ethnic groups. Limited data are available on EOCRC-related mortality differences when disaggregating racial and ethnic groups. To investigate racial and ethnic differences in EOCRC mortality, including disaggregation of Asian American populations separately, including Native Hawaiian or Other Pacific Islander populations and specific Asian American groups, and to quantify the contribution of clinical and sociodemographic factors accounting for these differences. This population-based cohort study included California Cancer Registry data for individuals aged 18 to 49 years with EOCRC between January 1, 2000, to December 31, 2019. Median follow-up was 4.2 (IQR, 1.6-10.0) years. The data analysis was conducted between July 1, 2021, and September 30, 2024. Race and ethnicity defined as Asian American (and 7 disaggregated subgroups), Hispanic, Native Hawaiian or Other Pacific Islander, non-Hispanic American Indian or Alaska Native, non-Hispanic Black, and non-Hispanic White. Cox proportional hazards regression models were used to measure association between race and ethnicity and CRC mortality risk, yielding adjusted hazard ratios (AHRs) and 95% CIs. Associations of sociodemographic, health system, and clinical factors with differences in mortality by racial and ethnic minority group were assessed using sequential modeling. There were 22 834 individuals diagnosed with EOCRC between 2000 and 2019 (12 215 [53.5%] male; median age, 44 [IQR, 39-47] years). Racial and ethnic identity included 3544 (15.5%) Asian American, 6889 (30.2%) Hispanic, 135 (0.6%) Native Hawaiian or Other Pacific Islander, 125 (0.5%) non-Hispanic American Indian or Alaska Native, 1668 (7.3%) non-Hispanic Black, and 10 473 (45.9%) non-Hispanic White individuals. Compared with non-Hispanic White individuals, higher EOCRC mortality was found for Native Hawaiian or Other Pacific Islander (AHR, 1.34; 95% CI, 1.01-1.76) and non-Hispanic Black (AHR, 1.18; 95% CI, 1.07-1.29) individuals. Disaggregation of Asian American ethnic groups revealed notable heterogeneity, but no single group had increased EOCRC mortality risk after full adjustment for covariates. For Hispanic individuals, there was higher EOCRC mortality (AHR, 1.15 [95% CI, 1.08-1.22]) with the base model (adjustment for age, sex, and tumor characteristics), but the association disappeared once neighborhood socioeconomic status was added to the base model (AHR, 1.00 [95% CI, 0.94-1.06]). Similarly, there was higher EOCRC mortality among Southeast Asian individuals with the base model (AHR, 1.17 [95% CI, 1.03-1.34], but that association disappeared with the addition of insurance status to the model (AHR, 1.10 [95% CI, 0.96-1.25]). In this cohort study, racial and ethnic disparities in EOCRC mortality were evident, with the highest burden among Native Hawaiian or Other Pacific Islander and non-Hispanic Black individuals. These results provide evidence of the role of social determinants of health in explaining these differences.

Racial and ethnic differences in lung cancer screening (LCS) completion and follow-up may be associated with lung cancer incidence and mortality rates among high-risk populations. Aggregation of Asian American, Native Hawaiian, and Pacific Islander racial and ethnic groups may mask the true underlying disparities in screening uptake and diagnostic follow-up, creating barriers for targeted, preventive health care. To examine racial and ethnic differences in LCS completion and follow-up rates in a multiethnic population. This population-based cohort study was conducted at a health maintenance organization in Hawaii. LCS program participants were identified using electronic medical records from January 1, 2015, to December 31, 2019. Study eligibility requirements included being aged 55 to 79 years, a 30 pack-year smoking history, a current smoker or having quit within the past 15 years, at least 5 years past any lung cancer diagnosis and treatment, and cancer free. Data analysis was performed from June 2019 to October 2020. Eligible for LCS. Screening rates were analyzed by self-reported race and ethnicity and completion of a low-dose computed tomography (LDCT) test. Diagnostic follow-up results were based on the Lung Imaging Reporting and Data System (Lung-RADS) staging system. A total of 1030 eligible LCS program members had an order placed; their mean (SD) age was 65.5 (5.8) years, and 633 (61%) were men. The largest racial and ethnic groups were non-Hispanic White (381 participants [37.0%]), Native Hawaiian or part Native Hawaiian (186 participants [18.1%]), and Japanese (146 participants [14.2%]). Men and Filipino, Chinese, Japanese, and non-Hispanic White individuals had a higher proportion of screen orders for LDCT compared with women and individuals of the other racial and ethnic groups. The overall LCS completion rate was 81% (838 participants). There was a 14% to 15% screening completion rate gap among groups. Asian individuals had the highest screening completion rate (266 participants [86%]) followed by Native Hawaiian (149 participants [80%]) and non-Hispanic White individuals (305 participants [80%]), Pacific Islander (50 participants [79%]) individuals, and individuals of other racial and ethnic groups (68 participants [77%]). Within Asian subgroups, Korean (31 participants [94%]) and Japanese (129 participants [88%]) individuals had the highest completion rates followed by Chinese individuals (28 participants [82%]) and Filipino individuals (78 participants [79%]). Of the 54 participants with Lung-RADS stage 3 disease, 93% (50 participants) completed a 6-month surveillance LDCT test; of 37 individuals with Lung-RADS stage 4 disease, 35 (97%) were followed-up for additional procedures. This cohort study found racial and ethnic disparities in LCS completion rates after disaggregation of Native Hawaiian, Pacific Islander, and Asian individuals and their subgroups. These findings suggest that future research is needed to understand factors that may be associated with LCS completion and follow-up behaviors among these racial and ethnic groups.

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

The United States 2020 Census data: implications for precision medicine and theresearch landscape.

Life expectancy (LE) and health expectancy have increased throughout much of the world. However, these gains have not been shared equally across all population groups. Socioeconomic disparities exist, though varied methodologies and data sources have made it difficult to ascertain changes over time in Canada. The 1996 and 2011 Canadian Census Health and Environment Cohorts, with a five-year mortality follow-up, were used to estimate the LE of the household population at ages 25 and 65, according to individual-level education and income. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys and was used to adjust LE to estimate health-adjusted life expectancy (HALE). Disparities in LE and HALE, and differences between cohorts, were examined. LE, HALE and the ratio of HALE to LE were greater at higher levels of education or income. A stepwise gradient was also observed by level of education within and across income quintiles, with people in the lowest combined education and income categories at the greatest disadvantage. Disparities were wider in the 2011 cohort compared with the 1996 cohort, but not necessarily to the same extent for both sexes or at different ages. In Canada, education-related and income-related disparities in life and health expectancy persist and may be wider than they were in the past. This underscores the importance of ongoing data development for routine monitoring of trends in mortality and morbidity, which can, in turn, inform policy development and planning to advance health equity.

Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes. To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals. This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023. Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White). The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity. A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50). In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.

To date, research on sex differentials in lifespan variation and life expectancy has mainly been conducted in Western countries and there is a dearth of data from South Korea. This study aimed to further the understanding of mortality transition and life expectancy in South Korea, and the associated trajectories of age-at-death variation, through an analysis of life disparity by gender. Using complete life tables for South Korea for 1970-2015, sex differentials (female-male differences) in life disparity and life expectancy at birth were estimated, and sex differentials in life expectancy were decomposed by age and cause of death. The results showed that sex differentials in life expectancy at birth have not reduced significantly in the last 45 years (1970: 7.1 years; 2015: 6.2 years). Life disparity has reduced more rapidly for females than males, and the difference increased from -0.1 year in 1981 to -1.6 years in 2015. Sex differentials in life expectancy and life disparity in South Korea were higher during 1970-2015 than in several Western countries with high life expectancy. The elderly age group (60 and above) contributed 50% of the total sex difference in life expectancy at birth in 1970, and this increased to 70% in 2015. The contribution of the age group 15-59 years reduced significantly over the period. Decomposition of life expectancy at birth by cause revealed that diseases of the circulatory system (2.2 years), followed by external causes (1.3 years), were the most important causes of the sex differences in life expectancy at birth in 1983, and in 2015 neoplasms (2.2 years) and external causes (1.1 years) explained half of the total sex differences. There has been a significant shift in the age-specific pattern of the contribution towards each cause of death. Overall, sex differentials in life disparity and life expectancy at birth have remained significant in South Korea in the last 45 years.