Whites In California Research Articles

The Long-Run Impacts of Mexican American School Desegregation

We present the first quantitative analysis of the impact of ending de jure segregation of Mexican American schoolchildren in the United States by examining the effects of the 1947 Mendez v. Westminster court decision on long-run educational attainment for Hispanics and non-Hispanic Whites in California. Our identification strategy relies on comparing individuals across California counties that vary in their likelihood of segregating and across birth cohorts that vary in their exposure to the Mendez court ruling based on school start age. Results point to a significant increase in educational attainment for Hispanics who were fully exposed to school desegregation. (JEL H75, I24, J13, J15, K10, N32, R23)

The Long-Run Impacts of Mexican-American School Desegregation

We present the first quantitative analysis of the impact of ending de jure segregation of Mexican-American school children in the United States by examining the effects of the 1947 Mendez v. Westminster court decision on long-run educational attainment for Hispanics and non-Hispanic whites in California. Our identification strategy relies on comparing individuals across California counties that vary in their likelihood of segregating and across birth cohorts that vary in their exposure to the Mendez court ruling based on school start age. Results point to a significant increase in educational attainment for Hispanics who were fully exposed to school desegregation. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

The Long-Run Impacts of Mexican-American School Desegregation

We present the first quantitative analysis of the impact of ending de jure segregation of Mexican-American school children in the United States by examining the effects of the 1947 Mendez v. Westminster court decision on long-run educational attainment for Hispanics and non-Hispanic whites in California. Our identification strategy relies on comparing individuals across California counties that vary in their likelihood of segregating and across birth cohorts that vary in their exposure to the Mendez court ruling based on school start age. Results point to a significant increase in educational attainment for Hispanics who were fully exposed to school desegregation.

Incidence Rates of Colorectal Cancer in South Asians, Other Asian Groups, and Non-Hispanic Whites in California

Introduction: The incidence of colorectal cancer (CRC) varies by race and region. South Asians constitute a fast-growing group in the U.S. and are concentrated in California. We studied the most recent incidence rates and trends of CRC in South Asians in comparison to other Asian groups and Non-Hispanic Whites in California. Methods: Using the California Cancer Registry SEER*Stat database, we calculated age-adjusted CRC incidence rates between 2011-2015 for South Asians, other Asian groups, and Non-Hispanic Whites. We defined South Asians as Asian Indians, Pakistanis, Bangladeshis, Sri Lankans, Nepalis, Bhutanese, and Maldivians. We also studied the annual percentage change (APC) in CRC incidence rates in South Asians, other Asian groups, and Non-Hispanic Whites between 1988-2014. Results: South Asians had a significantly lower incidence of colon, rectal, and rectosigmoid cancer than other Asian groups and non-Hispanic Whites, among both males and females (Table 1). Males in other Asian groups had higher CRC rates than Whites. Both proximal and distal CRC incidence rates in South Asians were lower than other Asians and Whites. Distal CRC rates were higher in other Asian groups than in Whites. Whites had the highest CRC incidence in the <50-year age group. No significant change was noted in the incidence rates of CRC in South Asians between 1988-2014 (Table 2, p<0.05). There was a significant decrease in the rates of colon (proximal and distal) and rectal carcinoma in other Asians in both males and females between 2000-2014 (Table 2, p<0.05), and in Whites (proximal and distal) in both males and females between 1988-2014 (Table 2, p<0.05). CRC rates in the <50-year age group increased significantly in Whites between 1992-2014, and non-significantly in South Asians and other Asians (Table 2, p<0.05). Conclusion: In this study, we found that South Asians had a significantly lower incidence of CRC in comparison to other Asian groups and Non-Hispanic Whites. CRC rates in other Asians is approaching that of Whites. CRC incidence trends show a significant decrease in other Asian groups and in Non-Hispanic Whites between 1988-2014, but not in South Asians. CRC rates are increasing in the <50-year age group across all racial groups. Continued efforts are needed to reduce the incidence of CRC in Asian populations, and to further investigate the etiologies of younger onset CRC.256_A Figure 1. Age adjusted incidence rates of CRC in South Asians, other Asian groups, and Non-Hispanic Whites in California between 2011-2015.256_B Figure 2. Trend in CRC incidence rates in South Asians, other Asian groups, and Non-Hispanic Whites in California between 1988-2014.

Cancer risk in different generations of Middle Eastern immigrants to California, 1988-2013.

The objective of this study is to compare cancer risk among different generations of Middle Eastern immigrants (ME) and non-Hispanic whites (NHW) in California between 1988 and 2013. We used data from the California Cancer Registry to identify invasive primary incident cancer cases in three population groups: (i) first-generation ME immigrants, (ii) second- or subsequent-generations ME immigrants, and (iii) NHW. Proportional incidence ratio (PIR) was used to compare cancer risk of the 15 selected most common cancers in the 3 population groups taking into consideration time since immigration for first-generation ME immigrants. First generation ME immigrants were more likely to be at increased risk of stomach (PIR= 3.13) and hepatobiliary (PIR = 2.27) cancers in females and thyroid (PIR = 2.19) and stomach (PIR = 2.13) cancers in males in comparison with NHW. Second- or subsequent-generations ME immigrants were at increased risk of thyroid cancer (PIR = 1.43 in females and 2.00 in males) in comparison with NHW, and malignant melanoma cancer (PIR = 4.53 in females and 4.61 in males) in comparison with first-generation ME immigrants. The risk levels of breast, thyroid and bladder cancers in ME first generation were significantly higher compared to NHW regardless of time spent in the United States suggesting the role of genetic predisposition, and/or cultural characteristics associated with these cancers. The results suggest that differences in cancer risk between ME first-generation immigrants and NHW change in second or subsequent generations, approaching the risk level of NHW and indicating the impact of acculturation in this immigrant population.

Abstract B25: Impact of neighborhood obesogenic factors on obesity in over 100,000 participants of the Multiethnic Cohort Study

Abstract Introduction: The obesity epidemic is a serious health priority with important consequences on obesity-associated cancers. Socioeconomic (SES) and “obesogenic” attributes of neighborhoods may promote obesity by providing a context where it is difficult to engage in physical activity and/or access healthy foods. This may be particularly relevant for minority populations that have limited neighborhood resources and experience higher levels of obesity. However, the extent to which these neighborhood factors translate into individual levels of body mass index (BMI) have been mixed among racial/ethnic groups. Therefore, leveraging the scale and racial/ethnic diversity of the Multiethnic Cohort (MEC) study, we examined the associations between neighborhood obesogenic factors and BMI among African Americans, Japanese Americans, Latinos, and Whites in California. Methods: Study subjects included 107,697 MEC participants, ages 45-75, residing in California (93% from Los Angeles County) with geocoded addresses and data available on BMI at baseline questionnaire (1993-1996). Residential baseline addresses were geocoded to latitude and longitude coordinates and assigned to 1990 Census block groups to ascertain neighborhood levels of SES, population density, and commute patterns. In addition, geocodes were linked to business data to quantify neighborhood attributes of the retail/restaurant food environment, parks, recreational facilities, walkability, traffic density, and total businesses within a residential buffer area of one mile in radius. Polytomous logistic regression was conducted to examine the relationship between the obesogenic environment and BMI in kg/m2 (underweight: BMI&amp;lt;18.5; normal weight: BMI=18.5-&amp;lt;25 (reference); overweight BMI=25-&amp;lt;30; obese BMI&amp;gt;30) adjusting for age, sex, and race/ethnicity and including all neighborhood obesogenic factors. Stratified analyses were conducted by gender and race/ethnicity. Results: Lower neighborhood SES was significantly associated with higher odds of being overweight and obese. For males, in comparison to the highest SES quintile (Q5), the odds ratios and 95% confidence intervals for obesity with decreasing SES quintiles were Q4: OR=1.36 (95% CI: 1.20-1.50), Q3: OR=1.59; (95% CI: 1.40-1.81), Q2: OR=1.70 (95% CI: 1.49-1.93), and Q1: OR=1.89 (95% CI: 1.63-2.19). For females, similar patterns of associations were seen although larger associations were observed (Q4: OR=1.52 (95% CI: 1.36-1.70), Q3: OR=2.11 (95% CI: 1.89-2.34), Q2: OR=2.72 (95% CI: 2.43-3.03), Q1: OR=3.34 (95% CI: 2.94-3.78)). All racial/ethnic groups demonstrated similar patterns of associations between SES and obesity. Neighborhoods with smaller density of businesses (i.e. fewer nearby walkable destinations) were significantly associated with higher odds of obesity (ORQ1 vs. Q5=1.24; 95% CI: 1.14-1.34). This association was consistently observed among African American males and females, U.S. born Latino males, foreign-born Latino females, and White females. For White males and females, residence in neighborhoods with lower levels of commuting by car or motorcycle were associated with lower odds of obesity in comparison to residence in neighborhoods at the highest level of commuting by car or motorcycle (males ORQ1 vs. Q5=0.51; 95% CI: 0.35-0.76; females ORQ1 vs. Q5=0.64; 95% CI: 0.48-0.84). Conclusion: These findings demonstrate the impact of the neighborhood environment on obesity with complex relationships observed across gender and racial/ethnic groups. Future analyses will incorporate individual-level health behaviors such as dietary factors, physical activity and smoking, as well estimates of genetic ancestry. Our understanding of this relationship between the obesogenic environment and obesity provides a framework for future studies of neighborhood obesogenic factors and cancer risk. Citation Format: Iona Cheng, Juan Yang, Andrew Hertz, Christina Clarke, Cheryl Albright, Loic Le Marchand, Laurence Kolonel, Brian Henderson, Kristine Monroe, Scarlett Lin-Gomez, Lynne Wilkens. Impact of neighborhood obesogenic factors on obesity in over 100,000 participants of the Multiethnic Cohort Study. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B25.

Preterm birth among the Hmong, other Asian subgroups and non-Hispanic whites in California.

BackgroundWe investigated very preterm (VPTB) and preterm birth (PTB) risk among Hmong women relative to non-Hispanic whites and other Asian subgroups. We also examined the maternal education health gradient across subgroups.MethodsCalifornia birth record data (2002–2004) were used to analyze 568,652 singleton births to white and Asian women. Pearson Chi-square and logistic regression were used to assess variation in maternal characteristics and VPTB/PTB risk by subgroup.ResultsWhite, Chinese, Japanese, Korean, Asian Indian, and Vietnamese women had 36–59 % lower odds of VPTB and 30–56 % lower odds of PTB than Hmong women. Controls for covariates did not substantially diminish these disparities. Cambodian, Filipino and Lao/Thai women’s odds of VPTB were similar to that of Hmong women. But they had higher adjusted odds of PTB compared to the Hmong. There was heterogeneity in the educational gradient of PTB, with significant differences between the least and most educated women among whites, Chinese, Japanese, Asian Indians, Cambodians, and Laoians/Thais. Maternal education was not associated with PTB for Hmong, Vietnamese and Korean women, however.ConclusionsStudies of Hmong infant health from the 1980s, the decade immediately following the group’s mass migration to the US, found no significant differences in adverse birth outcomes between Hmong and white women. By the early 2000s, however, the disparities in VPTB and PTB between Hmong and white women, as well as between Hmong and other Asian women had become substantial. Moreover, despite gains in post-secondary education among childbearing-age Hmong women, the returns to education for the Hmong are negligible. Higher educational attainment does not confer the same health benefits for Hmong women as it does for whites and other Asian subgroups.

Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California.

ObjectivesEmpirical evidence regarding cancer screening and health literacy is mixed. Cancer is the leading cause of death in Asian Americans, yet screening rates are notably low. Using a population-based sample, we determined if health literacy: (1) was associated with breast and cervical cancer screening, and (2) helped to explain Asian cancer screening disparities.MethodsWe analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, other Asian) and white women within age groups relevant to US Preventive Services Task Force (USPSTF) screening guidelines: cervical: ages 21–65 (n = 15,210) and breast: ages 50–74 (n = 11,163). Multilevel logistic regression models predicted meeting USPSTF screening guidelines both with and without self-reported health literacy controlling for individual-level and contextual-level factors.ResultsLow health literacy significantly (p < 0.05) predicted lower cancer screening in final models for both cancer types. In unadjusted models, Asians were significantly less likely than whites to receive both screening types and significantly more likely to report low health literacy. However, in multivariable models, the addition of the low health literacy variable did not diminish Asian vs. white cancer screening disparities.ConclusionsSelf-reported health literacy predicted cervical and breast cancer screening, but was not able to explain Asian cancer screening disparities. We provide new evidence to support a relationship between health literacy and cancer screening. Health literacy is likely a useful focus for interventions to improve cancer screening and ultimately reduce the burden of cancer. To specifically reduce Asian cancer disparities, additional areas of focus should be considered.

Smoking Trends and Disparities Among Black and Non-Hispanic Whites in California.

The current study examined disparities in smoking trends across Blacks and non-Hispanic Whites in California. Data from the 1996 to 2008 California Tobacco Survey were analyzed to examine trends in smoking behaviors and cessation across Blacks and non-Hispanic Whites. A decrease in overall ever and current smoking was observed for both Black and non-Hispanic Whites across the 12-year time period. A striking decrease in proportions of heavy daily smokers for both Black and non-Hispanic Whites were observed. Proportions of light and intermittent smokers and moderate daily smokers displayed modest increases for Blacks, but large increases for non-Hispanic Whites. Increases in successful cessation were also observed for Blacks and, to a lesser extent, for non-Hispanic Whites. Smoking behavior and cessation trends across Blacks and non-Hispanic Whites were revealing. The decline in heavy daily and former smokers may demonstrate the success and effectiveness of tobacco control efforts in California. However, the increase in proportions of light and intermittent smokers and moderate daily smokers for both Blacks and non-Hispanic Whites demonstrates a need for tobacco cessation efforts focused on lighter smokers.

Effect of acculturation on variations in having a usual source of care among Asian Americans and non-Hispanic whites in California.

We examined variations in having a usual source of care (USC) among non-Hispanic White and Asian American adults in California. Data were from the 2005 and 2009 California Health Interview Survey. Using a modified Anderson model, we used multiple logistic regression to compare odds of having a USC between non-Hispanic White (n=38554) and Asian American adults (n=7566) and to examine associations with acculturation factors (English proficiency, length of residence, residence in a racially concordant neighborhood) and key enabling (employment, income, insurance) and predisposing (education) factors. Race-related disparities between Asian Americans and non-Hispanic Whites in having a USC were no longer significant after accounting for acculturation factors. Limited English proficiency and short time in the United States (<5 years) were significantly associated with not having a USC for both races. Increasing levels of education and insurance were not associated with better access among Asian Americans. Key differences exist in how Asian American and non-Hispanic White adults access care. Acculturation factors are key drivers of disparities and should be included in access-to-care models with Asians. Insurance and education are differentially significant for Asian Americans and non-Hispanic Whites.

Colorectal Cancer Screening: Low Health Literacy and Limited English Proficiency Among Asians and Whites in California

The authors examined the relationship between low health literacy (LHL), limited English proficiency (LEP), and meeting current U.S. Preventive Service Task Force colorectal cancer (CRC) screening guidelines for Asians and Whites in California. For 1,478 Asian and 14,410 White respondents 50–75 years of age in the 2007 California Health Interview Survey, the authors examined meeting CRC screening guidelines using multivariable logistic models by LEP and LHL separately and in combination. Analyses were run with the full sample, then separately for Whites and Asians controlling for demographics and insurance. For those with LEP, patient-provider language concordance and CRC screening was examined. Overall, respondents with LEP and LHL were the least likely to meet CRC screening guidelines (36%) followed by LEP-only (45%), LHL-only (51%), and those with neither LHL nor LEP (59%), a hierarchy that remained significant in multivariable models. For Whites, LHL-only was associated with screening, whereas LEP-only and LEP and LHL were significant for Asians. Having a language concordant provider was not significantly associated with CRC screening among those with LEP. Health literacy is associated with CRC screening, but English proficiency is also critical to consider. Asians with both LEP and LHL appear particularly vulnerable to cancer screening disparities.

Food Insecurity and Obesity Among American Indians and Alaska Natives and Whites in California

Food insecurity is linked to obesity among some, but not all, racial and ethnic populations. We examined the prevalence of food insecurity and the association between food insecurity and obesity among American Indians (AIs) and Alaska Natives (ANs) and a comparison group of whites. Using the 2009 California Health Interview Survey, we analyzed responses from 592 AIs/ANs and 7371 white adults with household incomes at or below 200% of the federal poverty level. Food insecurity was measured using a standard 6-item scale. Sociodemographics, exercise, and obesity were all obtained using self-reported survey data. Logistic regression was used to estimate associations. The prevalence of food insecurity was similar among AIs/ANs and whites (38.7% vs 39.3%). Food insecurity was not associated with obesity in either group in analyses adjusted for sociodemographics and exercise. The ability to afford high-quality foods is extremely limited for low-income Californians regardless of race. Health policy discussions must include increased attention on healthy food access among the poor, including AIs/ANs, for whom little data exist. [Supplemental materials are available for this article. Go to the publisher's online edition of Journal of Hunger & Environmental Nutrition to view the free supplemental file: Supplemental Tables.doc.].

Colorectal cancer among Koreans living in South Korea versus California: incidence, mortality, and screening rates

Objectives. This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations.Design. Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999–2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations.Results. CRC incidence and mortality rates among South Koreans increased during 1999–2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening.Conclusion. Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries.

Serum zinc and prostate cancer risk in a nested case–control study: The multiethnic cohort

Experimental studies have provided evidence that zinc has a protective effect against development and progression of prostate cancer. However, epidemiological studies have reported inconsistent findings. We evaluated the association between prediagnostic serum zinc and prostate cancer risk in a cohort of multiethnic population. This case-control study is nested within the Multiethnic Cohort of African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in Hawaii and California. The analysis included 392 prostate cancer cases and 783 controls matched on age, race/ethnicity, date/time of blood draw and fasting status. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). The mean serum zinc concentrations did not significantly differ between cases (94.9 µg/dl) and controls (93.9 µg/dl). No association was found between serum zinc levels and prostate cancer either overall or by tumor stage/grade. In ethnic-specific analyses, positive associations were found in Japanese Americans (OR for the highest vs. the lowest tertile = 2.59, 95% CI: 1.09-6.17) and Latinos (OR = 2.74, 95% CI: 1.05-7.10), whereas no association was observed in African Americans and whites. We found no evidence to support an inverse relationship between serum zinc and prostate cancer risk, and, to the contrary, found a suggestion in the ethnic-specific results of a possible increase in risk; however, blood concentrations of zinc may not adequately reflect the levels in prostate tissue. Further study with a larger sample size, and if possible, with assessment of zinc tissue levels, is warranted to confirm these findings.

Disparities in Health Status and Health Care Access and Use Among Older American Indians and Alaska Natives and Non-Hispanic Whites in California

The present study compared the characteristics of health status and health care access and use among older American Indians and Alaska Natives (AIANs) to those of non-Hispanic Whites (NHWs). Data were drawn from the 2009 California Health Interview Survey, with a total of 17,156 adults aged 60 and older (198 AIANs and 16,958 NHWs) analyzed. Older AIANs reported poorer physical and mental health than did NHWs. AIANs were less likely than NHWs to see a medical doctor and have a usual source of medical care and were more likely than NHWs to delay getting needed medical care and report difficulty understanding the doctor at their last visit. These findings highlight the vulnerability and unmet health care needs of older AIANs. More research on the older AIAN population is clearly needed to document their health care needs in order to better inform efforts to reduce health disparities.

Serum Zinc and Prostate Cancer Risk in the Multiethnic Cohort study

ISEE-0248 Background and Objective: Because zinc is highly concentrated in prostatic tissue and is essential to DNA synthesis, immune function, and antioxidant activity, it may be protective against the development and progression of prostate cancer. On the other hand, because it is essential for androgen production, it may increase prostate cancer risk. In this study, we evaluated the association between prediagnostic serum zinc and subsequent prostate cancer risk in a multiethnic population. Methods: This case-control study was nested within the Multiethnic Cohort of African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in Hawaii and California. The analysis included 392 incident prostate cancer cases and 783 matched controls over a 1.9-year follow-up period. Multivariate conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: The mean serum zinc concentration did not significantly differ between cases (94.9 μg/dl) and controls (93.9 μg/dl). No association was found between serum zinc level and prostate cancer either overall or by tumor stage/grade. In ethnic-specific analyses, positive associations were found in Japanese Americans (OR for the highest vs. the lowest tertile = 2.54, 95% CI = 1.08–6.00, P for trend = 0.03) and Latinos (OR = 2.72, 95% CI = 1.04–7.08, P for trend = 0.09), whereas no association was observed in African Americans and whites; however, there was no heterogeneity across ethnic groups (P = 0.11). Additional adjustment for soy intake, the only dietary factor associated with risk in this cohort, did not alter the findings. Conclusion: We found no evidence to support a protective effect of zinc against prostate cancer, and a suggestion in the ethnic-specific results of a possible increase in risk. This offers some support to the hypothesis that higher zinc exposure may increase prostate cancer risk by raising testosterone levels.

Traffic Law Knowledge Disparity Between Hispanics and Non-Hispanic Whites in California

The Hispanic population is one group that is involved in a disproportionately high percentage of fatal motor vehicle collisions in the United States. This study investigated demographic factors contributing to a lack of knowledge and awareness of traffic laws among Hispanic drivers involved in motor vehicle collisions (MVCs) in southern California. The cross-sectional study enrolled adults (n = 190) involved in MVCs presenting to a Level I trauma center in southern California over a 7-month period. Subjects completed a survey about California traffic law knowledge (TLK) consisting of eight multiple-choice questions. The mean number of questions answered correctly was compared between groups defined by demographic data. The mean number of TLK questions answered correctly by Hispanic and non-Hispanic white groups were significantly different at 4.13 and 4.62, respectively (p = 0.005; 95% confidence interval -0.83 to -0.15). Scores were significantly lower in subjects who were not fluent in English, had less than a high school education, did not possess a current driver's license, and received their TLK from sources other than a driver's education class or Department of Motor Vehicle materials. Analysis of variance showed that the source of knowledge was the strongest predictor of accurate TLK. Source of TLK is a major contributing factor to poor TLK in Hispanics. An emphasis on culturally specific traffic law education is needed.

Cardiovascular Risk Factors and Knowledge of Symptoms Among Vietnamese Americans

BACKGROUNDThere are few population-based studies of cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans.OBJECTIVETo describe cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans and compare the results to non-Hispanic whites.DESIGNComparison of data from two population-based, cross-sectional telephone surveys.PARTICIPANTSVietnamese Americans in Santa Clara County, California, and non-Hispanic whites in California, aged 18 and older.MEASUREMENTSSurvey measures included sociodemographics, diagnoses, body mass index, fruit and vegetable intake, exercise, and tobacco use. Knowledge of symptoms of heart attack and stroke was collected for Vietnamese Americans.MAIN RESULTSCompared to non-Hispanic whites (n = 19,324), Vietnamese Americans (n = 4,254) reported lower prevalences of obesity, diabetes mellitus, coronary heart disease, and hypertension, and similar prevalences of stroke and hypercholesterolemia. Fewer Vietnamese Americans consumed fruits and vegetables five or more times daily (27.8% vs 16.3%, p < 0.05), and more reported no moderate or vigorous physical activity (12.1% vs 40.1%, p < 0.05). More Vietnamese men than non-Hispanic White men were current smokers (29.8% vs 19.0%, p < 0.05). Vietnamese Americans who spoke Vietnamese were more likely than those who spoke English to eat fruits and vegetables less frequently, engage in no moderate or vigorous physical activity, and, among men, be current smokers. Only 59% of Vietnamese Americans knew that chest pain was a symptom of heart attack.CONCLUSIONSThere are significant disparities in risk factors and knowledge of symptoms of cardiovascular diseases among Vietnamese Americans. Culturally appropriate studies and interventions are needed to understand and to reduce these disparities.

Racial Disparities in the Development of Dysphagia After Stroke: Analysis of the California (MIRCal) and New York (SPARCS) Inpatient Databases

Gonzalez-Fernandez M, Kuhlemeier KV, Palmer JB. Racial disparities in the development of dysphagia after stroke: analysis of the California (MIRCal) and New York (SPARCS) inpatient databases. Objectives To determine whether the proportion of patients with stroke experiencing dysphagia differs among racial groups and whether this relation can be explained by stroke type or severity. Design Case-control study using California's Medical Information Reporting and New York's Statewide Planning and Research Cooperative System databases for 2002. Cases had primary diagnosis of cerebrovascular disease ( International Classification of Disease, 9th Revision [ICD-9] codes 430–438.9, excluding transient [435–435.9] and late-effects [438–438.9]), and self-identified race was white, black, or Asian. Two comparison groups were selected: (1) Parkinson's disease (ICD-9 codes 332–332.1) and (2) oral cancer (ICD-9 codes 141–149). Setting Inpatient admissions in the respective states. Participants Cases with primary diagnosis of cerebrovascular disease whose self-identified race was white, black, or Asian. Interventions Not applicable. Main Outcome Measure Dysphagia, defined by ICD-9 codes 787.2 (dysphagia), 507.0 (aspiration pneumonia), or presence of a feeding tube in the absence of a diagnosis of coma (Current Procedural Terminology codes 432.46 or 437.50 without ICD-9 code 780.01). Results In the stroke group, the adjusted odds ratio (OR) with 95% confidence interval (CI) for dysphagia was significantly higher for Asians than whites in New York (OR=1.64; 95% CI, 1.50–1.79) and California (OR=1.69; 95% CI, 1.34–2.13). The adjusted OR was slightly but significantly higher for blacks than whites in New York (OR=1.15; 95% CI, 1.03–1.28), but not in California (OR=1.08; 95% CI, 0.97–1.19). No statistically significant differences among racial groups were found in patients with Parkinson's disease or oral cancer. Other factors strongly associated with dysphagia included hemiplegia (OR=2.19; 95% CI, 2.07–2.32) and aphasia (OR=1.97; 95% CI, 1.83–2.11). Conclusions Asians were more likely to have dysphagia after stroke. This association was statistically significant after adjusting for age, sex, stroke severity indicators, comorbidities, and stroke type.

Predicting Readmission Stroke Type Among Blacks and Whites in California

It is generally assumed that initial and recurrent strokes are of the same type, but data from South London, United Kingdom; Lausanne, Switzerland; and other studies suggest this may not be true for certain subtypes. In these studies, however, the number of recurrent strokes observed during the follow-up period was small, thereby limiting the ability of these studies to provide reliable estimates of stroke type concordance. Using a large, diverse, inpatient database, this study sought to: (1) estimate the relative agreement (Cohen's kappa) between initial and recurrent stroke types for blacks and whites; and (2) develop a risk-adjusted logistic model for readmission stroke type, with the initial admission stroke type as the main predictor and race, other sociodemographic variables, and clinical and hospital characteristics as potential covariates. Stroke type concordance was similar for blacks (kappa = 0.77, 95% confidence interval [CI] = 0.71-0.83) and whites (kappa = 0.77, 95% CI = 0.74-0.79). In the adjusted logistic regression models, the initial admission stroke type strongly predicted the readmission stroke type (subarachnoid hemorrhage: odds ratio [OR] = 738.31, 95% CI = 422.58-1289.93; intracerebral hemorrhage [ICH]: OR = 80.86, 95% CI = 61.57-106.19; ischemic: OR = 125.81, 95% CI = 96.12-164.67). Other patient factors, but not race, also predicted readmission stroke type (e.g., younger age increased the odds of having an subarachnoid hemorrhage readmission; atrial fibrillation increased the odds of having an ICH readmission; older age, diabetes mellitus, and heart failure increased the odds of having an ischemic stroke readmission). This study showed that the initial stroke type and other factors were independently associated with the readmission stroke type and that patterns of stroke type concordance were similar for blacks and whites. These results may help to identify patients in high-risk subgroups who are more likely to have a recurrent hemorrhagic stroke, which could inform patient treatment decisions. For example, patients with atrial fibrillation may be at greater risk for having an ICH readmission because of the adverse effects of anticoagulant therapy, antiplatelet treatment, or both, which should be investigated further.