Young Asian Women Research Articles

Ketorash: An underdiagnosed entity

Ketoacidosis-Induced Prurigo Pigmentosa is a rare, inflammatory disease characterized by pruritic, erythematous papules with a reticulate pattern on the torso and neck. It affects predominantly young adult Asian women with risk factors for metabolic ketosis, such as Diabetes Mellitus, anorexia nervosa, bariatric surgery and ketogenic diet. A 26-year-old female being treated for refractory focal frontal and generalized epilepsy with ketogenic diet for four months was consulted due to a three-month-long dermatosis which started in the anterior and posterior cervical region and progressed towards the dorsal midline area. Skin lesions were papular and erythematous, often merging with a vaguely reticulated pattern. These lesions were highly pruriginous and worsened during periods ofhigher ketonemia. Histological examination of a cutaneous biopsy sample was compatible with Ketorash. The patient suspended ketogenic diet and was medicated with topical erythromycin, with full resolution of the lesions and no recurrences after 8 months.

Financial Toxicity Among Women with Breast Cancer Varies by Age and Race.

Financial toxicity negatively affects clinical outcomes in breast cancer. Underrepresented demographics may be at higher risk for financial toxicity. We characterized disparities on the basis of age and other factors. Surveys completed by women with stage 0-IV breast cancer treated at Memorial Sloan Kettering Cancer Center between 06/2022 and 05/2023 were analyzed. The comprehensive score for financial toxicity (COST) scale was used to assess financial toxicity. Descriptive statistics were calculated for differences in financial toxicity/related factors, and outcomes by age and race. Associations between variables of interest and COST scores were analyzed using linear regression. Of 8512 respondents (75% white, 9.3% Asian, 8.4% Black), most (68%) had clinical stage 0/I disease. Stratified by age, young Black women had higher financial toxicity than young white or Asian women (p < 0.001). On multivariable analysis, women age < 45years experienced higher financial toxicity than older women (coefficient - 2.0, 95% CI - 2.8 to - 1.1, p < 0.001). Compared with white women, financial toxicity was greater among Black (coefficient - 6.8, 95% CI - 7.8 to - 5.8) and Asian women (coefficient - 3.5, 95% CI - 4.4 to - 2.5). Cost-related medication non-adherence was more frequent among Black and Asian women (p < 0.001). Asian women more often paid for treatment with savings than white and Black women (p < 0.001). Young women reported using savings for treatment-related costs more than older (45% vs. 32%); p < 0.001). Racial minorities and young patients are disproportionately affected by financial toxicity. Further studies are planned to determine how financial toxicity evolves over time and whether referral to financial services effectively reduces toxicity.

Takayasu arteritis masquerading as recurrent abdominal pain

Takayasu arteritis (TA) is a rare granulomatous inflammation of large arteries, specifically the aorta and its branches. It is more prevalent in young Asian women with the highest incidence in Japan. There is a delay in diagnosis due to nonspecific early symptoms and unfamiliarity with this disease. We present a case of a young female who presented with recurrent abdominal pain suggestive of mesenteric angina and constitutional symptoms over one-year. Her radial pulses were absent, and she had multiple bruits on examination over the right subclavian and carotid arteries and the epigastrium, along with high inflammatory markers. Her CT angiography of large vessels confirmed the diagnosis of TA and she was treated with high-dose steroids with good clinical remission confirmed by a reduction in inflammatory markers and improvement in symptoms.

Survival outcomes of young patients under 40 with breast cancer in Asian countries according to subtype: An international multicenter cohort study.

562 Background: The incidence of young Asian women with breast cancer has been increasing but these patients are underrepresented in global data. We analyzed the epidemiology and outcomes of the young Asian patients with breast cancer in different subtypes with clinically unmet need. Methods: Female patients of age 20 years or older diagnosed with early breast cancer of stage I, II, or III from the prospective cohort of the Asian Breast Cancer Cooperative Group (ABCCG) were analyzed. For comparison, data of patients with early breast cancer from Surveillance, Epidemiology, and End Results Program (SEER) cancer registry was used. The patients were divided into three age groups: young (below 40 years), alleged premenopausal mid-age (40-49 years), and alleged postmenopausal elderly (50 years and older). Multivariable Cox proportional-hazard models for survivals were adjusted with age, subtypes consisting of hormone receptor (HR) and human epithelial growth factor receptor 2 (HER2) status, histologic grade, T stage, nodal status, and countries. Patients diagnosed in 2000–2010 were censored at 6 years for comparability with SEER database. Results: Total 45,021 patients with breast cancer from Asian countries, 496,332 of SEER Whites and 18,279 from SEER non-Whites were included. The median age at diagnosis was younger in Asians compared to SEER Whites and non-Whites (51, 62, 58 years, respectively). Among subtypes, HR-positive and HER2-negative breast cancer was more frequent among SEER Whites and SEER non-Whites, compared to Asians (75.89%, 73.38% vs. 65.75%, respectively). In the young group, HR-positive and HER2-negative breast cancer was prevalent in Asians and SEER non-Whites, compared to SEER Whites (61.2% and 59.8% vs. 54.7%, respectively). In the elderly group, the proportion of HR-positive breast cancer increased in SEER Whites, while that of triple-negative breast cancer (TNBC) increased in Asians. Elderly group showed the worst survival in all subtypes and in all populations. In Asian population, the mid-age group of the patients with HR-positive and HER2-negative breast cancer showed significantly superior overall survival (OS) than the young group (6 year OS 96.6% vs. 94.4%; hazard ratio 0.62, 95% confidence interval 0.50-0.76; p&lt;0.001). Similarly, young patients in SEER Whites also showed early decline of survival curve compared those in mid-age group (89.1% vs. 94.0%, p&lt;0.001), while young patients of SEER non-Whites showed equivalent prognosis to those in mid-age group (92.4% vs. 95.0%, p=0.118). Conclusions: Young Asian breast cancer patients diagnosed with HR-positive and HER2-negative subtypes, but not HER2-positive or TNBC subtypes, are more likely to have worse survival outcomes than those in mid-age. Further studies on young patients with breast cancer are needed for tailored treatments among different subtypes and ethnic groups.

Comparison of the efficacy and safety of leflunomide versus placebo combined with basic prednisone therapy in patients with active disease phase of Takayasu arteritis: study protocol for a randomized, double-blinded controlled trial (Takayasu arteritis clinical trial in China: TACTIC).

Takayasu arteritis (TAK) is an immune-induced granulomatous vasculitis that occurs primarily in young Asian women. Our previous cohort studies have indicated that leflunomide (LEF), which can lead to rapid induction and might be a promising alternative treatment for TAK. To compare the efficacy and safety of LEF versus placebo combined with prednisone for active TAK in a Chinese population. This will be a multicenter, randomized, double-blinded controlled trial aiming to recruit 116 TAK patients with active disease. This study will last 52 weeks. Participants will be assigned randomly to the LEF intervention arm or placebo control arm at a 1:1 ratio. Initially, LEF combined with prednisone will be given to the intervention arm and a placebo tablet combined with prednisone will be given to the placebo arm. At the end of week 24, subjects who achieved clinical remission or partial clinical remission will proceed to maintenance therapy with LEF to the end of week 52; those who did not achieve clinical remission or partial clinical remission in the LEF intervention arm will drop out from the study, and those in the placebo control arm will switch to LEF treatment to week 52. The primary endpoint will be the clinical remission rate of LEF versus placebo at the end of week 24. The secondary endpoints will be the time to clinical remission, mean dose of prednisone, disease recurrence, time to recurrence, adverse events, as well as clinical remission in subjects who switched from the placebo control arm to LEF therapy after week 24. Intention to treat will be the primary analysis. This is the first randomized double-blinded placebo-controlled trial to clarify the efficacy and safety of LEF in treating active TAK. The results will provide more evidence for TAK management. ClinicalTrials.gov identifier: NCT02981979.

Racialized-gendered Experiences and Mental Health Vulnerabilities of Young Asian Women in Toronto, Canada

Discourses of mental health vulnerabilities of women in the Asian diaspora s are often invoked through the concepts of “culture” with little consideration of asymmetric power relations and structural influences. We used a narrative approach to explore the experiences and perspectives on culture, identities, relationships, and mental health among young Asian women living in Toronto, Canada. We engaged 14 participants in focus groups and individual interviews, and identified four overall themes: (1) racialized-gendered bodily abjection, (2) experiences of enacted racism and sexism, (3) perceptions of familial expectations, and (4) their strategies of coping and resilience. Our analysis revealed how Whiteness and structural violence shape the racialized-gendered experiences of young Asian women and perpetuate microaggressions that compromise their mental health and well-being. Critical nursing practice must question the idea of “culture” embedded in the dominant discourse of “culturally competent” care. Nurses need to achieve structural competence to dismantle systems of oppression and unequal power relations.

NUP98-HOXA9 Bearing Acute Myeloid Leukemia

Acute myeloid leukemia (AML) with NUP98-HOXA9 fusion gene is rare, which is caused by t(7;11)(p15;p15). Not only the prognosis is poor, the efficacy of conventional induction regimen is also barely satisfactory. Here we report two cases of NUP98-HOXA9 bearing AML. Patient 1 was a 54-year-old female. In September of 2019, she felt fatigue with complete blood count (CBC) result of leukocytes 246.78× 109/L, hemoglobin 81g/L, and platelet 119 × 109/L. Peripheral blood smear showed 5% blast cells, and bone marrow (BM) smear demonstrated AML-M5. Chromosome 46, XX, t (7; 11) (p15; p15) [20], NuP98/HOXA9 fusion gene, EVI1 expression, FLT3-ITD and KRAS mutation was also found in her BM. One course of standard induced chemotherapy regimen IA reached CR, with MRD＜10-4, low expression of EVI1, and FLT3-ITD(-)，normal chromosome, but NuP98/HOXA9（+）. After the second course of IA, relapse occurred partly due to delayed admission under the influence of COVID-19. Reinduction with IA, azacytidine +HE, FLAG regimen failed to reach remission, and the patient died of bone marrow suppression and gastrointestinal bleeding. Patient 2 was a 65-years-old male. In September of 2019, he suffered from fatigue and CBC showed leukocytes 2.52× 109/L, hemoglobin 36g/L and platelet 139 × 109/L. Peripheral blood smear showed immature cells of 7%, and his BM smear demonstrated AML-M4. Chromosome 46, XY, t (7; 11) (p15; p15) [18]/46, XY[1], NuP98/HOXA9 fusion gene and IDH2 R140Q mutation were found in the patient. He had a history of chemotherapy for small cell lung cancer. After induced by regimen of DIAG, DHEG and DCAG successively, he did not reach remission. Repeated fever and lung infection occurred during the course of the disease. He was discharged automatically due to the progression of lung cancer. NuP98/HOXA9 bearing AML is more common in young Asian women, and the majority is type M2. The two patients in this report were older with M4 or M5 type, which was rare in this kind of leukemia. NuP98/HOXA9 is a poor prognostic factor for AML. Patient 1 could reach cytogenetic CR after IA induction, relapsed before transplantation, and the effect of reinduction therapy was poor; Patient 2 did not achieve remission. It is suggested from the these patients that patients with NuP98/HOXA9 bearing AML should undergo hematopoietic stem cell transplantation as soon as possible after CR with intensive therapy if their physical conditions permit.

A Case Series With Acquired Dermal Melanocytosis: A Retrospective Study From 2001 to 2018.

Acquired dermal melanocytosis (ADM) is a pigmented lesion caused by melanocytes in the dermis, and it is most often observed on the face of young and middle-aged Asian women. ADM development may be associated with melanin synthesis alterations, but little evidence of its molecular and histological alteration has yet been reported. This study aimed to evaluate ADM in different body locations using different immunohistochemical and chemical staining techniques. This retrospective case series includes consecutive patients confirmed as ADM by biopsy between 2001 and 2018. Patient data and archival images were used to determine the pattern and duration of skin lesions, as confirmed by data analysis of immunohistopathological staining of skin biopsy specimens. A total of 22 ADM patients were included with mean age at diagnosis of 47 years, and 63.6% were female. The most common site was limbs (36.4%), followed by face (27.3%), trunk (22.7%), and scalp (13.6%). Melanin levels were highest in the face and upper extremities and lowest in the trunk. All participants had perivascular distribution of dermal melanocytes, particularly on the face and limbs. The perineural distribution of dermal melanocytes was observed in the lower limbs, with prominent inflammation and fibrosis on the scalp. Dermal melanocytes expressed most markers recognizing melanocytes except for CD117. Analysis of this ADM case series has confirmed that melanin is activated by dermal melanocytes that may aggregate along blood vessels. CD117 may be a useful biomarker by which to identify the migration of epidermal melanocytes.

Feeding a High-Fat Diet for a Limited Duration Increases Cancer Incidence in a Breast Cancer Model

High-fat intake by young Asian women impacts the risk of breast cancer. Understanding the underlying molecular mechanisms may be essential for disease prevention in Asia as well as globally. We aimed to examine the effects of corn oil- and animal fat-based high-fat diets (32.9 and 31.4%, respectively, of fat energy ratio as compared to 12.3% in the standard diet) on mammary carcinogenesis and alterations in gene expression and epigenetic statuses in the mammary gland during the growth stages in a rat model. An increased incidence of carcinomas was observed after the cessation of high-fat feeding. In addition, rapid tumor growth and elevations in Celsr2 expression, which may be a result of DNA hypomethylation patterns in the 3′ untranslated region of the gene were noted in the animal fat group. In the human breast carcinoma cell line MCF7, a marginal decrease in cell viability was observed following the knockdown of Celsr2, suggesting that the animal fat-associated risk of cancer is partly due to the deregulation of mammary cell proliferation via non-metabolic gene functions. The present results will contribute to the development of strategies for controlling the food-associated risk of breast cancer, particularly in younger age groups.

S1602 The Disproportionate Rise of Non-Cardia Primary Gastric Cancer Incidence Rates in Younger Women Is Driven by Black and White Race but Not Asian Race: A Population-Based Time-Trend Analysis Using the USCS Database

S1602 The Disproportionate Rise of Non-Cardia Primary Gastric Cancer Incidence Rates in Younger Women Is Driven by Black and White Race but Not Asian Race: A Population-Based Time-Trend Analysis Using the USCS Database

Health Disparity and Breast Cancer Outcomes in Asian Women.

Health disparities in Asian women are complex and multifactorial. Screening attendance is low among Asian women, regardless of nativity or acculturation, and breast cancer detection has decreased by more than half in this population during the COVID-19 pandemic. The follow-up rate after abnormal screening results is similarly poor among Asian women compared with that among other groups, often resulting in a delay of cancer diagnosis. Yet the incidence of breast cancer in Asian women is increasing in the United States, with no such increase observed in other racial and ethnic groups in recent years. The age distribution of breast cancer in Asian women is distinct and peaks in younger women, underscoring the importance of early screening. The predilection for human epidermal growth factor receptor 2 (HER2)-enriched tumors may reflect the unique biologic characteristics of breast cancer among Asian subgroups, which are not well understood. Known biomarkers for breast cancer risk such as body mass index and mammographic density do not perform the same way in Asian women, as compared with other groups, owing to a lack of Asian population-specific data. Within that limitation, the association between body mass index and breast cancer is strongest in older Asian women, and the association between breast density and breast cancer is strongest in younger Asian women. There is an unmet need to improve breast cancer care in Asian women, a heterogeneous and growing population that is facing an increasing burden of breast cancer. An invited commentary by Leung is available online. ©RSNA, 2022.

Young South Asian women in the United Kingdom show evidence of blunted endothelium-dependent dilatation: implications for future cardiovascular disease.

Prevalence of cardiovascular disease (CVD) is higher in South Asians than white Europeans. The offspring of hypertensive parents (OH) have greater risk of hypertension than offspring of normotensive parents (ON). We hypothesized that endothelium-dependent dilatation is already blunted in young South Asians, relative to young white European women, particularly in South Asian OH women. In young white European ON, South Asian ON and OH women (18-25 years old; 10 per group) who were normotensive, we recorded cutaneous perfusion by laser Doppler fluximetry during reactive hyperaemia and iontophoresis of acetylcholine (ACh), before and after inhibiting NO synthesis (NOS) or/and cyclooxygenase (COX). In these and an additional 135 age-matched South Asian and white European women, physical activity and life-style factors were assessed by questionnaire. ACh-evoked dilatation was blunted in young South Asians, relative to white European women. It was attenuated by NOS or COX inhibition in white European ON; by NOS inhibition only in South Asian ON, but not OH women. After combined NOS and COX inhibition, ACh-evoked dilatations were similar to control ACh responses. Similar findings were made for reactive hyperaemia. Questionnaire data indicated young South Asians have lower physical activity levels, fresh fruit and vegetable intake than white European women, South Asian OH being lower than white European ON, or OH women. Endothelium-dependent dilatation is blunted in young South Asians, relative to white European women, especially in South Asian OH in whom NO-dependent and prostaglandin-dependent dilatation is blunted. We suggest improved diet and greater physical activity could be particularly effective in improving endothelium-dependent dilatation and reducing future CVD risk in young South Asian OH women.

The increasing incidence of cancer in younger women: What preventative strategy is best? (397)

Objectives: Cancers are increasingly being diagnosed in younger women. We aimed to determine which socio-behavioral risk factor was associated with these trends. Methods: Data were obtained from the United States Cancer Statistics (USCS) database from 2001-2018. SEER*Stat 8.3.8 and Joinpoint regression program 4.8.01 were used to calculate incidence trends of cancers per 100,000 for women under the age of 50 years. The average annual percent change (AAPC) in incidence rate was calculated and stratified by age and race. Obesity trends were evaluated using the Behavioral Risk Factor Surveillance System (BRFSS). Results: Using the USCS data, 23,460,648 cancer cases were diagnosed in females, of which 2.4 million (11%) were identified in young patients. Alcohol use (39%), obesity (27%), tobacco (20%), physical inactivity (8%), and HPV infection (6%) related cancers contributed to the distribution of cancers in younger women. Although alcohol use accounted for the highest number of cases, physical inactivity and obesity-related cancers increased at rates of 6% and 5% each year, respectively. Compared to 2001, young women in 2018 were 2.4-2.8 times more likely to be diagnosed with cancers related to physical inactivity and obesity. As one of the risk factors associated with cancer in young women, we evaluated obesity-related cancers and showed that young Asian women (30/100,000) had the highest incidence of uterine cancer compared to White women (27/100,000). However, Hispanic women had the highest rate of increase in uterine cancer at 4.5% annually. Using the BRFSS data, we then examined obesity trends and noted that young (35-44 years old) Asian women had the greatest increase in obesity at 4.4% per year; however, Black women had the highest overall obesity rates at 47% compared to 30% of White women. Conclusions: Compared to other racial groups, the rates of obesity and uterine cancer are rising in young Asian women. Early intervention against obesity, particularly in high-risk groups is warranted. Objectives: Cancers are increasingly being diagnosed in younger women. We aimed to determine which socio-behavioral risk factor was associated with these trends. Methods: Data were obtained from the United States Cancer Statistics (USCS) database from 2001-2018. SEER*Stat 8.3.8 and Joinpoint regression program 4.8.01 were used to calculate incidence trends of cancers per 100,000 for women under the age of 50 years. The average annual percent change (AAPC) in incidence rate was calculated and stratified by age and race. Obesity trends were evaluated using the Behavioral Risk Factor Surveillance System (BRFSS). Results: Using the USCS data, 23,460,648 cancer cases were diagnosed in females, of which 2.4 million (11%) were identified in young patients. Alcohol use (39%), obesity (27%), tobacco (20%), physical inactivity (8%), and HPV infection (6%) related cancers contributed to the distribution of cancers in younger women. Although alcohol use accounted for the highest number of cases, physical inactivity and obesity-related cancers increased at rates of 6% and 5% each year, respectively. Compared to 2001, young women in 2018 were 2.4-2.8 times more likely to be diagnosed with cancers related to physical inactivity and obesity. As one of the risk factors associated with cancer in young women, we evaluated obesity-related cancers and showed that young Asian women (30/100,000) had the highest incidence of uterine cancer compared to White women (27/100,000). However, Hispanic women had the highest rate of increase in uterine cancer at 4.5% annually. Using the BRFSS data, we then examined obesity trends and noted that young (35-44 years old) Asian women had the greatest increase in obesity at 4.4% per year; however, Black women had the highest overall obesity rates at 47% compared to 30% of White women. Conclusions: Compared to other racial groups, the rates of obesity and uterine cancer are rising in young Asian women. Early intervention against obesity, particularly in high-risk groups is warranted.

Clinicopathological Features, Prognostic Factors, and Treatment Outcomes in Non-metastatic Breast Cancer in Young Asian Women in Hong Kong

Clinicopathological Features, Prognostic Factors, and Treatment Outcomes in Non-metastatic Breast Cancer in Young Asian Women in Hong Kong

Preageing of the skin among Asian populations

AbstractSkin ageing is a complex process. Both intrinsic and extrinsic factors have a role in determining the speed, progression and phenotypic outcomes of the process. Typical clinical signs of ageing, such as wrinkles, thinning and sagging of the skin, are usually first noticed in the mid‐20s to early 30s. However, real‐world studies report that younger Asian women between the ages of 18 and 24 years are perceiving emerging signs of ageing, including dull skin, uneven skin tone, dryness, transient wrinkles, and a lack of skin firmness. These observations have led to a hypothesis that a phase of preageing may exist, where clinical signs of ageing are not yet present, but an individual starts to notice subtle changes in their skin's appearance. This paper discusses the concept of preageing in Asian populations and provides recommendations for recognising and managing the preageing process in clinical practice.

Invited Commentary: The Challenges of Early-Onset Breast Cancer.

Invited Commentary: The Challenges of Early-Onset Breast Cancer.

Kikuchi-Fujimoto Disease Masquerading as Bilateral Lymph Node Metastasis in a Patient With Papillary Thyroid Carcinoma: A Case Report and Literature Review

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is common in young Asian women under the age of 30, and is usually characterized by fever, myalgia, fatigue, and cervical lymphadenopathy. Because patients with KFD often present with necrotic lesions that are also features of lymph node metastasis, ipsilateral or bilateral lymph node enlargement in head and neck cancer patients can be disguised as lymph node metastasis. We present an unusual case of KFD mimicking bilateral metastatic papillary carcinoma of the thyroid. This study emphasizes that KFD should be considered when diagnosing lymph nodes with necrotic lesions but without malignant cells in young women.

Abstract 9485: Hypertension Risk Differs by Ethnicity in Young Asian Women Independent of Cardiometabolic Conditions

Introduction: Prevalence of polycystic ovary syndrome (PCOS) and diabetes (DM), two cardiometabolic conditions (CMCs), vary by ethnicity in Asian women. Hypertension (HTN) also varies by ethnicity, but this has not been well studied in young Asian women with CMCs. We examined whether HTN diagnosis (Dx) in Asians varies by ethnicity, independent of body mass index (BMI), PCOS and DM. Methods: We used electronic health record data from a large US health plan to examine prevalence of HTN (≥2 Dx) in a cohort of 19,258 Chinese, 23,213 Filipina, and 19,108 South Asian women aged 21-44 years for whom BMI, PCOS (≥2 Dx) and DM (≥2 Dx + DM treatment) were ascertained. The associations of ethnicity and CMCs with HTN were examined using multivariable logistic regression. Results: Prevalence of HTN was 2% among Chinese and South Asian and 8% among Filipina women. Across all ethnic groups, compared to women with no CMCs, HTN prevalence was highest among those with DM and somewhat higher among those with PCOS and obesity. For all CMCs, Filipinas had the highest HTN prevalence (Figure). Adjusting for age, smoking, BMI, CMCs, and ethnicity, the odds of HTN were higher for Filipinas (2.6; CI 2.3-2.9) and slightly lower for South Asians (0.9; CI 0.7-0.98) compared to Chinese women; DM was associated with 4.7-fold higher odds (CI 4.1-5.3) and PCOS 1.4-fold higher odds (CI 1.1-1.8) of HTN. Conclusion: In young Asian women, DM, PCOS and obesity are associated with greater HTN burden. Compared to Chinese women, Filipinas have higher odds and South Asian women lower odds of HTN independent of BMI, PCOS, and DM. These data suggest a need for heightened BP surveillance in young Filipina women and Asian women with obesity or CMCs.

Kikuchi-Fujimoto Disease Associated With Mycoplasma Pneumoniae Infection.

Kikuchi-Fujimoto disease (KFD) is a self-limited disease that is more common in young Asian women. Typical presentations included fever and cervical lymphadenopathy. The etiology of KFD is unknown, and diagnosis is based mainly on lymph node biopsy. KFD has been reported to be associated with Mycoplasma pneumoniae infection. However, the role of antibiotic treatment is unclear. We reported 2 cases of KFD associated with Mycoplasma pneumoniae infection and were successfully treated with a macrolide.

The Risks of Polycystic Ovary Syndrome and Diabetes Vary by Ethnic Subgroup Among Young Asian Women

Background: Previous studies demonstrate that aggregation of Asian ethnic subgroups masks variation in the prevalence of diabetes (DM) across these groups. Population data also suggest that Asian ethnic differences exist in the prevalence of diagnosed polycystic ovary syndrome (PCOS), but few studies have compared the risk of PCOS and DM in the same Asian subgroups, accounting for differences in BMI. We previously found that the prevalence of PCOS based on ≥1 diagnosis ranged from 1.6–1.9% in White, Hispanic, and Black women and 1.2%, 1.7%, and 3.5% for Chinese, Filipina, and South Asian women age 21–44 years. In this study, we further examined and compared the risk of clinical PCOS and clinical DM by weight status in these Asian subgroups. METHODS: Using data from women receiving care in a large integrated healthcare system, we conducted a cross-sectional, retrospective study of 19,848 Chinese, 23,890 Filipina, and 19,905 South Asian women aged 21–44 years who had ≥1 clinic visit in 2016. Ethnicity was based on data from the electronic health record (EHR), and those identified in the EHR as Asian with unspecified ethnicity were assigned as Chinese, Filipina, and South Asian based on algorithms that included primary language and surname. BMI was calculated from non-gestational height and weight and classified as healthy, overweight (23 to <27.5), or obese (≥27.5 kg/m2) using Asian BMI thresholds. Clinical PCOS was defined by ≥2 ambulatory PCOS diagnoses (ICD-9 256.4, ICD-10 E28.2) in 2015–2016 and clinical DM by ≥2 ambulatory DM diagnoses (ICD-9 250, ICD-10 E10-11,13) in 2015–2016 and history of DM pharmacotherapy. Multivariable logistic regression was used to produce adjusted odds ratios (aOR) for PCOS and DM comparing Filipina and South Asian to Chinese women after adjusting for age and weight status. Results: Among Chinese, Filipina, and South Asian women, respectively, prevalence of PCOS was 1.0%, 1.5%, and 3.2%, prevalence of DM was 1.2%, 4.2%, and 2.5%, and prevalence of obesity was 15.6%, 38.5%, and 30.1%. The prevalence of obesity was high in women with PCOS (58.9%) and women with diabetes (70.0%). South Asian women had a 2.5-fold higher adjusted odds of PCOS than Chinese women (95% CI 2.1–3.0), with no difference for Filipina versus Chinese women (aOR 1.0, 95% CI 0.8–1.2). In contrast, South Asian (aOR 1.5, 95% CI 1.3–1.8) and Filipina women (aOR 2.2, 95% CI 1.9–2.6) had higher adjusted odds of DM than Chinese women. Conclusion: Despite the known metabolic association of PCOS and insulin resistance, we found that the risk profiles of PCOS and DM differed by Asian ethnicity, with risk of PCOS highest in South Asian women and risk of DM highest in Filipina women. While our analyses were limited to women with BMI assessed at a clinical visit and not a screened population, the differential risk of PCOS and DM in Asian subgroups and higher burden of PCOS in South Asian women, independent of BMI, warrant further study.