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Try out PMC Labs and tell us what you think. Learn More. To examine trends in the prevalence of type 2 diabetes and related conditions in Asian Americans compared with non-Hispanic whites. Of these adults, 11, identified themselves as Asian Americans andas non-Hispanic whites. The age- and sex-adjusted prevalence of type 2 diabetes was higher in Asian Americans than in whites throughout the study period 4. In addition, Asian Indians had the highest odds of prevalent type 2 diabetes, followed by Filipinos, other Asians, and Chinese. Compared with their white counterparts, Asian Americans have a ificantly higher risk for type 2 diabetes, despite having substantially lower BMI.
Additional investigation of this disparity is warranted, with the aim of tailoring optimal diabetes prevention strategies to Asian Americans. Asian Americans are a fast-growing subpopulation in the U. However, apart from focused studies of Japanese immigrants in Hawaii and the West Coast 34few data are available regarding diabetes in Asian Americans nationwide 56.
We therefore analyzed data from the NHIS to examine trends in the prevalence of type 2 diabetes and related conditions in Asian Americans compared with non-Hispanic whites. The National Health Interview Survey NHIS is an ongoing annual survey deed to collect health-related information on the noninstitutionalized civilian population of the U. All data are based on respondent self-report. There are no laboratory assays or physical assessments. Details regarding study de and procedures are available elsewhere 7.
The year average response rate was Thus, the final sample comprised 11, Asian American henceforth Asian andnon-Hispanic white henceforth white adults. However, we were unable to differentiate Pacific Islanders from other Asians based on the public-use dataset. These are sometimes called oral agents or oral hypoglycemic agents.
Other variables of interests included age, sex, educational attainment, incomes, nation of birth, current smoking and alcohol drinking status, leisure-time physical activity, and BMI. Leisure-time physical activity was dichotomized at the level of regular activity recommended by the American Heart Association i.
We merged 12 years of data and created new de variables that incorporated stratum, primary sampling unit, and sampling weight in order to accommodate different sampling des between — and — 7. All analyses ed for complex sampling des and weights developed by the NHIS to represent the U. Subsequent analyses were performed by pooling data into four 3-year periods —, —, —, and — to enhance robustness.
Characteristics of Asians versus whites were compared over time. To examine differences in diabetes prevalence between Asians and whites, we calculated age- and sex-adjusted rates using the U. Census data as the standard and displayed the rates as Lowess-smoothed lines. The mean difference of age- and sex-adjusted prevalence in Asians versus whites was examined using a linear regression model by period.
We constructed several multivariable logistic regression models to obtain adjusted odds ratios ORs of prevalent type 2 diabetes in Asians versus whites. To check for effect modification by sex, we conducted fully adjusted analyses stratified by sex.
Nonparametric trend tests across calendar-years were used to conservatively test for secular trends and to for different sampling des in — versus — Compared with whites, Asians were younger, were less likely to be born in the U.
Characteristics of Asian and white adults in the U. Percent met the recommended leisure-time physical activities: 20 min of vigorous activity three times per week or 30 min of light to moderate activity five times per week.
As expected, Asians had lower BMI than whites mean 24 vs. After applying modified adiposity criteria for Asians, their excess prevalence of obesity persisted 13—17 vs. Figure 1 displays secular trends in type 2 diabetes and BMI after adjusting for age and sex.
Prevalent type 2 diabetes was substantially more common in Asians than in whites throughout the interval 4.
On the contrary, BMI was substantially lower in Asians than in whites throughout the interval. Lowess-smoothed line curves represent age- and sex-standardized prevalence rates of type 2 diabetes in —, after ing for sampling weight. The solid line represents Asians A and the dotted line represents whites W. Box-plot reveals age- and sex-standardized BMI in each period —, —, —, and — and draw at the midpoint of each period. Finally, we calculated the adjusted OR of prevalent type 2 diabetes in Asians versus whites over the interval Table 2.
In the fully adjusted model, the odds of prevalent type 2 diabetes in Asians remained consistently greater than those in whites throughout the period OR range 1. No ificant secular trends were observed. Furthermore, we calculated the adjusted ORs of prevalent type 2 diabetes in Asian subgroups versus whites over the study period.
Asian Indians had the highest odds of prevalent type 2 diabetes, followed by Filipinos, other Asians, and Chinese. Figure 3 depicts the for the period of — These data support the following three main conclusions.
Third, although the OR of diabetes in Asians versus whites has remained relatively stable over the past decade, the steady climb in diabetes prevalence in both groups coincides with a widening gap in terms of absolute diabetes prevalence. We noted that compared with whites, Asian Americans were more likely to be overweight but less likely to be obese, after applying the modified Asian criteria. Our are consistent with studies of diabetes in Asian Americans.
In a study using the U. Most recently, two studies used NHIS data to compare the risk of type 2 diabetes in subgroups of Asians i. Oza-Frank et al.
Ye et al. In this study, we further investigated trends in diabetes prevalence over time and in relation to patterns of change in BMI. We found that although the ORs of diabetes in Asians versus whites has remained quite stable over the past decade, obesity and diabetes prevalence in both race groups increased concurrently.
Those increases contribute to the growing medical and societal burdens in the U. There are several possible explanations for the Asian—white disparity in diabetes risk. First, Asians appear to be more genetically predisposed to develop type 2 diabetes compared with their white counterparts 14 — Second, chronic stress related to immigration acculturation could contribute to visceral adiposity and insulin resistance Finally, Asians are known to have higher visceral fat accumulation compared with whites at any given level of BMI Rush et al.
Likewise, for the same waist circumference, Filipino women had a higher visceral fat and visceral-to-subcutaneous abdominal fat ratio than white women Those unfavorable fat distributions may contribute to the higher risk of diabetes in those two Asian populations 9. Physical inactivity is a well-established risk factor for incident type 2 diabetes independent from adiposity Although physical inactivity did not completely explain the excess risk of type 2 diabetes in Asian Americans in our analysis, it is known to be a common diabetes risk factor in Asian Americans. For example, Kandula et al.
Physical inactivity is of particular interest from a public health perspective because it is more readily modifiable than adiposity. Strengths of our study include a very large, nationally representative sample with uniform ascertainment of diabetes and related variables over a time interval during which the population of Asian Americans and the prevalence of type 2 diabetes have both climbed dramatically.
Nevertheless, several limitations deserve mention. Second, the NHIS is based exclusively on self-reported data. Because participants were asked to select a primary race, possible misclassification in mixed-race participants may underestimate the associations. Use of self-reported height and weight may lead to underestimation of BMI, but we know of no evidence that the degree of underestimation differs systematically in Asian Americans versus whites Finally, information on other diabetes risk factors, such as dietary intake and family history of diabetes, are not available in the NHIS.
Hence, we could not rule out the possibility of residual confounding. The main implication of our study is that type 2 diabetes is a growing public health problem for Asian Americans that requires urgent attention.
Although greater genetic predisposition no doubt plays a role, future research should identify modifiable risk factors that underlie the Asian—white disparity in diabetes prevalence as a step toward the development of culturally tailored prevention strategies.
No potential conflicts of interest relevant to this article were reported. National Center for Biotechnology InformationU. Journal List Diabetes Care v. Diabetes Care. Published online Jan Ji Won R. Frederick L. Author information Article notes Copyright and information Disclaimer. Corresponding author: Hsin-Chieh Yeh, ude. Received Apr 25; Accepted Oct Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. This article has been cited by other articles in PMC. Covariates Other variables of interests included age, sex, educational attainment, incomes, nation of birth, current smoking and alcohol drinking status, leisure-time physical activity, and BMI.
Statistical analysis We merged 12 years of data and created new de variables that incorporated stratum, primary sampling unit, and sampling weight in order to accommodate different sampling des between — and — 7. Table 1 Characteristics of Asian and white adults in the U. Open in a separate window. Figure 1.Asian sex College Station
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