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      Mortality Trends and Disparities Among Racial/Ethnic and Sex Subgroups in New York City, 1990 to 2000

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          Abstract

          New York City census data for 1990 and 2000 for all-cause and disease-specific mortality adjusted by age were examined by race/ethnicity. Primary cause of death was coded as HIV/AIDS, cardiovascular disease, coronary heart disease, acute myocardial infarction, stroke, diabetes, or cancer. For White, Black, Hispanic and Asian groups, relative mortality ratios (RMR) were derived for 2000 relative to 1990. Ratios of RMR’s for minority groups were derived relative to Whites. From 1990 to 2000, HIV, cancer, CVD, CHD, AMI, and stroke-related mortality decreased. Decreases in HIV-related mortality were notably less for minority males. Diabetes mortality rates rose dramatically, with Hispanic and Asian males having notably greater increases than White males. Increases in mortality among Asians exceeded those of other groups, and appear to correspond with increased immigration/acculturation. Mortality shifts among different diseases and racial groups should alert public health officials to consider immigration patterns in designing, implementing, and evaluating interventions to prevent disease-related mortality, with a goal to eliminate disparities

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          The gap gets bigger: changes in mortality and life expectancy, by education, 1981-2000.

          In this paper we examine educational disparities in mortality and life expectancy among non-Hispanic blacks and whites in the 1980s and 1990s. Despite increased attention and substantial dollars directed to groups with low socioeconomic status, within race and gender groups, the educational gap in life expectancy is rising, mainly because of rising differentials among the elderly. With the exception of black males, all recent gains in life expectancy at age twenty-five have occurred among better-educated groups, raising educational differentials in life expectancy by 30 percent. Differential trends in smoking-related diseases explain at least 20 percent of this trend.
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            Diabetes trends in the U.S.: 1990-1998.

            To examine trends in diabetes prevalence in the U.S. This study was conducted via telephone surveys in states that participated in the Behavioral Risk Factor Surveillance System between 1990 and 1998. The participants consisted of noninstitutionalized adults aged 18 years or older. The main outcome measure was self-reported diabetes. The prevalence of diabetes rose from 4.9% in 1990 to 6.5% in 1998--an increase of 33%. Increases were observed in both sexes, all ages, all ethnic groups, all education levels, and nearly all states. Changes in prevalence varied by state. The prevalence of diabetes was highly correlated with the prevalence of obesity (r = 0.64, P<0.001). The prevalence of diabetes continues to increase rapidly in the U.S. Because the prevalence of obesity is also rising, diabetes will become even more common. Major efforts are needed to alter these trends.
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              Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia.

              Rates of coronary heart disease are higher in South Asians (Indians, Pakistanis, and Bangladeshis) settled overseas than in other ethnic groups. We tested the hypothesis that this excess risk results from metabolic disturbances associated with insulin resistance. There were 1,421 South Asian men and 1,515 European men aged 40-69 years in London examined in the Southall Study. Prevalence of ischemic ECG abnormalities was higher in South Asians than in Europeans (17% versus 12%, p < 0.001), with an excess of major Q waves (Minnesota codes 1-1 or 1-2) in younger South Asian men (p = 0.01 for the age-ethnicity interaction). Major Q waves were strongly associated with glucose intolerance and hyperinsulinemia in younger South Asians; these factors accounted statistically for 73% of major Q waves in those aged 40-54 years. Age-standardized prevalence of a positive history of coronary heart disease was similar in South Asians and Europeans (8.5% versus 8.2%, NS), and positive history without Q waves was not associated with glucose intolerance or hyperinsulinemia in South Asians. Smoking rates and average plasma cholesterol were lower in South Asians than in Europeans; in a logistic model controlling for smoking and cholesterol, the odds ratio for major Q waves in South Asians compared with Europeans was 2.4 (95% CI, 1.5-3.8). Adjusting for glucose intolerance and hyperinsulinemia reduced this ratio to 1.5 (95% CI, 0.9-2.5). These results are consistent with the hypothesis that insulin resistance underlies the high coronary risk in South Asian people and strengthen the evidence for a fundamental role of this metabolic pattern in the etiology of coronary heart disease.
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                Author and article information

                Contributors
                +1-718-2316704 , +1-718-5158514 , kfreeman@montefiore.org
                Journal
                J Immigr Minor Health
                Journal of Immigrant and Minority Health
                Springer US (Boston )
                1557-1912
                1557-1920
                22 April 2010
                22 April 2010
                June 2011
                : 13
                : 3
                : 546-554
                Affiliations
                [1 ]Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467 USA
                [2 ]Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
                [3 ]Center for the Study of Asian American Health, New York University School of Medicine, New York City, NY USA
                [4 ]Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY USA
                Article
                9345
                10.1007/s10903-010-9345-5
                3088827
                20411331
                619d583b-2505-471a-965d-2b7906877535
                © The Author(s) 2010
                History
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media, LLC 2011

                Health & Social care
                mortality ratio,mortality,immigration,disparities
                Health & Social care
                mortality ratio, mortality, immigration, disparities

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