High cardiovascular disease mortality among Native Hawaiian and Pacific Islander adults

1. In this cross-sectional study, researchers found that Native Hawaiian and Pacific Islander (NHPI) adults aged 35 years or older died of cardiovascular disease at a rate 50% higher than Asian adults, a group in which they had historically been classified.

2. The age-standardized mortality rate among NHPI adults was the third highest after Black adults and White adults.

Evidence Rating Level: 3 (Average)

Study Rundown: NHPI adults have a high prevalence of chronic disease, thought to have been caused in part by the societal effects of Western colonization of the Pacific region. However, data on cardiovascular disease (CVD) mortality among NHPI adults across the US have been elusive since they have largely been grouped with Asian adults for national studies. This study aimed to examine CVD mortality among NHPI adults aged 35 years or older and compare mortality rates with those among other racial groups in the US, including Asian adults. The researchers found that over 10,000 NHPI adults died of CVD between 2018 and 2022. Over one-third of these deaths occurred in adults younger than 65 years, and the majority occurred in males. The highest risk subgroup within this population was non-Hispanic, single-race NHPI adults, who had a 20% higher CVD ASMR compared with all NHPI adults. After age-standardization, the overall mortality rate was found to be the third highest nationally after Black adults and White adults; further, this rate was 50% higher compared with Asian adults. The generalizability of this study was limited by the potential for misclassification of both cause of death and reported race on death certificates. Nevertheless, this study demonstrated the necessity of considering NHPI adults as a separate group for public health research and surveillance to achieve health equity in this population.

Click to read the study in AIM

Relevant Reading: Cardiometabolic Health Disparities in Native Hawaiians and Other Pacific Islanders

In-Depth [cross-sectional study]: This observational, cross-sectional study investigated the characteristics of NHPI adults aged 35 years or older who died of CVD in the US between 2018 and 2022 and compared age-standardized mortality rates (ASMRs) among this group with those among other race groups. Mortality data were taken from the National Vital Statistics System (NVSS) of the National Center for Health Statistics and included deaths among adults aged 35 years or older in all 50 states and the District of Columbia. Individuals were considered to be NHPI if they were reported as being Native Hawaiian, Guamanian or Chamorro, Samoan, or other Pacific Islander; NHPI adults who identified as multiracial or Hispanic were also included in primary analyses. There were a total of 4,510,183 deaths from CVD included for analysis, of which 10,870 (0.24%) deaths were among NHPI adults with a mean of 2174 deaths per year. A significant number of deaths among NHPI adults occurred below the age of 65 years (37.1%), and 57.0% of those who died were male. Single-race NHPI adults made up the majority of the population (59.5%); the largest subgroups among these persons was Native Hawaiian (14.4%), followed by Samoan (13.8%), and Guamanian or Chamorro (7.0%). The CVD ASMR among NHPI adults was 369.6 deaths per 100,000 people (95% CI, 362.4 to 376.7), which was the third highest after Black adults (558.8 deaths per 100,000 people [95% CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100,000 people [95% CI, 423.2 to 424.1]). NHPI adults had a relative risk of 1.5 (95% CI, 1.5 to 1.5) for CVD death compared with Asian adults, who had a CVD ASMR of 243.9 deaths per 100,000 people (95% CI, 242.6 to 245.2). The leading cause of CVD mortality among NHPI adults was heart disease (72.6%), most commonly coronary heart disease (40.5%); a further 19.0% of CVD deaths among NHPI adults were from cerebrovascular disease. In subgroup analyses, it was found that 56.1% of CVD deaths among NHPI adults were in those who were neither Hispanic nor multiracial. These adults had a CVD ASMR of 458.5 deaths per 100,000 persons (95% CI, 446.6 to 470.4) and had a relative risk of 1.2 (95% CI, 1.2 to 1.3) for CVD death compared with NHPI adults overall. In summary, this study showed differing CVD mortality data between NHPI adults and adults of other race groups, especially Asian adults, thus underlining the importance of assessing NHPI individuals as a distinct population to achieve further health equity.

Image: PD

©2024 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.