Subgroup Variation and Neighborhood Social Gradients—an Analysis of Hypertension and Diabetes Among Asian Patients (New York City, 2014–2017)

Abstract

Diabetes and hypertension are socially patterned by individual race/ethnicity and by neighborhood economic context, but distributions among Asian subgroups are undercharacterized. We examined variation in prevalence for both conditions, comparing between US Asian subgroups, including within South Asian nationalities, and comparing within subgroups by neighborhood economic context. We obtained data on a non-probability sample of 633,664 patients ages 18–64 in New York City, NY, USA (2014–2017); 30,138 belonged to one of seven Asian subgroups (Asian Indian, Bangladeshi, Pakistani, Chinese, Korean, Japanese, and Filipino). We used electronic health records to classify disease status. We characterized census tract economic context using the Index of Concentration at the Extremes and estimated prevalence differences using multilevel models. Among Asian men, hypertension prevalence was highest for Filipinos. Among Asian women, hypertension prevalence was highest for Filipinas and Bangladeshis. Diabetes prevalence was highest among Pakistanis and Bangladeshis of both genders, exceeding all other Asian and non-Asian groups. There was consistent evidence of an economic gradient for both conditions, whereby persons residing in the most privileged neighborhood tertile had the lowest disease prevalence. The economic gradient was particularly strong for diabetes among Pakistanis, whose prevalence in the most deprived tertile exceeded that of the most privileged by 9 percentage points (95% CI 3, 14). Only Koreans departed from the trend, experiencing the highest diabetes prevalence in the most privileged tertile. US Asian subgroups largely demonstrate similar neighborhood economic gradients as other groups. Disaggregating Asian subgroups, including within South Asian nationalities, reveals important heterogeneity in prevalence.

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Funding

This study was supported by the NYU Center for the Study of Asian American Health Under the NIH National Institute on Minority Health & Health Disparities grant award #U54MD000538-15. It was additionally supported by grant award #U48DP005008 from the Centers for Disease Control and Prevention (CDC) and #R01DK110048 from the National Institute of Diabetes and Digestive and Kidney Diseases.

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Correspondence to Justin M. Feldman.

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Our study was deemed exempt from review by the NYU School of Medicine Institutional Review Board because the dataset did not contain individually identifiable patient records.

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The authors declare that they have no conflicts of interest.

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Feldman, J.M., Conderino, S., Islam, N.S. et al. Subgroup Variation and Neighborhood Social Gradients—an Analysis of Hypertension and Diabetes Among Asian Patients (New York City, 2014–2017). J. Racial and Ethnic Health Disparities 8, 256–263 (2021). https://doi.org/10.1007/s40615-020-00779-7

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Keywords

  • Asian Americans
  • Hypertension
  • Diabetes
  • Neighborhoods