Causes of Asian American mortality Understood by Socio-Economic Status (CAUSES) Study
The CAUSES Study is a five-year study designed to examine mortality differences in Asian American racial/ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) compared to three referent groups (NHWs, Blacks/African Americans, Hispanics). It is funded by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health.Background | Study Team
Asian Americans are the fastest growing racial/ethnic group in the United States, with a population of over 14 million that is projected to reach nearly 34 million by 2050. However, our current understanding of Asian Americans is as an aggregated group, and very little is known about the six diverse Asian American racial/ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese), who have a wide range of disease risks, immigration histories, and socioeconomic status.
Our current understanding of Asian American mortality patterns is distorted by the aggregation of distinct subgroups, the grouping of foreign-born and U.S.- born populations, and the unknown impact of sociodemographic factors. While the U.S. Census first started disaggregating Asian subgroups in 1980, disaggregation of Asian subgroups on U.S. death records occurred much later in 2003, and now over half of the 50 U.S. States disaggregate Asian subgroups. A decade of national mortality data (2003-2012) for Asian American subgroups will soon be available. In this proposal, we aim to examine mortality differences in Asian American racial/ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) compared to three referent groups (NHWs, Blacks/African Americans, Hispanics). This study will fill the current knowledge gap, and provide important insights to inform treatment and prevention efforts for diverse Asian American subgroups.
Our specific aims are:
Aim1. We will determine racial/ethnic differences in cause-specific mortality.
Hypotheses: The leading cause of death will differ by Asian American subgroup, with coronary heart disease as the leading cause for Asian Indians, and aggregated cancers for Japanese and Chinese.
Aim 2. We will evaluate whether nativity (foreign-born vs. U.S.-born) influences cause-specific mortality and survival within each racial/ethnic group.
Hypotheses: For foreign-born Asian Americans cause-specific mortality will mirror country of origin; this relationship will be attenuated for U.S.-born Asian Americans.
Hypothesis: Survival to age 70 will be greater for foreign-born Asian Americans, which may be due to reverse migration.
Aim 3. We will test whether county-level social, economic, health services, environmental and demographic factors explain survival differences between Asian American subgroups and compared to the referent groups.
Hypothesis: The association between county level social, economic, health services, environmental and demographic factors with mortality will be strongest for the referent groups, and weaker for Asian American subgroups, especially so for foreign-born individuals.
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Latha Palaniappan, M.D., M.S. Principal Investigator
Dr. Palaniappan is an Associate Investigator at the Palo Alto Medical Foundation Research Institute (PAMFRI). She is an Adjunct Associate Professor at the Stanford University School of Medicine. Dr. Palaniappan will oversee all aspects of the study together with Dr. Mark Cullen and will take primary responsibility for managing the overall project. She will provide budgetary oversight, participate in staff training, monitor study progress, supervise statistical analysis, and publications.
Dr. Mark Cullen, M.D. Co-Principal Investigator
Dr. Cullen is the Chief of the Division of General Internal Medicine, and has conducted many ecological studies of social and environmental determinants of health and health disparities in diverse populations. Dr. Cullen will oversee all aspects of the study together with Dr. Palaniappan. He will take primary responsibility for the ecological modeling of sociodemographic and environmental variables in explaining racial/ethnic differences in mortality.
David Rehkopf, Sc.D., M.P.H Co-Investigator
Dr. David Rehkopf is an Assistant Professor at Stanford University School of Medicine. The aim of his research at Stanford University focuses on the mechanisms and processes linking income deprivation and work environment with early life health and future adult chronic disease risk. As an investigator, Dr. Rehkopf will work closely with Dr. Cullen on examining the social and environmental determinants that explain racial/ethnic differences in mortality.
Karen Eggleston, Ph.D., Investigator
Dr. Karen Eggleston is the Director of the Asia Health Policy Program at Walter H. Shorenstein Asia-Pacific Research Center and a fellow at the Center for Health Policy/Primary Care and Outcomes Research at the Freeman Spogli Institute for International Studies at Stanford University. Dr. Eggleston’s research focuses on comparative healthcare systems and health reform in Asia. As an investigator, Dr. Karen Eggleston will consult on study design and analysis, and will provide life tables from Asian countries of interest, using inputs from the Census Bureau.
Ben Goldstein, Ph.D., M.P.H., Statistician
Dr. Ben Goldstein received his Ph.D. in Biostatistics with a designated emphasis in Computational and Genomic Biology and a M.P.H in Epidemiology & Biostatistics from University of California Berkeley. Dr. Goldstein is currently a faculty member in the Quantitative Sciences Unit at Stanford University School of Medicine. His primary role in this study is to oversee the technical aspects of the analyses of Drs. Cullen, Rehkopf and Palaniappan from a statistical perspective.
Kristopher Kapphahn, M.S., Statistical Programmer
Kristopher is a Biostatistician at Stanford University School of Medicine. As the statistical programmer, he will work with the statistician, Dr. Ben Goldstein, to lead the modeling and oversee the output for each of the Aims.
Powell Jose, M.D., Postdoctoral Scholar
Dr. Jose is a Research Physician at the PAMFRI. Prior to joining the PAMFRI, he worked as a postdoctoral research fellow at Northwestern University Feinberg School of Medicine and Brigham & Women’s Hospital. The Postdoctoral Scholar will assist Dr. Palaniappan and the study team in examining differences in all-cause and cause-specific mortality among Asian American subgroups by nativity (U.S.-born versus foreign-born).
Ariel Holland Frank, B.A., Project Coordinator
Ms. Frank is a Research Associate at the PAMFRI. She will provide project coordination and will also assist the study team with manuscript development. Ms. Frank will also prepare and manage correspondence with the PAMF Institutional Review Board.
Diane Lauderdale, Ph.D., Consultant
Dr. Lauderdale is an Associate Professor in the Department of Health Studies and in the College of the University of Chicago. She is also the Associate Director of the Center on the Demography and Economics of Aging at the University of Chicago and the National Opinion Research Center. She will advise in epidemiologic issues in study design and statistical methods. In addition, she will be involved in statistical analysis for manuscript preparation for the proposed study.
Shripad Tuljapurkar, Ph.D., Consultant
Dr.Tuljapurkar is the Dean and Virginia Morrison Professor of Population Studies at Stanford University, as well as Member of the Center for the Economics and Demography of Aging at the University of California, Berkeley. Dr. Tuljapurkar will consult on matters of statistical methodology and interpretation of results for this proposed project. His research methods have been applied to demographic studies of many countries and heterogeneous populations, and will be involved in statistical analyses for manuscript preparation for this study.
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