do ethnic groups living in ontario differ in their cardiovascular risk profiles?
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Do ethnic groups living in Ontario differ in their cardiovascular risk profiles?. Maria Chiu, MSc, PhD Candidate Inst. of Medical Science, University of Toronto Inst. for Clinical Evaluative Sciences. Citation: - PowerPoint PPT PresentationTRANSCRIPT
Chiu et al., CMAJ 2010
Do ethnic groups living in Ontariodiffer in their cardiovascular risk profiles?
Maria Chiu, MSc, PhD CandidateInst. of Medical Science, University of Toronto
Inst. for Clinical Evaluative Sciences
Chiu et al., CMAJ 2010
Citation:
Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996
and 2007
Maria Chiu, Peter C. Austin, Douglas G. Manuel, and Jack V. Tu
CMAJ 2010 Apr. DOI:10.1503/cmaj.091676
Chiu et al., CMAJ 2010
Acknowledgment:
We thank all the participants of Statistics Canada’s NPHS and CCHS, and the staff from Statistics Canada
who assisted in the collection and management of the survey data.
Funding Sources: Heart and Stroke Foundation of OntarioCIHR Canada Graduate Scholarship
Canadian Cardiovascular Outcomes Research Team
Chiu et al., CMAJ 2010
To compare the prevalence of
a. CVD risk factors (e.g. smoking, diabetes, etc.)
b. Heart disease
c. Stroke
in the 4 largest ethnic groups in Ontario:White, Chinese, South Asian, and Black
Study objective
Chiu et al., CMAJ 2010
METHODS
Chiu et al., CMAJ 2010
Methods
National Population Health Survey (NPHS) and Canadian Community Health Survey (CCHS)
Data source
Population-based cross-sectional surveys conducted by Statistics Canada
Provide timely, reliable estimates of health determinants, health status and health system utilization
Include: Aged 12+ in private dwellings
Exclude: People on Indian Reserves, Canadian Forces Bases
Chiu et al., CMAJ 2010
Q: People living in Canada come from many different cultural and racial backgrounds. Are you:
White
Chinese
South Asian (e.g. East Indian, Pakistani, Punjabi, Sri-Lankan)
Black
etc…
Study variables
Ethnic/racial background
Chiu et al., CMAJ 2010
Study variables
CVD risk factors
Current smokingCurrent smoking
ObesityObesity
DiabetesDiabetes
HypertensionHypertension
Psychosocial stress
Inadequate fruit/vegetablesInadequate fruit/vegetables
Inadequate physical activityInadequate physical activity
Non-regular alcohol intakeNon-regular alcohol intake
CVD Heart diseaseHeart disease
StrokeStroke
Chiu et al., CMAJ 2010
Methods
Statistical analysis
Statistical software: SAS v9.1Statistical software: SAS v9.1
Age-sex standardized prevalence of CVD risk Age-sex standardized prevalence of CVD risk factors, heart disease, strokefactors, heart disease, stroke
Standard population: 2001 Ontario censusStandard population: 2001 Ontario census
All estimates weighted by sample weights from All estimates weighted by sample weights from Statistics CanadaStatistics Canada
Bootstrap method for variance estimation for Bootstrap method for variance estimation for 95% CI and P values95% CI and P values
Chiu et al., CMAJ 2010
RESULTS
Chiu et al., CMAJ 2010
Results
White Chinese S. Asian Black
154 653 3 038 3 364 2 742
TOTAL N = 163 797
Study sample size, NPHS/CCHS 1996-2007
Chiu et al., CMAJ 2010
Results
Sociodemographic characteristics (%)
White Chinese South Asian Black
Mean age (years) 42.3 42.3 42.2 42.3
Male sex 49.1 49.1 49.1 49.1
Highest level education (household)Some high school 7.7 4.9 5.1 7.6
High school graduate 12.9 11.5 10.0 11.3
Some post-sec schooling 6.0 4.4 6.1 8.2
College/university degree 73.4 79.2 78.8 73.0
Mean household income (CAD) 78930.0 66954.0 63886.0 54428.0
Household size 3.1 3.6 4.2 3.3
Income adequacy group1 (lowest) 7.1 11.0 11.9 16.5
2 (lower-mid) 17.7 22.1 28.5 27.7
3 (mid-higher) 34.3 32.9 33.1 33.9
4 (highest) 40.9 33.9 26.5 21.9
Chiu et al., CMAJ 2010
Risk Factors
Chiu et al., CMAJ 2010
Results
Age-sex standardized prevalence (%)1. Major CV risk factors
White ChineseSouth Asian
Black
Current smoking 24.8 8.7 8.6 11.4
Obesity 14.8 2.5 8.1 14.1
Diabetes 4.2 4.3 8.1 8.5
Hypertension 13.7 15.1 17.0 19.8
% with 2+ major risk factors 10.1 4.3 7.9 11.1
Chiu et al., CMAJ 2010
Results
Age-sex standardized prevalence (%)1. Major CV risk factors—by sex
White ChineseSouth Asian
Black
Current smoking M 25.2 14.4 13.8 15.4F 20.3 3.3 3.6 7.6
Obesity M 14.9 2.5 7.8 11.2F 13.1 2.6 8.5 16.8
Diabetes M 4.8 4.0 9.4 7.4F 4.1 4.6 6.8 9.5
Hypertension M 13.1 14.4 16.0 17.7F 14.8 15.8 17.9 21.7
Chiu et al., CMAJ 2010
Results
Age-sex standardized prevalence (%)2. Other CV risk factors
White ChineseSouth Asian
Black
Psychosocial stress 23.6 19.2 21.5 19.4
Inadequate fruits/vegetables 22.1 24.0 19.2 24.4
Inadequate physical activity 62.7 72.8 72.8 68.3
Non-regular alcohol consumption 65.5 91.2 89.0 85.3
Chiu et al., CMAJ 2010
Results
Age standardized prevalence (%)2. Other cardiovascular risk factors – by sex
White ChineseSouth Asian
Black
Psychosocial stress M 21.9 18.8 22.3 18.2F 24.4 19.7 20.8 20.5
Inadequate fruits/vegetables M 26.6 28.1 22.5 30.0F 17.8 20.0 16.0 18.9
Inadequate physical activity M 63.1 71.0 70.3 65.2F 64.7 74.6 75.2 71.3
Non-regular alcohol consumption M 59.0 86.5 81.8 77.1F 77.6 95.8 96.0 93.1
Chiu et al., CMAJ 2010
Heart disease and Stroke
Chiu et al., CMAJ 2010
Results
Prevalence of heart disease (%)
95% CI
5.25.1
3.43.2
0
2
4
6
Chinese Black White S. Asian
Ag
e-se
x st
and
ard
ized
rat
es (
%)
Standard Population: 2001 Ontario Census
* *
* P<0.05
Chiu et al., CMAJ 2010
Results
Prevalence of stroke (%)
95% CI
1.7
1.31.1
0.60.0
1.0
2.0
Chinese White Black S. Asian
Ag
e-se
x st
and
ard
ized
rat
es (
%)
Standard Population: 2001 Ontario Census
* P<0.05
*
Chiu et al., CMAJ 2010
CONCLUSION
Chiu et al., CMAJ 2010
Discussion
Striking differences in cardiovascular risk profiles Striking differences in cardiovascular risk profiles across 4 major ethnic groups in Ontarioacross 4 major ethnic groups in Ontario
Every group can improve their cardiovascular Every group can improve their cardiovascular healthhealth
Chinese: physical inactivityChinese: physical inactivity
South Asian: diabetes, hypertension, physical South Asian: diabetes, hypertension, physical inactivityinactivity
White: smoking, obesity, psychosocial stressWhite: smoking, obesity, psychosocial stress
Black: diabetes, hypertension, obesity (females), Black: diabetes, hypertension, obesity (females), physical inactivity (females)physical inactivity (females)
Help identify priorities for development of ethnic-Help identify priorities for development of ethnic-specific cardiovascular disease-prevention specific cardiovascular disease-prevention programsprograms