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Background Asian adults develop Type 2 diabetes at a lower body mass index (BMI) compared to other racial/ethnic groups. We examined the variation in prevalence of prediabetes and diabetes among Asian ethnic groups within weight strata by comparing middle-aged Chinese, Filipino, South Asian, and White adults receiving care in the same integrated healthcare delivery system. Methods Our retrospective cross-sectional U.S. study examined data from 283,110 (non-Hispanic) White, 33,263 Chinese, 38,766 Filipino, and 17,959 South Asian adults aged 45–64 years who were members of a Northern California health plan in 2016 and had measured height and weight. Prediabetes and diabetes were classified based on laboratory data, clinical diagnoses, or diabetes pharmacotherapy. Age-standardized prevalence of prediabetes and diabetes were compared by race/ethnicity within healthy weight, overweight, and obesity categories, using standard BMI thresholds for White adults (18.5 to < 25, 25 to < 30, ≥ 30 kg/m 2 ) and lower BMI thresholds for Asian adults (18.5 to < 23, 23 to < 27.5, ≥ 27.5 kg/m 2 ). Prevalence ratios (PRs) were used to compare the prevalence of diabetes and prediabetes for Asian groups to White adults in each weight category, adjusted for age and BMI. Results Across all weight categories, diabetes prevalence was higher for Asian than White adults, and among Asian groups it was highest for Filipino and South Asian adults. Compared to White, PRs for South Asian men/women at healthy BMI were 1.8/2.8 for prediabetes and 5.9/8.0 for diabetes, respectively. The PRs for Filipino men/women at healthy BMI were 1.8/2.6 for prediabetes and 5.0/7.5 for diabetes, respectively. For Chinese men/women at healthy BMI, the PRs for prediabetes (2.1/2.9) were similar to Filipino and South Asian, but the PRs for diabetes were lower (2.1/3.4). Conclusion Chinese, Filipino, and South Asian adults have higher prevalence of prediabetes and diabetes than White adults in all weight categories, despite using lower BMI thresholds for weight classification in Asian groups. Within Asian ethnic groups, Filipino and South Asian adults had considerably higher diabetes prevalence than Chinese adults. Our data emphasize the disproportionate metabolic risk among middle-aged Asian adults and underscore the need for diabetes screening among high-risk Asian groups at healthy BMI levels.

Background Little is known about possible differences in advance directive completion (ADC) based on ethnicity and language preference among Chinese Americans on a regional level. Objective To understand the association of ethnicity and language preference with ADC among Chinese Americans. Design Retrospective cohort analysis with direct standardization. Participants A total of 31,498 Chinese and 502,991 non-Hispanic White members enrolled in Kaiser Permanente Northern California during the entire study period between 2013 and 2017 who were 55 or older as of January 1, 2018. Main Measures We compared the proportion of ADC among non-Hispanic White and Chinese patients, and also analyzed the rates according to language preference within the Chinese population. We calculated ADC rates with direct standardization using covariates previously found in literature to be significant predictors of ADC such as age and utilization. Key Results Among Chinese members, 60% preferred English, 16% preferred another language without needing an interpreter, and 23% needed an interpreter. After standardizing for age and utilization, non-Hispanic Whites were more than twice as likely to have ADC as Chinese members (20.6% (95% confidence interval (CI): 20.5–20.7%) vs. 10.0% (95% CI: 9.6–10.3%), respectively). Among Chinese members, there was an inverse association between preference for a language other than English and ADC (13.3% (95% CI: 12.8–13.8%) if preferring English, 6.1% (95% CI: 5.4–6.7%) if preferring non-English language but not needing an interpreter, and 5.1% (95% CI: 4.6–5.6%) if preferring non-English language and needing an interpreter). Conclusions Chinese members are less likely to have ADC relative to non-Hispanic White members, and those preferring a language other than English are most affected. Further studies can assess reasons for lower ADC among Chinese members, differences in other Asian American populations, and interventions to reduce differences among Chinese members especially among those preferring a language other than English.

INTRODUCTION:The prevalence of inflammatory bowel disease (IBD, ulcerative colitis (UC) and Crohn's disease (CD)) has been estimated to be approximately 400-600 per 100,000 persons in the United States,3 but this relies on data skewed heavily towards Caucasian populations. Previous studies have suggested that IBD prevalence in Asia is much lower, around 30-60 per 100,000.7 A recent study highlighted higher rates and more extensive UC in migrant groups than in their home countries.5 However, the overall trend with IBD being more prevalent in Caucasians compared to Asians has been shown previously. One caveat to this is in South Asians, who have a higher incidence and prevalence of UC compared to the indigenous population of the UK.5 In this study we seek to further breakdown the prevalence of IBD among Asian subgroups in a Northern California integrated health care delivery system.METHODS:Adults aged 18 years and older diagnosed with IBD between 1/1/2014-12/31/2014 were identified with ICD-9 diagnosis codes for UC (556.x) and CD (555.x). We calculated overall period prevalence of IBD, UC and CD by race/ethnicity, including Asian subtypes.RESULTS:Among 7,766 Kaiser Permanente Northern California (KPNC) members with IBD, the prevalence of IBD was higher in Caucasians compared to Asians (377 vs 125 per 100,000, P < 0.01 Table 1). However, when Asians were further subclassified, the period prevalence among South Asians was significantly higher than not only the other Asian subgroups, but also the Caucasian group (504 vs 377 per 100,000). Breaking up IBD into CD and UC, the period prevalence among Asians continued to be significantly lower than Caucasians (Table 2). However, among South Asians the prevalence of UC is again higher than that of Caucasians (417 vs 208 per 100,000). Interestingly, the prevalence of CD is less among South Asians compared to Caucasians (87 vs 169 per 100,000).CONCLUSION:Our data from a diverse patient population in Northern California show an overall lower prevalence of IBD in Asian compared to Caucasian patients overall but a higher prevalence among South Asians. Our data is consistent with prior Canadian and UK studies.5 Most American studies combine South Asians into the Asian category, which shows a deceptively decreased prevalence compared to the Caucasian population. Further studies are needed to understand the etiology of this finding and seek to further explore the differences among Asian subpopulations.Table 1.Prevalence of IBD, UC, and CD by Race/Ethnicity SubgroupsTable 2.Prevalence of IBD, UC, and CD by Asian Subgroups

Lay Summary This study examined relative psychiatric burden among patients who presented to the emergency department once or more than once for inflammatory bowel disease visits. Results highlight the need for integration of psychiatric and gastrointestinal care among high-risk inflammatory bowel disease patients.

Objective: There is increasing recognition that cardiovascular disease (CVD) risk factors vary by Asian subgroups. We examined CVD risk factor prevalence among Vietnamese adults in a northern California health plan. Methods: We used electronic health record data to examine smoking, overweight/obesity (body mass index ≥23.0 kg/m2), obesity (body mass index ≥27.5 kg/m2), prediabetes, diabetes, and hypertension among middle-aged (n = 12 757; aged 45-64 years) and older (n = 3418; aged 65-84 years) Vietnamese adults, including 37.8% whose preferred language was Vietnamese. Findings were compared with East Asian adults. Results: Current smoking prevalence was 20.3% for middle-aged men, 7.0% for older men, and <1% for women in both age groups. Obesity prevalence was 12.0% for older men, 17.9% for middle-aged men, and 10% for women in both age groups. Among middle-aged men and women, 20.9% and 17.0% had hypertension and 13.5% and 8.5% had diabetes, respectively. Among older men and women, 64.0% and 60.0% had hypertension and 32.8% and 29.3% had diabetes, respectively. In both age groups, Vietnamese language preference was associated with higher risk of smoking (men only) and of diabetes and hypertension (women only). Compared with East Asian adults, Vietnamese adults had lower obesity prevalence but similar prevalence of diabetes, prediabetes, and hypertension. Vietnamese men were more likely and Vietnamese women less likely than East Asian adults to be current smokers. Conclusions: Study results suggest that more research on health conditions, lifestyle, and social factors among Vietnamese American adults is needed to develop culturally competent interventions to reduce CVD risk in this growing ethnic group.