Prevalence and Associations of Asthma and Cardiovascular Disease among Asians and Pacific Islanders in Hawai‘i: A Single-Year Cross-Sectional Study from the Cardiovascular Disease Among Asians and Pacific Islanders (CASPER) Study

Howick, Connor Keaumakalani
Wu, Yan Yan
Public Health
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Introduction and Objective: Asthma and cardiovascular disease (CVD) are two of the most burdensome chronic diseases worldwide, yet rapidly-growing Asian and Pacific Islander (API) populations are underrepresented in current literature, including in Hawai‘i. Prior research suggests the asthma exposure may be linked with CVD outcomes, but the nature of the relationship is not yet fully understood. The aims of this study are (1) to estimate overall and race-and-age-specific prevalence proportions for lifetime asthma and CVD among Hawai‘i API, and (2) to determine if lifetime asthma prevalence is associated with CVD prevalence in those aged 45 years and older. Methods: Electronic health record (EHR) data from 2018 were collected from 128,269 Kaiser Permanente Hawai‘i (KPHI) adult members enrolled in the Cardiovascular Disease Among Asian and Pacific Islanders (CASPER) study. Descriptive statistics were used to describe characteristics of the sample, and to estimate single-year period prevalence for both asthma and CVD in 2018 (overall and age-and-race-specific prevalence). Multivariable log-link and identity-link regression models assuming a Poisson distribution calculated prevalence ratios (PR) and prevalence differences (PD) as measures of the asthma-CVD association. Results: Overall period prevalence of asthma and CVD were 11.23% and 10.66%, respectively, in the 2018 sample population. Native Hawaiians and mixed-race API appeared to have higher prevalence proportions of both diseases across the age groups, and CVD prevalence increased with age. Confounder-adjusted estimates reported a 19% increase of CVD prevalence in lifetime asthmatics compared to those with no history of asthma [PR: 1.19; 95% CI: 1.13, 1.26], but did not have a significant excess in absolute CVD diagnoses [PD: 0.0253; 95% CI: -0.0069, 0.0575]. Discussion and Conclusions: Prevalence of asthma and CVD was greatest among Native Hawaiians and mixed-race API in 2018. Asthma was found to be significantly associated with overall CVD among a sample representing API and White Hawai‘i adults aged ≥45 years by relative measures of association, but not for absolute measures; further research is needed on the asthma-CVD relationship and the role that confounding factors play. These findings suggest that asthma and CVD are connected in some manner, and addressing this relationship may be crucial to preventing or moderating future CVD events in Hawai‘i.
Epidemiology, Asian, Asthma, Cardiovascular disease, Hawaii, Native Hawaiian, Pacific Islander
63 pages
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