Epidemiology of Aging: Racial/Ethnic Specifi c Disease Prevalence
8.2 Risk Factors
The primary risk factors for heart disease include hypertension, hyperlipidemia, diabetes, and smoking. Additional risk factors include body habitus/weight, activity level, family history, diet, and age. Smoking is a behavior that changes in prevalence with aging. Tobacco smoking is the leading cause of preventable disease and death in the United States according to the Centers for Disease Control and Prevention (CDC). Overall there has been a decline in cigarette usage from 20.9 % in 2005 to 16.8 % in 2014 (MMWR 2015). In a review of the National Health Interview Survey, smoking was lowest among those over the age of 65 at 8.5 %. In general, racial and ethnic group analysis showed smoking prevalence was highest among American Indian/Alaska Natives (29.2 %) and multiracial adults (27.9 %), and lowest among Asians (9.5 %) (MMWR 2015). In addition, smoking prevalence was higher among those receiving Medicaid (29.1 %) and uninsured (27.9 %) than those with private health insurance (12.9 %). As noted in Morbidity and Mortality Weekly Report,
Table 8.1 The ten leading causes of death by race/ethnicity, 65–69 years 65–69 years White AAs American Indian or Alaskan Native Asian or Pacifi c Islander Hispanic (65–74 years) 1 Malignant Neoplasm Malignant Neoplasm Malignant Neoplasm Malignant Neoplasm Malignant Neoplasm 2 Diseases of heart Diseases of heart Diseases of heart Diseases of heart Diseases of heart 3 Chronic lower respiratory diseases Cerebrovascular diseases Diabetes mellitus Cerebrovascular diseases Diabetes mellitus 4 Diabetes mellitus Diabetes mellitus Chronic lower respiratory diseases Diabetes mellitus Cerebrovascular diseases 5 Cerebrovascular diseases Chronic lower respiratory diseases Cerebrovascular diseases Accidents Chronic lower respiratory diseases 6 Accidents Nephritis, nephrotic syndrome, and nephrosis Chronic liver disease and cirrhosis Chronic lower respiratory diseases Chronic liver disease and cirrhosis 7 Chronic liver disease and cirrhosis Septicemia Accidents Nephritis, nephrotic syndrome, and nephrosis Nephritis, nephrotic syndrome, and nephrosis 8 Septicemia Essential hypertension and hypertensive renal disease Nephritis, nephrotic syndrome, and nephrosis Infl uenza and pneumonia Accidents 9 Nephritis, nephrotic syndrome, and nephrosis Infl uenza and pneumonia Septicemia Septicemia Infl uenza and pneumonia 10 Infl uenza and pneumonia Accidents Infl uenza and pneumonia Chronic liver disease and cirrhosis Septicemia Compiled from CDC/NCHS, National Vital Statistics System, Mortality 2013, National Vital Statistics Reports, Vol 62, No 6, December 2013. http://www.cdc. gov/nchs/data/dvs/LCWK1_2013.pdf [accessed 1/30/2016] [ 55 ]
Table 8.2 The ten leading causes of death by race/ethnicity, 80–84 years 80–84 years White AAs American Indian or Alaskan Native Asian or Pacifi c Islander Hispanic (85 years and older) 1 Diseases of heart Diseases of heart Diseases of heart Malignant Neoplasm Diseases of heart 2 Malignant neoplasms Malignant Neoplasm Malignant Neoplasm Diseases of heart Malignant Neoplasm 3 Chronic Lower Respiratory Diseases Cerebrovascular diseases Chronic Lower Respiratory Diseases Cerebrovascular diseases Cerebrovascular diseases 4 Cerebrovascular Diseases Diabetes mellitus Diabetes mellitus Chronic Lower Respiratory Diseases Alzheimer’s disease 5 Alzheimer’s disease Chronic lower respiratory diseases Cerebrovascular diseases Diabetes Mellitus Chronic lower respiratory diseases 6 Diabetes Mellitus Nephritis, nephrotic syndrome, and nephrosis Alzheimer’s disease Infl uenza and pneumonia Diabetes Mellitus 7 Accidents Alzheimer’s disease Accidents Alzheimer’s disease Infl uenza and pneumonia 8 Infl uenza and pneumonia Septicemia Infl uenza and pneumonia Accidents Nephritis, nephrotic syndrome, and nephrosis 9 Nephritis, nephrotic syndrome, and nephrosis Essential hypertension and hypertensive renal disease Nephritis, nephrotic syndrome, and nephrosis Nephritis, nephrotic syndrome, and nephrosis Essential hypertension and hypertensive renal disease 10 Parkinson’s disease Infl uenza and pneumonia Septicemia Essential hypertension and hypertensive renal disease Accidents Compiled from CDC/NCHS, National Vital Statistics System, Mortality 2013, National Vital Statistics Reports, Vol 62, No 6, December 2013
difference in smoking might be infl uenced by sociocultural and normative factors.
In addition, differences in smoking prevalence mediated by insurance status have been infl uenced by tobacco cessation coverage.
There are possible ethnic differences between the association of cigarette smok- ing and disease. In a study of Hispanic and non-Hispanic White (NHW) women, an association was found between breast cancer risk and former and ≥31 years of smoking in Mexican women when compared to never smokers [ 3 ]. Although the association was found in NHWs the association was noted with smoking ≥20 ciga- rettes per day. In addition, risk for pneumonia and infl uenza is clearly linked to structural preexisting lung disease and vaccination.
Park and colleagues note that smoking (versus never smoking) and a history of diabetes were the only factors signifi cantly associated with an increased risk of prostate cancer and education was related to an increased risk [ 4 ]. These lifestyle- related associations were specifi c for localized cancer, not advanced tumors, and did not necessarily explain racial/ethnic prostate cancer risk differences in this study.
Although no current evidence exists for lifestyle factors and prostate cancer risk, these same factors should be considered in examinations of other cancers.
Although obesity is linked to many diseases, their relative impact on disease might also have mediating factors that are different across different ethnicities and races. Bandera and colleagues note possible stronger associations between obesity and breast cancer in Asians and central obesity appears to have a greater impact in African American (AA) women [ 5 ].
Environmental exposure has been implicated in some diseases. One study notes the potential that exposure to estrogen and endocrine disrupting chemicals might have some part in breast cancer risk [ 6 ]. Notably, they examined the possibility that the use of these products by AA women might be a risk factor. Different environ- mental exposures are also a factor in immigrant populations. For example, infec- tious diseases such as viral hepatitis and Helicobacter Pylori are important contributors to gastrointestinal cancer risk. According to the World Health Organization, chronic Hepatitis B has high endemicity (70–90 % infected by age 40 and 20 % are Hepatitis B carriers) in south-east Asia, Pacifi c Basin (excluding Japan, Australia, and New Zealand), sub-Saharan Africa, the Amazon basin, parts of the Middle East, the central Asian Republics, and some countries in eastern Europe.
Air pollution, especially household air pollution from open fi res and simple stove cooking, is also a great contributor to health risk in developing countries.
The deferment of screening is a concern for all patients and is a potential barrier to timely diagnosis. For example, Hispanics have been noted to be less likely to undergo colorectal and cervical cancer screening when compared to NHWs [ 7 ].
Swan and colleagues analyzed the 2000 National Health Interview Survey [ 8 ]. The results indicated that there were not improvements in those with the most disparities including those without a usual source of care, those within 10 years of immigration, or those with no health insurance. Many of these factors are likely to have a greater impact in racial/ethnic minority populations given the rapid growth of some groups such as Asian American and Pacifi c Islanders. Geographic access to screening is a barrier experienced by many and especially American Indians and Alaskan Natives.