Pinpointing the sources of the Asian mortality advantage in the USA

Abstract

Background Asian-Americans outlive whites by an average of nearly 8 years. By determining the sources of the Asian mortality advantage, we can pinpoint where there is the greatest potential for raising the life expectancy of whites and other groups in the United States. Methods Our analyses include all Asian and white deaths in the United States between 2006 and 2010, from the Center for Disease Control (CDC). Using the International Classification of Diseases (version 10), we code causes of deaths into 19 categories, based on the most common causes as well as causes particularly relevant to racial differences. We then create life tables and apply a newly-developed demographic method to determine whether Asians have longer life expectancy because they are less likely than whites to die of causes of death that strike at younger ages, or because they tend to outlive whites regardless of cause of death. Results Nearly 90% of the Asian-white life expectancy gap is attributable to the fact that Asians tend to outlive whites regardless of the cause of death. The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). Men contribute somewhat more to the gap than women do (55% versus 45%), primarily because Asian-white differences in mortality are greater among men than among women with respect to suicide, traffic accidents, and accidental poisoning. Conclusions For almost all causes of death, Asian victims tend to be older than white victims. The greatest potential for raising the life expectancy of whites to that of Asians, then, resides in efforts that effectively increase whites' average age at death for the most common causes of death.

Examining the gastric cancer survival gap between Asians and whites in the United States

“…Loss to followup, which contributes to inflated survival estimates, may occur because of the return of immigrants with serious illnesses to their countries of origin to die, a phenomenon known as the salmon bias [47,48]. However, studies thus far indicate that salmon bias has limited impact on Asian American survival, likely due to travel being too distant and time-consuming for gravely ill individuals to undertake [49,50]. Lastly, some important covariates, such as residual tumor category, comorbidities, and postoperative complications, are critical factors impacting gastric cancer survival.…”

Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011

“…A recent study found selective reverse migration to be true among Mexican migrants in the USA, with higher probabilities of Mexican migrants in poor health to return home (and lower probabilities of return in improving health). 42 Statistical immortality may differ by Asian subgroup, given possible differences in ease of return migration. For instance, it may be easier for US citizens to return migrate to Japan rather than China, given the more favourable visa and citizenship requirements.…”

Understanding the contribution of suicide to life expectancy in South Korea

“…The age-incidence decomposition isolates these two sources of change. In the twofactor approach, used in Acciai, Noah, and Firebaugh (2015) and in Firebaugh et al (2014), the age component for cause c is as follows:…”

“…By separating the incidence and age components we determine whether change in life expectancy is occurring because people are dying of different causes, or because they are dying of the same causes but at different ages (Acciai, Noah, and Firebaugh 2015;Firebaugh et al 2014). Change in life expectancy is due to change in death rates, and age-incidence decomposition reveals the locus of the death rate changes that are driving the change in life expectancy.…”

“…To reduce the number of causes, we collapsed them into nine broad categories (plus a residual category) representing key causes of death: cardiovascular diseases, cancer, chronic diseases, communicable diseases, suicide, external causes (other than suicide), mental and behavioral disorders, infant conditions, ill-defined causes, and minor causes not elsewhere classified (NEC). We adapted this scheme based on prior analyses (Acciai, Noah, and Firebaugh 2015;Firebaugh et al 2014;Nau and Firebaugh 2012), but we created separate categories for causes that are relevant to our investigation (i.e., suicide, and mental and behavioral disorders). Appendix Table A-1 describes our cause grouping in more detail.…”