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
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 Ontario
CIHR Canada Graduate Scholarship
Canadian Cardiovascular Outcomes Research Team
Chiu et al., CMAJ 2010
Study objective
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
Chiu et al., CMAJ 2010
METHODS
Chiu et al., CMAJ 2010
Methods
Data source
National Population Health Survey (NPHS) and
Canadian Community Health Survey (CCHS)
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
Study variables
Ethnic/racial background
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…
Chiu et al., CMAJ 2010
Study variables
CVD risk factors
CVD
Current smoking
Heart disease
Obesity
Stroke
Diabetes
Hypertension
Psychosocial stress
Inadequate fruit/vegetables
Inadequate physical activity
Non-regular alcohol intake
Chiu et al., CMAJ 2010
Methods
Statistical analysis
Statistical software: SAS v9.1
Age-sex standardized prevalence of CVD risk factors,
heart disease, stroke
Standard population: 2001 Ontario census
All estimates weighted by sample weights from
Statistics Canada
Bootstrap method for variance estimation for 95% CI
and P values
Chiu et al., CMAJ 2010
RESULTS
Chiu et al., CMAJ 2010
Results
Study sample size, NPHS/CCHS 1996-2007
White
Chinese
S. Asian
Black
154 653
3 038
3 364
2 742
TOTAL N = 163 797
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
High school graduate
12.9
Some post-sec schooling
6.0
College/university degree
73.4
4.9
11.5
4.4
79.2
5.1
10.0
6.1
78.8
7.6
11.3
8.2
73.0
78930.0
66954.0
63886.0
54428.0
3.1
3.6
4.2
3.3
7.1
17.7
34.3
40.9
11.0
22.1
32.9
33.9
11.9
28.5
33.1
26.5
16.5
27.7
33.9
21.9
Mean household income (CAD)
Household size
Income adequacy group
1 (lowest)
2 (lower-mid)
3 (mid-higher)
4 (highest)
Chiu et al., CMAJ 2010
Risk Factors
Chiu et al., CMAJ 2010
Results
Age-sex standardized prevalence (%)
1. Major CV risk factors
White
Chinese
South
Asian
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
Black
Results
Age-sex standardized prevalence (%)
1. Major CV risk factors—by sex
White
Chinese
South
Asian
Black
Current smoking
M
F
25.2
20.3
14.4
3.3
13.8
3.6
15.4
7.6
Obesity
M
F
14.9
13.1
2.5
2.6
7.8
8.5
11.2
16.8
Diabetes
M
F
4.8
4.1
4.0
4.6
9.4
6.8
7.4
9.5
Hypertension
M
F
13.1
14.8
14.4
15.8
16.0
17.9
17.7
21.7
Chiu et al., CMAJ 2010
Results
Age-sex standardized prevalence (%)
2. Other CV risk factors
White Chinese
South
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 Chinese
South
Asian
Black
Psychosocial stress
M
F
21.9
24.4
18.8
19.7
22.3
20.8
18.2
20.5
Inadequate fruits/vegetables
M
F
26.6
17.8
28.1
20.0
22.5
16.0
30.0
18.9
Inadequate physical activity
M
F
63.1
64.7
71.0
74.6
70.3
75.2
65.2
71.3
Non-regular alcohol consumption
M
F
59.0
77.6
86.5
95.8
81.8
96.0
77.1
93.1
Chiu et al., CMAJ 2010
Heart disease and Stroke
Chiu et al., CMAJ 2010
Results
Age-sex standardized rates (%)
Prevalence of heart disease (%)
* P<0.05
95% CI
6
*
*
4
5.1
2
3.2
5.2
3.4
0
Chinese
Black
White
Standard Population: 2001 Ontario Census
Chiu et al., CMAJ 2010
S. Asian
Results
Prevalence of stroke (%)
* P<0.05
Age-sex standardized rates (%)
95% CI
2.0
*
1.0
1.7
1.1
1.3
0.6
0.0
Chinese
White
Standard Population: 2001 Ontario Census
Chiu et al., CMAJ 2010
Black
S. Asian
CONCLUSION
Chiu et al., CMAJ 2010
Discussion
Striking differences in cardiovascular risk profiles across
4 major ethnic groups in Ontario
Every group can improve their cardiovascular health
Chinese: physical inactivity
South Asian: diabetes, hypertension, physical inactivity
White: smoking, obesity, psychosocial stress
Black: diabetes, hypertension, obesity (females), physical
inactivity (females)
Help identify priorities for development of ethnic-specific
cardiovascular disease-prevention programs
Chiu et al., CMAJ 2010
