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Cited by 31Healthcare Systems and Public HealthCardiovascular Health and Risk FactorsHealth disparities and outcomes

Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California

Open access
Waitzfelder, Beth, Palaniappan, Latha, Varga, Alexandra, Frankland, Timothy B., Li, Jiang, Daida, Yihe G., Kaholokula, Joseph Keawe’aimoku, Bacong, Adrian Matias +4 more·2023·BMC Public Health
DOI 10.1186/s12889-023-15795-5PMC PMC10184427
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Abstract

Abstract Background Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations. Methods The study cohort was comprised of all adult patients at Kaiser Permanente Hawai’i and Palo Alto Medical Foundation in California during 2014–2018 ( n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups. Results The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos). Conclusions Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.

AI snapshot

Written from the paper’s full text.

TL;DR

In a cohort of 684,363 adults in Hawai’i and California, cardiovascular disease prevalence differed substantially across 12 disaggregated Asian, Pacific Islander, and multi-race groups. Filipino, Native Hawaiian, Other Pacific Islander, and multi-race API groups had elevated prevalence, supporting disaggregation of API populations in health research.

Key findings

  • CHD and PVD prevalence varied 4-fold, and stroke and overall CVD prevalence varied 3-fold, across API subpopulations. Among Asians, Filipinos had the highest prevalence of all three CVD conditions and overall CVD; Chinese had the lowest prevalence of CHD, PVD, and overall CVD.
  • Compared with Non-Hispanic White (NHW) participants: CHD prevalence was 1.81% among NHW, lower among Chinese (1.08%), Korean (1.10%), and Japanese (1.45%), and higher among Other Pacific Islanders and all multi-race groups, ranging from 2.13% (Asian + White) to 4.32% (Pacific Islander + Asian + White). Stroke prevalence was 1.01% among NHW, lower among Asian Indian (0.74%) and Chinese (0.81%), and higher in all other racial/ethnic groups, ranging from 1.20% among Filipinos to 2.24% among Pacific Islander + White. PVD prevalence was 1.68% among NHW, lower among all Asian groups (0.63% Chinese to 1.07% Filipino), comparable among Native Hawaiians, Other Pacific Islanders, and Asian + White, and higher among Pacific Islander + Asian, Pacific Islander + White, and Pacific Islander + Asian + White. Overall CVD prevalence was 4.02% among NHW, lower among all Asian groups except Filipinos (2.27% Chinese to 3.35% Japanese), not significantly different among Filipinos, and higher among all Pacific Islander single and multi-race groups (5.27% Native Hawaiian to 8.53% Pacific Islander + White).
  • Other Pacific Islanders had significantly higher CHD prevalence than Native Hawaiians; stroke and overall CVD were higher but not significantly different. Multi-race groups including Pacific Islanders (Pacific Islander + Asian, Pacific Islander + White, Pacific Islander + Asian + White) had significantly higher overall CVD prevalence than either single-race Native Hawaiians or Other Pacific Islanders, largely due to CHD differences. The Asian + White group had significantly higher overall CVD prevalence than both NHW and Filipinos.

Methods

  • Cohort included all adult patients ages 18 years and older at Kaiser Permanente Hawai’i and Palo Alto Medical Foundation in California during 2014–2018 who had at least one primary care visit in the prior two years (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes indicated CHD, stroke, PVD, and overall CVD; self-reported race and ethnicity were used to construct 12 mutually exclusive single and multi-race groups plus a Non-Hispanic White comparison group.
  • Logistic regression models adjusted for site, gender, and age as a continuous variable were used to derive prevalence estimates, odds ratios, and 95% confidence intervals for each race/ethnicity group, with NHW as the reference. Least square means estimated prevalence at the mean values of all covariates; CVD prevalence estimates reflect the mean age of the study population, 49.6 years.

Limitations

  • The paper states that results may not be generalizable to other US API populations; subgroups were not uniformly distributed across sites (South Asians more common in California, Pacific Islanders in Hawai’i); the study was limited to insured people and likely underrepresents recent immigrants and lower-income individuals; it did not include Hispanic or Black populations; it lacked individual-level socioeconomic measures; and it was limited to two health care systems.
  • The text also makes evident that prevalence estimates are adjusted only for site, gender, and age, and reflect the cohort’s mean age of 49.6; race/ethnicity was self-reported and multi-race classification can be fluid; small single Asian ethnic groups and “Other” or “Unknown” race/ethnicity categories were excluded.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12889-023-15795-5

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

26 of 41 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § Introduction · p. 2

    Knowledge gaps about the health of single and multiracial Asian and Pacific Islander populations have persisted in part due to the problematic practice of aggregating broad and diverse Asian and Pacific Islander populations for research purposes.

    “Knowledge gaps about the health of single and multiracial Asian and Pacific Islander populations have persisted in part due to the problematic practice of aggregating broad and diverse Asian and Pacific Islander populations for research purposes.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [9] Holland AT, Wong EC, Lauderdale DS, Palaniappan LP. Spectrum of cardiovascular diseases inAsian-American racial/ethnic subgroups. Ann Epidemiol. 2011;21(8):608–14. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [10] Gordon NP, Lin TY, Rau J, Lo JC. Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study. BMC Public Health. 2019;19(1):1551. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [11] Kaholokula JKa, Okamoto SK, Yee BWK. Special issue introduction: advancing Native Hawaiian and other Pacific Islander health. Asian Am J Psychol. 2019;10(3):197–205. source
  • Premisecitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    Psychosocial stress associated with racial discrimination and bias has a negative impact on cardiovascular disease risk, including among Pacific Islanders.

    “There is evidence that psychosocial stress associated with racial discrimination and bias has a negative impact upon cardiovascular disease risk, including among Pacific Islanders [39, 40].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [39] Kershaw KN, Lewis TT, Diez Roux AV, Jenny NS, Liu K, Penedo FJ, Carnethon MR. Self-reported experiences of discrimination and inflammation among men and women: the multi-ethnic study of atherosclerosis. Health Psychol. 2016;35(4):343–50. source

      The Results and Discussion (page numbers unavailable) provide some evidence linking discrimination with an inflammatory marker relevant to cardiovascular risk, particularly among women, but the findings varied by gender and do not establish a causal impact on cardiovascular disease risk. The Method > Sample and Design section lists White, Black, Hispanic, and Chinese participants, not Pacific Islanders; the claim's extension to Pacific Islanders is unsupported by this paper. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [40] Hermosura AH, Haynes SN, Kaholokula JK. A preliminary study of the relationship between perceived racism and cardiovascular reactivity and recovery in Native Hawaiians. J Racial Ethn Health Disparities. 2018;5(5):1142–54. source
  • Interpretationcitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    Among Asian populations, study findings of higher prevalence of all three CVD conditions among Filipinos is consistent with previous reports of higher cardiometabolic risk and poorer health outcomes in this population.

    “Among Asian populations, study findings of higher prevalence of all three CVD conditions among Filipinos is consistent with previous reports of higher cardiometabolic risk and poorer health outcomes in this population [4, 7, 13, 15, 19, 22, 30-34].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [4] Iyer DG, Shah NS, Hastings KG, Hu J, Rodriguez F, Boothroyd DB, Krishnan AV, Falasinnu T, Palaniappan L. Years of potential life lost because of cardiovascular disease in Asian-American subgroups, 2003–2012. J Am Heart Assoc. 2019;8(7):e010744. source
    • cites [7] Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, et al. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol. 2021;7:100219. source
    • cites [13] Shah NS, Shimbo D, Muntner P, Huffman MD, Kandula NR, Mefford MT, et al. Hypertension-related cardiovascular mortality in Asian American subgroups. Am J Prev Med. 2023. source
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.
  • Findingown data
    § Peripheral Vascular Disease (PVD) · p. 4

    Higher PVD prevalence was observed among the three other multi-race groups (PIA, PIW, PIAW) in comparison to NHWs.

    “Higher prevalence was observed among the three other multi-race groups (PIA, PIW, PIAW) in comparison to NHWs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.
  • Findingown data
    § Stroke · p. 4

    Korean stroke prevalence was not significantly different from NHWs (1.06%).

    “Estimates for Korean and Japanese members of the cohort were not significantly different from NHWs (1.06% and 1.10%, respectively).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 27

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    Patients' experience of health care is affected by perceived discrimination, resulting in distrust in the provider and, potentially, racial concordance with providers.

    “Patients' experience of health care is also affected by perceived discrimination, resulting distrust in the provider, and, potentially, racial concordance with providers [47-51].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [47] Kaholokula JK, Antonio MC, Ing CK, Hermosura A, Hall KE, Knight R, Wills TA. The effects of perceived racism on psychological distress mediated by venting and disengagement coping in Native Hawaiians. BMC Psychol. 2017;5(1):2. source

      The Background and Conclusion (page not provided) discuss perceived racism, psychological distress, and health among Native Hawaiians. Searches for patient health-care experience, provider distrust, and racial concordance found no passage addressing those points. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [48] Gregg EW, Karter AJ, Gerzoff RB, Safford M, Brown AF, Tseng CW, Waitzfielder B, Herman WH, Mangione CM, Selby JV, et al. Characteristics of insured patients with persistent gaps in diabetes care services: the Translating Research into Action for Diabetes (TRIAD) study. Med Care. 2010;48(1):31–7. source

      The Results discuss differences in missed diabetes services by patient race/ethnicity, while the Discussion says the study did not examine the relative impact of provider practices and perceptions on persistent lapses. Searches for discrimination, distrust, and racial concordance found no passage linking them to patients’ experience of care. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [49] Selby JV, Swain BE, Gerzoff RB, Karter AJ, Waitzfelder BE, Brown AF, Ackermann RT, Duru OK, Ferrara A, Herman W, et al. Understanding the gap between good processes of diabetes care and poor intermediate outcomes: Translating Research into Action for Diabetes (TRIAD). Med Care. 2007;45(12):1144–53. source
    • cites [50] Konrad TR, Howard DL, Edwards LJ, Ivanova A, Carey TS. Physician-patient racial concordance, continuity of care, and patterns of care for hypertension. Am J Public Health. 2005;95(12):2186–90. source
    • cites [51] Blanchard J, Nayar S, Lurie N. Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting. J Gen Intern Med. 2007;22(8):1184–9. source

      The Methods section measures perceived race-based unfair treatment, and the Results and Discussion associate racial concordance with perceptions of mistreatment, with findings that vary by racial group. The paper does not report that perceived discrimination causes distrust in providers or leads patients to seek racially concordant providers. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation
    § Introduction · p. 2

    Limited evidence suggests that there is up to a six-fold difference in CVD rates among API subpopulations.

    “Limited evidence suggests that there is up to a six-fold difference in CVD rates among API subpopulations.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] Holland AT, Wong EC, Lauderdale DS, Palaniappan LP. Spectrum of cardiovascular diseases inAsian-American racial/ethnic subgroups. Ann Epidemiol. 2011;21(8):608–14. source

  • May combine two claims.

    Interpretationcitation
    § Differences in CVD prevalence among disaggregated API populations · p. 5

    CASPER study results are consistent with existing evidence of higher CVD prevalence among Pacific Islanders and lower prevalence among Asians in comparison to NHWs.

    “However, CASPER study results are consistent with existing evidence of higher CVD prevalence among Pacific Islanders and lower prevalence among Asians in comparison to NHWs [1, 19, 29].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [1] Heart disease facts. https://www.cdc.gov/heartdisease/facts.htm.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] Gordon NP, Hsueh L. Racial/ethnic, gender, and age group differences in cardiometabolic risks among adults in a Northern California health plan: a cross-sectional study. BMC Public Health. 2021;21(1):1227. source

      The Background discusses coronary heart disease in Filipino versus Chinese adults, but does not compare CVD prevalence in Asians with non-Hispanic Whites. A search for Pacific Islanders and CVD prevalence found no passage addressing the claimed comparison with Whites. The Results passages concern cardiometabolic risk factors rather than CVD prevalence. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [29] Table A-1a. Age-adjusted percentages (with standard errors) of selected circulatory diseases among adults aged 18 and over, by selected characteristics: United States, 2018. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_A-1.pdf.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Introduction · p. 2

    Recent studies have highlighted both the need to disaggregate API subgroups and relatively higher CVD burden among some subpopulations, particularly South Asians and Filipinos.

    “Recent studies have highlighted both the need to disaggregate API subgroups [7, 8, 13, 14] and relatively higher CVD burden among some subpopulations, particularly South Asians and Filipinos [6, 15, 16].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [7] Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, et al. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol. 2021;7:100219. source
    • cites [8] Shah NS, Palaniappan LP, Khan SS. Proportional mortality from ischemic heart disease among Asian American subgroups, from 2018 to 2020. JAMA Intern Med. 2022;182(10):1101–3. source
    • cites [13] Shah NS, Shimbo D, Muntner P, Huffman MD, Kandula NR, Mefford MT, et al. Hypertension-related cardiovascular mortality in Asian American subgroups. Am J Prev Med. 2023. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction · p. 2

    Previous studies have shown the prevalence of CVD among API subpopulations ranging from 1.7% to 5.2%; stroke from 0.3% to 1.8%; and peripheral vascular disease from 0.9% to 3.4%.

    “Previous studies have shown the prevalence of CVD among API subpopulations ranging from 1.7% to 5.2%; stroke from 0.3% to 1.8%; and peripheral vascular disease from 0.9% to 3.4% [9].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] Holland AT, Wong EC, Lauderdale DS, Palaniappan LP. Spectrum of cardiovascular diseases inAsian-American racial/ethnic subgroups. Ann Epidemiol. 2011;21(8):608–14. source

      The Abstract Results give the exact age-adjusted ranges for stroke (0.3%–1.8%) and PVD (0.9%–3.4%). They give 1.7%–5.2% for coronary heart disease (CHD), however, not for cardiovascular disease (CVD) as a whole. The figures are this paper’s findings rather than ranges it attributes to previous studies. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    Socioeconomic status is inversely associated with all phases of CVD progression, from the onset of risk factors through mortality due to CVD.

    “The inverse association of socioeconomic status (SES) with all phases of the progression of CVD is well established, from the onset of risk factors through mortality due to CVD [41-45].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [41] Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993;88(4 Pt 1):1973–98. source
    • cites [42] Bashinskaya B, Nahed BV, Walcott BP, Coumans JV, Onuma OK. Socioeconomic status correlates with the prevalence of advanced coronary artery disease in the United States. PLoS One. 2012;7(9):e46314. source

      The Introduction links socioeconomic factors to CAD risk factors, and the Discussion reports an inverse relationship between education level and cardiac revascularization procedures (pages not provided). These passages support parts of the claimed progression, but the paper does not establish an inverse SES association with every phase or with CVD mortality specifically. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [43] Winkleby M, Sundquist K, Cubbin C. Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med. 2007;32(2):97–106. source

      The Abstract (page not supplied) reports higher CHD incidence and one-year case fatality in more deprived neighborhoods, supporting the association for those outcomes. The paper does not establish an association across all phases of CVD progression: it does not measure the onset of risk factors, and its outcomes concern CHD rather than all CVD. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [44] Kamphuis CB, Turrell G, Giskes K, Mackenbach JP, van Lenthe FJ. Life course socioeconomic conditions, adulthood risk factors and cardiovascular mortality among men and women: a 17-year follow up of the GLOBE study. Int J Cardiol. 2013;168(3):2207–13. source
    • cites [45] Nordstrom CK, Diez Roux AV, Jackson SA, Gardin JM. The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study. Soc Sci Med. 2004;59(10):2139–47. source

      The Introduction (page not provided) reports inverse associations between socioeconomic position and CVD prevalence and incidence, and discusses socioeconomic differences in CVD risk factors. The Discussion (page not provided) reports an association with subclinical disease in older adults. Our copy does not establish the claimed association across all phases through CVD mortality. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Introduction · p. 2

    Emerging research suggests that some Asian subgroups, and Pacific Islanders, may be at higher risk for CVD and poorer outcomes than NHW, and that there are important differences among API subgroups.

    “Emerging research suggests that some Asian subgroups, and Pacific Islanders, may be at higher risk for CVD and poorer outcomes than NHW, and that there are important differences among API subgroups [4-8].”
    Quote in the paperSubstantial claim5 of 5 sources checked
    • cites [4] Iyer DG, Shah NS, Hastings KG, Hu J, Rodriguez F, Boothroyd DB, Krishnan AV, Falasinnu T, Palaniappan L. Years of potential life lost because of cardiovascular disease in Asian-American subgroups, 2003–2012. J Am Heart Assoc. 2019;8(7):e010744. source

      The Methods and Results report differences in CVD burden among Asian-American subgroups and higher years of life lost to cerebrovascular disease than among non-Hispanic whites. The Discussion also identifies Filipino and Vietnamese populations as having more years of life lost than the non-Hispanic white population studied. The paper does not report CVD risk or outcomes for Pacific Islanders, so it does not support that part of the sentence. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [5] Mau MK, Sinclair K, Saito EP, Baumhofer KN, Kaholokula JK. Cardiometabolic health disparities in Native Hawaiians and Other Pacific Islanders. Epidemiol Rev. 2009;31:113–29. source

      The Results (Cardiovascular disease; page not supplied) report more hypertension and high cholesterol among NHOPI women than among whites, as well as differences in cardiac treatment. The Introduction reports higher cardiovascular mortality among Native Hawaiians than among Japanese, supporting differences between subgroups. This paper does not establish that Asian subgroups have higher CVD risk or poorer outcomes than non-Hispanic whites, nor does it directly compare Pacific Islanders’ CVD outcomes with that group. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [6] Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, Lichtman JH, Mehta LS, Patel HN, Shah KS, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018;138(1):e1–34. source

      The Coronary Heart Disease section reports higher ischemic-heart-disease proportional mortality for Asian Indian men and women, and Filipino men, than for non-Hispanic whites; it also reports lower rates for most other Asian subgroups. This supports differences among Asian subgroups and poorer outcomes for some, but the paper does not establish the claimed elevated CVD risk or poorer outcomes for Pacific Islanders. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [7] Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, et al. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol. 2021;7:100219. source

      The Introduction (page not specified) reports prior findings of higher ischemic heart disease prevalence and mortality among Asian Indian and Filipino people than among non-Hispanic White people. The Discussion (page not specified) reports substantial differences in cardiovascular risk factors across Asian subgroups. The paper does not establish the claim about Pacific Islanders; its own adjusted analysis also found no statistically significant difference in ASCVD odds between the Asian subgroups studied and non-Hispanic White respondents. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [8] Shah NS, Palaniappan LP, Khan SS. Proportional mortality from ischemic heart disease among Asian American subgroups, from 2018 to 2020. JAMA Intern Med. 2022;182(10):1101–3. source

      The Results report higher proportional mortality from ischemic heart disease for some Asian American subgroups than for non-Hispanic White decedents, as well as differences among subgroups. The Methods cover six Asian American subgroups, not Pacific Islanders; the study measures deaths attributed to ischemic heart disease, not overall CVD risk or outcomes. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    Immigration status and acculturation processes may impact CVD risk among Asian and Pacific Islander populations.

    “Immigration status and acculturation processes may also impact CVD risk among Asian and Pacific Islander populations [46].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [46] Kaholokula JK, Nacapoy AH, Grandinetti A, Chang HK. Association between acculturation modes and type 2 diabetes among Native Hawaiians. Diabetes Care. 2008;31(4):698–700. source

      The Results report an association between acculturation mode and type 2 diabetes prevalence among Native Hawaiians. The Methods describe the parent project as a study of diabetes and cardiovascular risk factors, but this paper does not establish an effect on CVD risk, assess immigration status, or study Asian populations. The cited passages do not provide page labels. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Implications for the classification of Asians, Pacific Islanders, and multi-race people in research · p. 6

    Past efforts have reduced multi-race populations to a single category by assigning them to the largest or smallest group they belong to, asking which one race the person most identifies with, or grouping all multi-race individuals into a single category.

    “Efforts in the past have reduced multi-race populations to a single category by assigning them to either the largest or smallest group they belong to, asking which one race the person most identifies with, or grouping all multi-race individuals into a single category (e.g., two or more races) [52, 53].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [52] Klein DJ, Elliott MN, Haviland AM, Morrison PA, Orr N, Gaillot S, Weech-Maldonado R. A comparison of methods for classifying and modeling respondents who endorse multiple racial/ethnic categories: a health care experience application. Med Care. 2019;57(6):e34–41. source
    • cites [53] Mays VM, Ponce NA, Washington DL, Cochran SD. Classification of race and ethnicity: implications for public health. Annu Rev Public Health. 2003;24:83–110. source

  • May combine two claims.

    Premisecitation
    § Introduction · p. 2

    Aggregating broad and diverse Asian and Pacific Islander populations for research purposes can result in masking the extent of health disparities across these populations, and limit efforts to identify underlying drivers of health inequity.

    “This practice can result in masking the extent of health disparities across these populations, and limit efforts to identify underlying drivers of health inequity [9-11].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [9] Holland AT, Wong EC, Lauderdale DS, Palaniappan LP. Spectrum of cardiovascular diseases inAsian-American racial/ethnic subgroups. Ann Epidemiol. 2011;21(8):608–14. source

      The Introduction says aggregated Asian-American data can mask subgroup differences, and the Discussion reports that aggregation obscures marked differences in cardiovascular disease prevalence. The Discussion also calls for subgroup-specific risk-factor research to better understand those differences. The paper does not examine Pacific Islanders or health disparities beyond cardiovascular disease, so the claim is broader than its evidence. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [10] Gordon NP, Lin TY, Rau J, Lo JC. Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study. BMC Public Health. 2019;19(1):1551. source

      The Conclusions (page not provided) state that aggregated Asian-American statistics mask meaningful differences between ethnic subgroups, and the Discussion reports that aggregated Asian/PI estimates underestimated prevalence for Pacific Islanders. The paper does not establish the further claim that aggregation limits efforts to identify the underlying drivers of health inequity. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [11] Kaholokula JKa, Okamoto SK, Yee BWK. Special issue introduction: advancing Native Hawaiian and other Pacific Islander health. Asian Am J Psychol. 2019;10(3):197–205. source

  • May combine two claims.

    Findingown data
    § Abstract · p. 1

    Chinese people had the lowest prevalence of CHD, PVD and overall CVD.

    “Chinese people had the lowest prevalence of CHD, PVD and overall CVD.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Coronary Heart Disease Prevalence (CHD) · p. 4

    CHD prevalence estimates for Other Pacific Islanders and all multi-race groups were significantly higher than for NHWs, ranging from 2.13% among Asian+White to 4.32% among Pacific Islander+Asian+White.

    “Estimates for Other Pacific Islanders and all the multi-race groups were significantly higher than for NHWs, ranging from 2.13% among AWs to 4.32% among PIAW.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Coronary Heart Disease Prevalence (CHD) · p. 4

    The prevalence of CHD among Korean cohort members was 1.10%, significantly lower than among NHWs.

    “the prevalence of CHD among Chinese, Korean, and Japanese members of the cohort was significantly lower (1.08%, 1.10%, and 1.45%, respectively).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Peripheral Vascular Disease (PVD) · p. 4

    In comparison to NHWs (1.68%), the prevalence of PVD was significantly lower among all Asian study groups, ranging from 0.63% among Chinese individuals to 1.07% among Filipinos.

    “In comparison to NHWs (1.68%), the prevalence of PVD was significantly lower among all Asian study groups (ranging from 0.63% among Chinese individuals to 1.07% among Filipinos).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Stroke · p. 4

    All other racial/ethnic groups in the study had significantly higher stroke prevalence than NHWs, ranging from 1.20% among Filipinos to 2.24% among PIWs.

    “All other racial/ethnic groups in the study had significantly higher stroke prevalence than NHWs, ranging from 1.20% among Filipinos to 2.24% among PIWs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Abstract · p. 1

    The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos).

    “The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Coronary Heart Disease Prevalence (CHD) · p. 4

    The prevalence of CHD among Chinese cohort members was 1.08%, significantly lower than among NHWs.

    “the prevalence of CHD among Chinese, Korean, and Japanese members of the cohort was significantly lower (1.08%, 1.10%, and 1.45%, respectively).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Coronary Heart Disease Prevalence (CHD) · p. 4

    The prevalence of CHD among Japanese cohort members was 1.45%, significantly lower than among NHWs.

    “the prevalence of CHD among Chinese, Korean, and Japanese members of the cohort was significantly lower (1.08%, 1.10%, and 1.45%, respectively).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Overall CVD prevalence · p. 4

    For all Asian groups except Filipinos, estimated overall CVD prevalence was significantly lower than that for NHWs, ranging from 2.27% among Chinese individuals to 3.35% among Japanese individuals.

    “For all Asian groups except Filipinos, estimated overall CVD prevalence was significantly lower than that for NHWs, ranging from 2.27% among Chinese individuals to 3.35% among Japanese individuals.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § Overall CVD prevalence · p. 4

    Observed prevalence of overall CVD among all the Pacific Islander single ethnic and multi-race groups was significantly higher than for NHWs, ranging from 5.27% among Native Hawaiians to 8.53% among PIWs.

    “Observed prevalence among all the Pacific Islander single ethnic and multi-race groups was significantly higher than for NHWs, ranging from 5.27% among Native Hawaiians to 8.53% among PIWs.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingown data
    § CVD patterns among Asians, Pacific Islanders and multi-race API groups · p. 4

    In general, analyses show a pattern of lower CVD prevalence among Asians and higher prevalence among Pacific Islanders in comparison to NHWs.

    “In general, these analyses show a pattern of lower CVD prevalence among Asians and higher prevalence among Pacific Islanders in comparison to NHWs”
    Quote in the paperSubstantial claim
    • Rests on an assumption: ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.
    • Rests on an assumption: Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.
    • Rests on an assumption: Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

  • May combine two claims.

    Findingnone given
    § Study limitations and strengths · p. 7

    The study population subgroups were not uniformly distributed across the two sites; South Asians were more common in the California sample and Pacific Islanders in Hawai'i.

    “The population subgroups in this study were not uniformly distributed across the two sites; South Asians are more common in the California sample and Pacific Islanders in Hawai'i.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Conclusions · p. 7

    Study findings provide evidence of significant differences in overall CVD, as well as CHD, stroke, and PVD, among the 11 study API groups and the NHW comparison group.

    “Study findings provide evidence of significant differences in overall CVD, as well as CHD, stroke, and PVD, among the 11 study API groups and the NHW comparison group.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data
    § Implications for the classification of Asians, Pacific Islanders, and multi-race people in research · p. 6

    CASPER study results support the need to disaggregate Asian and Pacific Islander populations when studying CVD and other health conditions.

    “Results of the CASPER study further support the need to disaggregate Asian and Pacific Islander populations to study CVD and other health conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    Overweight and obesity were reported to be most prevalent among those reporting Native Hawaiian ancestry alone, and lowest among those reporting Native Hawaiian ancestry in combination with Asian ancestry.

    “Overweight and obesity, important risk factors for CVD, were also reported to be most prevalent among those reporting Native Hawaiian ancestry alone, and lowest among those reporting Native Hawaiian ancestry in combination with Asian ancestry [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Grandinetti A, Chen R, Kaholokula JK, Yano K, Rodriguez BL, Chang HK, Curb JD. Relationship of blood pressure with degree of Hawaiian ancestry. Ethn Dis. 2002;12(2):221–8.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation
    § Implications for the classification of Asians, Pacific Islanders, and multi-race people in research · p. 6

    One cannot assume that multi-race individuals identify more with one race they belong to than another.

    “Similarly, we cannot assume that multi-race individuals would necessarily identify more with one race they belong to than another [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Multiracial in America. https://www.pewresearch.org/social-trends/2015/06/11/multiracial-in-america/.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Implications for the classification of Asians, Pacific Islanders, and multi-race people in research · p. 6

    Self-identification among multi-racial people is fluid, varying in different social contexts and changing over time.

    “Some additional considerations include the fluidity of self-identification among multi-racial people, which can vary in different social contexts and change over time [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Millions of Americans changed their racial or ethnic identity from one census to the next. https://www.pewresearch.org/fact-tank/2014/05/05/millions-of-americans-changed-their-racial-or-ethnic-identity-from-one-census-to-the-next/.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Introduction · p. 2

    Limitations in the classification of API ethnic and multiracial groups in health research has greatly hampered the ability to detect and reduce the burden of CVD among APIs and multi-race groups.

    “Limitations in the classification of API ethnic and multiracial groups in health research has greatly hampered our ability to detect and reduce the burden of CVD among APIs and multi-race groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Differences in CVD prevalence among disaggregated API populations · p. 6

    A previous study comparing hypertension prevalence among people with varying degrees of Hawaiian ancestry reported significantly lower rates associated with higher proportion of Hawaiian ancestry.

    “A previous study comparing hypertension prevalence among people with varying degrees of Hawaiian ancestry reported significantly lower rates associated with higher proportion of Hawaiian ancestry [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Grandinetti A, Chen R, Kaholokula JK, Yano K, Rodriguez BL, Chang HK, Curb JD. Relationship of blood pressure with degree of Hawaiian ancestry. Ethn Dis. 2002;12(2):221–8.

  • May combine two claims.

    Study design and conductnone given
    § Study limitations and strengths · p. 7

    The study included patients receiving care from two different health care systems, and CVD was defined by clinical evidence contained in EHR data.

    “Importantly, the study included patients receiving care from two different health care systems and CVD was defined by clinical evidence contained in EHR data.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Ethics approval and consent to participate · p. 8

    The study was conducted with the approval and oversight of Institutional Review Boards at Kaiser Permanente Hawai'i (KPHI) and the Palo Alto Medical Foundation (PAMF).

    “The study was conducted with the approval and oversight of Institutional Review Boards at Kaiser Permanente Hawai'i (KPHI) and the Palo Alto Medical Foundation (PAMF).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Study limitations and strengths · p. 7

    Although California and Hawai'i have the largest populations of Asians and Pacific Islanders in the country, the CASPER results may not be generalizable to other US API populations.

    “Although California and Hawai'i have the largest populations of Asians and Pacific Islanders in the country, results may not be generalizable to other US API populations.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Different Asian populations are clustered in different parts of the country, and individuals of the same group may have different experiences related to population diversity in the region.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning
    § Study limitations and strengths · p. 7

    Individuals from the groups excluded by the insurance requirement may have an even greater burden of CVD compared to the CASPER population.

    “Individuals from these excluded groups may have an even greater burden of CVD compared to the CASPER population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given
    § Study limitations and strengths · p. 7

    Individuals and subpopulations in the CASPER study may have experienced different barriers to health care, or differences in 'realized' access, despite having insurance.

    “However, individuals and subpopulations in the CASPER study may have experienced different barriers to health care, or differences in 'realized' access, despite having insurance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Implications for the classification of Asians, Pacific Islanders, and multi-race people in research · p. 6

    The Asian and Pacific Islander groups are not homogeneous (as are other convenient groupings such as Hispanic and Black).

    “Clearly, researchers need to recognize that the Asian and Pacific Islander groups are not homogeneous; this is also true of other convenient groupings, such as Hispanic and Black.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning
    § Conclusions · p. 7

    Differences in disease risk are likely to be mirrored in other cardio-metabolic conditions, supporting further application of the disaggregation of API groups in health research.

    “Differences in disease risk are likely to be mirrored in other cardio-metabolic conditions, supporting further application of the disaggregation of API groups in health research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Ethics approval and consent to participate · p. 8

    Informed consent was obtained from all subjects or their legal guardian(s) for the surveys administered to a subgroup.

    “Informed consent was obtained from all subjects or their legal guardian(s) for the surveys administered to a subgroup.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data
    § Study limitations and strengths · p. 7

    The CASPER study is among the largest studies of its kind, using recent five-year EHR data for a total population of more than 684,000 people, including more than 237,000 Asians, 9,000 Pacific Islanders, and nearly 42,000 multi-race API people.

    “With recent five-year EHR data for a total population of more than 684,000 people, including more than 237,000 Asians, 9,000 Pacific Islanders, and nearly 42,000 multi-race API people, it is among the largest studies of its kind.”
    Quote in the paperSubstantial claim
38 of 38

  • The paper relies on this without support.

    ICD-9 and ICD-10 diagnosis codes recorded in the electronic health record accurately identify prevalent coronary heart disease, stroke, peripheral vascular disease, and overall cardiovascular disease.

    “EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD.”

  • The paper relies on this without support.

    Self-reported race and ethnicity accurately classify individuals into the study's race and ethnicity groups.

    “Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group.”

  • The paper relies on this without support.

    The 12 constructed race and ethnicity groups are meaningful and sufficiently large for analysis.

    “This study population was then separated into single race and specific multi-race groups with large enough numbers for analysis: White, Asian, Native Hawaiian/Other Pacific Islander, Native Hawaiian/Other Pacific Islander + Asian (PIA), Native Hawaiian/Other Pacific Islander + White (PIW), Asian + White (AW), and Native Hawaiian/Other Pacific Islander + Asian + White (PIAW).”

  • The paper relies on this without support.

    Adjusting for site, gender, and age as a continuous variable adequately controls for confounding in the logistic regression models.

    “Models were adjusted for site, gender, and age (as a continuous variable).”

  • The paper relies on this without support.

    There is a paucity of health information available on multi-race groups in general, and even less for well-defined multi-race groups.

    “There is a paucity of health information available on multi-race groups in general, and even less for well-defined multi-race groups.”

  • The paper relies on this without support.

    Health disparities among different race/ethnicity groups are often related to differences in demographic, clinical, economic, psychosocial, and other social determinants of health.

    “Health disparities among different race/ethnicity groups are often related to differences in demographic, clinical, economic, psychosocial, and other social determinants of health.”

  • The paper relies on this without support.

    Different Asian populations are clustered in different parts of the country, and individuals of the same group may have different experiences related to population diversity in the region.

    “Different Asian populations are clustered in different parts of the country and individuals of the same group may have different experiences related to population diversity in the region.”
7 of 7

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Authors
Waitzfelder, B., Palaniappan, L., Varga, A., Frankland, T. B., Li, J., Daida, Y. G., Kaholokula, J. K., Bacong, A. M., Rawlings, A. M., Chung, S., Howick, C., & Fortmann, S. P.
Affiliations
  • Kaiser Permanente (US)
  • Stanford Medicine (US)
  • Kaiser Permanente Center for Health Research (US)
  • Sutter Health (US)
  • University of Hawaiʻi at Mānoa (US)
Corresponding author
Fortmann, Stephen P.
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2023-05-15
Volume
23
Issue
1
Pages
885-885
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-023-15795-5
PMC
PMC10184427
OpenAlex
W4376610665
Semantic Scholar
b8751d291c21e7534abd6d62b504ed11a39824e4
Cited by
31
References
45
Citations by year
2026: 8 · 2025: 13 · 2024: 9 · 2023: 1
FWCI
5.16
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Heart, Lung, and Blood Institute, National Institutes of Health (HL 126172)
  • National Center for Advancing Translational Sciences, National Institutes of Health, Award Number (1UL1TR003142)
Topics
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Social Sciences › Health › Health disparities and outcomes
Keywords
cardiovascular disease prevalence, Asian and Pacific Islander populations, racial and ethnic disparities, coronary artery disease, stroke, peripheral vascular disease, Native Hawaiians, Filipino Americans, Chinese Americans, Kaiser Permanente, Hawaii, California
MeSH terms
Asian American Native Hawaiian and Pacific Islander, Pacific Island People, Adult, Asian, California, Cardiovascular Diseases, Hawaii, Humans, Prevalence, Population Groups, Native Hawaiian or Other Pacific Islander

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-20.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-20.

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