Mei Leng

Risk Factors for Chronic Liver Disease in Blacks, Mexican Americans, and Whites in the United States: Results From NHANES IV, 1999–2004

OBJECTIVES:Morbidity and mortality due to liver disease and cirrhosis vary significantly by race/ethnicity in the United States. We examined the prevalence of liver disease risk factors among blacks, Mexican Americans, and whites, including elevated aspartate aminotransferase and alanine aminotransferase activity, infection with viral hepatitis B or hepatitis C, alcohol intake, obesity, diabetes, and metabolic syndrome.METHODS:Data were obtained from the Fourth National Health and Nutrition Examination Survey (NHANES IV). A logistic regression was used to examine the association of race/ethnicity to liver disease risk factors, controlling for the demographic and socioeconomic variables.RESULTS:Mexican-American men and women are the most likely to have elevated aminotransferase activity. Among men, Mexican Americans are more likely than whites to be heavy/binge drinkers, and blacks are more likely to have hepatitis B or hepatitis C. Among women, Mexican Americans are more likely than whites to be obese and diabetic, and less likely to be heavy/binge drinkers; blacks are more likely than whites to have hepatitis B or hepatitis C, be obese or diabetic, and less likely to be heavy/binge drinkers.CONCLUSIONS:In this national sample, the prevalence of risk factors for liver disease varies by race/ethnicity. Mexican Americans and blacks have a greater risk of developing liver disease than their white counterparts. These findings are consistent with the observed racial/ethnic disparities in morbidity and mortality due to chronic liver disease and contribute to the efforts to identify the causes of these disparities. This information can be used by health professionals to tailor screening and intervention programs.

Risk of Cardiovascular Disease in First and Second Generation Mexican-Americans

This study examines the cardiovascular disease (CVD) risk profiles of first generation (FG) and second generation (SG) Mexican-Americans (MA) in two large national studies––the Hispanic Health and Nutrition Examination Study (HHANES) (1982–1984) and the National Health and Examination Study (NHANES) (1999–2004). The main outcome measures were five individual risk indicators of CVD (total cholesterol, HDL cholesterol, hypertension, diabetes, and smoking) and a composite measure (the Framingham Risk Score [FRS]). The analyses included cross-survey (pseudocohort) and within-survey (cross-sectional) comparisons. In multivariate analyses, SG men had higher rates of hypertension and lower rates of smoking than FG men; and SG women had lower total cholesterol levels, higher rates of hypertension, and lower rates of smoking than FG women. There was no generational difference in the FRS in men or women. The cross-survey comparisons detected generational differences in CVD risk factors not detected in within-survey comparisons, particularly among MA women. Future studies of generational differences in risk should consider using pseudocohort comparisons when possible.

Health Status and Behavioral Risk Factors in Older Adult Mexicans and Mexican Immigrants to the United States

Objectives: Investigate the “salmon-bias” hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status. Method: Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome. Results: The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators. Discussion: Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.

The risk of developing invasive breast cancer in Hispanic women

Current evidence on breast cancer among US Hispanic women indicates a significant public health threat, although few studies have assessed the heterogeneity in breast cancer risk among Hispanics of different origin.

The risk of developing invasive breast cancer in Hispanic women : a look across Hispanic subgroups.

Current evidence on breast cancer among US Hispanic women indicates a significant public health threat, although few studies have assessed the heterogeneity in breast cancer risk among Hispanics of different origin.

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico

AIM To compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico. METHODS Data for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors. RESULTS After adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans. CONCLUSION In this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

Abstract A34: Risk factors for liver disease/cancer among adults of Mexican descent in the United States and Mexico

Background: Latinos in the United States (US) have disproportionately higher rates of chronic liver disease (CLD). Since 2002, CLD has consistently been the sixth leading cause of overall mortality for Latinos, and the third cause of death among Latino males, ages 55-64. Latino men and women are twice as likely to have CLD and are 1.7 and 1.8 times more likely to die from liver cancer, respectively, than non-Hispanic whites (whites). The frequency of earlier stage liver disease, such as steatohepatitis, is also higher among Latinos (45%), than among whites (33%) or Blacks (24%). In Mexico, cirrhosis and other forms of CLD were the fifth leading cause of general mortality in 2015, and the third among males between the ages of 45 and 65 years. By 2050, an estimated 90% of cases of CLD in Mexico will be attributable to obesity and excessive alcohol consumption, as compared to other populations that have high rates of CLD due to infection with hepatitis B (HBV) or hepatitis C (HCV). Although infection with HBV or HCV and heavy alcohol use are well-known risk factors for CLD and liver cancer, up to 50% of cases do not present these risk factors. Other risk factors for CLD include obesity and diabetes, and the proposed mechanism is through the development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD is found in 80-90% of obese adults, 30-50% of diabetics, and 90% of patients with hyperlipidemia. In the U.S., the prevalence of NAFLD and NASH is highest among Latinos, followed by whites and Blacks. Rates of obesity are also higher among Latinos (42.5%) than whites (34.5%) in the US. In 2012, approximately 69% of men and 73% of women in Mexico were overweight or obese, and these numbers are predicted to rise to 88% and 91%, respectively, by 2050. The objective of this study was to compare the prevalence of risk factors for liver disease/cancer in a representative sample of Mexican-Americans who were born in the U.S. or Mexico, to a sample of adults who reside in Mexico. We hypothesized that Mexican-Americans in the U.S. would be at greater risk for CLD than their counterparts in Mexico. This hypothesis is based on studies suggesting that immigrant Mexican-Americans have better health outcomes than more acculturated, U.S.-born Mexican-Americans. Methods: Data for Mexican-Americans in the U.S. were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, representative, examination survey of the total civilian noninstitutionalized population. The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the U.S. or Mexico, not pregnant or breastfeeding, with medical insurance. The final NHANES sample consisted of 2,097 males and 2,177 females with complete questionnaire and laboratory data. The data in Mexico came from the Heath Worker Cohort Study (HWCS), a longitudinal study of workers and their immediate family members from two large health care institutions in Cuernavaca, Mexico: the Mexican Institute of Social Security (IMSS) and the National Institute of Public Health (INSP). Briefly, the HWCS collects information using physical examinations, self-reported questionnaires, and laboratory tests, which are comparable to those used for the NHANES surveys. From 2004 to 2006 (Wave 1), approximately 9,000 health workers enrolled in the HWCS. During 2011 to 2013 (Wave 2), a total of 1,855 participants were followed up. The final HWCS sample consisted of 3,010 men and 6,475 women 20 years and older who reside and were born in Mexico, with complete questionnaire and laboratory data. The total study sample of 13,798 individuals consisted of 9,485 Mexican subjects who currently reside in Mexico, 2,324 U.S.-born Mexican-Americans who live in the U.S., and 1,989 Mexican-Americans who were born in Mexico and now live in the U.S. The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated ALT was defined as >40 IU/L for men and women; elevated AST was defined as >40 IU/L for men and women), infection with HBV or HCV, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico versus the U.S.) and place of birth (i.e., U.S.-born versus Mexico- born). The HWCS participants represent Mexicans who were born and currently live in Mexico. Individuals from the NHANES sample were further classified by birthplace (U.S.-born versus Mexico-born). The following three groups were compared: (1) HWCS (Mexico resident, Mexico-born), (2) NHANES (U.S. resident, Mexico-born), and (3) NHANES (U.S. resident, U.S.-born). Other independent variables included age, sex, marital status, and education level. Regression analyses were used to investigate liver disease/cancer risk factors. Results: After controlling for age, marital status, and education level, the logistic regression results indicate that Mexico-born Mexican-American males were less likely to have HBV or HCV (OR 0.2, 95% CI 0.1-0.6) but were more likely to have high cholesterol (OR 1.4, 95% CI 1.1-1.8) than their counterparts in Mexico. U.S.-born Mexican-American males were more likely to have metabolic syndrome (OR 1.4, 95% CI 1.1-1.9) and diabetes (OR 3.0, 95% CI 1.9-4.8) than males in Mexico. Mexican-American males were much more likely to be obese, diabetic, have abdominal obesity, or be heavy/binge drinkers than Mexican males. The prevalence ratios and prevalence differences confirm the multivariate analyses findings and may provide more precise estimates of the increased risk of diabetes, obesity, abdominal obesity, and heavy/binge drinking observed among Mexico- and U.S.-born Mexican-American males, as compared to males in Mexico. The probability of having any of the aforementioned risk factors is greater among U.S.-born Mexican-Americans than among their Mexico-born counterparts. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, have abdominal obesity, or be heavy/binge drinkers than Mexican males. The prevalence ratios and prevalence differences mirror the multivariate analyses findings for the aforementioned risk factors, showing a greater risk among U.S.-born as compared to Mexico-born Mexican-Americans. However, the prevalence ratio results indicate that Mexico- and U.S.-born Mexican-American females are significantly less likely to be infected with HBV or HCV than females in Mexico. Conclusions: The results of this binational analysis indicate that Mexican-Americans in the U.S. have more risk factors for liver disease/cancer than their counterparts in Mexico. These results can be used to design and implement more effective health-promotion programs to address the specific factors that put Mexicans at higher risk of developing liver disease/cancer in both countries. This study adds to the relatively scarce literature on binational research, and provides preliminary data for future studies of migrant health in the U.S. and Mexico. Other binational primary data collection projects with representative samples and comparable demographic, socioeconomic, and health status measures are needed to further investigate the growing problem of liver disease/cancer among Mexicans in both countries. Citation Format: Yvonne N. Flores, Zuo-Feng Zhang, Roshan Bastani, Mei Leng, Catherine M. Crespi, Paula Ramirez, Heather A. Stevens, Jorge Salmeron. Risk factors for liver disease/cancer among adults of Mexican descent in the United States and Mexico [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A34.

Risk of developing invasive breast cancer in Hispanic women: A look across Hispanic subgroups

Current evidence on breast cancer among US Hispanic women indicates a significant public health threat, although few studies have assessed the heterogeneity in breast cancer risk among Hispanics of different origin.

Abstract A60: Risk of developing invasive breast cancer risk in Hispanic women: A look across Hispanic subgroups.

Background: Breast cancer is a significant public health threat to Hispanic women in the United States (US). While evidence on the burden of breast cancer among US Hispanic women is available, it is important to assess the heterogeneity in breast cancer risk among Hispanic women of different origins. To address this gap, the purpose of our study was to assess the distribution of breast cancer risk among women from six Hispanic subgroups. Methods: Using data from the 2000 and 2005 National Health Interview Survey (NHIS) Cancer Control Modules, we assessed the Breast Cancer Risk Assessment Tool (BCRAT) 5-year and lifetime risk of developing invasive breast cancer among Mexican/Mexican-American (n=1,932), Puerto Rican (n=385), Cuban/Cuban-American (n=274), Dominican (Republic) (n=123), Central/South American (n=468), Other Hispanic (n=204) and non-Hispanic whites (n=16,131). Multivariate linear regression models used to compare the distribution of both the BCRAT 5-year and lifetime absolute breast cancer risk between: i) Hispanic versus non-Hispanic white women and ii) Hispanic subgroups. Results: Hispanic women, overall, had a significantly lower mean BCRAT 5-year risk and lifetime risk estimates compared to non-Hispanic whites (p<0.001). Cuban/Cuban-American women had a significantly higher BCRAT 5-year risk (p<0.05), while Dominican women had a higher lifetime risk, compared Mexican/Mexican-American women (p<0.001). A significantly lower proportion of Hispanic women, overall, were at high risk of breast cancer, based on both the BCRAT 5-year and lifetime risk estimates, compared to non-Hispanic white women (p<0.001). Approximately 2.6% of all Hispanic women had BCRAT 5-year risk ≥1.67% and only 0.2% had a lifetime risk ≥20.0%. A greater proportion of Central/South American women had a BCRAT 5-year risk ≥1.67 compared to Mexican/Mexican-American women (p<0.001). Conclusion: Our findings indicate that, based on the BCRAT, Hispanic women have a significantly lower risk of developing invasive breast cancer, compared to non-Hispanic white women; furthermore, we highlight differences in the BCRAT risk among women in different Hispanic subgroups. Lastly, we provide national estimates of the number of Hispanic women from six key subgroups, who would be eligible for prophylactic breast cancer chemoprevention as recommended by ASCO and NCCN. Future studies are warranted that further investigate differences in breast cancer risk as well as important breast cancer risk factors between Hispanics women of different origins. Citation Format: Matthew P. Banegas, Mei Leng, Barry I. Graubard, Leo S. Morales. Risk of developing invasive breast cancer risk in Hispanic women: A look across Hispanic subgroups. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A60.