|
 |
|
|||||||
|
|||||||||
© 2003 American Public Health Association
RESEARCH AND PRACTICE |
Akiko S. Hosler and Thomas A. Melnik are with the Bureau of Chronic Disease Epidemiology and Surveillance, New York State Department of Health, Albany. Akiko S. Hosler is also with the Department of Epidemiology, University at Albany School of Public Health, Albany, NY.
Correspondence: Requests for reprints should be sent to Akiko S. Hosler, PhD, 565 Corning Tower, Empire State Plaza, Albany, NY 12237-0679 (e-mail: ash05{at}health.state.ny.us).
 |
INTRODUCTION |
|---|
 TOP INTRODUCTION METHODSRESULTSDISCUSSION AND CONCLUSIONReferences |
|---|
Following migration to the West, intergenerational increases in the prevalence of diabetes among Japanese have been reported.1,2 Diabetes prevalence among second- and third-generation Japanese American adults was considerably higher compared with the rates in Japan.3,4 This phenomenon has generated the "Westernization hypothesis," whereby gradual adaptation of a Western lifestyle, including a high-fat diet and physical inactivity, contributes to an increase in diabetes.5
The extent to which the prevalence of diabetes is high among all Japanese populations in the United States and its regional variation are unknown. East Coast Japanese, who tend to be less acculturated newcomers,6 are likely to have a different profile of diabetes prevalence and associated risk compared with West Coast Japanese. Information specific to geographically defined ethnic groups is needed to tailor interventions and preventive services. We report the results of a 1999 mail survey of the largest Japanese residential community in New York State.
|
METHODS |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONReferences |
|---|
The 1990 census was used to identify 17 zip code areas in southern Westchester County, NY, with the highest concentration of Japanese residents, and these areas were designated as our survey area.7 Commercially available telephone directories8,9 were used to generate a listing of Japanese households, and 1100 households were randomly selected for the mailing. All adults within the household were invited to participate. The total number of respondents was 911, for a household response rate of 58.0%. Compared with the 1990 Integrated Public Use Microdata Series data,10 the sample was not significantly different from adult Japanese residents in Westchester County with respect to gender and birthplace, but the participants were slightly older.
The questionnaire was adapted largely from the Behavioral Risk Factor Surveillance System, including the question for identifying physician-diagnosed diabetes.11 English and Japanese versions of the questionnaire were made available following a review by a bilingual focus group. Community preparation and follow-up mailings according to Dillman’s methods were used to increase survey cooperation.12 Gender- and gender-within-age–specific estimates and 95% confidence intervals (CIs) for diabetes and its major risk factors were calculated. Ageadjusted estimates were calculated with the 2000 census as the standard population.
|
RESULTS |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONReferences |
|---|
Westchester County Japanese people were predominantly Japanese-born recent arrivals, many of whom were temporary residents (Table 1
). Educational attainment was high, with more than 85% reporting at least 2 years of college education. Socioeconomic status also was high despite a relatively low degree of acculturation, as indicated by Japanese language preference at home.
|
The prevalence of diagnosed diabetes for Westchester County Japanese adults was 2.7% (95% CI = 1.8, 4.0) and lower than 6.5% (95% CI = 3.5, 9.5) for all Westchester County adults (unpublished results of pooled 1998–2000 Behavioral Risk Factor Surveillance System). The age-adjusted rates were 4.6% (95% CI = 3.4, 6.1) for Westchester County Japanese adults and 6.8% (95% CI = 3.7, 9.9) for all Westchester County adults. Gender-specific prevalence was 4.0% for men (95% CI = 2.5, 6.0) and 1.2% for women (95% CI = 0.4, 2.7) (Table 2
). Men 45 years and older had the highest prevalence (7.6%), and women 18 to 44 years had the lowest prevalence (0.0%).
|
Men were more likely to be centrally obese according to the Japanese definition13 and overweight. Men also were more likely to be current smokers and to have high blood pressure and high blood cholesterol. There were no significant gender differences in physical inactivity and consumption of traditional Japanese meals.
|
DISCUSSION AND CONCLUSION |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONReferences |
|---|
The findings of this study show a relatively low prevalence of diabetes among predominantly foreign-born East Coast Japanese residing in Westchester County. This may be attributed, in part, to the leanness of this population. Only 27.4% of the men and 4.5% of women were overweight, compared with more than 55% of US adults.14 Together with the fact that traditional Japanese meals are consumed frequently, the findings suggest that the negative effect of "Westernization"15 has not fully affected this population. However, high rates of physical inactivity, smoking, and other related risk factors, particularly among men, raise concerns about the future risk for diabetes and its complications.
Gender differences in diabetes prevalence and its risks have previously been reported in Japan.16–18 Japanese cultural norms that expect women to be thin and nonsmokers may have a role. Work-related factors also can place men at higher risk for diabetes. Ninety-three percent of the Westchester County Japanese men worked full time, whereas only 10% of the women did so. Studies in Japan found that work-related stress19 and managerial occupation20 are linked to higher diabetes prevalence and its risks.
The observed gender differences call for innovative intervention strategies for this population. Worksite physical activities and weight reduction programs are suitable for middle-aged men. US subsidiaries of Japanese corporations, where many Westchester Japanese men work,21 can incorporate these programs into their existing employee wellness programs. For women and the elderly, community-based physical activity programs are suggested.
The limitations of this study include those related to mail surveys, self-reporting, and undiagnosed diabetes. Because the levels of health care coverage and use were comparable to those of US adults, we also expect the rate of undiagnosed diabetes to be comparable to the rate of 32% previously reported.22
|
Acknowledgments |
|---|
This project was funded in part by the Centers for Disease Control and Prevention State-Based Diabetes Control Program Cooperative Agreement.
We thank our student intern Ritsuko Nakajima of the University at Albany for her assistance in data collection and data entry.
Human Participant Protection
The survey questionnaire, protocols, and consent forms were approved by the New York State Department of Health institutional review board.
|
Footnotes |
|---|
Contributors
A. S. Hosler designed and conducted the survey, analyzed the data, summarized the results, and drafted the brief. T. A. Melnik provided guidance in data collection, analysis, and summary presentation and participated in the writing and revision of the brief.
Accepted for publication September 27, 2002.
|
References |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONReferences |
|---|
1. Hara H, Egusa G, Yamakido M, Kawate R. The high prevalence of diabetes mellitus and hyperinsulinemia among the Japanese-Americans living in Hawaii and Los Angeles. Diabetes Res Clin Pract. 1994;24(suppl):37–42.
2. Iunes M, Franco LJ, Wakisaka K, et al. Selfreported prevalence of non insulin-dependent diabetes mellitus in the 1st (Issei) and 2nd (Nisei) generation of Japanese-Brazilians over 40 years of age. Diabetes Res Clin Pract. 1994;24(suppl):53–57.
3. Fujimoto WY, Leonetti DL, Kinyoun JL, et al. Prevalence of diabetes mellitus and impaired glucose tolerance among second-generation Japanese-American men. Diabetes. 1987;36:721–729.[Abstract]
4. Fujimoto WY, Leonetti DL, Bergstrom RW, Kinyoun JL, Stolov WC, Wahl PW. Glucose intolerance and diabetic complications among Japanese-American women. Diabetes Res Clin Pract.1991;13:119–129.[Web of Science][Medline]
5. Hara H, Egusa G, Yamakido M. Incidence of non-insulin-dependent diabetes mellitus and its risk factors in Japanese-Americans living in Hawaii and Los Angeles. Diabet Med. 1996;13(suppl):133–142.[Web of Science][Medline]
6. Hosler AS. Japanese Immigrant Entrepreneurs in New York City: A New Wave of Ethnic Business. New York, NY: Garland Publishing; 1998.
7. 1990 U.S. Census Summary Tape File 3B. Washington, DC: US Census Bureau; 1993.
8. Phone Search USA [CD-ROM]. Version 4.0. Yarmouth, Me: DeLorme; 1998.
9. White Pages for Westchester County, February 1999-January 2000. New York, NY: Nynex; 1999.
10. Ruggles S, Sobek M, Fitch CA, Hall PK, Ronnander C. Integrated Public Use Microdata Series (IPUMS), Version 2.0. Minneapolis, Minn: Historical Census Projects, University of Minnesota; 1997.
11. Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the U.S.: 1990–1998. Diabetes Care.2000;23:1278–1283.
12. Dillman DA. Mail and Telephone Surveys. New York, NY: John Wiley & Sons; 1978.
13. Shirai K. Evaluation of obesity and diagnostic criteria of obesity as a disease for Japanese. Nippon Rinsho. 2001;59:578–585.
14. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA.2001;286:1195–1200.
15. Huang B, Rodriguez BL, Burchfiel CM, Chyou PH, Curb JD, Yano K. Acculturation and prevalence of diabetes among Japanese-American men in Hawaii. Am J Epidemiol. 1996;144:674–681.
16. Islam MM, Horibe H, Kobayashi F. Current trend in prevalence of diabetes mellitus in Japan 1964–1992. J Epidemiol. 1999;9:155–162.[Medline]
17. World Health Organization. Tobacco or health: a global status report: country profiles by region, 1997. Available at: http://www.cdc.gov/tobacco/who/whofirst.htm. Accessed July 3, 2002.
18. Liu L, Choudhury SR, Okayama A, Hayakawa T, Kita Y, Ueshima H. Changes in body mass index and relationships to other cardiovascular risk factors among Japanese population: results from the 1980 and 1990 national cardiovascular surveys in Japan. J Epidemiol. 1999;9:163–174.[Medline]
19. Kawakami N, Araki S, Takatsuka N, Shimizu H, Ishibashi H. Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men. J Epidemiol Community Health.1999;53:359–363.[Abstract]
20. Mikuni E, Ohoshi T, Hayashi K, Miyamura K. Glucose intolerance in an employed population. Tohoku J Exp Med. 1983;141(suppl):251–256.
21. Handleman D. Japanning of Scarsdale: East meets Westchester. New York Magazine. April 29, 1991:40–45.
22. Healthy People 2010: Understanding and Improving Health. Washington, DC: US Dept of Health and Human Services; 2001.
This article has been cited by other articles:
|
|
 |
|
  N. R. Kandula, A. V. Diez-Roux, C. Chan, M. L. Daviglus, S. A. Jackson, H. Ni, and P. J. Schreiner Association of Acculturation Levels and Prevalence of Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA) Diabetes Care, August 1, 2008; 31(8): 1621 - 1628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Shai, R. Jiang, J. E. Manson, M. J. Stampfer, W. C. Willett, G. A. Colditz, and F. B. Hu Ethnicity, Obesity, and Risk of Type 2 Diabetes in Women: A 20-year follow-up study Diabetes Care, July 1, 2006; 29(7): 1585 - 1590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. McBean, S. Li, D. T. Gilbertson, and A. J. Collins Differences in Diabetes Prevalence, Incidence, and Mortality Among the Elderly of Four Racial/Ethnic Groups: Whites, Blacks, Hispanics, and Asians Diabetes Care, October 1, 2004; 27(10): 2317 - 2324. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |