Socio-Demographic Determinants of Comorbidity at the Time of Death in Four Asian American Groups

Mira M. Hidajat, Pennsylvania State University

This study examines the intersection between morbidity and adult mortality in four Asian American groups: Japanese, Korean, Chinese, and Vietnamese Americans. Early life conditions in the home countries of these largely foreign-born groups coupled with the history and experience of migration into the United States as mediated by observed socio-demographic factors are expected influence the level of morbidity at the time of death. The Total Cause approach developed by Johnson and Christenson (1998) of summing the total causes of deaths mentioned in the death certificate is used as an indicator of comorbidity at the time of death. Multivariate analyses using the 1997 United States Multiple Cause of Death data were performed. The largest differences in average level of comorbidity are found by race, residence in the West, and underlying cause of death (UC). Further analysis showed that foreign-born status and several UCs such as nephritis, atherosclerosis, and suicide decrease the risk of dying with greater comorbidities. Age, residence in the West, lower levels of education, male gender, and Asian American race negatively influence the chance of dying at a healthier state. The positive influence of marriage on health for all groups disappeared after controlling for UCs. Separate analyses on whites, Chinese, and Japanese Americans show different influences of socio-demographic variables. There was no gender advantage for Japanese Americans. Furthermore, UCs such as septicemia and homicide increase the risk of dying with greater comorbidity in this population. The foreign-born advantage was found in all groups except Chinese Americans. Uniquely, Chinese American decedents whose UCs were liver disease and HIV had increased risks of dying with a greater level of comorbidity. Residence in the West has a larger negative effect on Japanese and Chinese Americans compared to whites. Accidents as a UC increase whites’ risks for greater comorbidity at the time of death and decrease the risks for Chinese and Japanese Americans. These findings reinforce the significant influence of immigration histories and socioeconomic statuses of the four Asian American groups as mediated through residence and UC on the level of comorbidity at the time of death.