2004 Articles

Hospitalization for heart disease, stroke, and diabetes mellitus among Indian-born persons: a small area analysis

Muennig, Peter A.; Jia, Haomiao; Kahn, Kamran

Background: We set out to describe the risk of hospitalization from heart disease, stroke, and
diabetes among persons born in India, all foreign-born persons, and U.S.-born persons residing in
New York City.
Methods: We examined billing records of 1,083,817 persons hospitalized in New York City during
the year 2000. The zip code of each patient's residence was linked to corresponding data from the
2000 U.S. Census to obtain covariates not present in the billing records. Using logistic models, we
evaluated the risk of hospitalization for heart disease, stroke and diabetes by country of origin.
Results: After controlling for covariates, Indian-born persons are at similar risk of hospitalization
for heart disease (RR = 1.02, 95% confidence interval 1.02, 1.03), stroke (RR = 1.00, 95% confidence
interval, 0.99, 1.01), and diabetes mellitus (RR = 0.96 95% confidence interval 0.94, 0.97) as nativeborn
persons. However, Indian-born persons are more likely to be hospitalized for these diseases
than other foreign-born persons. For instance, the risk of hospitalization for heart disease among
foreign-born persons is 0.70 (95% confidence interval 0.67, 0.72) and the risk of hospitalization for
diabetes is 0.39 (95% confidence interval 0.37, 0.42) relative to native-born persons.
Conclusions: South Asians have considerably lower rates of hospitalization in New York than
reported in countries with national health systems. Access may play a role. Clinicians working in
immigrant settings should nonetheless maintain a higher vigilance for these conditions among
Indian-born persons than among other foreign-born populations.