The Prevalence of Medical Conditions Among U.S. Chinese Community-Dwelling Older Adults

As life expectancy has increased, medical conditions have become increasingly prevalent. In the United States, approximately one in four adults has two or more medical conditions (1). Between 2010 and 2030, the prevalence of hypertension, coronary heart disease, heart failure, and stroke among U.S. adults is projected to increase by 9.9%, 16.6%, 25.0%, and 24.9%, respectively. These medical conditions may result in additional adverse health outcomes, such as increased risk for physical disability, social isolation, depressive symptoms, suicidal ideation, and mortality (2,3). The growing crisis of medical conditions has also resulted in an enormous social and economic burden. The medical cost of chronic conditions makes up 84% of annual U.S. health care spending (4). Preventing medical conditions is a priority for research and public health practice. Older adults are disproportionally affected by medical conditions, with 91% of older adults having one medical condition and 73% having at least two medical conditions (5). Chronic medical conditions, including heart disease, cancer, and stroke, are leading causes of death among U.S. adults aged 65 years and older (6). Other medical conditions, such as high cholesterol, thyroid disease, and osteoarthritis, although not directly linked with death, may cause functional limitations and threaten older adults’ quality of life across a variety of dimensions. In 2012, the Institute of Medicine proposed a “living well with chronic conditions” conceptual framework to confront the increasing challenge of chronic illness; the framework emphasizes that population approaches to living well with chronic disease should account for social determinants of health and differences between older and younger persons (7). Despite the public health significance, older adults have often been under-represented in epidemiological studies of medical conditions. In particular, there has been a dearth of research on medical conditions among minority older adults. The occurrence and management of medical conditions are affected by environmental, social, economic, and cultural factors. In Chinese culture, health beliefs are substantially influenced by Yin and Yang philosophy, which emphasizes the balance of the internal body and the external environment. Traditional Chinese medicine such as herbal medicines and acupuncture therapy are based on the Yin and Yang theory and are commonly adopted as treatments for medical conditions. Although Chinese older adults highly adhere to traditional cultural beliefs, immigration may introduce changes that may affect the onset, severity, and care of medical conditions. Existing evidence consistently suggests that the majority of Chinese American older adults have low socioeconomic status and experience substantial language and cultural barriers as well as disparities in access to healthcare, all of which may increase older adults’ vulnerabilities to medical conditions (8, 9). The 2010 census counted 4 million Chinese people in the U.S., a growth of 55% over the last decade (10). Yet we know very little about the medical conditions burdening U.S. Chinese older adults. A number of prior studies are based on data from the Centers for Medicare and Medicaid Services. However, for immigrants, Medicare and Medicaid enrollment depends on citizenship status and length of stay in the United States. As a result, noncitizens or recent immigrants are often ineligible for insurance coverage (11). Studies based solely on insurance records may therefore underestimate the prevalence of medical conditions among U.S. Chinese older adults (12). There is a need for population-based studies that estimate the prevalence of medical conditions among this population so as to inform the allocation of medical resources and development of effective prevention strategies. In this study of U.S. community-dwelling Chinese older adults in the Greater Chicago area, we aimed to (i) explore the prevalence of heart disease, stroke, cancer, high cholesterol, hypertension, diabetes, thyroid disease, osteoarthritis, and problems with joints; and (ii) examine the correlates of medical conditions among U.S. Chinese older adults.