The COVID-19 Pandemic: Effects on Civil Registration of Births and Deaths and on Availability and Utility of Vital Events Data.

The complex and evolving picture of COVID-19-related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registration of births and deaths associated with COVID-19 related restrictions.We found considerable intercountry variation and grouped countries according to the level of disruption to birth and particularly death registration. Only a minority of the 66 countries were able to maintain service continuity during the COVID-19 restrictions. In the majority, a combination of legal and operational challenges resulted in declines in birth and death registration. Few countries established business continuity plans or developed strategies to deal with the backlog when restrictions are lifted.Civil registration systems and the vital statistics they generate must be strengthened as essential services during health emergencies and as core components of the response to COVID-19.

The Mortality Effects of Reduced Medicaid Coverage Among International Migrants in Hawaii: 2012-2018.

Objectives. To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant.Methods. We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates.Results. We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants (P = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy.Conclusions. Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.

Life Expectancies in Hawai'i: A Multi-ethnic Analysis of 2010 Life Tables.

The objective of this study is to examine longevity disparities in Hawai'i by race/ethnicity and gender based on age-specific death rates in 2010. Abridged life tables for Chinese, Japanese, Filipino, Hawaiians, and Caucasians in Hawai'i are presented for the age groups: <1, 1-4, every 5-year interval from 5-84, and 85+ years for the year of 2010. Death data were provided by the Hawai'i Department of Health Office of Health Status Monitoring, and population data were based on 2010 Census modified based on ethnicity estimates from the Hawai'i Health Survey. Life expectancy at birth in Hawai'i has increased consistently from 69.5 years in 1950 to 82.4 years in 2010. Longevity disparities seen in past decades continue to persist between the longest-living groups, Japanese and Chinese, and the shortest-living group, Native Hawaiians, with a gap of approximately 10 years. In addition, females lived 6 years longer than males on average. Racial/ethnic disparities in longevity can be partially explained by differences in socioeconomic status, health behaviors, health care access, and racism. Native Hawaiians continue to have the shortest life expectancy of the ethnic groups examined, requiring expanded efforts to address Native Hawaiian health across the life course. Our findings also support more ethnic-specific research to understand the health care needs and utilization patterns of each group.

Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai'i.

Health literacy is understudied in Asian Americans/Pacific Islanders (AA/PI). We used a population-based sample in Hawai'i to consider if low health literacy is associated with poor health outcomes in Japanese, Filipino, Native Hawaiians, and other AA/PI groups compared with Whites. In data weighted and adjusted for population undercounts and complex survey design, low health literacy varied significantly by group, from 23.9% among Filipinos, 20.6% in Other AA/PI, 16.0% in Japanese, 15.9% in Native Hawaiians, and 13.2% in Whites (χ(2) (4) = 52.22; p < .001). In multivariate models, low health literacy was significantly associated with (a) poor self-reported health in Japanese, Filipinos, Other AA/PI, and Whites; (b) diabetes in Hawaiians and Japanese; and (c) depression for Hawaiians. Low health literacy did not significantly predict overweight/obesity in any ethnic grouping in multivariate models. The design and relevance of health literacy interventions, as well as the pathways that link health literacy to health status, may vary by race/ethnicity, culture, and health outcomes.

Association of maternal and intrauterine characteristics with age at menarche in a multiethnic population in Hawaii.

This study seeks to further elucidate the mother-daughter hormonal relationship and its effects on daughter's breast cancer risk through the association with early age at menarche. Four hundred and thirty-eight healthy girls, age 9-18 and of White, Asian, and/or Polynesian race/ethnicity, were recruited from an HMO on Oahu, Hawaii. Anthropometric measures were taken at a clinic visit, and family background questionnaires were completed. Cox proportional hazards regression was used to test the association of maternal and intrauterine hormone-related exposures with age at menarche. Weight and gestational age at birth and maternal pregnancy-induced nausea were not associated with age at menarche. Each year older of the mother's age at menarche was associated with a 21% reduced risk of an early age at menarche for the daughter (95% CI: 0.73-0.86). This association between mother's and daughter's menarcheal age was statistically significant for girls of Asian, White, and Mixed, Asian/White race/ethnicity, but not for girls of Mixed, part-Polynesian race/ethnicity (p (interaction) = 0.01). There was a suggestion that maternal history of breast cancer was associated with an increased risk of early age at menarche (HR = 2.18, 95% CI: 0.95-4.98); there was no association with second-degree family history. These findings support the hypothesis that maternal and intrauterine hormone-related exposures are associated with age at menarche.

Longevity disparities in multiethnic Hawaii: an analysis of 2000 life tables.

OBJECTIVE: We examined differences among seven major ethnic groups in Hawaii in life expectancy at birth (e[0]) and mortality at broad age groups. METHODS: We constructed life tables for 2000 for Caucasian, Chinese, Filipino, Hawaiian, Japanese, Korean, and Samoan ethnic groups in Hawaii. We partitioned overall mortality into broad age groups: <15 (representing premature mortality), 15-65 (representing working age), and 66-84 and > or =85 (representing senescent mortality). RESULTS: The overall e(O) in Hawaii was 80.5 years, but the difference between the longest-living group (Chinese) and the shortest-living group (Samoan) was 13 years. Chinese had the lowest mortality rates in each age group except the > or =85 category. In this last age group, we observed anomalously low rates for some new immigrant groups (especially Samoan males) suggesting, as a cause, that elders in these immigrant groups may return to natal countries in their old age and die there. In the <15 age group, mortality rates for Samoans and Koreans were highest, especially for Korean girls, suggesting some continuance in the U.S. of a preference for boy children. Outside of these anomalies, ethnic differences in e(O) were likely explained by socioeconomic and behavioral variables known to affect mortality levels, which are closely associated with ethnicity in Hawaii. CONCLUSIONS: These findings confirm the need to disaggregate Asian and Pacific Islander data, to conduct ethnic-specific research, and to address socioeconomic disparities.

Influence of type 2 diabetes mellitus on cardiovascular disease mortality: findings from the Hawaii-Los Angeles-Hiroshima study.

The present study addressed whether diabetes mellitus was a strong risk factor for cardiovascular disease (CVD) death. Between 1976 and 1984, 927 (404 men) Japanese-Americans in Hawaii aged 40-79 years participated at baseline examination including a 75 g oral glucose tolerance test. Diabetes was defined as fasting serum glucose >or=140 mg/dl, 2 h postload glucose >or=180 mg/dl, or the use of drugs for diabetes. Causes of death were classified by ICD-9 codes on the reports from the Hawaii State Public Health Bureau. Until 1994, 178 individuals suffered death; 81 were attributed to CVD and 43 to coronary heart disease (CHD). The age-adjusted and coronary risk factors-adjusted relative risks for CHD and CVD mortality were significant for diabetes both in men and women. The impact of diabetes on CHD mortality was greater for women. However, no gender difference in the contribution of diabetes to fatal CVD was observed. Serum fasting glucose levels tended to be associated with CHD death and were associated with CVD death in diabetic subjects. In conclusion, diabetes is a strong independent risk factor for CVD mortality in Japanese-American men and women. Hyperglycemia is associated with CVD mortality in diabetic subjects.

Maternal pelvic size, measured by dual energy X-ray absorptiometry, predicts infant birthweight.

Indicators of infant birthweight are important because infant birthweight is related to later health outcomes. This study developed and validated new measures of the pelvis from dual energy absorptiometry (DEXA). Predictors of the new measures of maternal pelvic size were examined and the pelvic size measures were examined as predictors of infant birthweight. Data were drawn from a sample of 326 women in Hawaii and their 608 infants. The women were 45-60 years old at the time of the DEXA bone scan and when they recalled the birthweights of their infants. The birthweights were validated with birth certificate data. The women were participants in the Early Postmenopausal Interventional Cohort (EPIC) to study the effects of alendronate on bone density. Questions on birth histories were added to that study. Adolescent milk consumption and age at menarche were positively associated with the DEXA hip measure, while Asian ethnicity was negatively associated with the hip measure in multiple regression analysis. In multiple regression analysis, the hip measure, together with infant gender and gestational age predicted infant birthweight; mother's height, weight, and ethnicity did not add significantly to the model. DEXA provided measures of the pelvis, which varied by ethnicity, hormonal and nutritional variables, and which were indicators of infant birthweight. Am. J. Hum. Biol. 12:552-557, 2000. Copyright 2000 Wiley-Liss, Inc.

Age-Specific Native Hawaiian Mortality: A Comparison of Full, Part, and Non-Hawaiians.

PURPOSE OF THE PAPER: The purpose of this paper is to test if the previously identified disparity in mortality rates among full Hawaiians, part Hawaiians, and non­Hawaiians in the state of Hawaii has continued into the 1990s. SUMMARY OF METHODS UTILIZED: Based on Hawaii vital records and population data, standardized age­specific mortality rates by cause and 95% confidence intervals were estimated. PRINCIPAL FINDINGS: The most striking finding was the significant differences in mortality rates in four age strata ­­ 45­54, 55­64, 65­74, and 75­84 ­­ with mortality rates highest for full Hawaiians, lowest for non­Hawaiians, and intermediate for part Hawaiians. CONCLUSIONS: Findings suggest that Native Hawaiians continue to be at greater risk of death compared with non­Hawaiians, with full Hawaiians at greatest risk. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: Asian and Pacific Islander Americans have been called the model minority. These data provide evidence that Native Hawaiians, especially full Hawaiians, have dramatically higher mortality rates than non­Hawaiians and merit special attention.