Epidemiology of COVID-19 and Its Cardiac and Neurologic Complications Among Chinese and South Asians in Ontario: Waves 1, 2, and 3.

Background: Although we had previously reported the cardiac and neurologic outcomes of Chinese and South Asian Ontarians in wave 1 of COVID-19, data on subsequent waves of COVID-19 remain unexamined. This is an extension study of this cohort in waves 2 and 3. Methods: We identified adult Ontarians with a positive COVID-19 polymerase chain reaction test from January 1, 2020 to June 30, 2021, and they were classified as being Chinese or South Asian using a validated surname algorithm; we compared their outcomes of mortality, and cardiac and neurologic complications with those of the general population using multivariable logistic regression models. Results: Compared to the general population (n = 439,977), the Chinese population (n = 15,208) was older (mean age 44.2 vs 40.6 years, P < 0.001) and the South Asian population (n = 46,333) was younger (39.2 years, P < 0.001). The Chinese population had a higher 30-day mortality (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.28-1.61) and more hospitalization or emergency department visits (OR, 1.14; 95% CI, 1.09-1.28), with a trend toward a higher incidence of cardiac complications (OR, 1.03; 95% CI, 0.87-1.12) and neurologic complications (OR, 1.23; 95% CI, 0.96-1.58). South Asians had a lower 30-day mortality (OR, 0.88; 95% CI, 0.78-0.98) but a higher incidence of hospitalization or emergency department visits (OR, 1.17; 95% CI, 1.14-1.20) with a trend toward a lower incidence of cardiac complications (OR, 0.76; 95% CI, 0.67-0.87) and neurologic complications (OR, 0.89; 95% CI, 0.73-1.09). There was also a significant difference in these outcomes between wave 1, 2 and 3, with a greater mortality in all groups in waves 2 and 3. Conclusions: Ethnicity continues to be an important determinant of mortality, cardiac and neurologic outcomes, and healthcare use among patients with COVID-19, requiring further studies to understand factors driving these differences.

Contexte: Nous avons déjà présenté les issues cliniques cardiaques et neurologiques chez les Ontariens de descendance chinoise ou sud-asiatique pour la première vague de la pandémie de COVID-19, mais les données au sujet des vagues ultérieures n'avaient pas encore été analysées. Nous présentons ici une prolongation de cette étude de cohortes pour la seconde et la troisième vague de COVID-19. Méthodologie: Notre analyse porte sur des adultes ontariens ayant obtenu un résultat positif à un test de COVID-19 par réaction en chaîne de la polymérase entre le 1er janvier 2020 et le 30 juin 2021. Un algorithme validé pour l'analyse des noms de famille a été utilisé pour isoler les sujets de descendance chinoise ou sud-asiatique, et leur taux de mortalité de même que les complications cardiaques et neurologiques ont été comparés à ceux de la population générale à l'aide de modèles de régression logistique multivariée. Résultats: En comparaison de la population générale (n = 439 977), les personnes de descendance chinoise (n = 15 208) se sont révélées plus âgées (âge moyen de 44,2 ans contre 40,6 ans, P < 0,001), tandis que les personnes de descendance sud-asiatique (n = 46 333) étaient plus jeunes (39,2 ans, P < 0,001). Dans la population de descendance chinoise, le taux de mortalité après 30 jours était plus élevé (rapport de cotes [RC] de 1,44; intervalle de confiance [IC] à 95 % de 1,28 à 1,61), et davantage d'hospitalisations ou de consultations aux urgences sont survenues (RC de 1,14; IC à 95 % de 1,09 à 1,28). L'incidence de complications cardiaques (RC de 1,03; IC à 95 % de 0,87 à 1,12) et de complications neurologiques (RC de 1,23; IC à 95 % de 0,96 à 1,58) avait également tendance à être plus élevée. Chez les personnes de descendance sud-asiatique, le taux de mortalité après 30 jours était plus faible (RC de 0,88; IC à 95 % de 0,78 à 0,98), mais l'incidence d'hospitalisations ou de consultations aux urgences était plus élevée (RC de 1,17; IC à 95 % de 1,14 à 1,20). Elles présentaient également une tendance vers une plus faible incidence de complications cardiaques (RC de 0,76; IC à 95 % de 0,67 à 0,87) et de complications neurologiques (RC de 0,89; IC à 95 % de 0,73 à 1,09). Des différences significatives ont également été observées pour ces paramètres entre les vagues 1, 2 et 3 de la maladie, et le taux de mortalité était plus élevé pour tous les groupes des vagues 2 et 3. Conclusions: L'origine ethnique demeure un déterminant important de la mortalité, des issues cliniques cardiaques et neurologiques ainsi que de l'utilisation des ressources en santé chez les patients atteints de la COVID-19. D'autres études sont toutefois nécessaires pour mieux comprendre les facteurs qui expliquent ces différences.

COVID-19 and its Cardiac and Neurological Complications among Ontario Visible Minorities.

BACKGROUND: Due to lack of data on the epidemiology, cardiac, and neurological complications among Ontario visible minorities (Chinese and South Asians) affected by coronavirus disease (COVID-19), this population-based retrospective study was undertaken to study them systematically. METHODS: From January 1, 2020 to September 30, 2020 using the last name algorithm to identify Ontario Chinese and South Asians who were tested positive by PCR for COVID-19, their demographics, cardiac, and neurological complications including hospitalization and emergency visit rates were analyzed compared to the general population. RESULTS: Chinese (N = 1,186) with COVID-19 were found to be older (mean age 50.7 years) compared to the general population (N = 42,547) (mean age 47.6 years) (p < 0.001), while South Asians (N = 3,459) were younger (age of 42.1 years) (p < 0.001). The 30-day crude rate for cardiac complications among Chinese was 169/10,000 (p = 0.069), while for South Asians, it was 64/10,000 (p = 0.008) and, for the general population, it was 112/10,000. For neurological complications, the 30-day crude rate for Chinese was 160/10,000 (p < 0.001); South Asians was 40/10,000 (p = 0.526), and general population was 48/10,000. The 30-day all-cause mortality rate was significantly higher for Chinese at 8.1% vs 5.0% for the general population (p < 0.001), while it was lower in South Asians at 2.1% (p < 0.001). CONCLUSIONS: Chinese and South Asians in Ontario affected by COVID-19 during the first wave of the pandemic were found to have a significant difference in their demographics, cardiac, and neurological outcomes.

Awareness of Warning Symptoms of Heart Disease and Stroke: Results of a Follow-up Study of the Chinese Canadian Cardiovascular Health Project.

BACKGROUND: Our original pilot study in 2008 demonstrated a poor degree of awareness of heart disease and stroke among Chinese Canadians, warranting an updated survey of their knowledge. We sought to determine the current degree of knowledge of cardiovascular disease, including stroke, among ethnic Chinese residents of Canada. METHODS: A 35-question online survey was conducted in the fall of 2017 among 1001 Chinese Canadians (aged ≥ 18 years) in the greater Toronto area (n = 501) and Vancouver (n = 500). Knowledge of heart disease and stroke, such as signs and symptoms of stroke and heart attack, health habits, and initial response to a cardiovascular emergency were assessed. RESULTS: A total of 52.0% of the respondents were female, and 46.3% were aged <45 years. A total of 40.1% spoke Cantonese, and 23.7% spoke Mandarin; 79.5% were immigrants, and 31% had lived in Canada < 10 years. A total of 85% identified at least one heart attack symptom, and 80% identified at least one stroke symptom; 86.2% indicated that they would call 911 if experiencing a heart attack or stroke. Internet use was positively associated with the ability to identify a greater number of heart attack and stroke symptoms, compared to the number among non-Internet users (P < 0.001). Women were 14% more likely to overlook gender as a risk factor for cardiovascular disease (CVD). CONCLUSIONS: This study found that in 2017, compared to 2008, awareness of symptoms of heart disease and stroke improved among Chinese Canadians residing in Toronto and Vancouver.

CONTEXTE: Dans le cadre d'une première étude pilote menée en 2008, nous avions montré que les Canadiens d'origine chinoise connaissaient si mal les maladies cœur et l'accident vasculaire cérébral (AVC) qu'une enquête de suivi de leurs connaissances s'imposait. Nous avons donc entrepris d'évaluer les connaissances actuelles des maladies cardiovasculaires, y compris l'AVC, chez les résidents canadiens d'origine chinoise. MÉTHODOLOGIE: Un sondage en ligne comprenant 35 questions a été effectué à l'automne 2017 auprès de 1 001 Canadiens d'origine chinoise (âgés de 18 ans ou plus) de la région du Grand Toronto (n = 501) et de Vancouver (n = 500). Les connaissances relatives aux maladies cœur et à l'AVC, notamment les signes et symptômes d'AVC et de crise cardiaque, les saines habitudes de vie et la première chose à faire en cas d'urgence cardiovasculaire, ont été évaluées. RÉSULTATS: Au total, 52,0 % des répondants étaient des femmes, et 46,3 % étaient âgés de moins de 45 ans; 40,1 % parlaient cantonnais et 23,7 %, mandarin; 79,5 % étaient des immigrants, et 31 % vivaient au Canada depuis moins de 10 ans. Au total, 85 % des répondants connaissaient au moins un symptôme de crise cardiaque et 80 %, au moins un symptôme d'AVC; 86,2 % ont indiqué qu'ils composeraient le 9-1-1 s'ils subissaient une crise cardiaque ou un AVC. Les répondants qui utilisaient l'Internet étaient capables de reconnaître un plus grand nombre de symptômes de crise cardiaque et d'AVC que les répondants qui n'utilisaient pas l'Internet (p < 0,001). Les femmes avaient 14 % plus de chances de ne pas tenir compte du sexe comme facteur de risque de maladie cardiovasculaire. CONCLUSIONS: L'étude a révélé qu'en 2017, comparativement à 2008, la connaissance des symptômes de maladie cœur et d'AVC s'est améliorée chez les Canadiens d'origine chinoise vivant à Toronto et à Vancouver.

Epidemiology of Cerebrovascular Disease Among Chinese Canadian Adults With Type 2 Diabetes.

BACKGROUND: First-generation Chinese Canadians have usually maintained different lifestyles before immigration to North America, and the question of whether Chinese Canadians with type 2 diabetes have a different stroke profile than that of non-Chinese Canadians remains unanswered. OBJECTIVES: To determine whether 1) Chinese Canadians who have had a stroke within the last 15 years are more likely to have diabetes than non-Chinese Canadians and 2) to explore differences in stroke profiles between the 2 cohorts. METHODS: Age- and sex-matched Chinese Canadians (n=70) and non-Chinese Canadians (n=107) were compared on the basis of stroke type, age at stroke onset, stroke etiology and common risk factors. Classifications for disease were done according to professional guidelines. Statistical analysis was done with Student t test and odds ratios to confirm differences between groups. RESULTS: Chinese Canadians with stroke had a higher frequency of diabetes mellitus than non-Chinese Canadians. Chinese Canadians with diabetes were more likely to have small vessel disease, specifically lacunar stroke. Chinese Canadians at high risk for stroke were more likely to have a poor prognosis than non-Chinese Canadians, with near significance. CONCLUSION: Chinese Canadians with diabetes who had ischemic strokes were especially susceptible to intracranial small vessel disease compared with non-Chinese Canadians. These results signify that risk factor prevalence and stroke types differ considerably between Chinese Canadians and non-Chinese Canadians residing in Toronto, warranting further study.

Lack of awareness of heart disease and stroke among Chinese Canadians: results of a pilot study of the Chinese Canadian Cardiovascular Health Project.

BACKGROUND: According to Statistics Canada's 2001 census, the Chinese make up the largest (27.5%) visible minority population in Canada. The cardiovascular health information for this population is therefore important for the allocation of health care and promotion resources. OBJECTIVES: In the present pilot study, the authors sought to define the degree of awareness and knowledge of cardiovascular disease, as well as their risk factors, among the Chinese Canadian population. METHODS: A 16-item telephone survey was conducted among 1004 ethnic Chinese subjects (18 years of age and older) in the greater Toronto area of Ontario (n=503) and the greater Vancouver area of British Columbia (n=501) in February 2004. RESULTS: Among the respondents, 73% spoke Cantonese at home and 21% spoke Mandarin. Ninety-seven per cent were immigrants, and 53% had been in Canada for less than 10 years. A history of hypertension was reported in 9.2% of respondents, diabetes in 3.2% and high cholesterol in 14.5%. Thirty-two per cent and 40% of respondents were unable to name at least one symptom of heart attack or stroke, respectively, unaided. Thirty-two per cent and 35% of respondents named at least one incorrect symptom of heart attack and stroke, respectively. When asked about their immediate response in a hypothetical case of a heart attack or stroke, only 20% would have called 911. CONCLUSIONS: The present study is the first to address the awareness of cardiovascular health and disease among Chinese Canadians. These data suggest that Chinese Canadians have a relatively low awareness of the warning symptoms for common cardiovascular emergency situations. The findings presented here have important implications for the development of future health promotion and research initiatives targeted to visible minority populations in Canada.