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Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011
  1. Katherine G Hastings1,
  2. Karen Eggleston2,
  3. Derek Boothroyd3,
  4. Kristopher I Kapphahn3,
  5. Mark R Cullen4,
  6. Michele Barry5,
  7. Latha P Palaniappan1
  1. 1Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California, USA
  2. 2Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
  3. 3Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
  4. 4Population Health Sciences Division, Stanford University School of Medicine, Stanford, California, USA
  5. 5Center for Innovation in Global Health, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Latha P Palaniappan; lathap{at}


Background With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations.

Methods We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003–2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported.

Results We examined a total of 10 458 849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts.

Conclusions Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities.


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  • Contributors KGH and KE designed the analytic plan and formulated research questions/hypotheses. KIK and DB data cleaned, analysed the data and generated figures. KE, MB, MRC and LPP provided content expertise and critical overview of the various drafts. MRC and LPP are study co-principal investigators. All authors were involved in interpreting findings and revising the first draft, which was written by KGH. All authors approved the final draft of the manuscript.

  • Funding This work was supported by the National Institute for Minority Health and Health Disparities at the National Institutes of Health (R01 MD 007012).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data underlying the authors' findings in this study are freely available in public repositories, regulated by the National Center for Health Statistics (NCHS) and the WHO. The authors have obtained individual county-level characteristic data from NCHS for the analyses, thus its public use is restricted. If interested in acquiring these data, please visit the following link for more information:

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