PONE-D-21-08873Leading Causes of Death in Asian Indians 2005-2017: Mortality rates across nativity, age, and sexPLOS ONE

Dear Dr. Fernandez Perez,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Nov 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Jianhong Zhou

Associate Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The data appear to be HIPAA restricted data but it says authors with appropriate credentials may access the data. It was a little difficult to understand the age of mortality item in the earlier section of the paper though it is explained in the discussion. Maybe where it is first introduced, the authors might refer the reader to the later discussion or give a brief explanation? Additionally, now that the 2020 Census data are coming out, it could be good to note that and state additional examination of mortality for this key population should continue for the data to come using the 2020 population denominators etc. I understand use of ACS data for the later years in the current data set.

Reviewer #2: Overall, this is a well-conducted study characterizing patterns of mortality among an understudied yet at-risk population group in the United States. This builds upon prior longitudinal data investigating trends among Asian Indians to identify particularly vulnerable populations. My review largely surrounds the implications of this work for clinical and public health practice, along with minor comments, as enumerated below:

*The authors should provide a citation about the drivers of immigration for Asian Indians, both in the 1960s and more recently. The claims are made without references.

*The authors assert that blending of Asian Indian and American cultures may impact risks, but don't expand upon why specifically for this population group. In addition, they also state that this consideration supports "place of birth" as an important health determinant, which implies the presumption that this is only or primarily true for immigrants.

*Outside of being "in accordance with survey data", the rationale for special age brackets is unclear. Please provide more context.

*The US-born Asian Indian average age of death seems shocking low (35.1) and it is unclear how Figure 4 makes this clear (the title of the figure reflects age distributions by sex for selected endpoints). I would urge the authors to make sure that value is accurate. If so, this requires some attention in the Discussion.

*Building off the prior comment, I find the Discussion to be primarily a repeat of the results. Although it was not measured in this study, I would like to see the results placed in more nuanced context of the extant literature. Especially with respect to modifiable risk factors that have socio-cultural underpinnings, these need to be described more fully (currently there are generic statements about diet, physical activity, genetics, and response to medication). If the reader is to be a health professional, what do these results mean for intervention and prevention?

*Similarly, more detail about differential distributions of cancer among Asian Indians would be beneficial, as this study treats cancer death as a singular outcome.

*The idea that this study is in contrast with a "healthy immigrant" effect is compelling, and I wish more attention was provided to elucidate this; currently, the authors make general comments about generational and cultural differences related to behavior, along with health care access differences. I think an opportunity is lost for this paper to provide concrete directions for clinical and public health practice, as opposed to a reiteration of the findings in the final sections of the manuscript.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-21-08873R1Leading Causes of Death in Asian Indians in the United States (2005 - 2017)PLOS ONE

Dear Dr. Fernandez Perez,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. First off my apologies for the delay.  Your original handling editor needed to hand off this assignment and I stepped in to take over earlier this week.  I am sending this back to you to give you a chance to revise your rebuttal letter.  The one that your submitted makes no reference to any of the issues raised by reviewer two, instead mentioning only some minor revisions in response to editorial issues.  I have reproduced the original comments of reviewer two below for easy reference.  Please detail what revisions were made in response to each of these criticisms.  Please also keep in mind that reviewer two will be invited to review your revision. 

Please submit your revised manuscript by Apr 14 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Patrick R Stephens, Ph.D.

Academic Editor

PLOS ONE

Comments from reviewer two:

Overall, this is a well-conducted study characterizing patterns of mortality among an understudied yet at-risk population group in the United States. This builds upon prior longitudinal data investigating trends among Asian Indians to identify particularly vulnerable populations. My review largely surrounds the implications of this work for clinical and public health practice, along with minor comments, as enumerated below:

*The authors should provide a citation about the drivers of immigration for Asian Indians, both in the 1960s and more recently. The claims are made without references.

*The authors assert that blending of Asian Indian and American cultures may impact risks, but don't expand upon why specifically for this population group. In addition, they also state that this consideration supports "place of birth" as an important health determinant, which implies the presumption that this is only or primarily true for immigrants.

*Outside of being "in accordance with survey data", the rationale for special age brackets is unclear. Please provide more context.

*The US-born Asian Indian average age of death seems shocking low (35.1) and it is unclear how Figure 4 makes this clear (the title of the figure reflects age distributions by sex for selected endpoints). I would urge the authors to make sure that value is accurate. If so, this requires some attention in the Discussion.

*Building off the prior comment, I find the Discussion to be primarily a repeat of the results. Although it was not measured in this study, I would like to see the results placed in more nuanced context of the extant literature. Especially with respect to modifiable risk factors that have socio-cultural underpinnings, these need to be described more fully (currently there are generic statements about diet, physical activity, genetics, and response to medication). If the reader is to be a health professional, what do these results mean for intervention and prevention?

*Similarly, more detail about differential distributions of cancer among Asian Indians would be beneficial, as this study treats cancer death as a singular outcome.

*The idea that this study is in contrast with a "healthy immigrant" effect is compelling, and I wish more attention was provided to elucidate this; currently, the authors make general comments about generational and cultural differences related to behavior, along with health care access differences. I think an opportunity is lost for this paper to provide concrete directions for clinical and public health practice, as opposed to a reiteration of the findings in the final sections of the manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-21-08873R2

Leading Causes of Death in Asian Indians in the United States (2005 - 2017)

PLOS ONE

Dear Dr. Fernandez Perez,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

First off, my sincere apologies with the confusion around revisions to the previous versions and the delays that resulted from this.  The reviewer that asked for major revisions has had a chance to look at the updated manuscript now, and is happy with your updates.  The reviewer has also suggested a minor update to the discussion to make the recommendations to workers in the field more clear, particularly for HCWs that service Asian Indian populations.  I am sending this back to you one more time to give you a chance to implement this suggestion.  However, I leave the extent of the revision to your discretion since the manuscript is already technically sound.  I do not anticipate needing to send your final revision out for further review.

Please submit your revised manuscript by Jul 29 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Patrick R Stephens, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

********** 

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

********** 

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

********** 

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

********** 

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: For the most part, the concerns I articulated in my initial review have been addressed. However, in the Discussion, I would have liked to see more specificity in the recommendations for public health practice. For instance, there is a wealth of literature looking at specific dietary patterns among Asian Indians that could have been emphasized, or social/cultural barriers to cancer screening. Currently, the implications for disease prevention and treatment still remain in the realm of generic recommendations which could be applied to any population group.

I defer to the editors to determine if and how this sections could be more concrete and targeted, given the population-specificity of this work.

I look forward to seeing this manuscript as a publication in the base of peer-reviewed literature in the near future.

********** 

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Leading Causes of Death in Asian Indians in the United States (2005 - 2017)

PONE-D-21-08873R3

Dear Dr. Fernandez Perez,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.  Congratulations, and my apologies again that this took so long.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Patrick R Stephens, Ph.D.

Academic Editor

PLOS ONE