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To KG, Vandelanotte C, Huynh ANV, Schoeppe S, Alley S, Memon AR, Nguyen NTQ, To QG. Awareness of having hypertension, diabetes and dyslipidaemia among US adults: The 2011-2018 NHANES data. Scand J Public Health 2024:14034948241247612. [PMID: 38679806 DOI: 10.1177/14034948241247612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
AIM This study aimed to investigate awareness of having hypertension, diabetes and dyslipidaemia and their associated factors among US adults. METHODS Data from the National Health and Nutrition Examination Survey, including 21,399 adults aged ⩾20 years (pregnant women excluded) collected between 2011 and 2018, were used. Blood pressure was measured using a Baumanometer calibrated mercury true gravity wall model sphygmomanometer. Serum total cholesterol levels were measured using enzymatic assays. The percentage of haemoglobin A1C (HbA1c), which reflects long-term blood glucose levels, was measured and used to identify diabetes. Participants self-reported whether they were told by a doctor that they have hypertension, dyslipidaemia and diabetes. Awareness was defined as alignment between objective and self-reported measures for having the conditions. Sampling weights and the Taylor series linearisation variance estimation method were used in the analyses. RESULTS The findings showed that 64.06% of people with hypertension, 54.71% of those with dyslipidaemia and 78.40% of those with diabetes were aware of having the respective condition. Age, sex and health insurance were associated with awareness of having all three conditions, but marital status was not associated with any outcome. Weight status was associated with awareness of having hypertension and dyslipidaemia, whereas ethnicity was associated with awareness of having hypertension and diabetes. Relative family income was only associated with awareness of having hypertension. CONCLUSIONS Large proportions of US adults with hypertension, dyslipidaemia and diabetes are not aware of having the conditions. Interventions targeting groups at higher risk of being unaware of these conditions are needed.
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Affiliation(s)
- Kien G To
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Corneel Vandelanotte
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Anh N V Huynh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Stephanie Schoeppe
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Stephanie Alley
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | | | | | - Quyen G To
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
- RMIT University, Vietnam
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2
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Nguyen KH, Oronce CIA, Adia AC, Yeh JC, Ponce N. Inability to Access Needed Medical Care Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees. J Ambul Care Manage 2024; 47:96-103. [PMID: 38335049 PMCID: PMC10940179 DOI: 10.1097/jac.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
We examined self-reported inability to access to needed medical care and reasons for not accessing medical care among US-representative adult Medicaid enrollees, disaggregated across 10 Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Chinese (-4.54 percentage points [PP], P < .001), Other Asian (-4.42 PP, P < .001), and Native Hawaiian (-4.36 PP, P < .001) enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason reported was that a health plan would not approve, cover, or pay for care. Mitigating inequities may require different interventions specific to certain ethnic groups.
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Affiliation(s)
- Kevin H Nguyen
- Author Affiliations: Department of Health Law, Policy and Management, Boston University School of Public Health Boston, Massachusetts (Dr Nguyen and Mr Yeh); Department of Health Policy and Management, Fielding School of Public Health, University of California (Drs Oronce and Ponce); UCLA Center for Health Policy Research (Drs Oronce and Ponce); Filipinx/a/o Community Health Association (Drs Oronce and Ponce, Mr Adia); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (Dr Oronce); Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Oronce); and Department of Health Policy and Management, University of California, Berkeley, California (Mr Adia)
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Oh EG, Huang AW, Nguyen KH. Inequities in Patient Access to Care Among Asian American, Native Hawaiian, and Pacific Islander Adults in Medicaid. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01719-x. [PMID: 37491628 DOI: 10.1007/s40615-023-01719-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Despite decades of advocacy for disaggregated data collection and reporting for Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) people, significant gaps remain in our ability to understand AA and NHPI individuals' access to care. We assess inequities in access to care measures between non-Hispanic White and AA and NHPI adult Medicaid enrollees. METHODS We used the 2014-15 Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems, the first-and-only nationally representative sample of Medicaid enrollees. Our main outcomes were access to needed care, access to a personal doctor, timely access to a checkup, and timely access to specialty care. Using multivariable linear probability models, we assessed the relationship between racial/ethnic group and our outcomes, both in the aggregate and disaggregated into ten racial/ethnic groups, and adjusted for enrollee-level sociodemographic characteristics, health status, and state-level Medicaid expansion status. RESULTS In aggregate, AA and NHPI enrollees reported worse access to care than White enrollees on all four metrics (p < 0.001). The magnitude of disparities varied across the ten AA and NHPI ethnic groups. Disparities relative to White enrollees were particularly large in magnitude, roughly 1.5 to 2 times greater, for Chinese, Korean, and Vietnamese enrollees than for the aggregated AA and NHPI group. CONCLUSIONS Despite comparable insurance coverage, there were inequities in multiple access to care metrics between non-Hispanic White and AA and NHPI Medicaid enrollees. Collection of disaggregated health data on AA and NHPI patients reveals important variation in access to care by ethnic group.
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Affiliation(s)
- Eunhae Grace Oh
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, 02912, USA.
| | - Andrew W Huang
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Kevin H Nguyen
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
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4
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Chandrasekaran S, Key K, Ow A, Lindsey A, Chin J, Goode B, Dinh Q, Choi I, Choimorrow SY. The role of community and culture in abortion perceptions, decisions, and experiences among Asian Americans. Front Public Health 2023; 10:982215. [PMID: 36733282 PMCID: PMC9887147 DOI: 10.3389/fpubh.2022.982215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Culture and community can play a role in views, stigma, and access related to abortion. No research to date has documented the influence of culture and community attitudes on Asian American (AA) experiences accessing abortion care in the United States (US). This paper aims to fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs. Methods We used a community-based participatory research approach, which included collaboration among experts in public health, advocates, practitioners, and community partners to understand abortion knowledge, attitudes, and experiences among AAs. Using a semi-structured interview guide, we interviewed twenty-nine eligible people of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander (AANHPI), and had a medication abortion in the US between January 2016 and March 2021. Interviews were analyzed and coded in NVivo 12 using a modified grounded theory approach. Results Participants described various influences of religion negatively impacting acceptability of abortion among their family and community. Lack of openness around sexual and reproductive health (SRH) topics contributed to stigma and influenced most participants' decision not to disclose their abortion to family members, which resulted in participants feeling isolated throughout their abortion experience. When seeking abortion care, participants preferred to seek care with providers of color, especially if they were AANHPI due to past experiences involving stigma and judgment from White providers. Based on their experiences, respondents recommended ways to improve the abortion experience for AAs in the US including, (1) more culturally aware abortion providers from one's community who better understand their needs; (2) clinics providing abortion services located in or near AA communities with signage in local languages; and (3) tailored mental health resources with culturally aware therapists. Conclusion This study demonstrates ways in which culture and community opinions toward SRH can influence both the acceptability of abortion and experiences seeking abortion care among AAs. It is important to consider family and community dynamics among AAs to better tailor services and meet the needs of AAs seeking abortion care in the US.
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Affiliation(s)
| | - Katherine Key
- Ibis Reproductive Health, Cambridge, MA, United States,*Correspondence: Katherine Key ✉
| | - Abby Ow
- Ibis Reproductive Health, Cambridge, MA, United States
| | - Alyssa Lindsey
- National Asian Pacific American Women's Forum, Atlanta, GA, United States
| | - Jennifer Chin
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Bria Goode
- Ibis Reproductive Health, Oakland, CA, United States
| | - Quyen Dinh
- Southeast Asia Resource Action Center, Washington, DC, United States
| | - Inhe Choi
- HANA Center, Chicago, IL, United States
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Nguyen KH, Lew KP, Trivedi AN. Trends in Collection of Disaggregated Asian American, Native Hawaiian, and Pacific Islander Data: Opportunities in Federal Health Surveys. Am J Public Health 2022; 112:1429-1435. [PMID: 35952328 PMCID: PMC9480465 DOI: 10.2105/ajph.2022.306969] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/04/2022]
Abstract
Collection of data for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) persons that is disaggregated by ethnic subgroup may identify disparities that are not apparent in aggregated data. Using content analysis, we identified national population surveys administered by the US Department of Health and Human Services (HHS) and evaluated trends in the collection of disaggregated AANHPI data between 2011 and 2021. In 2011, 4 of 15 surveys (27%) collected disaggregated data for Asian American, 2 of 15 surveys (13%) collected data on Native Hawaiian, and 2 of 15 surveys (13%) collected disaggregated data for Pacific Islander people. By 2019, 14 of 21 HHS-administered surveys (67%) collected disaggregated data for Asian American (6 subgroups), 67% collected data on Native Hawaiian, and 67% collected disaggregated data on Pacific Islander (3 subgroups) people. Collection of disaggregated AANHPI data in HHS-administered surveys increased from 2011 to 2021, but opportunities to expand collection and reporting remain. Strategies include outreach with community organizations, increased language assistance, and oversampling approaches. Increased availability and reporting of these data can inform health policies and mitigate disparities. (Am J Public Health. 2022;112(10):1429-1435. https://doi.org/10.2105/AJPH.2022.306969).
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Affiliation(s)
- Kevin H Nguyen
- Kevin H. Nguyen is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI. Kaitlyn P. Lew is with the Center for Bioethics, Harvard Medical School, and the Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA. Amal N. Trivedi is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and Providence VA Medical Center, Providence, RI
| | - Kaitlyn P Lew
- Kevin H. Nguyen is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI. Kaitlyn P. Lew is with the Center for Bioethics, Harvard Medical School, and the Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA. Amal N. Trivedi is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and Providence VA Medical Center, Providence, RI
| | - Amal N Trivedi
- Kevin H. Nguyen is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI. Kaitlyn P. Lew is with the Center for Bioethics, Harvard Medical School, and the Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA. Amal N. Trivedi is with the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and Providence VA Medical Center, Providence, RI
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6
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Nguyen KH, Wilson IB, Wallack AR, Trivedi AN. Children's Health Insurance Coverage and Parental Immigration Status: 2015-2019. Pediatrics 2022; 150:188633. [PMID: 35909179 DOI: 10.1542/peds.2021-056012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Rhetoric and policies aimed at restricting immigration to the United States, such as those proposed during the Trump administration, may lead to reduced enrollment in Medicaid for children of immigrants, even those who were legally eligible. This study assessed how children's health insurance coverage changed before versus during the Trump administration by parental immigration status. METHODS Using American Community Survey data, we compared changes in rates of uninsurance and Medicaid enrollment for children in the United States before (2015 to 2016) versus during (2017 to 2019) the Trump administration. Children were categorized by parental immigration status: citizen children with US-born parents, citizen children with naturalized parents, children from mixed-status families, or noncitizen children. RESULTS The study population included 2 963 787 children between 2015 and 2019, representing approximately 64 million children annually. Throughout our study period, uninsurance rates for children from mixed-status families and noncitizen children were higher than citizen children with United States-born parents. Beginning in 2017, there were significant increases in uninsurance among children from mixed-status families (0.48 percentage points [PP], 95% confidence interval [CI]: 0.06 to 0.91) that increased to 1.48 PP (95% CI: 0.98 to 1.99) by 2019 when compared with concurrent trends among citizen children with US-born parents. Changes were accompanied by significant decreases in Medicaid enrollment by 2019 (-0.89 PP, 95% CI: -1.62 to -0.16). CONCLUSIONS There were substantial disparities in uninsurance rates by parental immigration status. Compared with citizen children with US-born parents, uninsurance rates among children from mixed-status families significantly increased between 2017 and 2019, with the magnitude of disparity widening over time.
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Affiliation(s)
- Kevin H Nguyen
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Anya R Wallack
- University of Vermont Health Network, Burlington, Vermont
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.,Providence, Virginia Medical Center
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Nguyen KH, Oh EG, Trivedi AN. Variation in Usual Source of Care in Asian American, Native Hawaiian, and Other Pacific Islander Adult Medicaid Beneficiaries. Med Care 2022; 60:648-654. [PMID: 35293884 PMCID: PMC9378343 DOI: 10.1097/mlr.0000000000001709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher uninsurance rates among AANHPI patients. Less is known about variation among individuals with Medicaid health insurance coverage and among AANHPI subgroups. OBJECTIVE The objective of this study was to examine differences in access to care between White and AANHPI adult Medicaid beneficiaries, both in the aggregate and disaggregated into 9 ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, Native Hawaiian, and Pacific Islander). RESEARCH DESIGN Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems data (2014-2015), a cross-sectional survey representative of all Medicaid beneficiaries. SUBJECTS A total of 126,728 White and 10,089 AANHPI Medicaid beneficiaries were included. MEASURES The study outcomes were: (1) having a usual source of care; and (2) reporting a health center or clinic as the usual site of care. Multivariable linear probability models assessed the relationship between race/ethnic subgroup and our outcomes, adjusting for sociodemographic characteristics and health status. RESULTS Compared with White beneficiaries, Korean beneficiaries were significantly less likely to report having a usual source of care [difference=-8.9 percentage points (PP), P =0.01], and Chinese (difference=8.4 PP, P =0.001), Native Hawaiian (difference=25.8 PP, P <0.001), and Pacific Islander (difference=22.2 PP, P =0.001) beneficiaries were significantly more likely to report a health center or clinic as their usual site of care. CONCLUSIONS Despite similar health insurance coverage, significant differences in access to care remain between White and AANHPI Medicaid beneficiaries. Disaggregated AANHPI data may reveal important variation in access to care and inform more targeted public policies.
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Affiliation(s)
- Kevin H. Nguyen
- Department of Health Services, Policy, and Practice, Brown University School of Public Health
| | - Eunhae G. Oh
- Department of Health Services, Policy, and Practice, Brown University School of Public Health
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health
- Providence VA Medical Center, Providence, RI
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Nguyen KH, Wilson IB, Wallack AR, Trivedi AN. Racial And Ethnic Disparities In Patient Experience Of Care Among Nonelderly Medicaid Managed Care Enrollees. Health Aff (Millwood) 2022; 41:256-264. [PMID: 35130065 PMCID: PMC10076226 DOI: 10.1377/hlthaff.2021.01331] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Medicaid managed care enrollees who are members of racial and ethnic minority groups have historically reported worse care experiences than White enrollees. Few recent studies have identified disparities within and between Medicaid managed care plans. Using 2014-18 data on 242,274 nonelderly Medicaid managed care enrollees in thirty-seven states, we examined racial and ethnic disparities in four patient experience metrics. Compared with White enrollees, minority enrollees reported significantly worse care experiences. Overall adjusted disparities for Black enrollees ranged between 1.5 and 4.5 percentage points; 1.6-3.9 percentage points for Hispanic or Latino enrollees; and 9.0-17.4 percentage points for Asian American, Native Hawaiian, or other Pacific Islander enrollees. Disparities were largely attributable to worse experiences by race or ethnicity within the same plan. For all outcomes, disparities were smaller in plans with the highest percentages of Hispanic or Latino enrollees, and for some outcomes, there were smaller disparities in plans with the highest percentages of Asian American, Native Hawaiian, or other Pacific Islander enrollees. Interventions to mitigate racial and ethnic inequities in care experiences include collection of comprehensive race and ethnicity data, adoption of health equity performance metrics, plan-level enrollee engagement, and multisectoral initiatives to dismantle structural racism.
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Affiliation(s)
- Kevin H Nguyen
- Kevin H. Nguyen , Brown University, Providence, Rhode Island
| | | | - Anya R Wallack
- Anya R. Wallack, University of Vermont Health Network, Burlington, Vermont
| | - Amal N Trivedi
- Amal N. Trivedi, Brown University and Providence Veterans Affairs Medical Center, Providence, Rhode Island
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Jiang JJ, Adia AC, Nazareno J, Operario D, Ponce NA, Shireman TI. The Association Between Moderate and Serious Mental Health Distress and General Health Services Utilization Among Chinese, Filipino, Japanese, Korean, and Vietnamese Adults in California. J Racial Ethn Health Disparities 2022; 9:227-235. [PMID: 33452574 DOI: 10.1007/s40615-020-00946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A growing body of literature has indicated that disaggregated analyses using distinct Asian subgroups allow for identification of varying mental health challenges and health services utilization. In this study, we examined the associations between distress and health services utilization among five Asian subgroups: Chinese, Korean, Japanese, Filipino, and Vietnamese adults in California. MATERIALS AND METHODS Using a combined dataset using the 2011-2018 cross-sectional cycles of the California Health Interview survey, we assessed moderate and serious distress and four health services utilization indicators in a set of disaggregated analyses among adults 18 years of age and older in five Asian subgroups. We performed bivariate and multivariable analyses. RESULTS The prevalence of and associations between moderate and serious distress and gaps in health services utilization varied among each Asian subgroup. Koreans had the highest prevalence of moderate and serious distress and the most gaps in health services utilization. Compared to those without moderate distress (p < .05), Japanese adults were more likely to delay care. Compared to those without serious distress (p < .05), Chinese adults who experienced serious distress were more likely to delay both medications and care, whereas Filipino and Vietnamese adults were more likely to delay medications. DISCUSSION Disaggregating health data elucidates the impact of mental distress on healthcare-seeking behaviors among specific Asian subgroups. Identifying these influences can facilitate future tailored interventions, yet fully understanding the mechanism linking mental distress and healthcare usage will necessitate a comprehensive assessment of structural influences and Asian American experiences without otherization.
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Affiliation(s)
- Joy J Jiang
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alexander C Adia
- Philippine Health Initiative for Research, Service, & Training, Brown University School of Public Health, Providence, RI, USA.
| | - Jennifer Nazareno
- Philippine Health Initiative for Research, Service, & Training, Brown University School of Public Health, Providence, RI, USA
| | - Don Operario
- Philippine Health Initiative for Research, Service, & Training, Brown University School of Public Health, Providence, RI, USA
| | - Ninez A Ponce
- UCLA Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Theresa I Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
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Navarro S, Yang Y, Ochoa CY, Mejia A, Kim SE, Liu L, Lerman C, Farias AJ. Asian Ethnic Subgroup Disparities in Delays of Surgical Treatment for Breast Cancer. JNCI Cancer Spectr 2022; 6:pkab089. [PMID: 35047750 PMCID: PMC8763369 DOI: 10.1093/jncics/pkab089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/31/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background As Asian American breast cancer incidence rises, it is necessary to investigate the origins of differential breast cancer outcomes among Asian ethnic subgroups. This study aimed to examine disparities in delays of breast cancer surgery among Asian ethnic subgroups. Methods We obtained California Cancer Registry data on female breast cancer diagnoses and treatment from 2012 to 2017. Our main independent variable was patient race and ethnicity, including 6 Asian ethnic subgroups. Dependent variables included time to surgical treatment for breast cancer and receipt of surgical treatment within 30 and 90 days of diagnosis. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of prolonged time to surgery. Results In our cohort of 93 168 breast cancer patients, Hispanic (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.82 to 0.89) and non-Hispanic Black (OR = 0.83, 95% CI = 0.78 to 0.88) patients were statistically significantly less likely than non-Hispanic White patients to receive surgery within 30 days of breast cancer diagnosis, whereas Asian Indian or Pakistani (OR = 1.23, 95% CI = 1.09 to 1.40) and Chinese (OR = 1.30, 95% CI = 1.20 to 1.40) patients were statistically significantly more likely to receive surgery within 30 days of diagnosis. Conclusions This large, population-based retrospective cohort study of female breast cancer patients is the first, to our knowledge, to demonstrate that time to surgical treatment is not equal for all Asians. Distinct differences among Asian ethnic subgroups suggest the necessity of further investigating breast cancer treatment patterns to fully understand and target disparities in breast cancer treatment.
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Affiliation(s)
- Stephanie Navarro
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yifei Yang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carol Y Ochoa
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Aaron Mejia
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sue E Kim
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Los Angeles Cancer Surveillance Program, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Park S, Chen J, Ma GX, Ortega AN. Inequities in Access to Care and Health Care Spending for Asian Americans With Cancer. Med Care 2021; 59:528-536. [PMID: 33782249 PMCID: PMC8119364 DOI: 10.1097/mlr.0000000000001538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asian Americans have lower cancer screening rates than non-Latino "Whites," suggesting inequities in cancer prevention among Asian Americans. Little is known about inequities in cancer treatment between Whites and Asian Americans with cancer. METHODS Using the 2002-2017 Medical Expenditure Panel Survey, we examined inequities in access to care and health care spending between Whites and Asian Americans with and without cancer. Our outcomes included 3 measures of access to care and 3 measures of health care spending. We used multivariable regressions while adjusting for predisposing, enabling, and need factors and estimated the mean adjusted values of the outcomes for each group. We then examined the differences in these adjusted mean outcomes among Asian Americans relative to Whites. RESULTS We observed evidence of inequities that Asian Americans without cancer experienced limited access to care due to a lack of a usual source of care. The likelihood of having a usual source of care was lower among Asian Americans without cancer than Whites without cancer. Inequities were not observed among Asian Americans with cancer. Compared with Whites with cancer, Asian Americans with cancer had similar or better levels of access to care. No or marginal differences in health care spending were detected between Whites and Asian Americans with cancer. These findings were consistent in both nonelderly and elderly groups. CONCLUSION While Asian Americans without cancer have unmet medical needs due to limited access to care, access to care and spending are relatively equitable between Whites and Asian Americans with cancer.
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Affiliation(s)
- Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD
| | - Grace X Ma
- Department of Clinical Sciences and Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Alexander N Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Nicholson HL, Ahmmad Z, Anderson A, Doan TT. Unequal Returns of Employment on Self-Rated Health: Asian-White Differences. J Racial Ethn Health Disparities 2021; 9:1106-1113. [PMID: 33977508 DOI: 10.1007/s40615-021-01050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous research has shown that employment status is one of the most powerful socioeconomic resources utilized to promote health and well-being. However, racial and ethnic minorities often experience diminished returns of socioeconomic resources compared to non-Hispanic Whites. This analysis explores the association between employment status and self-rated health among Asians and non-Hispanic Whites, and whether race or ethnicity moderates this association. METHODS We used data from the 2016 National Asian American Survey, a nationally representative survey of Asians from ten ethnic backgrounds. We measured the association between employment status and self-rated health, using race and ethnicity as the primary moderators. Age, gender, income, education, nativity status, and English proficiency were used as controls. Pooled (by race) and stratified (by ethnicity) logistic regressions were estimated. RESULTS The pooled logistic regressions showed that employment was associated with lower odds of poorer self-rated health among Asians and Whites. Race, however, moderated this relationship, indicating a stronger protective effect of employment for Whites. In the stratified logistic regressions, employment was not associated with lower odds of poorer self-rated health across all of the assessed Asian ethnic subgroups. Ethnicity moderated the association between employment and self-rated health, suggesting a stronger protective effect of employment for Whites than for Chinese, Hmong, Koreans, Japanese, and Filipinos. CONCLUSION The protective health benefits of employment do not operate the same for Whites and Asians. Discrimination and unequal labor market and working conditions may weaken the positive health returns of employment for Asians compared to their White counterparts.
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Affiliation(s)
- Harvey L Nicholson
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, USA.
| | - Zobayer Ahmmad
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Andrew Anderson
- Department of Health Policy & Management, Tulane University, New Orleans, LA, USA
| | - Tran T Doan
- Department of Health Management & Policy, University of Michigan, Ann Arbor, MI, USA
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Porteny T, Ponce N, Sommers BD. Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status. J Immigr Minor Health 2020; 24:86-94. [DOI: 10.1007/s10903-020-01124-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
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Montoya-Williams D, Peña MM, Fuentes-Afflick E. In Pursuit of Health Equity in Pediatrics. THE JOURNAL OF PEDIATRICS: X 2020; 5. [PMID: 33733084 PMCID: PMC7963264 DOI: 10.1016/j.ympdx.2020.100045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Diana Montoya-Williams
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | | | - Elena Fuentes-Afflick
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, California
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