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Truong-Vu KP. Racial, Ethnic, and Gender Differences in the Timing of Initiating the HPV Vaccine in the United States: the Case of Southeast Asian Americans. J Racial Ethn Health Disparities 2024; 11:2210-2223. [PMID: 37531020 DOI: 10.1007/s40615-023-01689-0] [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: 02/10/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 08/03/2023]
Abstract
Despite the availability of the human papillomavirus (HPV) vaccine, non-Latinx (NL) Southeast Asian Americans have the highest incidence of HPV-associated cervical cancer in the US. Little is known about NL-Southeast Asian Americans' HPV vaccination coverage due to being categorized under the "Asian American" monolith. Therefore, this study uses restricted data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) to disaggregate NL-Southeast Asian Americans and compare this population's age-specific probabilities of initiating HPV vaccinations to two Asian American subgroups (NL-East Asian and NL-South Asian Americans) and NL-White, NL-Black, and Latinx Americans. Multinomial logistic regression models examine the differences in the timing of initiating the HPV vaccine series, late (ages 13-26) or never, relative to on-time vaccination (by age 12). NL-Southeast Asian Americans are significantly more likely to never vaccinate and to vaccinate late than NL-White, NL-Black, and Latinx Americans, relative to on-time vaccination. NL-Southeast Asian American boys/men are significantly more likely to never initiate the HPV vaccine than Latinx boys/men, relative to on-time vaccination. NL-Southeast Asian American girls/women are significantly more likely to never vaccinate and vaccinate late than NL-White, NL-Black, and Latinx girls/women, relative to on-time vaccination. There are significant gender differences in uptake among all racial and ethnic groups, except among NL-Southeast and NL-East Asian Americans. Disaggregated data on NL-Southeast Asian Americans helps scholars and public health officials uncover health disparities and improve health interventions. Targeted HPV vaccine promotion and services for this population are needed to mitigate current and future health disparities and promote health equity.
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Affiliation(s)
- Kim-Phuong Truong-Vu
- Department of Sociology & Criminology, University of Miami, 5202 University Dr., Coral Gables, Miami, FL, 33146, USA.
- Cancer Control, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
- CU Population Center, University of Colorado Boulder, Boulder, CO, USA.
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Da L, Tarasenko Y, Chen C. Asian American sub-ethnic disparities and trends in epithelial ovarian cancer diagnosis, treatment and survival. ETHNICITY & HEALTH 2024:1-18. [PMID: 38967965 DOI: 10.1080/13557858.2024.2359387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Studies on ovarian cancer (OC) diagnosis, treatment and survival across disaggregated Asian sub-ethnic groups are sparse. Few studies have also conducted trend analyses of these outcomes within and across Asian groups. METHODS Using logistic, Cox, and Joinpoint regression analyses of the 2000-2018 Surveillance, Epidemiology, and End Results (SEER) data, we examined disparities and trends in OC advanced stage diagnosis, receipt of treatments and the 5-year cause-specific survival across seven Asian sub-ethnic groups. RESULTS There were 6491 OC patients across seven Asian sub-ethnic groups (mean [SD] age, 57.29 [13.90] years). There were 1583(24.39%) Filipino, 1183(18.23%) Chinese, and 761(11.72%) Asian Indian or Pakistani (AIP) patients. The majority (52.49%) were diagnosed with OC with at an advanced stage. AIP were more likely to have advanced stage diagnosis than other subgroups (ORs, 95%CIs: 0.77, 0.62-0.96 [Filipino]; 0.76, 0.60-0.95 [Chinese]; 0.71, 0.54-0.94 [Japanese]; 0.74, 0.56-0.98 [Vietnamese] and 0.66, 0.53-0.83 [Other Asians]). The Filipinos were least likely to receive surgery but most likely to undergo chemotherapy. Japanese patients had the worst 5-year OC cause-specific survival (50.29%, 95%CI: 46.20%-54.74%). Based on the aggregated analyses, there was a significantly decreased trend in advanced-stage diagnosis and an increased trend in receipt of chemotherapy. Trends in OC outcomes for several subethnicities differed from those observed in aggregated analyses. CONCLUSION In this cohort study of 6491 patients, OC diagnosis, treatment, survival, and trends differed across Asian American ethnic subgroups. Such differences must be considered in future research and interventions to ensure all Asian American subethnicities equally benefit from the advancements in OC care and control.
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Affiliation(s)
- Lijuan Da
- School of Public Health, Zhejiang University, Hangzhou, People's Republic of China
| | - Yelena Tarasenko
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University (GSU), Statesboro, USA
| | - Chen Chen
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, People's Republic of China
- Center for Biostatistics, Bioinformatics, and Big Data, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
- Department of Biostatistics, GoBroad Research Center, Shanghai, People's Republic of China
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Cheng LJ, Pan T, Chen LA, Cheng JY, Mulhern B, Devlin N, Luo N. The Ceiling Effects of EQ-5D-3L and 5L in General Population Health Surveys: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:986-997. [PMID: 38467187 DOI: 10.1016/j.jval.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES This review aims to examine the ceiling effects of EQ-5D-3L (3L) and EQ-5D-5L (5L) in general adult populations and identify the factors influencing these effects. METHODS We searched 8 databases for observational studies published in English from inception to 24 July 2023. Ceiling effects were calculated by dividing the number of participants reporting full health at dimension or profile level by the total sample size. Subgroup analysis and meta-regression using the metafor package in R software were performed. RESULTS We identified 94 studies from 70 articles, including 4 543 647 adults across 37 countries. The global pooled proportion of individuals reporting full health ("11111") was 56% (95% CI 51%-62%) for 3L and 49% (95% CI 44%-54%) for 5L. The self-care dimension showed the highest ceiling effects (3L: 97%; 5L: 94%), whereas pain/discomfort had the lowest (3L: 69%; 5L: 60%). The ceiling effects in East/South-East Asia were higher than in Europe by 25% (95% CI 18%-32%) in 3L and 9% (95% CI -2%-20%) in 5L. Adjusting for mean age and proportion of males, significant regional differences persisted in the overall profile level of 3L, in all 3L dimensions (except for self-care), and 5L dimensions (except for pain/discomfort and anxiety/depression). CONCLUSIONS This review highlights significant ceiling effects in the EQ-5D, especially in Asian populations. The 5L version exhibited fewer ceiling effects than the 3L, indicating its superiority for general population surveys. Further research is crucial to understand the disparities in self-reported health outcomes between Asians and other populations.
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Affiliation(s)
- Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tianxin Pan
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Le Ann Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jing Ying Cheng
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Peregrina HN, Bayog MLG, Pagdilao A, Bender MS, Doan T, Yoo GJ. Older Chinese and Filipino American Immigrants with Type 2 Diabetes and their Adult Child: A Qualitative Dyadic Exploration of Family Support. J Cross Cult Gerontol 2024; 39:151-172. [PMID: 38720112 PMCID: PMC11093813 DOI: 10.1007/s10823-024-09505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
Type 2 Diabetes (T2D) among older Asian American immigrants (AA) is a growing concern. Asian Americans represent 9% of diagnosed diabetes. Very little is known on how older Asian American immigrants with T2D navigate diabetes management, in particular the role of family support. This qualitative study examines Chinese and Filipino Americans, the two largest Asian subgroups in the US (4.2 million, and 3.6 million, respectively), and family support dynamics among adult children and their parents diagnosed with T2D. Ten dyads (n = 20) made up of adult children and aging parents participated in in-depth and dyadic interviews. Results indicate that family support occurs in a trajectory of stages. The following thematic patterns emerged in these dyads around support: independence, transitions, partnership, and stepping in. The findings point to various supportive stages that Asian American adult children and aging parents with T2D experience and the importance of developing supportive interventions for both adult children and aging parents at these various stages.
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Affiliation(s)
| | - Maria L G Bayog
- School of Nursing, University of California, San Francisco, San Francisco, USA
| | | | - Melinda S Bender
- School of Nursing, University of California, San Francisco, San Francisco, USA
| | - Therese Doan
- School of Nursing, San Francisco State University, San Francisco, USA
| | - Grace J Yoo
- Department of Asian American Studies, San Francisco State University, San Francisco, USA
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Bruno MK, Matsunaga M, Krening E, Nakagawa K, Chen JJ, Seto T, Gao F, Tanner C, Ross GW. Racial disparities in hospitalization characteristics among Native Hawaiians, Pacific Islanders and Asian American subgroups with Parkinson's disease. Parkinsonism Relat Disord 2024; 121:106018. [PMID: 38359475 DOI: 10.1016/j.parkreldis.2024.106018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Differences among Native Hawaiians/Pacific Islanders (NHPI) and Asian American (AA) subgroups have not been adequately studied in Parkinson's disease (PD). OBJECTIVE To determine differences in demographics, comorbidities, and healthcare utilization among NHPI, AA subgroups, and White hospitalized PD patients. METHODS We conducted a retrospective cross-sectional analysis of Hawai'is statewide registry (2016-2020). Patients with PD were identified using ICD10 code G20 and categorized as White, Japanese, Filipino, Chinese, NHPI, or Other. Variables collected included: age, sex, residence (county), primary source of payment, discharge status, length of stay, in-hospital expiration, Charlson Comorbidity Index (CCI) and Deep Brain Stimulation (DBS) utilization. Bivariate analyses were performed: differences in age and CCI were further examined by multivariable linear regression and proportional odds models. RESULTS Of 229,238 hospitalizations, 2428 had PD (Japanese: 31.3 %, White: 30.4 %, Filipino: 11.3 %, NHPI: 9.6 %, Chinese: 8.0 %). NHPI were younger compared to rest of the subgroups [estimate in years (95 % CI): Whites: 4.4 (3.0-5.8), Filipinos: 4.3 (2.7-5.9), Japanese: 7.7 (6.4-9.1), Chinese: 7.9 (6.1-9.7), p < 0.001)]. NHPI had a higher CCI compared to White, Japanese, and Chinese (p < 0.001). Among AA subgroups, Filipinos were younger and had a higher CCI compared to Japanese and Chinese (p < 0.001). There were no significant differences in DBS utilization among subgroups. CONCLUSIONS NHPI and Filipinos with PD were hospitalized at a younger age and had a greater comorbidity burden compared to other AAs and Whites. Further research, ideally prospective studies, are needed to understand these racial disparities.
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Affiliation(s)
- Michiko Kimura Bruno
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA.
| | - Masako Matsunaga
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Kazuma Nakagawa
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - John J Chen
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Todd Seto
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Fay Gao
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - G Webster Ross
- Pacific Health Research and Education Institute, VA Pacific Islands Health Care System, USA
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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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Bersamira CS, Lau SB, Lee YJ, Yamauchi J. Anti-Asian Hate's Impact on Asian American Social Workers: Implications for Professional Training and Education. SOCIAL WORK 2024; 69:117-124. [PMID: 38364307 DOI: 10.1093/sw/swae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 02/18/2024]
Abstract
This article explores the impact of recent incidents of anti-Asian hate and violence against Asian American social workers, clients, and communities. Asian Americans represent a small but growing proportion of the U.S. population. Yet, Asians are underrepresented in the social work profession-approximately 3.6 percent of the social work workforce and 2.1 percent of licensed social workers are Asian, and data on underrepresented racial and ethnic groups in the workforce continue to omit details on Asian people. Recent social and political framing of the COVID-19 pandemic as attributable to Asian people has fueled racist rhetoric and incidents of hate and bias crimes against Asian people. Through exploratory research to understand the experiences of Asian American social workers in the proliferation of anti-Asian hate, authors identified that more should be done to support and meet the needs of Asian American social workers, clients, and communities by improving social work education and training, by addressing the social work workforce and agency practices, and by expanding upon advocacy and community building.
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Affiliation(s)
- Clifford S Bersamira
- PhD, is assistant professor, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, 2430 Campus Road, Gartley Hall, Honolulu, HI 96822, USA
| | - Sophia B Lau
- PhD, are assistant professors, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yeonjung Jane Lee
- PhD, are assistant professors, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Jaron Yamauchi
- MSW, is an alumnus, Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI, USA
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Lim A, Elias S, Benjasirisan C, Byiringiro S, Chen Y, Turkson‐Ocran R, Dennison Himmelfarb CR, Commodore‐Mensah Y, Koirala B. Heterogeneity in the Prevalence of Cardiovascular Risk Factors by Ethnicity and Birthplace Among Asian Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey. J Am Heart Assoc 2024; 13:e031886. [PMID: 38420759 PMCID: PMC10944060 DOI: 10.1161/jaha.123.031886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Asian people in the United States have different sociodemographic and health-related characteristics that might affect cardiovascular disease (CVD) risk by ethnicity and birthplace. However, they are often studied as a monolithic group in health care research. This study aimed to examine heterogeneity in CVD risk factors on the basis of birthplace among the 3 largest Asian subgroups (Chinese, Asian Indian, and Filipino) compared with US-born non-Hispanic White (NHW) adults. METHODS AND RESULTS A cross-sectional analysis was conducted using the 2010 to 2018 National Health Interview Survey data from 125 008 US-born and foreign-born Chinese, Asian Indian, Filipino, and US-born NHW adults. Generalized linear models with Poisson distribution were used to examine the prevalence and prevalence ratios of self-reported hypertension, diabetes, high cholesterol, physical inactivity, smoking, and overweight/obesity among Asian subgroups compared with US-born NHW adults. The study included 118 979 US-born NHW and 6029 Asian adults who self-identified as Chinese (29%), Asian Indian (33%), and Filipino (38%). Participants' mean (±SD) age was 49±0.1 years, and 53% were females. In an adjusted analysis, foreign-born Asian Indians had significantly higher prevalence of diabetes, physical inactivity, and overweight/obesity; foreign-born Chinese had higher prevalence of physical inactivity, and foreign-born Filipinos had higher prevalence of all 5 CVD risk factors except smoking compared with NHW adults. CONCLUSIONS This study revealed significant heterogeneity in the prevalence of CVD risk factors among Asian subgroups by ethnicity and birthplace, stressing the necessity of disaggregating Asian subgroup data. Providers should consider this heterogeneity in CVD risk factors and establish tailored CVD prevention plans for Asian subgroups.
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Affiliation(s)
- Arum Lim
- Johns Hopkins School of NursingBaltimoreMDUSA
| | | | | | | | - Yuling Chen
- Johns Hopkins School of NursingBaltimoreMDUSA
| | - Ruth‐Alma Turkson‐Ocran
- Beth Israel Deaconess Medical Center, Division of General MedicineHarvard Medical SchoolBostonMAUSA
| | - Cheryl R. Dennison Himmelfarb
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Johns Hopkins School of MedicineBaltimoreMDUSA
| | - Yvonne Commodore‐Mensah
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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Adia AC, Nguyen KH, Ponce NA. EHR Data and Inclusion of Multiracial Asian American, Native Hawaiian, and Pacific Islander People-Opportunities for Advancing Data-Centered Equity in Health Research. JAMA Netw Open 2024; 7:e240719. [PMID: 38502131 DOI: 10.1001/jamanetworkopen.2024.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
| | - Kevin H Nguyen
- School of Public Health, Boston University, Boston, Massachusetts
| | - Ninez A Ponce
- Fielding School of Public Health, University of California, Los Angeles
- Center for Health Policy Research, University of California, Los Angeles
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Johnson CR, Liao CI, Tian C, Richardson MT, Duong K, Tran N, Winkler SS, Kapp DS, Darcy K, Chan JK. Uterine cancer among Asian Americans - Disparities & clinical characteristics. Gynecol Oncol 2024; 182:24-31. [PMID: 38246043 DOI: 10.1016/j.ygyno.2023.12.023] [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: 09/29/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the patterns and trends of uterine cancer among Asian subgroups living in the U.S. METHODS Data were obtained from United States Cancer Statistics (2001-2017), National Cancer Database (2004-2015), and World Population Review (2023). SEER*Stat version 8.3.9.2, Joinpoint regression program 4.9.0.0, and SAS v 9.4 were employed for statistical analysis. RESULTS Based on data from 778,891 women in the United States Cancer Statistics database, Asians had a 3.4-fold higher rate of incident uterine cancer compared to White populations (2.14% vs. 0.63%; p < 0.001). Using the National Cancer Database, 7,641 Asian women from six subgroups were analyzed: Filipino, Korean, Indian/Pakistani, Vietnamese, Chinese, and Japanese. Indian and Pakistani women had the greatest increase in the proportion of cancer diagnoses (5.0% to 14.4%; p = 0.0003). Additionally, Indian and Pakistani patients had higher comorbidity scores while Koreans had the lowest (22.7% vs. 10.7%, p < 0.0001). Regarding stage of disease, 25.3% of Filipinos presented with advanced stage disease compared to 19.2% of Indians and Pakistanis (p = 0.0001). Furthermore, Filipinos had the highest proportion of non-endometrioid cancers at 18.4% compared to other subgroups (p = 0.0003). Using the World Population Review, female obesity was highest in Pakistan (8.6%) and the Philippines (7.5%) and lowest in Vietnam (2.6%). CONCLUSION Uterine cancer incidence increased at higher rates among Asians compared to White populations. Specifically, Indian and Pakistani uterine cancer patients were more likely to have higher comorbidity rates and Filipino patients had more advanced stage cancer with non-endometrioid histologies than other Asian subgroups. Further research is warranted to better understand these trends.
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Affiliation(s)
- Caitlin R Johnson
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA.
| | - Cheng-I Liao
- Pingtung Veterans General Hospital, Department of Obstetrics and Gynecology, Pingtung, Taiwan
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Michael T Richardson
- University of California, Los Angeles, Department of Obstetrics and Gynecology, 757 Westwood Blvd, Los Angeles, CA, USA
| | - Kim Duong
- Western University of Health Sciences, College of Osteopathic Medicine, 309 E 2nd St, Pomona, CA 91766, USA
| | - Nathan Tran
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA
| | - Stuart S Winkler
- Brooke Army Medical Center, Department of Obstetrics and Gynecology, 3551 Roger Brooke Dr., Fort Sam Houston, TX, United States of America
| | - Daniel S Kapp
- Stanford University School of Medicine, Department of Radiation Oncology, 875 Blake Wilbur Dr, Stanford, CA 94304, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - John K Chan
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA
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Chen M, Bacong AM, Feng C, Kikuta NT, Datir RR, Chen S, Srinivasan M, Camargo CA, Palaniappan L, Arroyo AC. Asthma heterogeneity among Asian American children: The California Health Interview Survey. Ann Allergy Asthma Immunol 2024; 132:368-373.e2. [PMID: 37949352 PMCID: PMC10922489 DOI: 10.1016/j.anai.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear. OBJECTIVE To evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups. METHODS We analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex. RESULTS Of 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status. CONCLUSION Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.
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Affiliation(s)
- Meng Chen
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California.
| | - Adrian Matias Bacong
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Charles Feng
- Division of Allergy/Immunology, Palo Alto Medical Foundation, Mountain View, California
| | | | - Rohan Rahul Datir
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Shihua Chen
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carlos A Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Epidemiology and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anna Chen Arroyo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California
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Bruno MK, Matsunaga M, Krening E, Gao F, Chen JJ, Seto T, Ross GW. The Prevalence of Hospitalized Parkinson's Disease Patients in All Case Hospitalization among Different Race/Ethnic Subgroups in Hawaii. JOURNAL OF PARKINSON'S DISEASE 2024; 14:725-735. [PMID: 38607763 PMCID: PMC11191512 DOI: 10.3233/jpd-230341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
Background Little is known about the epidemiology of Parkinson's disease (PD) patients in Native Hawaiian Or Other Pacific Islander (NHPI) and Asian American (AA) subgroups. Objective To determine if the prevalence of hospitalized PD patients is different across age groups and racial/ethnic subgroups in Hawaii. Methods We conducted a retrospective analysis of Hawaii statewide registry (2016-2020) hospitalization data for patients who were 50 years or older. PD patients were identified using an ICD 10 code: Parkinson's Disease (G20) as their primary/secondary hospitalization discharge diagnosis code. Demographic and clinical characteristics among racial/ethnic subgroups (White, Japanese, Filipino, Chinese, NHPI, or Other) were compared. Results Of 146,844 total hospitalized patients (n = 429,879 records), 1.6% (n = 2,401) had a PD diagnosis. The prevalence of hospitalized PD patients was 2.3% among Japanese and Chinese, followed by 1.7% for Whites, 1.2% for Filipinos and was lowest for NHPI with 0.9% (p < 0.001). As patient's age increased, the prevalence of hospitalized PD patients increased, with 80-84 years old for the highest age range (3.4%). The prevalence of hospitalized PD patients at 80-84 years old varied across the race/ethnic subgroups (Chinese 4.3%, Japanese 4.0%, Whites 3.7%, Filipinos 2.5%, NHPI 2.3%). Conclusions The prevalence of hospitalized PD patients among all case hospitalizations were lower for NHPI and Filipino compared to that of Japanese, Chinese, and Whites. As patients' age increased, the prevalence of hospitalized patients with PD increased, but less so in NHPI and Filipino groups. Further research is warranted to understand the reason for these observed differences among racial/ethnic subgroups.
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Affiliation(s)
- Michiko Kimura Bruno
- The Queen’s Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - Masako Matsunaga
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | | | - Fay Gao
- The Queen’s Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - John J. Chen
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - Todd Seto
- The Queen’s Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - G. Webster Ross
- Pacific Health Research and Education Institute, VA Pacific Islands Health CareSystem, Honolulu, HI, USA
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Camara E, Safri A, Ko CL, Abdul-Mutakabbir JC, Bandali A, Brown BR. The implications of data aggregation on propagating racial and ethnic disparities within the health care landscape: Actionable recommendations and considerations for pharmacists. J Am Pharm Assoc (2003) 2024; 64:34-38.e1. [PMID: 37865310 DOI: 10.1016/j.japh.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
As the U.S. population becomes more racially and ethnically diverse, it is increasingly important to characterize health inequities for targeted intervention. As it stands, demographic data regarding race and ethnicity for patients and pharmacy trainees alike are aggregated into heterogenous population groups, resulting in findings that may inaccurately reflect the experiences of smaller subgroups. Disaggregation of patient outcomes data can serve to better inform public health interventions for the most vulnerable populations. In pharmacy, disaggregation can allow for better identification of racial and ethnic subgroups who have been traditionally excluded from funding support among other opportunities. In this commentary, we provide historical context and actionable recommendations to better describe our patient and pharmacy trainee populations, with the objectives of improving pharmacist representation and health equity.
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Tolentino DA, Brynes ME. Filipino Americans' Social and Cultural Experiences of Type 2 Diabetes Management: Cultural Paradox, Ownership, and Success Definition. J Transcult Nurs 2024; 35:41-52. [PMID: 37961912 PMCID: PMC10714704 DOI: 10.1177/10436596231209041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Although type 2 diabetes mellitus (T2DM) disproportionately affects Filipino Americans, they have not received much attention in the literature. Focusing on how Filipino Americans' social and cultural contextual experiences affect their self-management is critical. This study examined T2DM self-management among Filipino Americans by describing their sociocultural experiences, strategies, and significance of self-management. METHOD An interpretive descriptive qualitative design was used. Data were analyzed using thematic analysis. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Filipino Americans (n = 19) with T2DM were interviewed. Three themes emerged: (a) cultural paradox of being Filipino American, (b) movement from invisibility to ownership of T2DM, and (c) definition of successful management of T2DM. CONCLUSION Results contribute to a greater understanding of Filipino Americans' T2DM self-management experiences. Implications include the provision of culturally congruent health care, being aware of Filipino Americans' sociocultural experiences, and involvement of family/community.
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Islam JY, Parikh NS, Lappen H, Venkat V, Nalkar P, Kapadia F. Mental health burdens among North American Asian adults living with chronic conditions: a systematic review. Epidemiol Rev 2023; 45:82-92. [PMID: 37147853 DOI: 10.1093/epirev/mxad003] [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: 08/04/2022] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
Asians are likely to experience a high burden of chronic conditions, including, but not limited to, diabetes, cardiovascular disease, and cancer, due to differences in biologic, genetic, and environmental factors across Asian ethnic groups. A diagnosis of any chronic condition can contribute to increased mental health burdens, including depression, psychological distress, and posttraumatic stress disorder (PTSD). However, few studies have examined these comorbid conditions across distinct Asian ethnic groups-an important limitation given the differences in social, cultural, and behavioral drivers of mental health burdens within and across Asian ethnicities. To understand the disparities in mental health burdens among Asians living with a chronic health condition, we conducted a systematic literature review of relevant, peer-reviewed publication databases to identify studies reporting on mental health burdens (e.g., depression, anxiety, distress, PTSD) in distinct Asian ethnic groups in North America. Thirteen studies met the inclusion criteria for this review and collectively demonstrated a high burden of depression, psychological distress, and PTSD among Asians living with chronic conditions. Moreover, there were distinct disparities in mental health burdens across chronic conditions and across Asian ethnic groups. Despite the detrimental impact of poor mental health on chronic disease-specific outcomes, such as death and poor quality of life, few data exist that characterize mental health outcomes among Asian ethnicities living in North America with chronic conditions. Future work should prioritize estimating the national prevalence of mental health outcomes among adults with chronic conditions, by Asian ethnicities, to inform culturally tailored interventions to address this public health burden.
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Affiliation(s)
- Jessica Y Islam
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Nina S Parikh
- Department of Social and Behavioral Science, New York University, New York, NY 10003, United States
| | - Hope Lappen
- Division of Libraries, New York University, New York, NY 10003, United States
| | - Vandana Venkat
- Department of Epidemiology, New York University, New York, NY 10003, United States
| | - Priyanka Nalkar
- Department of Epidemiology, New York University, New York, NY 10003, United States
| | - Farzana Kapadia
- Department of Epidemiology, New York University, New York, NY 10003, United States
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Marks KJ, Nakayama JY, Chiang KV, Grap ME, Anstey EH, Boundy EO, Hamner HC, Li R. Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity - United States, 2020-2021. Prev Chronic Dis 2023; 20:E114. [PMID: 38096123 PMCID: PMC10723082 DOI: 10.5888/pcd20.230199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Introduction Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initiation rates by disaggregation of data to finer subgroups of race and ethnicity. Methods We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate whether an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross-tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated categories. Results The overall prevalence of breastfeeding initiation was 84.0%, ranging from 74.5% (mothers identifying as Black) to 94.0% (mothers identifying as Japanese). The aggregated prevalence of breastfeeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Conclusion Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggregation of racial and ethnic data unmasked differences that could reflect variations in cultural practices or systemic barriers to breastfeeding. Understanding why these differences exist could guide public health practitioners' efforts to improve and tailor breastfeeding support.
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Affiliation(s)
- Kristin J Marks
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-5, Atlanta, GA 30341
| | - Jasmine Y Nakayama
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katelyn V Chiang
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Mary Ellen Grap
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Erica H Anstey
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen O Boundy
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | - Heather C Hamner
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruowei Li
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
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Guan A, Pruitt SL, Henry KA, Lin K, Meltzer D, Canchola AJ, Rathod AB, Hughes AE, Kroenke CH, Gomez SL, Hiatt RA, Stroup AM, Pinheiro PS, Boscoe FP, Zhu H, Shariff-Marco S. Asian American Enclaves and Healthcare Accessibility: An Ecologic Study Across Five States. Am J Prev Med 2023; 65:1015-1025. [PMID: 37429388 PMCID: PMC10921977 DOI: 10.1016/j.amepre.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. METHODS U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022-2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. RESULTS Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). CONCLUSIONS Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods.
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Affiliation(s)
- Alice Guan
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin A Henry
- Department of Geography and Urban Studies, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Katherine Lin
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Dan Meltzer
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Alison J Canchola
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Aniruddha B Rathod
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy E Hughes
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candyce H Kroenke
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Paulo S Pinheiro
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | - Hong Zhu
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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18
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Tolentino DA, Costa DK, Jiang Y. Determinants of American Adults' Use of Digital Health and Willingness to Share Health Data to Providers, Family, and Social Media: A Cross-sectional Study. Comput Inform Nurs 2023; 41:892-902. [PMID: 37310724 PMCID: PMC10713855 DOI: 10.1097/cin.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
With the global pandemic driving the adoption of digital health, understanding the predictors or determinants of digital health usage and information sharing gives an opportunity to advocate for broader adoption. We examined the prevalence and predictors of digital health usage and information-sharing behaviors among American adults. Data were from the Health Information National Trends Survey 5 Cycle 4. More than two-thirds used a digital resource for health-related activities (eg, to check test results). About 81% were willing to share their digital data with their provider, 75% with family, and 58% with friends. Only 14% shared health information on social media. Gender, education, device types, and performance expectancy of digital health were common factors associated with both digital health usage and information-sharing behaviors. Other predictors included rurality, patient portal access, income, and having a chronic disease. Of note, we found that Asian American Pacific Islanders, compared with Whites, were less likely to share information with providers. Performance expectancy was a significant determinant of information sharing. Those diagnosed with diabetes were 4% less likely to share information with their providers. With the growing digital divide, there is a need to advocate for more usable and accessible digital health to assist with person-centered care.
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Affiliation(s)
| | | | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor
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19
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Lê AB, Huỳnh TB. The need for a multi-level approach to occupational safety and health among Asian and Asian American beauty service workers. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:495-505. [PMID: 37540163 DOI: 10.1080/15459624.2023.2245447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Asian and Asian Americans (A/AA) are a group overlooked in general health outcomes but especially occupational safety and health outcomes. In the United States, the beauty service microbusiness industry (e.g., nail salons) predominantly employs immigrant Asian women who regularly encounter a plethora of occupational hazards (e.g., harmful chemical exposures -toluene, formaldehyde, bloodborne pathogens, fungi. However, due to the precariousness of beauty service jobs, cultural and linguistic barriers, and social determinants of health, A/AA beauty service workers face complex occupational safety and health challenges that require interdisciplinary collaboration and cultural competency to address. This commentary will discuss a multi-level approach including specific outreach partners that will offer the required diverse skillsets necessary for improving the occupational safety and health for this worker population in this microbusiness industry. Implications and suggestions for interventions and policy changes are also recommended utilizing the National Institute on Minority Health and Health Disparities' Research Framework.
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Affiliation(s)
- Aurora B Lê
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Trân B Huỳnh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Davis J, Taira DA, Lim E, Chen J. Modeling Poverty and Health for Native Hawaiian and Pacific Islander and Asian Ethnic Populations. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:77-83. [PMID: 37901660 PMCID: PMC10612419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
This study examined differences in poverty and health among Native Hawaiians and Pacific Islanders (NHPI) and 6 disaggregated Asian ethnic subgroups and an aggregated Other Asian category. Participants were followed longitudinally for 2 years using data from 2009 to 2019 from the Current Population Survey, a monthly survey conducted by the Census Bureau. Having 2 years of data enabled the study to assess both prevalence of poverty and fair/poor health in only 1 of the 2 years and in both years. For NHPI, 13.5% were in poverty 1of the 2 years and 7.1% in both years. Asian ethnicities showed high variability ranging from a low of 6.4% for 1 year and 1.9% for 2 years among Asian Indians to 16.0% for 1 year and 6.3% for 2 years among Vietnamese. Fair/poor health also showed ethnic variability, made most apparent after age-sex adjustment in regression models. For poverty, after adjustment, Asian Indians, Filipinos and Japanese had significantly lower odds of being in poverty at least 1 year than NHPI. For having fair/poor health, Asian Indians and Japanese experienced lower odds than NHPI for both 1 and 2 years and Filipinos for 1 year, after age/sex adjustment. The results emphasize the diversity of Asian and Pacific Islander populations, the variability of poverty over time, and the importance of using disaggregated data to understand ethnic differences in poverty and health. These findings can be used to inform future modeling of social determinants on poverty and health among NHPI and Asian subgroups.
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Affiliation(s)
- James Davis
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (JD, EL, JC)
| | - Deborah A. Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, HI (DAT)
| | - Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (JD, EL, JC)
| | - John Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (JD, EL, JC)
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Zhang Y, Heelan-Fancher L, Leveille S, Shi L. Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6860. [PMID: 37835130 PMCID: PMC10572660 DOI: 10.3390/ijerph20196860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p < 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p < 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.
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Affiliation(s)
- Yuqing Zhang
- College of Nursing, University of Cincinnati, Cincinnati, OH 45040, USA
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Lisa Heelan-Fancher
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Suzanne Leveille
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Ling Shi
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
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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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Serafica R, Fudolig M, Kawi J, Thomas Reyes A, Leyva EWA, Sy FS, Evangelista LS. Correlates of Psychological Distress Among Filipino Americans and Filipinos Living in Urban Areas in the United States and the Philippines. J Transcult Nurs 2023; 34:256-262. [PMID: 36927196 PMCID: PMC10330160 DOI: 10.1177/10436596231159004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Many Asian immigrants, including Filipino Americans (FilAms), experience psychological distress (PD) due to the challenges in adjusting to their new country and culture. This descriptive comparative study aimed to compare FilAms and Filipinos concerning their levels of PD, sources of stress, and use of health-promotion strategies. METHODS Data from 89 FilAms and 95 Filipinos living in urban cities, obtained from the I-HELP-FILIPINOS database, measuring cardiometabolic risks, mental health, and environmental stressors in 2017, including PD, were examined. RESULTS The mean age of all participants (N = 184) was 44.2 ± 22.8 years old. Both groups rated their health as good to excellent, although Filipinos were significantly more likely to be distressed (p < .001). Filipinos were also more likely to ascribe stress to employment (48.3% vs. 68.2%, p =.006) and finances (28.1% vs. 52.6%, p <.001) than FilAms. DISCUSSION While both groups shared comparative perspectives on health, FilAms reported lower PD than Filipinos. The most significant source of stress was the country of residence. We recommend tailoring interventions to each local context's unique social and environmental circumstances.
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Wang RZ, Jamal A, Wang Z, Dan S, Srinivasan M, Kim G, Long J, Palaniappan L, Singh J, Eggert LE. Toward precision sleep medicine: variations in sleep outcomes among disaggregated Asian Americans in the National Health Interview Survey (2006-2018). J Clin Sleep Med 2023; 19:1259-1270. [PMID: 36883375 PMCID: PMC10315592 DOI: 10.5664/jcsm.10558] [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: 09/14/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
STUDY OBJECTIVES Asian Americans report higher rates of insufficient sleep than non-Hispanic Whites (NHWs). It is unclear how sleep outcomes differ among disaggregated Asian subgroups. METHODS The National Health Interview Survey (2006-2018) was used to analyze self-reported sleep duration and quality measures for Asian American subgroups (Chinese [n = 11,056], Asian Indian [n = 11,249], Filipino [n = 13,211], and other Asians [n = 21,767]). Outcomes included hours of sleep per day, the number of days reporting trouble falling asleep, staying asleep, waking up rested, and taking sleep medication in the past week. Subsetted multivariate logistic regression was used to assess factors impacting sleep outcomes by ethnicity. RESULTS 29.2% of NHWs, 26.4% of Chinese, 24.5% of Asian Indians, and 38.4% of Filipinos reported insufficient sleep duration. Filipinos were less likely to report sufficient sleep duration (odds ratio 0.55, [confidence interval 95% 0.50-0.59]) and more likely to report trouble falling asleep (1.16 [1.01-1.33]) than NHWs. Chinese and Asian Indians had less trouble staying asleep (0.67 [0.58-0.77], 0.51 [0.44-0.59]) and falling asleep (0.77 [0.66-0.89], 0.72, [0.62-0.82]) than NHWs, and Asian Indians were more likely to wake feeling well rested (1.66 [1.48-1.87]). All Asian subgroups were less likely to report using sleep medications than NHWs. Foreign-born status had a negative association with sufficient sleep duration in Filipinos but a positive association in Asian Indians and Chinese. CONCLUSIONS Filipinos report the highest burden of poor sleep outcomes, and Asian Indians report significantly better sleep outcomes. These findings highlight the importance of disaggregating Asian ethnic subgroups to address their health needs. CITATION Wang RZ, Jamal A, Wang Z, et al. Toward precision sleep medicine: variations in sleep outcomes among disaggregated Asian Americans in the National Health Interview Survey (2006-2018). J Clin Sleep Med. 2023;19(7):1259-1270.
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Affiliation(s)
- Ryan Z. Wang
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of BioSciences, Department of Computer Science, Rice University, Houston, Texas
| | - Armaan Jamal
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziqing Wang
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Statistics and Data Science, Cornell University, Ithaca, New York
| | - Shozen Dan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Mathematics, Statistics, Imperial College London, London, United Kingdom
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Gloria Kim
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Jaiveer Singh
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut
| | - Lauren E. Eggert
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
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Kannan A, Ishikawa K, Chen J, Krening E, Gao F, Ross GW, Bruno MK. Differences Among Native Hawaiian, Asian, and White Patients with Progressive Supranuclear Palsy. Mov Disord 2023; 38:1355-1361. [PMID: 37157060 DOI: 10.1002/mds.29431] [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: 02/05/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Most studies of progressive supranuclear palsy (PSP) have been conducted in White populations. OBJECTIVE The objective of this study was to identify whether differences exist for patients with PSP among Whites, East Asians (EAs), and Native Hawaiians/Pacific Islanders (NHPIs) in Hawaii. METHODS We conducted a single-center, retrospective study of patients meeting Movement Disorder Society probable PSP criteria (2006-2021). Data variables included age of onset and diagnosis, comorbidities, and survival rate. Variables were compared across groups using Fisher's exact test, Kruskal-Wallis rank sum test, and log-rank tests. RESULTS A total of 94 (59 EAs, 9 NHPIs, 16 Whites, and 10 Others) patients were identified. Mean age ± standard deviation (in years) of symptom onset/diagnosis were both youngest in NHPIs (64.0 ± 7.2/66.3 ± 8.0) followed by Whites (70.8 ± 7.6/73.9 ± 7.8), then EAs (75.9 ± 8.2/79.2 ± 8.3) (P < 0.001). Median survival from diagnosis was significantly lower (P < 0.05) in NHPIs (2 years) compared with EAs (4 years) and Whites (6 years). CONCLUSIONS There may be racial disparities for PSP, and studies are needed to identify genetic, environmental, and socioeconomic contributions. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ashok Kannan
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Kyle Ishikawa
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - John Chen
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Emma Krening
- The Queen's Medical Center, Honolulu, Hawaii, USA
| | - Fay Gao
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
- The Queen's Medical Center, Honolulu, Hawaii, USA
| | - G Webster Ross
- Pacific Health Research and Education Institute, Virginia Pacific Islands Health Care System, Honolulu, Hawaii, United States
| | - Michiko Kimura Bruno
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
- The Queen's Medical Center, Honolulu, Hawaii, USA
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Shah NS, Khan SS, Carnethon MR, Bacong AM, Palaniappan LP. Diabetes-Related Cardiovascular and All-Cause Mortality in Asian American Subgroups. JACC. ASIA 2023; 3:365-372. [PMID: 37323867 PMCID: PMC10261884 DOI: 10.1016/j.jacasi.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Background Asian Americans experience heterogeneity in cardiovascular risk factors and cardiovascular disease, with a particularly high burden of diabetes in several Asian subgroups. Objectives The objectives of this study were to quantify diabetes-related mortality in Asian American subgroups and compare this with Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Methods Using national-level vital statistics data and concurrent population estimates, age-standardized mortality rates and proportional mortality from diabetes-related mortality were calculated for non-Hispanic Asian (and subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Hispanic, non-Hispanic Black, and non-Hispanic White populations in the United States, 2018-2021. Results Diabetes-related deaths numbered 45,249 in non-Hispanic Asian, 159,279 in Hispanic, 209,281 in non-Hispanic Black, and 904,067 in non-Hispanic White individuals. Among Asian Americans, age-standardized mortality rates of diabetes-related mortality with cardiovascular disease as underlying cause ranged from 10.8 (95% CI: 9.9-11.6) per 100,000 in Japanese females to 19.9 (95% CI: 18.9-20.9) per 100,000 in Filipina females, and from 15.3 (95% CI: 13.9-16.8) per 100,000 in Korean males to 37.8 (95% CI: 36.1-39.5) per 100,000 in Filipino males. The proportion of all deaths related to diabetes was higher in all Asian subgroups (9.7%-16.4% for females; 11.8%-19.2% for males) compared with non-Hispanic Whites (8.5% for females; 10.7% for males). The highest proportion of diabetes-related deaths occurred in Filipino adults. Conclusions There was an approximately 2-fold variation in diabetes-related mortality among Asian American subgroups, with Filipino adults experiencing the greatest burden. All Asian subgroups experienced higher proportional mortality for diabetes-related mortality compared with non-Hispanic White individuals.
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Affiliation(s)
- Nilay S. Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA
| | - Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adrian M. Bacong
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Latha P. Palaniappan
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Hummer RA. Race and Ethnicity, Racism, and Population Health in the United States: The Straightforward, the Complex, Innovations, and the Future. Demography 2023; 60:633-657. [PMID: 37158783 PMCID: PMC10731781 DOI: 10.1215/00703370-10747542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
For far too long, U.S. racialized groups have experienced human suffering and loss of life far too often and early. Thus, it is critical that the population sciences community does its part to improve the science, education, and policy in this area of study and help to eliminate ethnoracial disparities in population health. My 2022 PAA Presidential Address focuses on race and ethnicity, racism, and U.S. population health in the United States and is organized into five sections. First, I provide a descriptive overview of ethnoracial disparities in U.S. population health. Second, I emphasize the often overlooked scientific value of such descriptive work and demonstrate how such seemingly straightforward description is complicated by issues of population heterogeneity, time and space, and the complexity of human health. Third, I make the case that the population sciences have generally been far too slow in incorporating the role of racism into explanations for ethnoracial health disparities and lay out a conceptual framework for doing so. Fourth, I discuss how my research team is designing, collecting, and disseminating data for the scientific community that will have potential to, among many other purposes, create a better understanding of ethnoracial health disparities and the role of racism in producing such disparities. Finally, I close by suggesting some policy- and education-related efforts that are needed to address racism and population health within U.S. institutions.
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Affiliation(s)
- Robert A Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Social Determinants of Health, Cardiovascular Risk Factors, and Atherosclerotic Cardiovascular Disease in Individuals of Vietnamese Origin. Am J Cardiol 2023; 189:11-21. [PMID: 36481374 DOI: 10.1016/j.amjcard.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
In 2022, the Vietnamese population in the United States (US) comprises 2.2 million individuals, and Vietnam ranks as the sixth most frequent country of origin among immigrants in the US. The American Heart Association and the National Institutes of Health have called for research to define the burden of cardiovascular risk factors, cardiovascular disease, and their determinants across Asian American subgroups, including Vietnamese Americans. Despite these calls, Vietnamese Americans remain remarkably overlooked in cardiovascular research in the US. Studies in Vietnam, small cross-sectional surveys in the US, and research using US mortality data point to a high prevalence of hypertension and tobacco use among men and a high incidence of gestational diabetes among women. Moreover, Vietnamese Americans have one of the highest rates of cerebrovascular mortality in the country. Adverse social determinants of health-including frequent language barriers, limited health literacy, and low average income-have been suggested as important factors that contribute to cardiovascular risk in this group. In this narrative review, we summarize the existing knowledge in this space, highlight the distinct characteristics of cardiac risk in both Vietnamese and Vietnamese American individuals, discuss upstream determinants, and identify key knowledge gaps. We then outline several proposed interventions and emphasize the need for further studies in this underrepresented population. Our aim is to increase awareness of the significant burden of risk factors and cardiovascular disease shouldered by this large-but thus far overlooked-population in the US, boost research in this space, and help inform tailored, effective preventive interventions.
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Hsueh L, Huang J, Millman AK, Gopalan A, Parikh RK, Teran S, Reed ME. Cross-Sectional Association of Patient Language and Patient-Provider Language Concordance with Video Telemedicine Use Among Patients with Limited English Proficiency. J Gen Intern Med 2023; 38:633-640. [PMID: 36357732 PMCID: PMC9649000 DOI: 10.1007/s11606-022-07887-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Telemedicine's dramatic increase during the COVID-19 pandemic elevates the importance of addressing patient-care gaps in telemedicine, especially for patients with limited English proficiency. OBJECTIVE To examine the associations of patient language and patient-provider language concordance with telemedicine visit type (video versus telephone visit). DESIGN Cross-sectional automated data study of patient-scheduled primary care telemedicine appointments from March 16, 2020, to October 31, 2020. SETTING Northern California integrated healthcare delivery system. PARTICIPANTS All 22,427 completed primary care telemedicine visits scheduled by 13,764 patients with limited English proficiency via the patient portal. MEASUREMENTS Cross-sectional association of electronic health record-documented patient language (Spanish as referent) and patient-provider language concordance with patients' choice of a video (versus telephone) visit, accounting for patient sociodemographics, technology access, and technology familiarity factors. RESULTS Of all patient-scheduled visits, 34.5% (n = 7747) were video visits. The top three patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). Adjusting for sociodemographic and technology access and familiarity factors and compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese (OR = 1.34, 95% CI: 1.18-1.52), Mandarin (OR = 1.33, 95% CI: 1.16-1.52), or Vietnamese (OR = 1.27, 95% CI: 1.09-1.47), but lower among patients speaking Punjabi (OR = 0.75, 95% CI: 0.75, 0.62-0.91). Language concordance was associated with lower video visit use (OR = 0.86, 95% CI: 0.80-0.93) and moderated associations of speaking Spanish, Cantonese, and Korean with video visit use. In addition, for all language groups, those with prior video visit use were more likely to re-use video visits compared to those with no prior use (p < .05 for all languages except Hindi with p = 0.06). CONCLUSIONS Among linguistically diverse patients with limited English proficiency, video telemedicine use differed by specific language. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.
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Affiliation(s)
- Loretta Hsueh
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
- University of Illinois at Chicago Department of Psychology, Chicago, USA.
| | - Jie Huang
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Andrea K Millman
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Anjali Gopalan
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | | | | | - Mary E Reed
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
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Li Q, Douglas JA, Subica AM. Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California. Glob Public Health 2023; 18:2273425. [PMID: 37902041 DOI: 10.1080/17441692.2023.2273425] [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: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.
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Affiliation(s)
- Qiuxi Li
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| | - Jason A Douglas
- Department of Health, Society, and Behavior, Program in Public Health, Center for Environmental Health Disparities Research, University of California, Irvine, CA, USA
| | - Andrew M Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
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Sijangga MO, Pack DV, Yokota NO, Vien MH, Dryland ADG, Ivey SL. Culturally-tailored cookbook for promoting positive dietary change among hypertensive Filipino Americans: a pilot study. Front Nutr 2023; 10:1114919. [PMID: 37153920 PMCID: PMC10157645 DOI: 10.3389/fnut.2023.1114919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/31/2023] [Indexed: 05/10/2023] Open
Abstract
Introduction Among all Asian American subgroups, Filipino-Americans have consistently been shown to have the highest rates of hypertension, raising risks of heart attack and stroke. Despite this alarming fact, little has been done to investigate culturally-sensitive interventions to control hypertension rates in this vulnerable population. To address the lack of culturally-relevant lifestyle options for blood pressure management currently available to the Filipino community, this exploratory pilot study used a design thinking approach informed by culinary medicine to develop a culturally-tailored, heart-healthy, and low sodium recipe cookbook for Filipino Americans with hypertension and evaluate its feasibility as a hypertension intervention. Methods Our team developed a cookbook using participatory methods and design thinking, utilizing input from five Filipino culinary experts and a Registered Dietitian. The cookbook incorporates traditional Filipino recipes, excerpts from community members' interviews, and nutrient analyses. Twenty Filipinx-identifying individuals* who self-reported physician-diagnosed hypertension were recruited from Filipino community-based organizations, enrolled into this study, provided with the cookbook, and asked to cook at least one recipe. Pre- and post-intervention surveys were conducted and centered around behavior change and features of the cookbook. Results This study provided evidence for the cookbook's acceptability and feasibility, with participants' open-ended responses revealing that the recipes, nutrition labels, illustrations, and cultural aspects of the cookbook increased motivation to achieve dietary change, including reducing sodium in their diet to improve their blood pressure. Participant responses also indicated positive behavior change as a result of using the cookbook, with participants reporting increased likelihood of adopting recommended actions to lower their BP after utilizing the cookbook ( x ¯ = 80.83%), compared to before ( x ¯ = 63.75%, p < 0.008), according to Hypertension Self-Care Management scaled scores. Discussion In conclusion, the results of this pilot study demonstrated acceptability of this unique cookbook and provide preliminary findings consistent with increased motivation in participants to make dietary changes and improve personal health, drawing attention to the importance of considering future culturally-tailored health interventions. Next steps should include a robust, randomized controlled trial design comparing measured blood pressure outcomes of an intervention vs. control group. *Filipinx is an inclusive term representing the gender identities of all participants in our study.
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Baluran DA. Life expectancy, life disparity, and differential racialization among Chinese, Asian Indians, and Filipinos in the United States. SSM Popul Health 2022; 21:101306. [PMID: 36567799 PMCID: PMC9772563 DOI: 10.1016/j.ssmph.2022.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
This article advances differential racialization as a lens to frame health disparity trends within the Asian racial category. Using formal demographic methods, I analyzed data from the Multiple Cause of Death File and the American Community Survey to examine the trends in life expectancy and life disparity among Chinese, Asian Indians, and Filipinos in the United States between 2005 and 2019. While Chinese, Asian Indian, and Filipino life expectancy oscillated between each period under study, those oscillations contributed to an overall widening advantage for Chinese over their Asian Indian and Filipino counterparts. I posit that widening inequalities between the three groups are suggestive of their increasingly disparate racial statuses. These findings underscore the importance of contextualizing disaggregated health data within the social conditions that produce inequalities, namely race/racialization/racism.
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Bane S, Abrams B, Mujahid M, Ma C, Shariff-Marco S, Main E, Profit J, Xue A, Palaniappan L, Carmichael SL. Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California. Ann Epidemiol 2022; 76:128-135.e9. [PMID: 36115627 PMCID: PMC10144523 DOI: 10.1016/j.annepidem.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. METHODS Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n = 904,232). RESULTS AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age <20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors. CONCLUSIONS Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into "AANHPI" is not appropriate for outcome reporting.
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Affiliation(s)
- Shalmali Bane
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA.
| | - Barbara Abrams
- School of Public Health, University of California, Berkeley, CA
| | - Mahasin Mujahid
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA
| | - Chen Ma
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford University, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Aileen Xue
- Department of Nutrition, Case Western Reserve University, Cleveland, OH
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford CA
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Watanabe G, Morden FTC, Gao F, Morita M, Bruno MK. Utilization and gender disparities of Deep Brain Stimulation surgery amongst Asian Americans, Native Hawaiians, and Other Pacific Islanders with Parkinson's disease in Hawai`i. Clin Neurol Neurosurg 2022; 222:107466. [PMID: 36209519 DOI: 10.1016/j.clineuro.2022.107466] [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: 06/19/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite its efficacy in Parkinson's disease (PD) management, Deep Brain Stimulation (DBS) is underutilized in sociodemographic minorities. Previous investigations of racial disparities in PD aggregated Asian American (AA) and Native Hawaiian or other Pacific Islander (NHPI) populations into a single category; however, these groups have significant health differences. We sought to characterize the PD population in Hawai`i and the use of DBS among AA subgroups and NHPI patients to elucidate potential sociodemographic and clinical disparities. METHODS Retrospective chart review of PD patients who received DBS from 2002 to 2021 was conducted at The Queen's Medical Center on Oahu, Hawai`i. Hawai`i PD admissions from 2016 to 2020 were collected from Laulima Data Alliance database. We compared the characteristics of DBS patients, total PD admissions, and Hawai`i census data. Alpha level of < 0.05 determined statistical significance. We did a subgroup analysis of white, AA and NHPI subgroups within the patients who underwent DBS. RESULTS Analysis included 4215 PD admissions and 74 DBS surgeries. Compared to census data, Whites (OR: 1.67; p < 0.0001) and AA (OR: 1.18; p < 0.0001) were overrepresented in total PD admissions; whereas NHPI (OR: 0.64; p < 0.0001) and Blacks (OR: 0.17; p < 0.0001) were underrepresented. Overall, males received DBS more than females. All NHPI patients who received DBS were male, despite 37.65 % of total NHPI PD admissions being female (p = 0.0049). Most DBS patients were AA (45.95 %), followed by Whites (43.24 %), and NHPI (10.81 %). CONCLUSIONS NHPI and Black PD patients were disproportionately underrepresented in the Hawai`i PD population. All NHPI receiving DBS were male. These racial and gender disparities must be explored in future studies to achieve health equity and improved quality of care in a culturally sensitive manner.
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Affiliation(s)
- Gina Watanabe
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Fay Gao
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA
| | - Michon Morita
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA
| | - Michiko Kimura Bruno
- University of Hawai`i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; The Queen's Medical Center, Honolulu, HI, USA.
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Ponce NA, Adia AC, Banawa RA, Tan S, Sabado-Liwag MD. Measuring Asian hate: Discordant reporting of race-based hate incidents and unfair treatment and association with measures of wellbeing. Front Public Health 2022; 10:958857. [PMID: 36299752 PMCID: PMC9589279 DOI: 10.3389/fpubh.2022.958857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/31/2022] [Indexed: 01/24/2023] Open
Abstract
Background During COVID-19, anti-Asian discrimination increased in attention. Hate and unfair treatment are related but do not completely overlap. We expect those who report a hate incident would also report race-based unfair treatment, yet feelings of social desirability or self-blame may lead to under-reporting of unfair treatment. Objectives To describe reporting of an experience of race-based hate but not an experience of race-based unfair treatment among Asians in California and explore the association between this reporting discordance with (1) serious psychological distress, (2) forgoing needed medical care, (3) increased household interpersonal conflict, and (4) feeling unsafe in their neighborhood. Methods We used the 2020 California Health Interview Survey's AANHPI COVID Module, conducted weighted descriptive and multivariate analyses, and computed adjusted relative risks (RR). The multivariate models controlled for Asian subgroup, age, gender, immigrant status, education level, poverty, and English proficiency. Results Among Asians who reported race-based hate (6.9% overall), 62.4% reported not experiencing race-based unfair treatment. Compared to Asians not reporting a hate incident, this "discordant" group was more likely to experience serious psychological distress (RR = 6.9), forgo necessary medical care (RR = 2.4), increased household interpersonal conflicts (RR = 2.7), and feel unsafe in their neighborhoods (RR = 3.0). The "concordant" group did not post significant effects for severe psychological distress nor forgoing necessary medical care. Discussion Most Asians reporting hate did not report race-based unfair treatment, and this group is most affected by the consequences of a hate incident. We indicate future directions for research and policy.
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Affiliation(s)
- Ninez A. Ponce
- UCLA Center for Health Policy Research, Los Angeles, CA, United States,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States,Filipinx/a/o Community Health Association, Los Angeles, CA, United States,*Correspondence: Ninez A. Ponce
| | - Alexander C. Adia
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States
| | - Rachel A. Banawa
- UCLA Center for Health Policy Research, Los Angeles, CA, United States,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States,Filipinx/a/o Community Health Association, Los Angeles, CA, United States
| | - Sean Tan
- UCLA Center for Health Policy Research, Los Angeles, CA, United States
| | - Melanie D. Sabado-Liwag
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,Department of Public Health, California State University, Los Angeles, CA, United States
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Al Rifai M, Kianoush S, Jain V, Joshi PH, Cainzos-Achirica M, Nasir K, Merchant AT, Dodani S, Wong SS, Samad Z, Mehta A, Chunara R, Kalra A, Virani SS. Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adults. Prev Med Rep 2022; 29:101916. [PMID: 35898194 PMCID: PMC9309422 DOI: 10.1016/j.pmedr.2022.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans. Methods We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S. Results The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean (standard error) age was 43.8 (0.21) years and 53 % were women. In multivariable-adjusted logistic regression models, U.S. birth was associated with a higher prevalence odds ratio (95 % confidence interval) of current smoking 1.31 (1.07,1.60), physical inactivity 0.62 (0.54,0.72), obesity 2.26 (1.91,2.69), hypertension 1.33 (1.12,1.58), and CAD 1.96 (1.24,3.11), but lower prevalence of stroke 0.28 (0.11,0.71). Spending greater than 15 years in the U.S. was associated with a higher prevalence of current smoking 1.65 (1.24,2.21), obesity 2.33 (1.57,3.47), diabetes 2.68 (1.17,6.15), and hyperlipidemia 1.72 (1.09,2.71). Conclusion Heterogeneity exists in cardiovascular risk factor burden among Asian Americans according to Asian ethnicity, U.S. birth, and duration of time living in the U.S.
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Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Parag H Joshi
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sunita Dodani
- Section of Cardiology, Department of Internal Medicine, Eastern Virginia Medical School (EVMS), Norfolk, VA, United States.,EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Norfolk, VA, United States
| | - Sally S Wong
- Office of Science, Medicine and Health, The American Heart Association, Dallas, TX, United States
| | | | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University & Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, NY, United States
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, & Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Luck J, Govier D, Ðoàn LN, Mahakalanda S, Zhang W, Mendez-Luck C. Functional Limitations and Physical Health in Community-Dwelling Medicare Advantage Beneficiaries: Variation by Race and Hispanic Subgroup. J Aging Health 2022; 34:1269-1280. [PMID: 36175065 DOI: 10.1177/08982643221113133] [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: 11/16/2022]
Abstract
Objectives: The objective is to examine racial and ethnic heterogeneity in older adults' functional limitations and physical health. Methods: Data were from 2011 to 2015 Health Outcomes Survey of Medicare Advantage beneficiaries 65 and older (N = 828,946). Outcomes were Physical Component Summary (PCS) scores and need for assistance with activities of daily living (ADLs). Six non-Hispanic racial groups and five Hispanic subgroups were analyzed. Regression models adjusted for sociodemographic and health characteristics. Results: White and Asian respondents had the lowest unadjusted ADL difficulty rates and highest PCS scores. In adjusted analyses, Cuban respondents had the highest PCS scores and lowest rates of any ADL difficulty; White respondents had the lowest rates of specific ADL difficulties. Native Hawaiian or other Pacific Islander and multiple Hispanic respondents had the highest ADL difficulty rates. Discussion: Both the healthiest and highest need subgroups of Medicare Advantage beneficiaries were Hispanic. Understanding racial and ethnic subgroup differences may help target interventions to prevent or aid with functional limitations.
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Affiliation(s)
- Jeff Luck
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Diana Govier
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Lan N Ðoàn
- Department of Population Health, Section for Health Equity, 2694NYU Grossman School of Medicine, New York, NY, USA
| | - Shyama Mahakalanda
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Wei Zhang
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Carolyn Mendez-Luck
- College of Public Health and Human Sciences, 51174Oregon State University, Corvallis, OR, USA
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Sabado-Liwag MD, Zamora M, Esmundo S, Sumibcay JR, Kwan PP. Preliminary Observations from The FILLED Project (FILipino Lived Experiences during COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12303. [PMID: 36231606 PMCID: PMC9566375 DOI: 10.3390/ijerph191912303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Health outcomes for Asian American subgroups are often aggregated, masking unique experiences and disparities exacerbated by the COVID-19 pandemic, specifically among Filipino Americans (FilAms). The FILLED (Filipino Lived Experiences during COVID-19) Project launched a cross-sectional online survey between April-August 2021 among FilAm adults in Southern California to document community issues and outcomes during the pandemic. Among 223 participants, 47.5% were immigrants, 50.9% identified as essential workers, and 40.6% had a pre-existing health condition before the pandemic. Despite high rates of health insurance (93.3%), 24.4% of the sample did not have a regular health care provider. During the pandemic, 32.7% needed mental health help but did not get it and 44.2% did not know where to get such services. Most respondents felt that the COVID-19 vaccination was a personal responsibility to others (76.9%) and the majority had received at least one dose of a COVID-19 vaccine (82.4%). Regarding COVID-19 impact, participants reported moderate-severe changes in their daily routines (73.5%), access to extended social support (38.9%), housing issues (15.4%), and access to medical care (11.6%). To our knowledge, this study is the first community-driven effort highlighting FilAm community experiences in Southern California, where the highest proportion of FilAms in the United States reside, specifically after the COVID-19 vaccine was made widely available. The observational findings may help community leaders, policy makers, and public health researchers in the design, development, and implementation of post-pandemic intervention strategies used by community-partnered projects that address FilAm and sub-Asian group health disparities at grassroots to societal levels.
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Affiliation(s)
| | - Mayra Zamora
- Department of Public Health, California State University, Los Angeles, CA 90032, USA
| | - Shenazar Esmundo
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
| | - Jake Ryann Sumibcay
- Department of Public Health, California State University, Los Angeles, CA 90032, USA
| | - Patchareeya P. Kwan
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
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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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Escobedo LA, Morey BN, Sabado-Liwag MD, Ponce NA. Lost on the frontline, and lost in the data: COVID-19 deaths among Filipinx healthcare workers in the United States. Front Public Health 2022; 10:958530. [PMID: 36091528 PMCID: PMC9452815 DOI: 10.3389/fpubh.2022.958530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Background Filipinx Americans working in healthcare are at risk for COVID-19 death but lack consistent mortality data on healthcare worker deaths. The lack of disaggregated data for Asian subgroups proliferates anti-Asian structural racism as the needs of high-risk groups are systematically undetected to merit a proper public health response. We work around this aggregated data problem by examining how the overrepresentation of Filipinxs in healthcare contributes to COVID-19 mortality among Asian American populations. Methods To overcome the lack of COVID-19 mortality data among Filipinx American healthcare workers, we merged data from several sources: Kanlungan website (the only known public-facing source of systematically reported mortality data on Filipinx healthcare workers nationally and globally), National Center for Health Statistics, and 2014-2018 American Community Survey. We examined county-level associations using t-tests, scatterplots, and linear regression. Findings A higher percentage of Filipinxs among Asian Americans was correlated with a higher percentage of COVID-19 decedents who are Asian Americans (r = 0.24, p = 0.01). The percentage of Filipinx in healthcare remained a strong predictor of COVID-19 deaths among Asian Americans even after adjusting for age, poverty, and population density (coef = 1.0, p < 0.001). For every 1% increase in Filipinx among the healthcare workforce, the percentage of Asian American COVID-19 decedents increased by 1%. Interpretation Our study shows that the overrepresentation of Filipinxs in healthcare contributes to COVID-19 mortality disparities among Asian Americans. Our findings advocate for systems change by practicing anti-racist data agendas that collect and report on Asian subgroups for effective real-time targeted approaches against health inequities.
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Affiliation(s)
- Loraine A. Escobedo
- Cancer Research Center for Health Equity, Cedars-Sinai Cancer, West Hollywood, CA, United States,*Correspondence: Loraine A. Escobedo
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Melanie D. Sabado-Liwag
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,Department of Public Health, California State University, Los Angeles, CA, United States
| | - Ninez A. Ponce
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,UCLA Center for Health Policy Research, Los Angeles, CA, United States,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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Đoàn LN, Takata Y, Mendez-Luck CA, Hooker K, Irvin VL. Cardiovascular Disease and Health-Related Quality of Life Among Asian American, Native Hawaiian and Pacific Islander Older Adults. J Aging Health 2022; 34:1254-1268. [PMID: 35981219 DOI: 10.1177/08982643221118440] [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: 11/17/2022]
Abstract
Objectives: Assess the relationship between cardiovascular disease (CVD) and health-related quality of life (HRQOL) among Asian American, Native Hawaiian, and Pacific Islander (NH/PI) compared to white older adults. Methods: Data were from the 2011-2015 Health Outcomes Survey. HRQOL was assessed using the Veterans RAND 12-Item Survey, composed of physical (PCS) and mental component scores (MCS). Lower scores represent worse health. Multivariate regression was conducted to estimate PCS and MCS mean score differences related to self-reported CVD (coronary artery disease, congestive heart failure, myocardial infarction, other heart conditions, stroke) and race/ethnicity. Results: There were marked differences in PCS and MCS scores by disaggregated Asian American and NH/PI subgroups. After adjustment, Asian American and NH/PI older adults had better PCS but worse MCS than white older adults. Race/ethnicity moderated the relationship between CVD and HRQOL. Discussion: Asian American and NH/PI older adults with CVD had poorer mental health compared to their white counterparts.
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Affiliation(s)
- Lan N Đoàn
- Department of Population Health, Section for Health Equity, 12296NYU Grossman School of Medicine, New York, NY, USA.,School of Social and Behavioral Health Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Yumie Takata
- School of Biological and Population Health Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Carolyn A Mendez-Luck
- School of Social and Behavioral Health Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Karen Hooker
- School of Social and Behavioral Health Sciences, 51174Oregon State University, Corvallis, OR, USA
| | - Veronica L Irvin
- School of Social and Behavioral Health Sciences, 51174Oregon State University, Corvallis, OR, USA
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Martin R, Rajan S, Shareef F, Xie KC, Allen KA, Zimmerman M, Jay J. Racial Disparities in Child Exposure to Firearm Violence Before and During COVID-19. Am J Prev Med 2022; 63:204-212. [PMID: 35418336 PMCID: PMC8921002 DOI: 10.1016/j.amepre.2022.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Childhood exposure to neighborhood firearm violence adversely affects mental and physical health across the life course. Study objectives were to (1) quantify racial disparities in these exposures across the U.S. and (2) assess changes during the COVID-19 pandemic, when firearm violence increased. METHODS The study used counts of children aged 5-17 years, disaggregated by U.S. Census racial category, for every census tract (N=73,056). Neighborhood firearm violence was the number of fatal shootings per census tract, based on 2015-2021 Gun Violence Archive data. Quasi-Poisson regressions were used to estimate baseline disparities and COVID-19‒related changes and examined differences across geographic regions. RESULTS Prepandemic exposure was lowest among White children and highest among Black children, who experienced 4.44 times more neighborhood firearm violence exposure (95% CI=4.33, 4.56, p<0.001) than White children. The pandemic increased exposure by 27% in the lowest risk group (i.e., White children; 95% CI=20%, 34%, p<0.001), but pandemic effects were even greater for children in nearly all non-White categories. Baseline violence levels and racial disparities varied considerably by region, with the highest levels in the South and the largest magnitude disparities observed in the Northeast and Midwest. CONCLUSIONS Large-scale racial disparities exist in child exposure to neighborhood firearm violence, and these disparities grew during the pandemic. Equitable access to trauma-informed programs, community-based prevention, and structural reforms are urgently needed.
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Affiliation(s)
- Rachel Martin
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Faizah Shareef
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Kristal C Xie
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Kalice A Allen
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Marc Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
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Bacong AM, Hing AK, Morey B, Crespi CM, Kabamalan MM, Lee NR, Wang MC, de Castro AB, Gee GC. Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000324. [PMID: 36082314 PMCID: PMC9450558 DOI: 10.1371/journal.pgph.0000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 06/04/2022] [Indexed: 02/03/2023]
Abstract
Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.
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Affiliation(s)
- Adrian Matias Bacong
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | - Anna K. Hing
- University of Minnesota – Twin Cities, Minneapolis, Minnesota, United States of America
| | - Brittany Morey
- University of California-Irvine, Irvine, California, United States of America
| | - Catherine M. Crespi
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | | | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
| | - May C. Wang
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | - A. B. de Castro
- University of Washington, Seattle, Washington, United States of America
| | - Gilbert C. Gee
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
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Wang Kong C, Green J, Hamity C, Jackson A. Health Disparity Measurement Among Asian American, Native Hawaiian, and Pacific Islander Populations Across the United States. Health Equity 2022; 6:533-539. [PMID: 36186616 PMCID: PMC9518797 DOI: 10.1089/heq.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/12/2022] Open
Abstract
Objective: The aim of this study was to describe current measurement of health disparities for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations and subgroups across U.S. states. Methods: State department of health websites were searched for publicly available online reports and interactive databases denoted as state health or minority health assessments. Sources were examined to determine whether health metrics stratified by any racial/ethnic groups included the AANHPI aggregate population or subgroups. The number and frequency of AANHPI population designations were tabulated, as were the proportion of states that included AANHPIs in stratified metrics in four domains across the life span and the median number of metrics (1) stratified by any racial/ethnic group and (2) including AANHPI populations. A Pearson correlation coefficient assessed the association between the proportion of AANHPIs in state populations and the proportion of state metrics that included AANHPIs in the stratification. Results: States used 17 AANHPI population descriptors. Of 49 states stratifying health metrics by race/ethnicity, 34 included AANHPI populations and 2 included disaggregated AANHPI subgroups in ≥1 metric. The proportion of states that included AANHPI populations in stratification ranged from 57% for maternal–infant health to 69% for adult health, and by metric groups within domains, the proportion ranged from 14% for maternal mortality to 100% for marital or head of household status. The median number of metrics reported for AANHPI populations was lower than the median number reported for other racial/ethnic groups in adult, maternal–infant, and child and adolescent health domains. The proportion of state metrics that included AANHPIs in racial/ethnic stratification was not correlated with the proportion of AANHPIs in state populations (r=0.30). Conclusions and Implications for Health Equity: AANHPIs were substantially underrepresented in state health equity data, with rare subgroup disaggregation. Reducing disparities and inequities affecting AANHPI health in the United States requires improved and equitable data.
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Affiliation(s)
- Carolyn Wang Kong
- Blue Shield Foundation of California, San Francisco, California, USA
| | | | - Courtnee Hamity
- Blue Shield Foundation of California, San Francisco, California, USA
| | - Ana Jackson
- Blue Shield Foundation of California, San Francisco, California, USA
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Le TK, Vongsachang H, Pang S, Zhang GQ, Li T, Lee JTC, Lawson SM. US medical student perspectives on asian american patient inclusion in medical education: a qualitative Study. BMC MEDICAL EDUCATION 2022; 22:482. [PMID: 35729562 PMCID: PMC9213094 DOI: 10.1186/s12909-022-03550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Asian American (AsAm) representation is lacking in conversations surrounding cultural humility in healthcare. We aimed to investigate US medical student perspectives on AsAm patient inclusion in cultural humility training in medical education. METHODS This qualitative study analyzed free-text responses to an optional, open-ended question presented at the conclusion of an online survey assessing medical student experiences with and perceptions regarding AsAm patients in their medical education. This survey was distributed to a convenience sample of nine US medical schools. Medical students who completed at least one clinical rotation were eligible to participate in the survey. Qualitative analysis of free-text responses was conducted in an iterative process to generate emergent themes. RESULTS There was a total of 195 optional free-text responses from 688 participants (28%). Motivation to learn about AsAm population included shared identity and desire to better serve the AsAm population in their local community and future careers. Topics of interest included healthcare-related cultural preferences, healthcare delivery strategies, and health disparities for the AsAm population and other minority patients. Students reported that they drew on personal experiences and some pre-clinical or clinical exposures to learn about AsAm patients. Respondents cited the lack of exposure in the medical school curriculum and clinical experiences as the main challenge to learning about AsAm health and provided suggestions for the delivery of this education in their pre-clinical and clinical education. Respondents emphasized that AsAms are treated as a monolith in medical education and healthcare, despite their heterogeneity. CONCLUSIONS Medical students identified a need and interest for greater inclusion of AsAm topics in medical education on cultural humility and minority health.
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Affiliation(s)
- Thomas K Le
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US
| | - Hursuong Vongsachang
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US
| | - Sharon Pang
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US
| | - George Q Zhang
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US
| | - Taibo Li
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US
| | - Jason T C Lee
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US
| | - Shari M Lawson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Miller Research Building Suite 137, MD, 21205, Baltimore, US.
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Kim KE, Humphrey HJ, Koh HK. Prioritizing Asian Americans, Native Hawaiians, and Pacific Islanders in the U.S. Health Equity Agenda. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:786-789. [PMID: 35320122 DOI: 10.1097/acm.0000000000004673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations are growing rapidly in the United States, yet AANHPIs remain understudied, overlooked, and misunderstood. During the COVID-19 pandemic, themes from the tragic history of anti-Asian bias and marginalization have resurfaced in a surge of renewed bigotry and xenophobic violence against AANHPIs. In this commentary, the authors discuss the role of medical schools in combating anti-Asian sentiment as an important step toward achieving health equity. Based on their collective expertise in health disparities research, medical education, and policy, they offer suggestions about how to disrupt the pattern of invisibility and exclusion faced by AANHPI populations. They consider ways that representative data, leadership in medical education, research funding, national policies, and broad partnerships can help address AANHPI health disparities.
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Affiliation(s)
- Karen E Kim
- K.E. Kim is vice provost for research, professor of medicine, and director, Center for Asian Health Equity, University of Chicago, Chicago, Illinois
| | - Holly J Humphrey
- H.J. Humphrey is president, Josiah Macy Jr. Foundation, New York, New York
| | - Howard K Koh
- H.K. Koh is Harvey V. Fineberg Professor of the Practice of Public Health Leadership, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Readhead A, Flood J, Barry P. Health insurance, healthcare utilization and language use among populations who experience risk for tuberculosis, California 2014–2017. PLoS One 2022; 17:e0268739. [PMID: 35609051 PMCID: PMC9129044 DOI: 10.1371/journal.pone.0268739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background California tuberculosis (TB) prevention goals include testing more than ten million at-risk Californians and treating two million infected with tuberculosis. Adequate health insurance and robust healthcare utilization are crucial to meeting these goals, but information on these factors for populations that experience risk for TB is limited. Methods We used data from the 2014–2017 California Health Interview Survey (n = 82,758), a population-based dual-frame telephone survey to calculate survey proportions and 95% confidence intervals (CI) stratified by country of birth, focusing on persons from countries of birth with the highest number of TB cases in California. Survey proportions for recent doctor’s visit, overall health, smoking, and diabetes were age-adjusted. Results Among 18–64 year-olds, 27% (CI: 25–30) of persons born in Mexico reported being uninsured in contrast with 3% (CI: 1–5) of persons born in India. Report of recent doctor’s visit was highest among persons born in the Philippines, 84% (CI: 80–89) and lowest among Chinese-born persons, 70% (CI: 63–76). Persons born in Mexico were more likely to report community clinics as their usual source of care than persons born in China, Vietnam, or the Philippines. Poverty was highest among Mexican-born persons, 56% (CI: 54–58) and lowest among Indian-born persons, 9% (CI: 5–13). Of adults with a medical visit in a non-English language, 96% (CI: 96–97) were non-U.S.-born, but only 42% (CI: 40–44) of non-U.S.-born persons had a visit in a non-English language. Discussion Many, though not all, of the populations that experience risk for TB had health insurance and used healthcare. We found key differences in usual source of care and language use by country of birth which should be considered when planning outreach to specific providers, clinic systems, insurers and communities for TB prevention and case-finding.
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Affiliation(s)
- Adam Readhead
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Jennifer Flood
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
| | - Pennan Barry
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America
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Data Disaggregation Reveals Disproportionate Levels of COVID-19 Risk Among Filipinxs in the USA. J Racial Ethn Health Disparities 2022; 10:1398-1402. [PMID: 35587861 PMCID: PMC9118811 DOI: 10.1007/s40615-022-01325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Background Recognizing the disproportionate rates of COVID-19 infection and death experienced by Filipinxs in the USA, this study examines whether data disaggregation reveals meaningful differences between Filipinxs, non-Asians, and other groups often aggregated into the problematic “Asian and Pacific Islander” category across a series of social and health variables associated with COVID-19 risk. Methods Using data from the California Health Interview Survey (CHIS, 2017–18; N = 42,330) and the National Survey on Drug Use and Health (NSDUH, 2018–19; N = 135,516), we ran chi-squared tests yielding Wald F-values to compare Filipinxs with other “Asians and Pacific islanders” and non-Asians across 10 social and 4 health-related variables. Health conditions included asthma, diabetes, heart conditions, and high blood pressure. Results Filipinxs were much more likely to report diabetes (CHIS: 12.6%; NSDUH: 14.4%) than other Asian/PI respondents (8.4%; 8.0%) or non-Asians (10.8%; 10.1%), as well as asthma and high blood pressure. Filipinxs were also disproportionately employed in the healthcare and service occupations (CHIS: 36.7%) in comparison to other Asian/PI respondents (19.0%) and non-Asians (22.4%). Discussion Across several variables, Filipinxs have less in common with other Asians and Pacific Islanders than with non-Asians. Combining these groups can obscure patterns that affect health and the risks of contracting or dying from COVID-19.
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Kianoush S, Al-Rifai M, Kalra A, Bk A, Mehta A, Sadaf MI, Misra A, Khalid U, Lavie CJ, Kayani WT, Virani SS. Use of preventive cardiovascular health care among Asian American individuals: A National Health Interview Survey Study. Curr Probl Cardiol 2022:101241. [PMID: 35513186 DOI: 10.1016/j.cpcardiol.2022.101241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006-2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2 ± 0.1 y; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3 ± 0.9 y; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogenous across the Asian American populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahmoud Al-Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Anupama Bk
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Murrium I Sadaf
- Division of Cardiology, University of Arkansas Medical Center, Little Rock, AR
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Umair Khalid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Waleed T Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX.
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Yang HH, Dhanjani SA, Chwa WJ, Cowgill B, Gee G. Disparity in Obesity and Hypertension Risks Observed Between Pacific Islander and Asian American Health Fair Attendees in Los Angeles, 2011-2019. J Racial Ethn Health Disparities 2022; 10:1127-1137. [PMID: 35426057 PMCID: PMC9009494 DOI: 10.1007/s40615-022-01300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Pacific Islander American population is understudied due to being aggregated with Asian Americans. In this study, we conduct a comparative analysis of directly measured body mass index (BMI), body fat percentage (%BF), and blood pressure (BP) between Pacific Islander Americans and Asian Americans from health screenings in Los Angeles, California. We hope to reveal intra-APIA health disparities masked by this data aggregation. METHODS We analyzed BMI, %BF, and BP that were objectively measured by trained personnel at health screenings in Los Angeles between January 2011 and December 2019. We performed multivariable multinomial logistic regression models with obesity and hypertensive categories as outcome variables and ethnicity as the primary independent variable of interest. Models controlled for year of visit, participant age, sex, income, education level, years living in the USA, employment status, English proficiency, regular doctor access, and health insurance status. RESULTS A total of 4,832 individuals were included in the analysis. Multivariable analyses revealed that Pacific Islander participants were at significantly higher risks for being classified as obese compared with all Asian American subgroups studied, including Chinese, Korean, Thai, Vietnamese, Filipino, and Japanese. Pacific Islanders also exhibited significantly lower predicted probability of having a normal blood pressure compared with Chinese and Thai participants. Some variation between Asian subgroups were also observed. CONCLUSIONS Pacific Islander participants had higher risk of several sentinel health problems compared to Asian American participants. Disaggregation of PI Americans from the APIA umbrella category in future studies is necessary to unmask the critical needs of this important community.
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Affiliation(s)
- Hong-Ho Yang
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Won Jong Chwa
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Burton Cowgill
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gilbert Gee
- Fielding School of Public Health, Department of Community Health Sciences, University of California, Los Angeles, 650 Charles Young Drive South, 46-081C, CHS, Los Angeles, CA, 90095, USA.
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