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Chen P, Patel PB, Ding J, Krimbill J, Siracuse JJ, O'Donnell TFX, Patel VI, Morrissey NJ. Asian race is associated with peripheral arterial disease severity and postoperative outcomes. J Vasc Surg 2023; 78:175-183.e3. [PMID: 36889608 DOI: 10.1016/j.jvs.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The nature of peripheral arterial disease and postoperative outcomes are understudied in Asian patients. We aimed to determine if there are disparities in disease severity at the time of presentation and postoperative outcomes with regard to Asian race. METHODS We analyzed the Society for Vascular Surgery Vascular Quality Initiative Peripheral Vascular Intervention dataset from 2017 to 2021, which includes endovascular lower extremity interventions. Propensity scores were used to match White and Asian patients based on age, sex, comorbidities, ambulatory/functional status, and intervention level. Differences were examined with regard to Asian race across all patients in the United States, Canada, and Singapore, and separately in the United States and Canada only. The primary outcome was emergent intervention. We also examined differences in severity of disease and postoperative outcomes. RESULTS A total of 80,312 White and 1689 Asian patients underwent peripheral vascular intervention. After propensity score matching, we identified 1669 matched pairs of patients across all centers including Singapore and 1072 matched pairs in the United States and Canada only. Among the matched cohort consisting of all centers, Asian patients had a higher rate of emergent intervention to prevent limb loss (5.6% vs 1.7%, P < .001). The majority of Asian patients presented with chronic limb threatening ischemia at a higher rate than White patients within the cohort including Singapore (71% vs 66%, P = .005). Within both propensity-matched cohorts, the rate of in-hospital death was higher in Asian patients (all centers: 3.1% vs 1.2%, P < .001; United States and Canada only: 2.1% vs 0.8%, P = .010). Logistic regression demonstrated greater odds of emergent intervention in Asian patients from all centers including Singapore (odds ratio [OR], 3.3; 95% confidence interval [CI], 2.2-5.1, P < .001) but not in the United States and Canada only (OR, 1.4; 95% CI, 0.8-2.8, P = .261). In addition, Asian patients had greater odds of in-hospital death in both matched cohorts (all centers: OR, 2.6; 95% CI, 1.5-4.4, P < .001; United States and Canada: OR, 2.5; 95% CI, 1.1-5.8, P = .026). Asian race was associated with a greater risk of loss of primary patency at 18 months (all centers: hazard ratio, 1.5; CI, 1.2-1.8, P = .001; United States and Canada only: hazard ratio, 1.5; CI, 1.2-1.9, P = .002). CONCLUSIONS Asian patients are more likely to present with advanced peripheral arterial disease and undergo emergent intervention to prevent limb loss, in addition to having worse postoperative outcomes and long-term patency. These results highlight the need for improved screening and postoperative follow-up in this understudied population.
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Affiliation(s)
- Panpan Chen
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Priya B Patel
- Division of General Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jessica Ding
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Jacob Krimbill
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA
| | - Thomas F X O'Donnell
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Virendra I Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Nicholas J Morrissey
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY.
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Alolod GP, Gardiner HM, Blunt R, Yucel RM, Siminoff LA. Organ Donation Willingness Among Asian Americans: Results from a National Study. J Racial Ethn Health Disparities 2023; 10:1478-1491. [PMID: 35595917 PMCID: PMC9675880 DOI: 10.1007/s40615-022-01333-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
Asian Americans are the fastest growing racial group in the USA, but their health disparities are often overlooked. Although their needs for transplantable organs are substantial, they have the lowest rates of organ donation per million compared to other Americans by race. To better understand Asian Americans' disposition toward organ donation, a self-administered survey was developed based on formative data collection and guidance from a Community Advisory Board composed of Asian American stakeholders. The instrument was deployed online, and quota sampling based on the 2017 American Community Survey was used to achieve a sample representative (N = 899) of the Asian American population. Bivariate tests using logistic regression and the chi-square test of independence were performed. Over half (58.1%) of respondents were willing to be organ donors. A majority (81.8%) expressed a willingness to donate a family member's organs, but enthusiasm depended on the family member's donor wishes. Only 9.5% of respondents indicated that the decision to donate their organs was theirs alone to make; the remainder would involve at least one other family member. Other key sociodemographic associations were found. This study demonstrates both the diversity of Asian Americans but also the centrality of the family's role in making decisions about organ donation. Practice and research considerations for the field are also presented.
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Affiliation(s)
- Gerard P Alolod
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Heather M Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ryan Blunt
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Recai M Yucel
- Department of Biostatistics and Epidemiology, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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Meyer OL, Park VT, Kanaya AM, Farias ST, Hinton L, Tiet QQ, Vuong Q, Nguyen S, Harvey D, Whitmer RA. Inclusion of Vietnamese Americans: Opportunities to understand dementia disparities. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12392. [PMID: 37251911 PMCID: PMC10209515 DOI: 10.1002/trc2.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
There is a dearth of research on cognitive aging and dementia in Asian Americans, particularly Vietnamese Americans, who are the fourth largest Asian subgroup in the United States. The National Institutes of Health is mandated to make certain that racially and ethnically diverse populations are included in clinical research. Despite the widespread recognition to ensure that research findings can be generalizable to all groups, there are no estimates of the prevalence or incidence of mild cognitive impairment and Alzheimer's disease and related dementias (ADRD) in Vietnamese Americans, nor do we understand ADRD risk and protective factors in this group. In this article, we posit that studying Vietnamese Americans contributes to a better understanding of ADRD in general and offers unique opportunities for elucidating life course and sociocultural factors that contribute to cognitive aging disparities. That is, the unique context of Vietnamese Americans may provide understanding in terms of within-group heterogeneity and key factors in ADRD and cognitive aging. Here, we provide a brief history of Vietnamese American immigration and describe the large but often ignored heterogeneity of Asian Americans in the United States, elucidate how early life adversity and stress might influence late-life cognitive aging, and provide a basis for the role of sociocultural and health factors in the study of Vietnamese cognitive aging disparities. Research with older Vietnamese Americans provides a unique and timely opportunity to more fully delineate the factors that contribute to ADRD disparities for all populations.
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Affiliation(s)
- Oanh L. Meyer
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Van Ta Park
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Alka M. Kanaya
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | - Ladson Hinton
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Quyen Q. Tiet
- California School of Professional Psychology at Alliant International UniversityEmeryvilleCaliforniaUSA
- National Center for PTSDDissemination and Training DivisionVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Quyen Vuong
- International Children Assistance Network (ICAN)San JoseCaliforniaUSA
| | | | - Danielle Harvey
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
| | - Rachel A. Whitmer
- School of MedicineUniversity of California, DavisSacramentoCaliforniaUSA
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4
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Schwartz GL, Jahn JL. Disaggregating Asian American and Pacific Islander Risk of Fatal Police Violence. PLoS One 2022; 17:e0274745. [PMID: 36215233 PMCID: PMC9550032 DOI: 10.1371/journal.pone.0274745] [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: 11/17/2021] [Accepted: 08/17/2022] [Indexed: 12/03/2022] Open
Abstract
High rates and racial inequities in U.S. fatal police violence are an urgent area of public health concern and policy attention. Asian Americans and Pacific Islanders (AAPIs) have been described as experiencing low rates of fatal police violence, yet AAPI subgroups vary widely on nearly every demographic and economic metric. Here, we calculate fatal police violence rates by AAPI regional and national/ethnic background, finding wide variation. We compile a list of AAPI people killed in interactions with police in 2013-2019, then use web searches and surname algorithms to identify decedents' backgrounds. Rates are then calculated by combining this numerator data with population denominators from the American Community Survey and fitting Poisson models. Excluding 18% of deaths with missing regional backgrounds, East and South Asian Americans died at a rate of 0.05 and 0.04 deaths per 100,000 (95% CI: 0.04-0.06 and 0.02-0.08), respectively, less than a third of Southeast Asian Americans' rate (0.16, CI: 0.13-0.19). Pacific Islanders suffered higher rates (0.88, CI: 0.65-1.19), on par with Native and Black Americans. More granularly, Southeast Asian American groups displaced by US war in Southeast Asia suffered higher rates than others from the same region. Traditional racial classifications thus obscure high risks of fatal police violence for AAPI subgroups. Disaggregation is needed to improve responses to fatal police violence and its racial/ethnic inequities.
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Affiliation(s)
- Gabriel L. Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jaquelyn L. Jahn
- The Ubuntu Center on Racism, Global Movements, and Population Health Equity and the Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
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Chen MS, Lee RJ, Madan RA, Ta Park V, Shinagawa SM, Sun T, Gomez SL. Charting a Path Towards Asian American Cancer Health Equity: A Way Forward. J Natl Cancer Inst 2022; 114:792-799. [PMID: 35437573 PMCID: PMC9194616 DOI: 10.1093/jnci/djac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/17/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022] Open
Abstract
On July 29, 2021, the US Food and Drug Administration’s Oncology Center of Excellence convened Conversations on Cancer. This Conversation, the first ever by the US Food and Drug Administration, focused on Asian Americans and served as the platform for this Commentary. Panelists elaborated on topics ranging from heterogeneity in Asian American demographics to racism through a path to health equity and supplemented this Commentary with literature citations. Asian Americans are the fastest-growing US race group, yet data aggregation obscures distinctions and cancer disparities within the more than 24 million Asians living in the United States with harmful impacts on communities and patients, as illustrated by breast cancer survivor Susan Shinagawa’s patient-to-advocate journey. Bigotry against Asian Americans has been pervasive since the 19th century, but especially during the COVID-19 pandemic. Asian Americans are unique as the first US population to experience cancer as the leading cause of death. Asian Americans are disproportionately affected by cancers because of infectious origins and have the highest rates of lung cancer among never-smoking women. The infinitesimal proportion of the National Institutes of Health’s budget compared with experiencing the highest percentage increases of any US racial population more than 3 decades highlights the dearth of focused research among Asian Americans. Recognizing the heterogeneity of Asian Americans and that disaggregated data are critical for accurately characterizing distinct ethnic groups, focusing on the impact of racism and COVID-19 on cancer disparities, and focusing and prioritizing funding resources are necessary steps forward for achieving health equity for Asian Americans.
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Affiliation(s)
- Moon S Chen
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Richard J Lee
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Susan M Shinagawa
- Asian and Pacific Islander National Cancer Survivors Network, Spring Valley, CA, USA
| | - Tracy Sun
- Asian and Pacific Islander American Health Forum, Washington, DC, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, UC San Francisco School of Medicine and the Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Sunderaraman P, Irani F, Krishnan K, Hundal JS. A narrative review of the biopsychosocial and health characteristics of Asian Indians in the United States: Clinical and research implications for neuropsychological functioning. Clin Neuropsychol 2021:1-19. [PMID: 34818985 DOI: 10.1080/13854046.2021.1987524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: The prevailing scientific literature aggregates Asians living in America into one omnibus category and thus can problematically result in a subpar and at times inaccurate understanding of health, social and cultural factors necessary for competent and informed medical care. Method: A literature search was conducted by cultural experts familiar with Asian Indian culture with a focus on immigrants from this community living in the US. Database using search engines was sought in the following domains: immigration patterns, prevalence for key medical and neurological conditions commonly associated with cognitive dysfunction, psychiatric/psychological needs in the community, some preliminary neuropsychological testing considerations while working with this community, and treatment considerations that could affect adherence and efficacy of outcomes. Articles were selected from 2000 to the most recent date, with emphasis on compiling information from review papers and meta-analysis from the past decade. Conclusions: Asian Indians living in the US are distinct from the larger Asian American community. Immigration trends underscore that Asian Indians have a bimodal distribution of wealth. Regarding medical conditions, a key and highly concerning finding is the higher prevalence of cardiovascular risk factors, especially in young males. The lack of non-existent cognitive data in this community is glaring and should serve as an impetus for conducting high-priority research in this community. Preliminary neuropsychological testing considerations are discussed from a practical perspective with emphasis on multilingualism and region of origin. Finally, treatment considerations include understanding attitudes and beliefs regarding traditional medicine.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H.Sergeivsky Center, and the Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,The Framingham Heart Study - Brain Aging Program, 73 Mount Wayte Avenue, Framingham, MA, USA
| | | | - Kamini Krishnan
- Lou Ruvo Center for Brain Health, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jasdeep S Hundal
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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7
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Cheng P, Johnson DA. Moving beyond the "model minority" myth to understand sleep health disparities in Asian American and Pacific Islander communities. J Clin Sleep Med 2021; 17:1969-1970. [PMID: 34170239 DOI: 10.5664/jcsm.9500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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8
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Racial-Ethnic and Socioeconomic Disparities in Guideline-Adherent Treatment for Endometrial Cancer. Obstet Gynecol 2021; 138:21-31. [PMID: 34259460 PMCID: PMC10403994 DOI: 10.1097/aog.0000000000004424] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/04/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the association of race-ethnicity and neighborhood socioeconomic status with adherence to National Comprehensive Cancer Network guidelines for endometrial carcinoma. METHODS Data are from the SEER (Surveillance, Epidemiology, and End Results) cancer registry of women diagnosed with endometrial carcinoma for the years 2006-2015. The sample included 83,883 women after inclusion and exclusion criteria were applied. Descriptive statistics, bivariate analyses, univariate, and multivariate logistic regression models were performed to evaluate the association between race-ethnicity and neighborhood socioeconomic status with adherence to treatment guidelines. RESULTS After controlling for demographic and clinical covariates, Black (odds ratio [OR] 0.89, P<.001), Latina (OR .92, P<.001), and American Indian or Alaska Native (OR 0.82, P=.034) women had lower odds of receiving adherent treatment and Asian (OR 1.14, P<.001) and Native Hawaiian or Pacific Islander (OR 1.19 P=.012) women had higher odds of receiving adherent treatment compared with White women. After controlling for covariates, there was a gradient by neighborhood socioeconomic status: women in the high-middle (OR 0.89, P<.001), middle (OR 0.84, P<.001), low-middle (OR 0.80, P<.001), and lowest (OR 0.73, P<.001) neighborhood socioeconomic status categories had lower odds of receiving adherent treatment than the those in the highest neighborhood socioeconomic status group. CONCLUSIONS Findings from this study suggest there are racial-ethnic and neighborhood socioeconomic disparities in National Comprehensive Cancer Network treatment adherence for endometrial cancer. Standard treatment therapies should not differ based on sociodemographics. Interventions are needed to ensure that equitable cancer treatment practices are available for all individuals, regardless of racial-ethnic or socioeconomic background.
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Kim JHJ, Lu Q, Stanton AL. Overcoming constraints of the model minority stereotype to advance Asian American health. AMERICAN PSYCHOLOGIST 2021; 76:611-626. [PMID: 34410738 PMCID: PMC8384115 DOI: 10.1037/amp0000799] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Asian Americans are the fastest growing U.S. immigrant group, projected to become the largest immigrant group by 2065, but the quantity of research on Asian Americans' health has not mirrored changing demographics. Asian Americans have been understudied for more than 25 years, with only 0.17% of National Institutes of Health (NIH) expenditures allocated to projects including Asian American, Native Hawaiian, and Pacific Islander populations (Ðoàn et al., 2019). This disproportionality may result in part from the model minority stereotype (MMS) being extended to health, perpetuating the ideas that Asian Americans are well-positioned with regard to health status and that associated research is not essential. Accordingly, the aims for this article are threefold: (a) bring attention to the inadequate representation of the Asian American population in health-related science, (b) question the MMS in health, and (c) outline potential pathways through which the MMS limits what is knowable on Asian American health issues and needs. We discuss the limited meaningfulness of nonrepresentative aggregated statistics purporting the model minority image and provide counterexamples. We also present a stereotype-constraints model with the MMS contributing to a bottleneck for Asian American health-related knowledge, accompanied by present-day circumstances (e.g., sparse data, few psychologists/behavioral medicine scientists focused on Asian American health). We conclude with initial recommendations for addressing MMS-associated constraints in psychology and more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
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Rodriguez VE, LeBrón AMW, Chang J, Bristow RE. Guideline-adherent treatment, sociodemographic disparities, and cause-specific survival for endometrial carcinomas. Cancer 2021; 127:2423-2431. [PMID: 33721357 DOI: 10.1002/cncr.33502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adherence to National Comprehensive Cancer Network guidelines have been adopted as the standard of care for various cancers and have been cited to have survival benefits. Few studies have examined the association of adherent treatment and endometrial cancer survival among various racial/ethnic groups and socioeconomic statuses. METHODS Between January 1, 2006 and December 31, 2015, 83,673 women diagnosed with endometrial carcinomas were identified from the Surveillance, Epidemiology, and End Results database. Descriptive statistics of demographic and clinical characteristics were performed. Cox-proportional hazards models were used to examine the effect on cause-specific survival for adherence to guidelines across racial/ethnic and socioeconomic groups. RESULTS Within our sample, 59.5% were treated according to guidelines. Nonadherence to treatment guidelines was significantly associated with decreased survival compared with adherent care (adjusted hazard ratio [HR], 1.59; 95% CI, 1.52-1.67). Being of Black (adjusted HR, 1.41; 95% CI, 1.32-1.51) or Native Hawaiian/Pacific Islander (adjusted HR, 1.44; 95% CI, 1.19-1.73) race/ethnicity compared with White women was significantly associated with worse survival. Being of Asian race/ethnicity (adjusted HR, 0.86, 95% CI, 0.78-0.94) was significantly associated with improved survival compared with White women. Lower neighborhood socioeconomic status was associated with a negative effect on survival relative to women in the highest socioeconomic status category. CONCLUSIONS Findings from this study suggest treatment adherence is an independent predictor of improved survival; however, improved survival was not observed equally among all racial/ethnic and socioeconomic status groups. LAY SUMMARY The National Comprehensive Cancer Network (NCCN) has developed guidelines for physicians to follow in treating various cancers. Within this study of 83,673 women with endometrial cancer, 59.5% of women were treated according to the NCCN guidelines. The findings suggest following NCCN guidelines for treatment of endometrial cancer improves survival. Black or Native Hawaiian/Pacific Islander race and lower neighborhood socioeconomic status has worse survival rates compared with other groups, indicating the importance of exploring other factors that may shape treatment across racial/ethnic and socioeconomic status groups.
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Affiliation(s)
- Victoria E Rodriguez
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California
| | - Alana M W LeBrón
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California.,Department of Chicano/Latino Studies, University of California, Irvine, Irvine, California
| | - Jenny Chang
- Department of Medicine, University of California, Irvine, School of Medicine, Irvine, California
| | - Robert E Bristow
- Department of Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Orange, California
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Alam MT, Echeverria SE, DuPont-Reyes MJ, Vasquez E, Murillo R, Gonzalez T, Rodriguez F. Educational Attainment and Prevalence of Cardiovascular Health (Life's Simple 7) in Asian Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041480. [PMID: 33557415 PMCID: PMC7914420 DOI: 10.3390/ijerph18041480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (<high school diploma, high school diploma, some college, and college degree+) was associated with CVH and if this varied by time in the United States (U.S.). Our study population included Asian Americans 20+ years of age sampled in the 2011-16 National Health and Nutrition Examination Survey (n = 1634). Ideal cardiovascular health was based on a composite score of adiposity, total cholesterol, blood pressure, blood glucose, smoking, physical activity, and diet. We fit sequential weighted multivariate logistic regression models for all analyses. The prevalence of ideal cardiovascular (CV) health was 17.1% among those living in the U.S. <10 years, 7.1% for those living in the U.S. >10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.
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Affiliation(s)
- Md Towfiqul Alam
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27412, USA;
- Correspondence:
| | - Sandra E. Echeverria
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27412, USA;
| | - Melissa J. DuPont-Reyes
- Department of Epidemiology & Biostatistics, Texas A&M University, College Station, TX 77843, USA;
| | - Elizabeth Vasquez
- Department of Epidemiology & Biostatistics, University at Albany, Albany, NY 12144, USA;
| | - Rosenda Murillo
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX 77204, USA;
| | - Tailisha Gonzalez
- Department of Community Health, CUNY Graduate School of Public Health & Health Policy, New York, NY 10027, USA;
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University, Quarry Road, Falk CVRC, Stanford, CA 94305, USA;
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12
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DeQuattro K, Trupin L, Murphy LB, Rush S, Criswell LA, Lanata CM, Dall'Era M, Katz P, Yazdany J. High Disease Severity Among Asians in a US Multiethnic Cohort of Individuals with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:896-903. [PMID: 33337580 DOI: 10.1002/acr.24544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Knowledge about systemic lupus erythematosus (SLE) outcomes among US Asians is lacking. We examined SLE disease activity, severity, and damage among Asians of primarily Chinese and Filipino descent in a multiethnic cohort. METHODS California Lupus Epidemiology Study (CLUES, n=328) data were analyzed. Data were collected in English, Cantonese, Mandarin or Spanish, using validated instruments for disease activity (Systemic Lupus Erythematosus Disease Activity Index), disease severity (Lupus Severity Index [LSI]) and disease damage (Systemic Lupus International Collaborating Clinics Damage Index). We assessed differences in SLE outcomes among racial/ethnic groups using multivariable linear regression including interaction terms for age at diagnosis and race/ethnicity. RESULTS Asians were the largest racial/ethnic group (38%; [Chinese=22%; Filipino=9%; Other=7%]). Average age at diagnosis (years) was younger among Asians (27.9), particularly Filipinos (22.2), compared with Whites (29.4) and Blacks (34.0). After adjustment, disease activity and damage were not significantly different across groups. Disease severity among Asians was significantly higher than Whites (LSI 7.1 vs 6.5; p<0.05) but similar to Blacks and Hispanics. Early age at diagnosis was associated with greater organ damage among Asians, Blacks, and Hispanics, but not Whites. CONCLUSIONS SLE was more severe among US Asians compared to Whites. Filipinos were affected at strikingly young ages. Asians and non-White groups with younger age at diagnosis had greater organ damage than Whites. Such racial/ethnic distinctions suggest the need for heightened clinical awareness to improve health outcomes among Asians with SLE. Further study of SLE outcomes across a range of US Asian subgroups is important.
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Affiliation(s)
- Kimberly DeQuattro
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Lindsey A Criswell
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Cristina M Lanata
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Maria Dall'Era
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
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Zhu L, Spence C, Yang WJ, Ma GX. The IDF Definition Is Better Suited for Screening Metabolic Syndrome and Estimating Risks of Diabetes in Asian American Adults: Evidence from NHANES 2011-2016. J Clin Med 2020; 9:jcm9123871. [PMID: 33260754 PMCID: PMC7759813 DOI: 10.3390/jcm9123871] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE extensive effort has been made to better define metabolic syndrome (MetS). Whether current definitions accurately diagnose MetS and predict risk of cardiovascular disease (CVD) or diabetes in diverse ethnic groups remains largely unknown. The objective of this study was to compare the prevalence of MetS and risk of CVD and diabetes among Asian American adults using two MetS definitions, one proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) and one by the International Diabetes Federation (IDF). METHODS we obtained a nationally representative sample of 2121 Asian American adults in the noninstitutionalized civilian population of the United States from the National Health and Nutrition Examination Survey (2011-2016). We computed age-adjusted, gender-specific MetS prevalence and each MetS component using ATP III and IDF definitions. RESULTS based on the IDF definition, MetS prevalence was 39.26% among Asian American men and 39.66% among Asian American women included in the study sample. Based on the ATP III definition, MetS prevalence in our sample was 39.38% among men and 36.11% among women. We found good concordance between the IDF and the ATP III definitions in identifying MetS in Asian American adults. Those with MetS defined only by the IDF definition had significantly higher body mass index (BMI) and waist circumference than those with MetS defined only by the ATP III definition. The IDF definition also better predicted elevated fasting insulin. CONCLUSIONS the IDF definition is more pertinent than the ATP III definition for screening and estimating risk of CVD and diabetes in Asian American adults. Future studies should examine differences in MetS prevalence across Asian ethnic groups to facilitate the development of culturally tailored strategies improve MetS prevention and detection in Asian Americans.
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Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (W.J.Y.); (G.X.M.)
- Correspondence: ; Tel.: +1-215-707-4039
| | - Cody Spence
- Department of Sociology, College of Liberal Art, Temple University, Philadelphia, PA 19122, USA;
| | - Wei Jenny Yang
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (W.J.Y.); (G.X.M.)
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (W.J.Y.); (G.X.M.)
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Mukand NH, Zolekar A, Ko NY, Calip GS. Risks of Second Primary Gynecologic Cancers following Ovarian Cancer Treatment in Asian Ethnic Subgroups in the United States, 2000-2016. Cancer Epidemiol Biomarkers Prev 2020; 29:2220-2229. [PMID: 32856609 PMCID: PMC10772992 DOI: 10.1158/1055-9965.epi-20-0095] [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: 01/18/2020] [Revised: 04/03/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The differential occurrence of second primary cancers by race following ovarian cancer is poorly understood. Our objective was to determine the incidence of second primary gynecologic cancers (SPGC) following definitive therapy for ovarian cancer. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups. METHODS We identified 27,602 women ages 20 years and older and diagnosed with first primary epithelial ovarian cancer between 2000 and 2016 who received surgery and chemotherapy in 18 population-based Surveillance, Epidemiology and End Results Program registries. We compared the incidence of SPGC with expected incidence rates in the general population of women using estimated standardized incidence ratios (SIR) and 95% confidence intervals (CI). RESULTS The incidence of SPGC was lower among White women (SIR = 0.73; 95% CI, 0.59-0.89), and higher among Black (SIR = 1.80; 95% CI, 0.96-3.08) and Asian/Pacific Islander (API) women (SIR = 1.83; 95% CI, 1.07-2.93). Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR = 26.76; 95% CI, 5.52-78.2) and were also significant for risk of uterine cancers (SIR = 2.53; 95% CI, 1.35-4.33). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers. CONCLUSIONS Risk of SPGC following treatment of ovarian cancer differs by race and ethnicity, with Filipina women having the highest rates of second gynecologic cancers among Asian women. IMPACT Ensuring access and adherence to surveillance may mitigate ethnic differences in the early detection and incidence of second gynecologic cancers.
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Affiliation(s)
- Nita H Mukand
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
- University of Illinois Cancer Center, Chicago, Illinois
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ashwini Zolekar
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Gregory S Calip
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois.
- University of Illinois Cancer Center, Chicago, Illinois
- Flatiron Health, New York, New York
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15
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Adia AC, Nazareno J, Operario D, Ponce NA. Health Conditions, Outcomes, and Service Access Among Filipino, Vietnamese, Chinese, Japanese, and Korean Adults in California, 2011-2017. Am J Public Health 2020; 110:520-526. [PMID: 32078359 PMCID: PMC7067106 DOI: 10.2105/ajph.2019.305523] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the impact of data disaggregation on the ability to identify health disparities and needs for future research for Filipino, Vietnamese, Chinese, Japanese, and Korean adults in California.Methods. Using available data from the 2011-2017 California Health Interview Survey, we conducted bivariate and multivariable analyses to assess disparities in health conditions, outcomes, and service access compared with non-Hispanic Whites for Asians as an overall group and for each individual subgroup.Results. As an aggregate category, Asians appeared healthier than did non-Hispanic Whites on most indicators. However, every Asian subgroup had at least 1 disparity disguised by aggregation. Filipinos had the most disparities, with higher prevalence of fair or poor health, being obese or overweight, and having high blood pressure, diabetes, or asthma compared with non-Hispanic Whites (P < .05) in multivariable analyses.Conclusions. Failure to disaggregate health data for individual Asian subgroups disguises disparities and leads to inaccurate conclusions about needs for interventions and research.
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Affiliation(s)
- Alexander C Adia
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
| | - Jennifer Nazareno
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
| | - Don Operario
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
| | - Ninez A Ponce
- Alexander C. Adia, Jennifer Nazareno, and Don Operario are with the Philippine Health Initiative for Research, Service, and Training, Brown University School of Public Health, Providence, RI. Ninez A. Ponce is with the University of California, Los Angeles Fielding School of Public Health and the University of California, Los Angeles Center for Health Policy Research
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Riley AR. Advancing the study of health inequality: Fundamental causes as systems of exposure. SSM Popul Health 2020; 10:100555. [PMID: 32099895 PMCID: PMC7029174 DOI: 10.1016/j.ssmph.2020.100555] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/28/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
We tend to study health inequalities as differentials in disease and death that exist within a population. But the most important cause of health inequality is social stratification, and social stratification only varies between populations. Here, I highlight a way forward in the study of health inequality that resolves this mismatch of analytical levels: we must study the fundamental causes as systems of exposure. Through this critical review of the literature, I argue that the explicit study of variation in social stratification is the next frontier in research on fundamental causes of health inequality.
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Swierad E, Huang TTK, Ballard E, Flórez K, Li S. Developing a Socioculturally Nuanced Systems Model of Childhood Obesity in Manhattan's Chinese American Community via Group Model Building. J Obes 2020; 2020:4819143. [PMID: 33628493 PMCID: PMC7895604 DOI: 10.1155/2020/4819143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/27/2020] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to develop a qualitative and socioculturally tailored systems model of childhood obesity in the Chinese American community in Manhattan's Chinatown. We utilized group model building (GMB) methodology as a form of participatory systems modeling. The study was conducted in Manhattan's Chinatown community. We recruited 16 Chinese American adults from the community. GMB workshops engendered a causal loop diagram (CLD), the visualization of a complex systems model illustrating the structures, feedbacks, and interdependencies among socioculturally specific pathways underlying childhood obesity, in Manhattan's Chinatown community. The analysis of CLD revealed that participants considered the following factors to influence childhood obesity: (1) traditional social norms affecting body image, how children are raised, parental pressure to study, and trust in health of traditional foods; (2) grandparents' responsibility for children; (3) limited time availability of parents at home; and (4) a significant amount of children's time spent indoors. GMB represents a novel method to understand the complexity of childhood obesity in culturally specific populations and contexts. The study identified sociocultural subsystems that may underlie the development and perpetuation of childhood obesity among Chinese American children. Insights from the study can be useful in the design of future empirical studies and interventions.
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Affiliation(s)
- Ewelina Swierad
- Columbia University Irving Medical Center, New York, NY, USA
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ellis Ballard
- Social System Design Lab, Brown School at Washington University in St. Louis, St. Louis, WA, USA
| | - Karen Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sheng Li
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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A Health Profile and Overview of Healthcare Experiences of Cambodian American Refugees and Immigrants Residing in Southern California. J Immigr Minor Health 2019; 21:346-355. [PMID: 29705910 DOI: 10.1007/s10903-018-0736-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Asian Americans are understudied in health research and often aggregated into one homogenous group, thereby disguising disparities across subgroups. Cambodian Americans, one of the largest refugee communities in the United States, may be at high risk for adverse health outcomes. This study compares the health status and healthcare experiences of Cambodian American refugees and immigrants. Data were collected via questionnaires and medical records from two community clinics in Southern California (n = 308). Chi square and t-tests examined the socio-demographic differences between immigrants and refugees, and ANCOVA models compared the mean differences in responses for each outcome, adjusting for age at immigration, education level, and clinic site. Cambodian American refugees reported overall lower levels of health-related quality of life (all p's < 0.05 in unadjusted models) and self-rated health [unadjusted means (SD) = 18.2 (16.8) vs. 21.7 (13.7), p < 0.05], but either similar or more positive healthcare experiences than Cambodian American immigrants. In adjusted analyses, refugees had higher rates of diabetes and cardiovascular disease risk (e.g. heart condition and hypertension; p's < 0.05) compared to Cambodian American immigrants. There were minimal differences in self-reported health behaviors between the two groups. There is a need for more health promotion efforts among Cambodian American refugees and immigrants to improve their health outcomes and perceived wellbeing.
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Đoàn LN, Takata Y, Sakuma KLK, Irvin VL. Trends in Clinical Research Including Asian American, Native Hawaiian, and Pacific Islander Participants Funded by the US National Institutes of Health, 1992 to 2018. JAMA Netw Open 2019; 2:e197432. [PMID: 31339543 PMCID: PMC6659145 DOI: 10.1001/jamanetworkopen.2019.7432] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/29/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Advancing the health equity agenda for Asian American, Native Hawaiian, and Pacific Islander (AA/NHPI) individuals has become an intersecting priority for federal agencies. However, the impact of federal investments and legislation to ensure systematic processes and resources to eliminate health disparities in AA/NHPI populations is unclear. Objective To perform a portfolio review of clinical research funded by the National Institutes of Health (NIH) for AA/NHPI populations and determine the level of NIH investment in serving these populations. Design, Setting, and Participants Cross-sectional study in which the NIH Research Portfolio Online Reporting Tools Expenditures and Results system was queried for extramural AA/NHPI-focused clinical research projects conducted in the United States from January 1, 1992, to December 31, 2018. Clinical research funded under research project grants, centers, cooperative awards, research career awards, training grants, and fellowships was included, with an advanced text search for AA/NHPI countries and cultures of origin. Project titles and terms were screened for inclusion and project abstracts were reviewed to verify eligibility. Descriptive analyses were completed. Main Outcomes and Measures Outcomes included NIH funding trends and characteristics of funded projects and organizations. The proportions of AA/NHPI-related funding trends were calculated using 2 denominators, total NIH expenditures and clinical research expenditures. Results There were 5460 records identified, of which 891 studies were reviewed for eligibility. Of these, 529 clinical research studies focused on AA/NHPI participants composed 0.17% of the total NIH budget over 26 years. Projects studying AA/NHPI individuals in addition to other populations were funded across 17 NIH institutes and centers. The top 5 funders collectively contributed almost 60% of the total funding dollars for AA/NHPI projects and were the National Cancer Institute ($231 584 664), National Institute on Aging ($108 365 124), National Heart, Lung, and Blood Institute ($67 232 910), National Institute on Minority Health and Health Disparities ($62 982 901), and National Institute on Mental Health ($60 072 779). Funding of these projects ($775 536 121) made up 0.17% of the overall NIH expenditures ($451 284 075 000) between 1992 and 2018, and 0.18% ($677 479 468) of the NIH research budget after 2000. Funding for AA/NHPI projects significantly increased over time, but the proportion of the total NIH budget has only increased from 0.12% before 2000 to 0.18% after 2000. Of total funding, 60.8% was awarded to research project grants compared with only 5.1% allocated to research career awards, training grants, and fellowships. Conclusions and Relevance Increases in research dollars for AA/NHPI clinical research were not associated with increases in the overall NIH research budget, and underrepresentation of AA/NHPI subgroups still remains. Without overt direction from federal entities and dedicated funds for health disparities research, as well as parallel efforts to increase diversity in the biomedical workforce, investments may continue to languish for AA/NHPI populations.
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Affiliation(s)
- Lan N. Đoàn
- College of Public Health and Human Sciences, School of Social and Behavioral Sciences, Oregon State University, Corvallis
| | - Yumie Takata
- College of Public Health and Human Sciences, School of Biological and Population Health Sciences, Oregon State University, Corvallis
| | - Kari-Lyn K. Sakuma
- College of Public Health and Human Sciences, School of Social and Behavioral Sciences, Oregon State University, Corvallis
| | - Veronica L. Irvin
- College of Public Health and Human Sciences, School of Social and Behavioral Sciences, Oregon State University, Corvallis
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Noah AJ. Heterogeneity of Hepatitis B Infection Among Pregnant Asian American and Pacific Islander Women. Am J Prev Med 2018; 55:213-221. [PMID: 30031455 DOI: 10.1016/j.amepre.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Perinatal transmission of hepatitis B virus among Asian Americans and Pacific Islanders is a key driver of racial health disparities in liver cancer and mortality in the U.S. This study documents the prevalence of hepatitis B virus infection among pregnant women across racial/ethnic groups and among Asian Americans and Pacific Islanders to assess the need for intervention, and then identifies the individual correlates of hepatitis B virus infection among Asian American and Pacific Islander pregnant women. METHODS Using the 2014-2015U.S. birth rate population data, this study estimates a series of logistic regression models to examine the associations between individual-level correlates and hepatitis B virus infection among Asian American and Pacific Islanders pregnant women. Data were analyzed in July 2017. RESULTS Among Asian American and Pacific Islander pregnant women, Chinese American mothers are ten times more likely to experience hepatitis B virus infection than are Asian Indian and Japanese American mothers. Foreign-born mothers are significantly more likely to experience hepatitis B virus infection during pregnancy than those of their U.S.-born counterparts. Maternal SES characteristics are important correlates of hepatitis B virus infection among pregnant women. CONCLUSIONS Studies must disaggregate the pan-ethnic Asian American and Pacific Islander category to examine the health and health disparities of Asian Americans and Pacific Islanders. Given the heterogeneity of hepatitis B virus infection prevalence among Asian American and Pacific Islander pregnant women, the effectiveness of prevention and intervention programs depends on careful consideration of ethnicity in conjunction with group-specific factors.
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Affiliation(s)
- Aggie J Noah
- School of Social Transformation, Arizona State University, Tempe, Arizona.
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Factors Associated with Health Insurance Status in an Asian American Population in New York City: Analysis of a Community-Based Survey. J Racial Ethn Health Disparities 2018; 5:1354-1364. [PMID: 29582383 DOI: 10.1007/s40615-018-0485-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Immigrants comprise approximately 13% of the US population and 33% lack health coverage. Asian Americans are the fastest growing immigrant group; many lack a usual source of care. This study examines factors associated with health insurance among Asian American immigrants living in New York City. METHODS Community needs assessments were conducted among Asian American subgroups in New York City from 2013 to 2015; analysis was completed in 2017 and 2018. Descriptive statistics examined factors associated with health insurance status while stratifying by Asian ethnic subgroup; multivariable logistic regression models further assessed these associations (p < 0.05 significance level). RESULTS Approximately 19% of the study population (n = 1399) was uninsured. Logistic regression models adjusted for all factors. Among East Asians, insurance status was associated with female sex (OR = 2.8, p = 0.005), excellent/very good health status (OR = 3.5, p = 0.014), and seeing a private doctor when sick or injured (OR = 3.2, p = 0.033). Among South Asians, insurance status was associated with high school/some college and college education (OR = 2.6 and 2.9, respectively, p = 0.039 and p = 0.021), having a routine health check in the past year (OR = 6.4, p < 0.001), no diabetes diagnosis (OR = 2.7, p = 0.030), and a tuberculosis diagnosis (OR = 4.7, p = 0.019). Among Southeast Asians, insurance status was associated with less than high school education (p < 0.05), living in the USA > 20 years (OR = 3.7, p = 0.009), having a routine health check in the past year (OR = 5.6, p = 0.025), and seeing a private doctor when sick or injured (OR = 2.6, p = 0.018). CONCLUSIONS Health insurance status was associated with differing factors among each subgroup. Findings may inform strategies to address challenges and barriers of healthcare access to immigrants, making healthcare more accessible to this underserved population.
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Burhansstipanov L, Krebs LU, Bradley A, Gamito E, Osborn K, Dignan MB, Kaur JS. Lessons Learned While Developing “Clinical Trials Education for Native Americans” Curriculum. Cancer Control 2017; 10:29-36. [PMID: 14581902 DOI: 10.1177/107327480301005s05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This paper highlights lessons learned while developing the Clinical Trials Education for Native Americans (CTENA) curriculum. The CTENA is a culturally specific clinical trials education curriculum that evolved from another ongoing NCI-supported project, Clinical Trials Education for Colorado Providers. The multicultural team learned many lessons while developing, pretesting, and revising this curriculum. These include allocating sufficient time and resources to tailor presentations for diverse tribal settings and workshop participants, addressing barriers to participation in clinical trials through culturally appropriate strategies, providing information to foster informed decision making related to participation, and writing as a team to increase cultural breadth of examples and interactive experiences. There are multiple challenges to developing and implementing a culturally acceptable curriculum on clinical trials within medically underserved communities. Both the multicultural team and the curriculum benefited from the collaborative process, resulting in a culturally relevant clinical trials curriculum that will assist Native Americans to make informed choices about clinical trials participation. The lessons shared here, which may need to be modified to be culturally relevant to other underrepresented communities, may be beneficial to others developing similar curricula for other medically underserved populations.
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Sakuma KLK, Felicitas-Perkins JQ, Blanco L, Fagan P, Pérez-Stable EJ, Pulvers K, Romero D, Trinidad DR. Tobacco use disparities by racial/ethnic groups: California compared to the United States. Prev Med 2016; 91:224-232. [PMID: 27575315 PMCID: PMC5554114 DOI: 10.1016/j.ypmed.2016.08.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/01/2016] [Accepted: 08/24/2016] [Indexed: 02/07/2023]
Abstract
Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US. Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR=0.45, 95% CI:0.38-0.54), more light and intermittent smokers (LITS; OR=1.68, 95%CI: 1.45-1.93), and a greater proportion of former smokers (OR=1.35, 95%CI: 1.24-1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. California's success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.
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Affiliation(s)
- Kari-Lyn K Sakuma
- Oregon State University, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences, Corvallis, OR, United States.
| | | | - Lyzette Blanco
- Claremont Graduate University, School of Community and Global Health, Claremont, CA, United States
| | - Pebbles Fagan
- University of Hawaii, Cancer Center, Honolulu, HI, United States
| | - Eliseo J Pérez-Stable
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, United States
| | - Kim Pulvers
- California State University San Marcos, San Marcos, CA, United States
| | - Devan Romero
- California State University San Marcos, San Marcos, CA, United States
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Lee-Tauler SY, Lee-Kwan SH, Han H, Lee HB, Gallo JJ, Joo JH. What Does Depression Mean for Korean American Elderly?: A Qualitative Follow-Up Study. Psychiatry Investig 2016; 13:558-565. [PMID: 27757135 PMCID: PMC5067351 DOI: 10.4306/pi.2016.13.5.558] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/22/2015] [Accepted: 06/26/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Korean American Elderly (KAE) have high rates of depression but underuse mental health services. The purpose of this study was to assess the meaning of depression and help seeking among KAE residing in the United States who have clinically significant depressive symptoms. METHODS As a follow up to the Memory and Aging Study of Koreans (MASK; n=1,118), a descriptive epidemiological study which showed that only one in four of KAE with clinically significant depressive symptoms (Patient Health Questionnaire-9≥10) used mental health services, we conducted a qualitative study using semi-structured interviews with participants with clinically significant depressive symptoms regarding the meaning of depression and beliefs about help seeking. Ten participants with clinically significant depressive symptoms were approached and 8 were recruited for semi-structured interviews. RESULTS KAE did not identify themselves as depressed though experiencing clinically significant depressive symptoms. They associated depression with social discrimination, social isolation, and suicide in the extreme circumstance. They attributed depression to not achieving social and material success in America and strained relationships with their children. Participants attempted to self-manage distress without telling others in their social network. However, KAE were willing to consult with mental health professionals if the services were bilingual, affordable, and confidential. CONCLUSION KAE with clinically significant depressive symptoms are a vulnerable group with need and desire for linguistically and culturally relevant mental health services who are isolated due to a complex array of psychological and social factors.
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Affiliation(s)
| | | | - Haera Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Hochang B. Lee
- Psychological Medicine Service, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph J. Gallo
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jin Hui Joo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Pasick RJ, D'onofrio CN, Otero-Sabogal R. Similarities and Differences Across Cultures: Questions to Inform a Third Generation for Health Promotion Research. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/109019819602301s11] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, This article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.
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Washio Y, Cassey H. Systematic Review of Interventions for Racial/Ethnic-Minority Pregnant Smokers. J Smok Cessat 2016; 11:12-27. [PMID: 26925170 PMCID: PMC4764131 DOI: 10.1017/jsc.2014.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Large disparities exist in smoking rates during pregnancy by racial/ethnic status. AIMS The current review examined controlled studies that predominantly included racial/ethnic-minority pregnant smokers for providing smoking cessation treatment. METHODS Two authors independently conducted the literature searches in the standard databases using a combination of the keywords with minority, pregnancy, smoking, and cessation identifiers. RESULTS The searches identified nine articles that met the inclusion criteria. Only two studies exclusively targeted specific minority groups. Most of them provided some form of brief smoking cessation counseling, with two combining with incentives and one combining with pharmacotherapy. Two studies provided intensive cognitive interventions. Pregnant smokers of American Indian or Alaska Native, Hispanic subgroups, and Asian or Pacific Islander are under-studied. CONCLUSIONS Future studies to treat minority pregnant smokers could target under-studied minority groups and may need to directly and intensely target smoking behavior, address cultural and psychosocial issues in an individualized and comprehensive manner, and analyze cost-benefit of an intervention.
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Affiliation(s)
- Yukiko Washio
- Treatment Research Institute, Philadelphia PA, 19106, U.S.A
| | - Heather Cassey
- Temple University, Department of Psychological, Organizational, and Leadership Studies, Philadelphia PA, 19122, U.S.A
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Lee BJ, Wang SK, So C, Chiu BG, Wang WY, Polisetty R, Quiñones-Boex A, Liu H. A Student-Led Health Education Initiative Addressing Health Disparities in a Chinatown Community. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2015; 79:132. [PMID: 26839422 PMCID: PMC4727369 DOI: 10.5688/ajpe799132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/01/2015] [Indexed: 05/22/2023]
Abstract
Together with community advocates, professional student organizations can help improve access to health care and sustain services to address the health disparities of a community in need. This paper examines the health concerns of an underserved Chinese community and introduces a student-led health education initiative that fosters service learning and student leadership. The initiative was recognized by the American Association of Colleges of Pharmacy (AACP) and received the 2012-2013 Student Community Engaged Service Award.
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Affiliation(s)
- Benjamin J. Lee
- Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Sheila K. Wang
- Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Chunkit So
- Clinical Pharmacist, University of Illinois at Chicago
| | - Brandon G. Chiu
- Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Wesley Y. Wang
- Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Radhika Polisetty
- Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Ana Quiñones-Boex
- Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
| | - Hong Liu
- Executive Director, Midwest Asian Health Association, Chicago, Illinois
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Nguyen TH, Nguyen TN, Fischer T, Ha W, Tran TV. Type 2 diabetes among Asian Americans: Prevalence and prevention. World J Diabetes 2015; 6:543-547. [PMID: 25987951 PMCID: PMC4434074 DOI: 10.4239/wjd.v6.i4.543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/31/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a growing problem among Asian Americans. Based on the Centers for Disease Control, the age-adjusted prevalence of T2DM for Asian Americans is 9%, placing them at “moderate risk”. However differential patterns of disease burden emerge when examining disaggregated data across Asian American ethnic groups; with Filipino, Pacific Islander, Japanese, and South Asian groups consistently described as having the highest prevalence of T2DM. Disentangling and strengthening prevalence data is vital for on-going prevention efforts. The strongest evidence currently available to guide the prevention of T2DM in the United States comes from a large multicenter randomized clinical control trial called the Diabetes Prevention Program, which targets individual lifestyle behavior changes. It has been translated and adopted for some Asian American groups, and shows promise. However stronger study designs and attention to several key methodological considerations will improve the science. Increased attention has also been directed toward population level downstream prevention efforts. Building an infrastructure that includes both individual and population approaches is needed to prevent T2DM among Asian American populations, and is essential for reducing health disparities.
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Affiliation(s)
- Tam H Nguyen
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Thuc-Nhi Nguyen
- Graduate School of Social Work, Boston College, Chestnut Hill, MA 02467, United States
| | - Taylor Fischer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Won Ha
- Graduate School of Social Work Library, Boston College, Chestnut Hill, MA 02467, United States
| | - Thanh V Tran
- Graduate School of Social Work, Boston College, Chestnut Hill, MA 02467, United States
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Srinivasan S, Moser RP, Willis G, Riley W, Alexander M, Berrigan D, Kobrin S. Small is essential: importance of subpopulation research in cancer control. Am J Public Health 2015; 105 Suppl 3:S371-3. [PMID: 25905825 DOI: 10.2105/ajph.2014.302267] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Shobha Srinivasan
- All of the authors are with the Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Trinh-Shevrin C, Kwon SC, Park R, Nadkarni SK, Islam NS. Moving the dial to advance population health equity in New York City Asian American populations. Am J Public Health 2015; 105 Suppl 3:e16-25. [PMID: 25905858 DOI: 10.2105/ajph.2015.302626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The shift toward a health equity framework for eliminating the health disparities burden of racial/ethnic minority populations has moved away from a disease-focused model to a social determinants framework that aims to achieve the highest attainment of health for all. The New York University Center for the Study of Asian American Health (CSAAH) has identified core themes and strategies for advancing population health equity for Asian American populations in New York City that are rooted in the following: social determinants of health; multisectoral, community-engaged approaches; leveraging community assets; improved disaggregated data collection and access to care; and building sustainability through community leadership and infrastructure-building activities. We describe the strategies CSAAH employed to move the dial on population health equity.
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Affiliation(s)
- Chau Trinh-Shevrin
- All of the authors are with the Center for the Study of Asian American Health, Department of Population Health, NYU School of Medicine, New York, NY
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Qian F, Fonarow GC, Krim SR, Vivo RP, Cox M, Hannan EL, Shaw BA, Hernandez AF, Eapen ZJ, Yancy CW, Bhatt DL. Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program. Int J Cardiol 2015; 189:141-7. [PMID: 25889445 DOI: 10.1016/j.ijcard.2015.03.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. METHODS We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. RESULTS Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk <RR>, 0.88; 95% confidence interval <CI>, 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). CONCLUSIONS Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts.
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Affiliation(s)
- Feng Qian
- University at Albany-State University of New York, Albany, United States.
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Rey P Vivo
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | | | - Edward L Hannan
- University at Albany-State University of New York, Albany, United States
| | - Benjamin A Shaw
- University at Albany-State University of New York, Albany, United States
| | | | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
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Nguyen AB, Chawla N, Noone AM, Srinivasan S. Disaggregated data and beyond: future queries in cancer control research. Cancer Epidemiol Biomarkers Prev 2014; 23:2266-72. [PMID: 25368401 PMCID: PMC4220244 DOI: 10.1158/1055-9965.epi-14-0387] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The goal of health equity requires the collection and reporting of disaggregated data in underrepresented populations such as Asian American (AA) and Native Hawaiian and Other Pacific Islander (NHOPI) communities. A recent Department of Health and Human Services report outlines the necessity for disaggregated data, which would offer communities, providers, and planners better tools to address health problems. In a recent collaboration, the National Cancer Institute (NCI) and several registries published a series of articles tracking cancer incidence data on AA and NHOPI communities using data from the NCI's Surveillance, Epidemiology, and End Results (SEER) program. The findings indicate a need for concentrated focus and planning for the next stages of cancer prevention and control for AA and NHOPI subpopulations. In this article, we provide (i) the context for the perpetuation of the model minority myth as well as historical and sociocultural factors that have shaped health and disease for AA and NHOPI subgroups; (ii) potential strategies for research and public health policy for AA and NHOPI groups using subpopulation-based approaches while addressing challenges and limitations; and (iii) a portfolio analysis of currently funded projects within the NCI/DCCPS to identify gaps and areas of potential research.
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Affiliation(s)
- Anh Bao Nguyen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Neetu Chawla
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Tsai J, Whealin JM, Pietrzak RH. Asian American and Pacific Islander military veterans in the United States: health service use and perceived barriers to mental health services. Am J Public Health 2014; 104 Suppl 4:S538-47. [PMID: 25100419 DOI: 10.2105/ajph.2014.302124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We (1) compared use of various health services nationally between Asian American and Pacific Islander (AA/PI) veterans and veterans of other racial/ethnic groups and (2) specifically compared perceived barriers and stigma related to mental health services. METHODS Using bivariate and multivariable statistics, we analyzed a population-weighted sample of 8315 veterans from the 2010 National Survey of Veterans and a random sample of 567 recent veterans from Hawaii. RESULTS A total of 1.5% of veterans were AA/PI compared with 0.4% a decade ago. Compared with other veterans, AA/PI veterans reported higher socioeconomic status and better mental health, although these findings may be specific to AA veterans. Adjusting for sociodemographic and health differences, we found no differences in health service use or perceived barriers or stigma related to mental health services. CONCLUSIONS AA/PIs are a small but fast-growing racial/ethnic group within the veteran population that deserves attention. Although veteran status may be protective against some barriers to mental health care found in the general AA/PI population, efforts to reduce barriers to health care among veterans should be continued.
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Affiliation(s)
- Jack Tsai
- Jack Tsai and Robert H. Pietrzak are with the VA Connecticut Healthcare System, West Haven, CT, and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT. Julia M. Whealin is with the VA Pacific Islands Health Care System and the Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu
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One size does not fit all: differences in newborn weight among mothers of Philippine and other East Asian origin. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:1026-1037. [PMID: 23231840 DOI: 10.1016/s1701-2163(16)35432-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the likelihood that infants born to Filipina, other East Asian, and Canadian-born women may be misclassified as small for gestational age when using conventional Canadian birth weight curves rather than those specific to their world region. METHODS We conducted a population-based study of 548 418 singleton live births in Ontario between 2002 and 2007. Smoothed birth weight percentile curves were generated for males and females born to women from Canada, the Philippines, and the rest of East Asia/Pacific. We determined the likelihood of misclassifying an infant as small for gestational age (SGA < 10th percentile weight) or large for gestational age (LGA ≥ 90th percentile weight) on a Canadian-born birth weight curve vs. a curve specific to the other two world regions. RESULTS For gestation-specific 10th and 50th percentiles, term infants born to women from the Philippines often had significantly lower birth weights than infants of Canadian-born mothers. Controlling for maternal age and parity, approximately 88 per 1000 male newborns (95% CI 82 to 95) and 72 per 1000 female newborns (95% CI 54 to 60) of mothers from the Philippines were at risk of being misclassified as SGA. LGA would be missed in approximately 54 per 1000 male newborns (95% CI 49 to 59) and 49 per 1000 female newborns (95% CI 44 to 54) of Filipina mothers. Misclassification of both SGA and LGA was more pronounced among infants of Filipina mothers than of mothers from other East Asian origin. CONCLUSIONS Infants of mothers born in the Philippines weigh significantly less than those of Canadian-born women or mothers emigrating from other East Asian countries. Those who use birth weight curves should consider these differences.
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Frey R, Raphael D, Bellamy G, Gott M. Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:290-299. [PMID: 24330009 DOI: 10.1111/hsc.12081] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 06/03/2023]
Abstract
Despite the benefits of advance care planning (ACP), international research has suggested that in pluralistic and multicultural societies such as New Zealand, significant differences exist in the uptake of ACP between European-based populations and other cultural groups [Crawley (2005)]. The purpose of this study was to therefore explore the views of generalist palliative care providers in both the community and hospital settings regarding the barriers to ACP adoption as well as methods to increase knowledge about ACP among Māori, Pacific and Asian cultural groups within New Zealand society. Eleven individual interviews, two joint interviews and three focus groups were conducted with health and social care professionals with a wide range of knowledge and experience in palliative care. Challenges were related to a number of issues based on culture, including family decision-making style, a need to 'do everything' and a reluctance to discuss issues surrounding dying and death. Suggestions to increase the knowledge of ACP included techniques to improve information access and the utilisation of shared norms and values to assist with discussions between Māori, Pacific and Asian health professionals and their patients and families/whānau. Findings indicate a need for more family/whānau-centred models of ACP, addressed much earlier in the healthcare process and within the community setting.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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De Souza LR, Fuller-Thomson E. Acculturation and disability rates among Filipino-Americans. J Immigr Minor Health 2014; 15:462-71. [PMID: 23054536 DOI: 10.1007/s10903-012-9708-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Filipinos are the fastest growing Asian subgroup in America. Among immigrants, higher acculturation (adaptation to host society) predicts disability outcomes and may relate to disability prevalence among older Filipinos. We conducted a secondary analysis of the 2006 American Community Survey using a representative sample of older Filipinos (2,113 males; 3,078 females) to measure functional limitations, limitations in activities of daily living, blindness/deafness and memory/learning problems. Filipino males who were Americans by birth/naturalization had higher odds of blindness/deafness (OR 2.94; 95% CI = 1.69, 5.12) than non-citizens. Males who spoke English at home had higher odds of blindness/deafness (OR 1.82; 95% CI = 1.05, 3.17) and memory/learning problems (OR 2.28; 95% CI = 1.25, 4.15), while females had higher odds of memory/learning problems (OR 1.75; 95% CI = 1.13, 2.73). Acculturation is associated with greater odds of disabilities for Filipino men. Males may be more sensitive to acculturation-effects than females due to culturally prescribed roles and gender-specific experiences at the time of immigration.
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Affiliation(s)
- Leanne R De Souza
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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Frey R, Gott M, Raphael D, Black S, Teleo-Hope L, Lee H, Wang Z. 'Where do I go from here'? A cultural perspective on challenges to the use of hospice services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:519-529. [PMID: 23638970 DOI: 10.1111/hsc.12038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 06/02/2023]
Abstract
Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care services for patients and families and provide consultative services to primary healthcare providers in the community.
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Affiliation(s)
- Rosemary Frey
- Faculty of Medical and Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand.
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Investigating the myth of the "model minority": a participatory community health assessment of Chinese and Vietnamese adults. J Immigr Minor Health 2013; 14:850-7. [PMID: 21874359 DOI: 10.1007/s10903-011-9517-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite the persistent belief that Asians are the "model minority" there is accumulating evidence of health concerns within Asian subgroups. In this study, we implemented a cross-sectional participatory community health assessment in an urban city in Massachusetts, to understand differences and similarities in demographics, health and healthcare access in Chinese and Vietnamese adults. We gathered qualitative data from community stakeholders to inform the development of a community health assessment tool. The tool elicited information on healthcare access, health status, behavioral health and chronic disease history and treatment. Healthcare access issues and poor health status, particularly among Chinese participants and mental health symptomotology in both groups were areas of concern. These findings revealed important health concerns in two Asian ethnic groups. Studies are needed to better understand these concerns and inform programs and policies to improve health outcomes in these Asian ethnic groups.
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Patel VV, Rajpathak S, Karasz A. Bangladeshi immigrants in New York City: a community based health needs assessment of a hard to reach population. J Immigr Minor Health 2013; 14:767-73. [PMID: 22116745 DOI: 10.1007/s10903-011-9555-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
South Asians, particularly Bangladeshis, are one of the fastest growing immigrant groups in the U.S. Limited data exist regarding the health needs of Bangladeshis in the U.S. More data are needed to guide health intervention efforts for this community. To help address this gap, we conducted a community-based health needs assessment survey among women in a Bangladeshi population living in Bronx, NY. Community health promoters conducted a door-to-door household survey and collected data from 167 women, an approach that yielded a participation rate over 90%. Over half reported fair or poor health and 36.5% screened positive for risk of depression. Only 35% had engaged in physical activity over the past month. 60% reported never having received a pap smear. Using WHO guidelines for BMI, 74% were either overweight or obese. Age-standardized prevalence of type 2 diabetes and hypertension were 15.4 and 36.5% respectively. In a multivariable logistic regression model, age and percent lifetime in the U.S. were independently associated with having diabetes. Poor health behaviors and high prevalence of cardiovascular risk factors observed in this group suggest the need for early health promotion and prevention interventions.
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Affiliation(s)
- Viraj V Patel
- Department of Family Medicine, North Bronx Health Network, Bronx, NY, USA.
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Fu H, VanLandingham MJ. Mental health consequences of international migration for Vietnamese Americans and the mediating effects of physical health and social networks: results from a natural experiment approach. Demography 2012; 49:393-424. [PMID: 22275002 DOI: 10.1007/s13524-011-0088-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although the existing literature on immigrant mental health is extensive, major substantive and methodological gaps remain. Substantively, there is little population-based research that focuses on the mental health consequences of migration for Vietnamese Americans. More generally, although a wide range of mental health problems among immigrants has been identified, the potential causal or mediating mechanisms underlying these problems remain elusive. This latter substantive shortcoming is related to a key methodological challenge involving the potentially confounding effects of selection on migration-related outcomes. This article addresses these challenges by employing a "natural experiment" design, involving comparisons among three population-based samples of Vietnamese immigrants, never-leavers, and returnees (N=709). Data were collected in Ho Chi Minh City and in New Orleans between 2003 and 2005. The study investigates the long-term impact of international migration on Vietnamese mental health, and the potential mediating effects of social networks and physical health on these migration-related outcomes. The results reveal both mental health advantages and disadvantages among Vietnamese immigrants relative to the two groups of Vietnamese nationals. Selection can be ruled out for some of these differences, and both social networks and physical health are found to play important explanatory roles.
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Affiliation(s)
- Hongyun Fu
- Population Services International/China, B-21F Zhiyuan Building, No. 389 Qingnian Road, Kunming, 650021 Yunnan, People's Republic of China.
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Kim BJ, Harris LM. Social Capital and Self-Rated Health Among Older Korean Immigrants. J Appl Gerontol 2012; 32:997-1014. [DOI: 10.1177/0733464812448528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose of the Study: The objective of this article is to investigate determinants of self-rated health and describe their association with social capital and socioeconomic characteristics among older Korean immigrants. Method: A cross-sectional study of 205 older Korean immigrants (aged 60 years and older) was conducted in Los Angeles county. Independent variables included age, gender, marital status, income of the older Koreans, and social capital included social norms, trust, partnership with the community, information sharing, and political participation. Self-rated health was the dependent variable. Results: Descriptive analyses were done to show group differences in self-rated health and logistic regression analyses to identify determinants of self-rated health. Gender (male), high income, and high levels of information sharing were significant determinants of high self-rated health status among older Korean immigrants. Implications: This population-based study provides empirical evidence that gender, income, and information sharing are directly associated with the self-rated health status of older Korean immigrants.
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Affiliation(s)
- Bum Jung Kim
- University of Hawaii at Manoa, Honolulu, HI, USA
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Toleran DE, Tran PD, Cabangun B, Lam J, Battle RS, Gardiner P. Substance Use Among Chinese, Filipino, and Vietnamese Adult Men Living in San Jose, Daly City, and San Francisco, and Its Implications on ATOD Prevention Services. J Ethn Subst Abuse 2012; 11:86-99. [DOI: 10.1080/15332640.2012.652534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Daniel E. Toleran
- a Asian American Recovery Services, Inc. , San Francisco , California
| | - Phu Duc Tran
- a Asian American Recovery Services, Inc. , San Francisco , California
| | - Ben Cabangun
- b Asian & Pacific Islander Wellness Center , San Francisco , California
| | - Jon Lam
- a Asian American Recovery Services, Inc. , San Francisco , California
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Qian F, Ling FS, Deedwania P, Hernandez AF, Fonarow GC, Cannon CP, Peterson ED, Peacock WF, Kaltenbach LA, Laskey WK, Schwamm LH, Bhatt DL. Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program. Circ Cardiovasc Qual Outcomes 2012; 5:126-33. [PMID: 22235068 DOI: 10.1161/circoutcomes.111.961987] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asian-Americans represent an important United States minority population, yet there are limited data regarding the clinical care and outcomes of Asian-Americans following acute myocardial infarction (AMI). Using data from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program, we compared use of and trends in evidence-based care AMI processes and outcome in Asian-American versus white patients. METHODS AND RESULTS We analyzed 107,403 AMI patients (4412 Asian-Americans, 4.1%) from 382 United States centers participating in the Get With The Guidelines-Coronary Artery Disease program between 2003 and 2008. Use of 6 AMI performance measures, composite "defect-free" care (proportion receiving all eligible performance measures), door-to-balloon time, and in-hospital mortality were examined. Trends in care over this time period were explored. Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (P≤0.048), defect-free care (P<0.001), and door-to-balloon time (P<0.001). The improvement rates were similar for both Asian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00-1.35; P=0.04). CONCLUSIONS Evidence-based care for AMI processes improved significantly over the period of 2003 to 2008 for Asian-American and white patients in the Get With The Guidelines-Coronary Artery Disease program. Differences in care between Asian-Americans and whites, when present, were reduced over time.
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Affiliation(s)
- Feng Qian
- University of Rochester, Rochester, NY 14642, USA.
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Abstract
The incidence of cervical cancer is high among Southeast Asian American women, but their participation in preventive cervical cancer screening is alarmingly low. This paper reviews the literature on factors associated with participation in cervical cancer screening among women of Vietnamese, Cambodian and Hmong descent in the United States. These factors include acculturation, age, marital status, knowledge about cervical cancer, apprehension about cervical cancer screening, financial concerns, access to health care, and physician characteristics and recommendation. Suggestions for future research include the need to investigate the role of physicians treating Southeast Asian American women, the need for more extensive up-to-date studies on the current generation of young Southeast Asian American women, and the use of more advanced assessments of acculturation. Overall, much more work is needed in order to deepen our understanding of the various ways to improve the rate of cervical cancer screening among Southeast Asian American women.
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Islam NS, Khan S, Kwon S, Jang D, Ro M, Trinh-Shevrin C. Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions. J Health Care Poor Underserved 2010; 21:1354-81. [PMID: 21099084 PMCID: PMC3086449 DOI: 10.1353/hpu.2010.0939] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are close to 15 million Asian Americans living in the United States, and they represent the fastest growing populations in the country. By the year 2050, there will be an estimated 33.4 million Asian Americans living in the country. However, their health needs remain poorly understood and there is a critical lack of data disaggregated by Asian American ethnic subgroups, primary language, and geography. This paper examines methodological issues, challenges, and potential solutions to addressing the collection, analysis, and reporting of disaggregated (or, granular) data on Asian Americans. The article explores emerging efforts to increase granular data through the use of innovative study design and analysis techniques. Concerted efforts to implement these techniques will be critical to the future development of sound research, health programs, and policy efforts targeting this and other minority populations.
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Panapasa SV, Mau MK, Williams DR, McNally JW. Mortality patterns of Native Hawaiians across their lifespan: 1990-2000. Am J Public Health 2010; 100:2304-10. [PMID: 20864716 PMCID: PMC2951954 DOI: 10.2105/ajph.2009.183541] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined mortality patterns across the lifespan of Native Hawaiians and compared mortality disparities across races. METHODS We determined the age-specific and age-adjusted mortality rates of Native Hawaiians from 1990 to 2000 by using national census and vital registration data. RESULTS Among Native Hawaiians aged younger than 1 year, expected deaths were 15% lower than for Blacks and 50% higher than for Whites. Among older adults, Native Hawaiians had higher rates of mortality compared with the general population, particularly in 1990 and 1995. Crude death rates for Native Hawaiians were similar to those for Blacks in 1990 and 1995 but were 20% lower than those for Blacks by 2000. Crude death rates for Native Hawaiians were 30% higher than for Whites in 1990 and 1995 and more than 40% higher than for Whites in 2000. CONCLUSIONS Compared with Whites, Native Hawaiians and Blacks face similar challenges regarding infant and early-life mortality and increasing risks of mortality in mid-life and early old age. Our analyses document a need for renewed efforts to identify the determinants of ill health and commitment to address them.
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Affiliation(s)
- Sela V Panapasa
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA.
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August KJ, Sorkin DH. Racial and ethnic disparities in indicators of physical health status: do they still exist throughout late life? J Am Geriatr Soc 2010; 58:2009-15. [PMID: 20929470 PMCID: PMC2953730 DOI: 10.1111/j.1532-5415.2010.03033.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Physical health problems become more common as people age and are associated with a great deal of disability. Although racial and ethnic disparities have been reported in physical health, little is known about whether these disparities remain in the latest part of older adulthood. Accordingly, the current study sought to examine racial and ethnic differences in the physical health status of three age groups of older adults, using the 2005 and 2007 California Health Interview Survey. The sample for the current study included 40,631 individuals aged 55 and older: 33,488 non-Hispanic whites, 1,858 blacks, 2,872 Asians and Pacific Islanders, and 2,412 Latinos. Respondents were compared with regard to three indicators of physical health: four chronic health conditions, difficulties with activities of daily living, and self-rated health. Analyses were conducted with and without adjustment for sex, marital status, education, English-language proficiency, nativity, and insurance status. Results revealed that, in general, racial and ethnic disparities existed for physical health in late adulthood, with differences less pronounced for Asians and Pacific Islanders and Latinos aged 75 and older after multivariable adjustment. Disparities between blacks and non-Hispanic whites and disparities across all racial and ethnic minorities in self-rated health still existed. These findings suggest that, to reduce racial and ethnic disparities, clinicians need to address specific sociodemographic and lifestyle factors related to racial and ethnic differences in health before these conditions are manifested in late adulthood.
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Affiliation(s)
- Kristin J. August
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, Irvine, California
| | - Dara H. Sorkin
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, Irvine, California
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Shah AM, Guo L, Magee M, Cheung W, Simon M, LaBreche A, Liu H. Comparing selected measures of health outcomes and health-seeking behaviors in Chinese, Cambodian, and Vietnamese communities of Chicago: results from local health surveys. J Urban Health 2010; 87:813-26. [PMID: 20625846 PMCID: PMC2937130 DOI: 10.1007/s11524-010-9469-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We describe how local community organizations partnered to conduct a survey in the Chinese, Cambodian, and Vietnamese populations of Chicago to compare health outcomes and assess progress toward Healthy People 2010 goals. Interviews were conducted with 380 randomly selected Chinese adults through door-to-door sampling, and with 250 Cambodian adults and 150 Vietnamese adults through respondent-driven sampling. Data on 14 key health outcomes are described for this analysis. The three surveyed communities were generally poorer, less educated, more often foreign-born, and had less English proficiency than Asians nationally. There were few significant variations among the three populations, but there were notable differences in the burden of tuberculosis, obesity, diabetes, and arthritis. Insurance coverage and cancer-screening utilization were also significantly lower than for US Asians. Health information about Chinese, Cambodian, and Vietnamese populations in Chicago are available for the first time and serve as baseline data for community interventions. Findings highlight important health concerns for these populations and have implications for funders and policy makers in allocating resources, setting health priorities, and addressing health disparities.
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Affiliation(s)
- Ami M Shah
- Sinai Urban Health Institute, Chicago, IL, USA.
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Weir RC, Tseng W, Yen IH, Caballero J. Primary health-care delivery gaps among medically underserved Asian American and Pacific Islander populations. Public Health Rep 2009; 124:831-40. [PMID: 19894426 PMCID: PMC2773947 DOI: 10.1177/003335490912400611] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them. METHODS We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs. RESULTS We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least 5000. CONCLUSION This project complements federal efforts to identify medically underserved health service areas and identifies U.S. counties that need new or expanded health services for medically underserved AAPIs.
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Affiliation(s)
- Rosy Chang Weir
- Association of Asian Pacific Community Health Organizations, Oakland, CA 94612, USA.
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Gee GC, Ro A, Shariff-Marco S, Chae D. Racial discrimination and health among Asian Americans: evidence, assessment, and directions for future research. Epidemiol Rev 2009; 31:130-51. [PMID: 19805401 PMCID: PMC4933297 DOI: 10.1093/epirev/mxp009] [Citation(s) in RCA: 241] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Research shows that racial discrimination is related to illness among diverse racial and ethnic populations. Studies of racial discrimination and health among Asian Americans, however, remain underdeveloped. In this paper, the authors review evidence on racial discrimination and health among Asian Americans, identify gaps in the literature, and provide suggestions for future research. They identified 62 empirical articles assessing the relation between discrimination and health among Asian Americans. The majority of articles focused on mental health problems, followed by physical and behavioral problems. Most studies find that discrimination was associated with poorer health, although the most consistent findings were for mental health problems. This review suggests that future studies should continue to investigate the following: 1) the measurement of discrimination among Asian Americans, whose experiences may be qualitatively different from those of other racial minority groups; 2) the heterogeneity among Asian Americans, including those factors that are particularly salient in this population, such as ethnic ancestry and immigration history; and 3) the health implications of discrimination at multiple ecologic levels, ranging from the individual level to the structural level.
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Affiliation(s)
- Gilbert C Gee
- School of Public Health, University of California, Los Angeles, CA 90095-1772, USA.
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