Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study

Nancy P Gordon,Jyoti Rau,Teresa Y Lin,Joan C Lo

doi:10.1186/s12889-019-7683-3

Abstract

BackgroundFew large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group.MethodsThis study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos.ResultsWe found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI ≥ 27.5 kg/m2 threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks.ConclusionsIn a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.

Highlights

Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs)
Prevalence among women in the All Asian group was 41.6% and 44.1% among men, with no significant sex difference observed for PIs
Using our criteria for meaningful differences, the only health condition for which the prevalence estimates for the majority of Asian ethnic groups were not meaningfully different from the aggregated Asian estimate was CAD in the 65–84 age group

Summary

Introduction

Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). Asian-Americans are among the fastest growing of all major racial or ethnic groups in the United States [1]. There is scant information about Asian-American health and healthcare utilization. State and national health surveys have generally not reported statistics for Asian-Americans, in part due to survey subgroup samples that are insufficiently-sized for producing stable prevalence estimates. Despite the cultural and sociodemographic heterogeneity of the Asian-American population, when Asian health data are reported, the statistics are seldom disaggregated by ethnic group and often include Native Hawaiian/Pacific Islanders (PI). There is currently little available information to examine differences in health and healthcare use among Asian and PI ethnic groups and how health characteristics of individual Asian ethnic groups differ from characteristics of the broader Asian/PI group [4]

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