Asian And Pacific Islander Research Articles

Disparities in germline testing by race/ethnicity and preferred language in patients with prostate cancer.

112 Background: A remote Genetic Testing Station (GTS) workflow was implemented at an academic medical institution to expand access to genetic testing for patients with prostate cancer. During a telephone appointment, a genetic counselor assistant collects family history and facilitates genetics education, research consent, and remote sample collection for multi-gene panel testing. We compared testing completion and patient loss from workflow based on race/ethnicity and preferred language to identify disparities. Methods: Metrics were collected prospectively and analyzed retrospectively for patients with metastatic or high-grade prostate cancer referred to genetics between 3/15/2020 – 6/30/2022. Self-reported race, ethnicity, and preferred language were collected by chart review. Testing completion was compared between groups using Fisher’s exact test, with White non-Hispanic (WNH) and Preferred Language English (PLE) cohorts as controls. Odds ratios and 95% confidence intervals were reported. Patient loss at workflow checkpoints (scheduling, consenting, sample collection, and results release) was summarized for each group. Results: 827 eligible patients were identified: 78 (9%) Asian /Pacific Islander (API), 51 (6%) Black non-Hispanic (BNH), 42 (5%) Hispanic, and 625 (76%) WNH. 31 patients reporting other non-Hispanic race were not included in the analysis. 30 patients (4%) self-reported Preferred Language non-English (PLNE) and 797 (96%) PLE. BNH patients were significantly less likely to complete testing compared to WNH patients (OR 0.320, 95%CI: 0.168, 0.632, p<0.001). There was no difference in testing completion in API (OR 0.918, 95%CI: 0.467, 1.944, p=0.797) or Hispanic (OR 0.743, 95%CI: 0.325, 1.918, p=0.466) compared to WNH patients. PLNE were significantly less likely to complete testing (OR 0.393, 95%CI: 0.171, 0.965, p=0.016) compared to PLE patients. Patient loss occurred primarily at consenting and sample collection. 14% of BNH, and 9% of Hispanic patients did not consent, compared to 4% of WNH. 17% of PLNE did not consent compared to 5% of PLE patients. 13% of BNH did not return a sample, compared to 3% of WNH patients. Conclusions: In remote GTS, BNH and PLNE patients were significantly less likely to complete germline testing than WNH and PLE patients respectively. Disparities in patient loss were most pronounced at consenting and sample collection. Measures to mitigate disparities include assisted consenting (with interpreter as needed) and video-assisted or in-clinic sample collection. [Table: see text]

Racial disparities in surgical treatment of type A acute aortic dissection

ObjectiveTo determine whether there are racial disparities associated with mortality, cost, and length of hospital stay after surgical repair of type A acute aortic dissection (TAAAD). MethodsPatient data from 2015 to 2018 were collected using the National Inpatient Sample. In-hospital mortality was the primary outcome. Multivariable logistical modeling was used to identify factors independently associated with mortality. ResultsAmong 3952 admissions, 2520 (63%) were White, 848 (21%) were Black/African American, 310 (8%) were Hispanic, 146 (4%) were Asian and Pacific Islander (API), and 128 (3%) were classified as Other. Black/African American and Hispanic admissions presented with TAAAD at a median age of 54 years and 55 years, respectively, whereas White and API admissions presented at a median age of 64 years and 63 years, respectively (P < .0001). Additionally, there were higher percentages of Black/African American (54%; n = 450) and Hispanic (32%; n = 94) admissions living in ZIP codes with the lowest median household income quartile. Despite these differences on presentation, when adjusting for age and comorbidity, there was no independent association between race and in-hospital mortality and no significant interactions between race and income on in-hospital mortality. ConclusionsBlack and Hispanic admissions present with TAAAD a decade earlier than White and API admissions. Additionally, Black and Hispanic TAAAD admissions are more likely to come from lower-income households. After adjusting for relevant cofactors, there was no independent association between race and in-hospital mortality after surgical treatment of TAAAD.

Disparities by Race and Ethnicity in Inpatient Hospitalizations Among Autistic Adults.

This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.

Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system

BackgroundThe COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups.MethodsThis retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n = 556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression.ResultsOf the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and “other Asian” populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR = 2.06, 95% CI = 1.30–3.25), “Other Asian” (OR = 2.13, 95% CI = 1.79–2.54), Filipino (OR = 1.78, 95% CI = 1.34–2.23), Japanese (OR = 1.78, 95% CI = 1.10–2.88), and Chinese (OR = 1.73, 95% CI = 1.34–2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR = 1.58, 95% CI = 1.19–2.10) and mixed race subgroups (OR = 1.55, 95% CI = 1.10–2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant.ConclusionsVariation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations.

Engaging Students with Art‐Based S‐R‐C (Sense of Belonging, Resistance, and Coalition Building) Strategies for Anti‐Racism

AbstractIn this article, we discuss our struggles and efforts to respond to Asian American and Pacific Islander (AAPI) hate crimes and anti‐Asian racism, as well as explore ways to address the issues of anti‐Asian racism, violence, myths, and stereotypes in the art classroom. We researched and learned from contemporary Asian American artists, attended anti‐racism virtual talks, and examined various anti‐racism pedagogical approaches. As an outcome of our research to confront anti‐racism, we developed S‐R‐C strategies to engage students with art‐based anti‐racism, which include facilitating a sense of belonging (S), resisting anti‐Asian racism (R), and coalescing with other minority groups and allies (C). These strategies were developed to fully embrace the equity, diversity, and inclusivity of AAPI sequentially and holistically. This article also reports how we use the S‐R‐C strategies to guide our pre‐service art teachers to confront anti‐Asian racism and advocate for anti‐racism teaching practices.

Understanding Public Opinion Toward the #StopAsianHate Movement and the Relation With Racially Motivated Hate Crimes in the US

#StopAsianHate and #StopAAPIHate are two of the most commonly used hashtags that represent the current movement to end hate crimes against the Asian American and Pacific Islander communities. We conduct a social media study of public opinion toward the #StopAsianHate and #StopAAPIHate movement based on 46 058 Twitter users across 30 states in USA ranging from March 18, 2021 to April 11, 2021. To facilitate fine-grained analyses, the demographic information of the Twitter users, including age, gender, race/ethnicity, social capital, political affiliation, geolocation, family, income, and religious status, is either retrieved from the user profiles or inferred using classifiers. We find that the movement attracts more participation from women, younger adults, Asian, and Black communities. It is noteworthy that most of them are also active in other online movements related to racial or social issues, such as #BlackLivesMatter or #SayHerName; 51.56% of the Twitter users show direct support, 18.38% are news about anti-Asian hate crimes, and 5.43% show a negative attitude toward the movement. By conducting logistic regression, we find that the public opinion varies across user characteristics. Furthermore, among the states with most racial bias-motivated hate crimes, the negative attitude toward the #StopAsianHate and #StopAAPIHate movement is the weakest. The majority of the top influencers are Asian–American reporters, journalists, or politicians. To the best of our knowledge, this is the first large-scale social media-based study to understand public opinion toward the #StopAsianHate and #StopAAPIHate movement. We hope that our study can provide insights and promote research on anti-Asian hate crimes and ultimately help address such a serious societal issue for the common benefits of all communities.

What matters to psychology trainees when making decisions about internship and postdoctoral training sites: Differences between racial/ethnic minority and White VA trainees.

It is projected that by 2045, racial/ethnic minorities in the U.S. will become the majority. Unfortunately, the numbers of racial/ethnic minority psychologists have not kept up with population trends. This discrepancy poses challenges for many psychology training sites, including the Department of Veterans Affairs (VA). There is a lack of data on what factors are important for psychology applicants, including racial/ethnic minority trainees when they are considering internship and postdoctoral training sites. This quality improvement project surveyed 237 VA psychology trainees (59% psychology interns, 32.5% psychology postdoctoral fellows, 69.6% White, 9.3% multiracial, 6.8% Asian American or Pacific Islander, 5.1% Black/African American, 4.2% Latinx American, 0.8% Native American, 0.8% Middle Eastern) to study what factors are important when considering training sites. Results indicated that overall, racial/ethnic minority and White trainees endorsed similar primary factors when considering training programs. Site related factors (e.g., perceived workload, training opportunities) and future work related factors (e.g., ease of licensure, obtaining a first job) were top considerations regardless of race/ethnicity. The groups diverged in secondary factors with racial/ethnic minorities desiring infusion of diversity in training more than White applicants and White applicants considering quality of life factors such as extracurricular opportunities and convenience of daily living more important than racial/ethnic minority applicants. Qualitative data indicated applicants perceived VA training sites to be more welcoming and offer more opportunities for learning about diversity than non-VA sites. Recommendations for recruiting psychology trainees in general, and then specifically for racial/ethnic minority applicants are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Non-small cell lung cancer disparities in stage at presentation and treatment for Asian American, Native Hawaiian, and Pacific Islander women.

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing group in the United States. While described in aggregate, great variations exist within the community. We aimed to determine whether there were differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer (NSCLC). Between 2004 and 2016, we identified 522 361 female patients with newly diagnosed NSCLC from the National Cancer Database. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) of presenting with stage IV disease and not receiving treatment. AANHPI women were more likely to present with stage IV disease compared to White (54.32% vs. 40.28%, p < 0.001). Aside from Hawaiian, Pakistani, and Hmong women, all other ethnic groups had greater odds of presenting with stage IV disease than White women. AANHPI women <65 years were more likely to present with stage IV disease (p = 0.030). Only Vietnamese women showed a significant difference (aOR = 1.30 [1.06-1.58], p = 0.010) for likelihood of receiving treatment compared to White. Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI ethnic groups when populations were disaggregated.

Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study.

The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits. We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs. Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ≥18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity. Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ≥60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use. Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic.

Asians Are Not Interchangeable.

To the Editor: As we celebrate Asian American and Pacific Islander Heritage Month (at the time of writing), we are compelled to address Liu and colleagues’ article by calling on medical schools across the nation to recognize the realities we face. 1 As 2 Asians in the United States, we repudiate the notion of an ethnic monolith deserving of hate by raising awareness of our distinct heritages and challenging the myth of the model minority, which assumes that all Asian American Pacific Islanders (AAPIs) are able to achieve high levels of success, because of their well-educated and hardworking nature. We are 2 AAPI physicians-in-training with unique backgrounds and experiences: Filipino-American and Hong Konger, Asian American and Asian Immigrant, native and non-native English speaker, united by this dialogue. We invite medical schools to join in this dialogue on anti-Asian hate, social invisibility, and the model minority myth by addressing the following 3 areas. First, we urge all medical schools to provide opportunities and scholarships for AAPI-related public health research. AAPI-health research is critically underfunded, comprising only 0.17% of the National Institutes of Health budget between 1992 and 2018. 1 This is exemplified by the shockingly low amount of clinical research dedicated to studying cancer in AAPIs. According to ClinicalTrials.gov, only 5 out of over 10,000 registered trials in January 2013 focused on cancer in AAPIs. 2 If research on the diseases that disproportionately affect AAPI individuals, such as liver and stomach cancers, remain underfunded, the research gap will only widen health disparities between AAPIs and the general U.S. population. Second, we ask medical schools to dismantle the barriers to success that AAPI individuals face by introducing inclusion efforts, mentorship, and career counseling. The “bamboo ceiling,” long-standing barriers in AAPI career advancement due to institutional racism, is especially salient in medicine. Compared with other ethnic groups, Asians experience a large disparity between the percentage of department chairs relative to the number of full-time faculty. 3 Third, we urge medical schools to overcome implicit bias and discrimination by integrating dialogue on the effects of anti-Asian hate within antiracism curriculum. Despite the success of AAPIs in medicine, we must not overlook the tragic history of anti-Asian sentiment in the United States, from the Chinese Exclusion Act of 1882, to the WWII Japanese internment camps, to the anti-Asian hate crimes that have risen in recent years. 1 These moments have had a profound impact on AAPIs, with race events since the COVID-19 pandemic as a particular concern for AAPI well-being and safety. As the fastest growing ethnicity group in the United States, 4 we urge all medical schools to proactively develop policies that demonstrate equity, justice, dignity, and respect toward the AAPI community.

The role of community and culture in abortion perceptions, decisions, and experiences among Asian Americans.

Culture and community can play a role in views, stigma, and access related to abortion. No research to date has documented the influence of culture and community attitudes on Asian American (AA) experiences accessing abortion care in the United States (US). This paper aims to fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs. We used a community-based participatory research approach, which included collaboration among experts in public health, advocates, practitioners, and community partners to understand abortion knowledge, attitudes, and experiences among AAs. Using a semi-structured interview guide, we interviewed twenty-nine eligible people of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander (AANHPI), and had a medication abortion in the US between January 2016 and March 2021. Interviews were analyzed and coded in NVivo 12 using a modified grounded theory approach. Participants described various influences of religion negatively impacting acceptability of abortion among their family and community. Lack of openness around sexual and reproductive health (SRH) topics contributed to stigma and influenced most participants' decision not to disclose their abortion to family members, which resulted in participants feeling isolated throughout their abortion experience. When seeking abortion care, participants preferred to seek care with providers of color, especially if they were AANHPI due to past experiences involving stigma and judgment from White providers. Based on their experiences, respondents recommended ways to improve the abortion experience for AAs in the US including, (1) more culturally aware abortion providers from one's community who better understand their needs; (2) clinics providing abortion services located in or near AA communities with signage in local languages; and (3) tailored mental health resources with culturally aware therapists. This study demonstrates ways in which culture and community opinions toward SRH can influence both the acceptability of abortion and experiences seeking abortion care among AAs. It is important to consider family and community dynamics among AAs to better tailor services and meet the needs of AAs seeking abortion care in the US.

Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection

There is a disproportionately greater burden of COVID-19 among Hispanic and non-Hispanic Black individuals, who also experience poorer cancer outcomes. Understanding individual-level and area-level factors contributing to inequities at the intersection of COVID-19 and cancer is critical. To evaluate associations of individual-level and area-level social determinants of health (SDOH) with delayed or discontinued cancer treatment following SARS-CoV-2 infection. This retrospective, registry-based cohort study used data from 4768 patients receiving cancer care who had positive test results for SARS-CoV-2 and were enrolled in the American Society for Clinical Oncology COVID-19 Registry. Data were collected from April 1, 2020, to September 26, 2022. Race and ethnicity, sex, age, and area-level SDOH based on zip codes of residence at the time of cancer diagnosis. Delayed (≥14 days) or discontinued cancer treatment (any cancer treatment, surgery, pharmacotherapy, or radiotherapy) and time (in days) to restart pharmacotherapy. A total of 4768 patients (2756 women [57.8%]; 1558 [32.7%] aged ≥70 years at diagnosis) were included in the analysis. There were 630 Hispanic (13.2%), 196 non-Hispanic Asian American or Pacific Islander (4.1%), 568 non-Hispanic Black (11.9%), and 3173 non-Hispanic White individuals (66.5%). Compared with non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were more likely to experience a delay of at least 14 days or discontinuation of any treatment and drug-based treatment; only estimates for non-Hispanic Black individuals were statistically significant, with correction for multiple comparisons (risk ratios [RRs], 1.35 [95% CI, 1.22-1.49] and 1.37 [95% CI, 1.23-1.52], respectively). Area-level SDOH (eg, geography, proportion of residents without health insurance or with only a high school education, lower median household income) were associated with delayed or discontinued treatment. In multivariable Cox proportinal hazards regression models, estimates suggested that Hispanic (hazard ratio [HR], 0.87 [95% CI, 0.71-1.05]), non-Hispanic Asian American or Pacific Islander (HR, 0.79 [95% CI, 0.46-1.35]), and non-Hispanic Black individuals (HR, 0.81 [95% CI, 0.67-0.97]) experienced longer delays to restarting pharmacotherapy compared with non-Hispanic White individuals. The findings of this cohort study suggest that race and ethnicity and area-level SDOH were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.

Challenges accessing contraceptive care and interest in over-the-counter oral contraceptive pill use among Black, Indigenous, and people of color: An online cross-sectional survey

ObjectiveTo examine challenges accessing contraception in the past year and their association with interest in using an over the counter (OTC) oral contraceptive pill (OCP) among Black, Indigenous, and people of color (BIPOC) in the United States. Study DesignFrom May 2021 to March 2022, a collaborative research team conducted a cross-sectional online survey using convenience sampling to recruit people who identify as Asian American, Native Hawaiian, or Pacific Islander, Black or African American, Indigenous, or Latina/Latinx and used or wanted to use a contraceptive method in the past year. Respondents were recruited through reproductive justice and community-based organizations. ResultsAmong 727 respondents, 45% reported experiencing at least one challenge accessing contraception in the past year of which 37% reported a logistical challenge, and 20% reported an interpersonal challenge. Sixty-seven percent of respondents said they were likely to use an OTC OCP. Respondents who reported experiencing at least one challenge accessing contraception in the past year were more likely to say they would use an OTC OCP. Fifty-seven percent of respondents who were not using a contraceptive method in the past year reported they were likely to use an OTC OCP. ConclusionAmong people in this study, interest in an OTC OCP is high, particularly among those who have faced challenges accessing contraception, and among those who are not currently using a contraceptive method. ImplicationsAvailability of an OCP OTC has the potential to address challenges accessing contraceptive care among BIPOC in the United States, who are often impacted by structural inequities and racism. Findings from this study can inform future OTC implementation strategies to ensure OTC access addresses logistical and interpersonal challenges.

Stop Asian hate: The mental health impact of racial discrimination among Asian Pacific Islander young and emerging adults during COVID-19

BackgroundThe rapid surge in anti-API discrimination and assault during the COVID-19 pandemic has the potential to exacerbate mental health disparities already pervasive among API populations. The primary of this study was to understand the impact of the pandemic and COVID-related discrimination on API college and university student mental health. MethodsSecondary data was used from three administrations (Fall 2019, Spring 2020, and Fall 2020) of the Healthy Minds Study (HMS). We conducted Chi-square analyses to analyze differences in mental health symptoms across the three academic semesters. Cross-sectional multivariable logistic regression models were utilized to examine the association between COVID-related discrimination and mental health symptoms and help-seeking behavior during Spring 2020 and Fall 2020. ResultsComparing Fall 2019 to Fall 2020, we found that API students reported a 17 % increase in severe depression and a 30 % increase in severe anxiety. Mental health treatment utilization among those experiencing clinically-significant mental health problems decreased by 26 % between Fall 2019 and Spring 2020. COVID-related discrimination was associated with greater odds of severe depression in both Spring 2020. LimitationsHMS does not include a random sample of campuses as schools themselves elect to participate. Analyses rely on self-report data. ConclusionsThroughout the COVID-19 pandemic, API students reported significant increases in clinically-significant mental health symptoms and decreases in treatment utilization. Our analyses also suggest that COVID-related discrimination is correlated with greater odds of clinically-significant mental health symptoms, including severe depression and severe anxiety, as well as lower odds of treatment utilization.

Examining the Scarcity of Asian America and Pacific Islander Presidents and Chancellors in North American Universities: Implications for Strategic Executive Advancement

The lived experiences of eight Asian American and Pacific Islander (AAPI) university presidents and chancellors in North America revealed the racism and discrimination these Asian academic executives faced and provided counternarratives to dismantle a White normative perspective. While these executive stories were meant to be understood as a unique journey of each academician, common themes and subthemes emerged relating to AAPI academic advancement. The lived experiences of these Asian executives focused on the prevalence of institutional racism, along with the remediation of social injustice through power redistribution to AAPI higher education leaders.

PS-P03-2: RACIAL AND ETHNIC DISPARITIES IN HYPERTENSION CONTROL IN AN INTEGRATED HEALTHCARE SYSTEM IN THE UNITED STATES, 2008–2019

Objective: To determine whether racial/ethnic disparities in control of hypertension changed from 2008 through 2019 within a large and diverse integrated healthcare system that implemented a series of health care delivery changes in 2011 to address disparities in hypertension control. Design and method: We evaluated hypertension control, defined as systolic BP &lt; 140 mmHg and diastolic BP &lt; 90 mmHg, among adults age 18 years and older with diagnosed hypertension identified from a clinical hypertension registry, stratified by race/ethnicity (self-reported as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, or Asian or Pacific Islander (API)) from 2008–2019. Results: Between 2008 and 2019, the population with hypertension increased from 624,094 to 855,257. Mean age was 61.8 years in 2008 and increased to 64.5 years in 2019; ∼52% of the population in each year was female. The proportion of NHW and NHB adults decreased during this period from 45.4% to 38.8% and 14.3% to 12.5%, respectively, while the proportion of API and Hispanic adults increased from 9.8% to 12.6% and 25.2% to 33.0%, respectively. The overall age-adjusted estimated proportion with controlled hypertension increased from 2008 to 2013 from 74.3% (95% CI, 74.1%-74.6%) to 83.0% (95% CI, 82.8%-83.2%) and then decreased from 2014 to 2019 from 81.1% (95% CI, 80.9%-81.3%) to 79.3% (95% CI, 79.1%-79.4%). This trend was present in men and women across all races/ethnicities (Figure). In each year, API adults had the highest and NHB adults had the lowest age-adjusted estimated proportion with controlled hypertension. The disparity in controlled hypertension between NHW and NHB women was 5.7% (p &lt; .001) in 2008 and decreased to 1.6% (p &lt; .001) in 2015 and increased to 2.7% (p &lt; .001) by 2019. In 2008, the disparity in controlled hypertension between NHW and NHB men was 7.1% (p &lt; .001) and decreased to 2.8% (p &lt; .001) in 2016 and increased to 3.7% (p &lt; .001) by 2019. In 2019, NHB adults were more likely to have uncontrolled hypertension compared with NHW adults (multivariable-adjusted prevalence ratio, 1.13 [95% CI, 1.12–1.14]). Conclusions: While disparities in hypertension control have narrowed between NHB and NHW adults in this integrated healthcare system, differences persist. Understanding these differences can help identify continued unmet needs and guide more equitable health care to reduce the burden of hypertension-related cardiovascular disease.

Minority groups underrepresented in hematologic cancer trials

Minority groups underrepresented in hematologic cancer trials

Abstract C119: Rising incidence and racial disparities of early-onset endometrial cancer in the United States, 1995-2018

Abstract BACKGROUND: Endometrial cancer (EC) is the most common gynecologic cancer and the fourth most common cancer among women in the United States (US). Although early-onset endometrial cancer (EOEC, diagnosed under age 50) is relatively uncommon, several studies have reported the incidence of EOEC has been increasing in recent decades. Because few studies have examined differences in incidence trends across race/ethnicity between EOEC and late-onset endometrial cancer (LOEC, diagnosed at age 50 or older), we compared the incidence trends between EOEC and LOEC in the US by race/ethnicity across two decades. METHODS: We used the CiNA Analytic File, 1995-2018, Public Use, obtained from the North American Association of Central Cancer Registries (NAACCR) and identified 930,176 invasive endometrial cancer cases (ICD-O-3 site code C54.1, excluding histology codes 9050-9055, 9140, and 9590-9992), of which 12.6% were EOEC and 87.4% LOEC. We examined the characteristics of these cases including race/ethnicity, year of diagnosis, tumor stage and grade by EOEC and LOEC status. We calculated the yearly race/ethnicity-specific age-adjusted incidence rates (AAIR) and the average annual percent change (AAPC) in the AAIRs for EOEC and LOEC respectively. RESULTS: Compared with LOEC cases, women with EOEC were less likely to be non-Hispanic (NH) White, more likely to be Hispanic or NH Asian/Pacific Islander (API), and less likely to have advanced stage or poorly differentiated grade. The AAIRs were highest in NH Whites in 1995 for both EOEC and LOEC. By 2018, the highest AAIR was found in Hispanics for EOEC and in NH Blacks for LOEC, resulting from faster increases in EC risk among the non-white groups. AAIRs for EOEC and LOEC increased over the study period, with the overall AAPC being three times as high for EOEC as LOEC (AAPC 1.72 vs. 0.57). For EOEC, the largest increases were observed in NH Blacks (AAPC=3.52) followed by Hispanics (AAPC=2.77) and NH API (AAPC=2.06). For LOEC, the largest increases were observed in NH APIs (AAPC=2.42) followed by NH Blacks (AAPC=2.28) and Hispanics (AAPC=1.71). For both EOEC and LOEC, the AAPCs were highest in NH Blacks and lowest in NH Whites. CONCLUSIONS: The faster increases in EOEC incidence among NH Black, Hispanic, and NH API women likely reflect racial/ethnic differences in the prevalence and trends of endometrial cancer risk factors. This indicates that these higher-risk populations might benefit from targeted surveillance and interventions. Future studies should evaluate whether these differences across race/ethnicity are attributable to specific tumor characteristics, biomarkers, or other sociodemographic factors. Citation Format: Talar S. Habeshian, Lihua Liu, Juan-Juan Zhang, Margaret Du, Immaculata De Vivo, Veronica W. Setiawan. Rising incidence and racial disparities of early-onset endometrial cancer in the United States, 1995-2018 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C119.

Abstract C118: Differences in cervical cancer incidence and screening rates in Guam

Abstract Background: Guam population is 85.9% Asian-Pacific Islander. The cervical cancer incidence and mortality rates are higher on Guam than in the US (9.8 vs 7.4 and 7.6 vs 2.3 respectively; per 100,000 women, aged adjusted, based on 2013-2017 cases and deaths). The purpose of this study was to explore the differences in cervical cancer incidence and screening among ethnic groups on Guam. Methods: This study included 171 in situ and 146 malignant cases reported to Guam Cancer Registry from 1998-2017 (N = 317) with known age and ethnicity. The negative binomial regressions were used to compare rates adjusted for age among CHamoru (N = 189), Filipino (N = 69), and Micronesian women (N = 63) by behavior. The 2012-2018 Behavioral Risk Factor Surveillance System (BRFSS) data was utilized to compare the Pap testing screening behaviors among three major ethnic groups on Guam; including 1077 Filipino, 1598 CHamoru, and 257 Micronesians women. The primary outcome was self-reported Pap testing within 3 years (yes/no). The multivariable logistic regression model was used to assess the differences in Pap testing by ethnicity after adjusting for covariates. Results: The incidence rate ratio (IRR) of invasive cases was significantly higher for CHamoru and Micronesian women when compared to Filipino women (IRR=2.04, 95% CI: 1.19-3.49, and IRR=4.89, 95% CI: 2.69-8.86 respectively). For in-situ cases, only CHamoru women had significantly higher rates than Filipino women (IRR=2.17, 95% CI=1.23-3.86). Pap testing prevalence differed significantly between ethnic groups even after adjusting for age, income level, education level and marital status (p&amp;lt;0.001). Compared to Filipino women, CHamoru women were more likely to receive Pap test (OR=1.56, 95% CI: 1.30-1.87), and Micronesian women were less likely to be screened (OR=0.70, 95% CI: 0.52-0.94). Conclusions: There were significant differences in cervical cancer incidence and screening rates. Micronesian women had the highest invasive incidence rate but the lowest screening rates. There is a need for more outreach effort on Guam. Citation Format: Louis Dulana, Rodney Teria, Renata Bordallo, Lynne Wilkens, Grazyna Badowski. Differences in cervical cancer incidence and screening rates in Guam [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C118.

Skilled Resilience: Revitalizing Asian American and Pacific Islander Entrepreneurship Through AI-Driven Social Media Marketing Techniques

Skilled Resilience: Revitalizing Asian American and Pacific Islander Entrepreneurship Through AI-Driven Social Media Marketing Techniques