Asia Pacific Research Articles

Cardiovascular Care and Research in the Asia-Pacific Region during the COVID-19 Pandemic: Insights from Early and Mid-career Physicians

Background: The COVID-19 pandemic imposed a significant burden on healthcare systems in the Asia-Pacific region and has had a varying impact on physicians at different stages of their career. This study sought to evaluate the personal perspectives and the experiences of early and mid-career cardiologists and cardiothoracic surgeons with regard to the impact of the pandemic in the region. Methods: A cross-sectional web-based survey was conducted from June to July 2023 among members of the Asian Pacific Society of Cardiology (APSC) young community. The survey aimed to assess the impact of COVID-19 on cardiovascular clinical care and research activities that contained sections on demographic information, pandemic-related clinical and research experiences, personal stories, and interest in long-COVID research. Results: Overall, 60 physicians (44%) in the APSC young community responded to the survey. Cardiovascular disease patient numbers initially dropped in 2020 during the pandemic’s early stages but gradually increased in the following 3 years. Non-cardiovascular patient care workloads also rose during the first 2 years of the pandemic. Respondents observed notable changes in clinical care, research and personal life. Positive aspects included increased adaptability and telemedicine adoption, while challenges involved higher workloads and stress. More than 70% expressed interest in understanding the impact of long COVID, with Southeast Asian members showing the highest levels of interest. Conclusion: This survey conducted in the aftermath of the pandemic shed light on the challenges experienced by early to mid-career Asia-Pacific cardiovascular physicians. Physicians at this career stage encounter distinctive hurdles that require thoughtful consideration and effective solutions.

Coronary Lesion Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction and No Standard Modifiable Risk Factors: analysis of Data From Across the Asia Pacific Region

Coronary Lesion Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction and No Standard Modifiable Risk Factors: analysis of Data From Across the Asia Pacific Region

Disaggregating Data Regarding Suicidal Ideation and Suicide Attempts among Post-9/11 Asian American and Pacific Islander Veterans

The suicide rate among Asian American and Pacific Islander veterans has increased; however, data aggregation for these groups, combined with underinclusion in research, limits understanding regarding risk. We conducted a secondary analysis of Comparative Health Assessment Interview Research Study 2018 data to compare suicidal ideation (SI) and suicide attempt (SA) prevalence among 668 post-9/11 veterans who identified as Asian American, Pacific Islander, or both and described SI and SA prevalence among specific subgroups. Veterans who identified as both Asian American and Pacific Islander were more likely to report experiencing SI (lifetime and during their military service), compared to those who identified solely as Asian American or Pacific Islander (military SI only). Statistically significant differences were not detected for SI preceding or following military service or for lifetime SA. Weighted estimates for lifetime SI and SA were 24.2% and 6.5%, respectively, and prevalence varied widely among specific Asian American and Pacific Islander groups. However, small cell sizes and wide confidence intervals were limitations. Increased clinical attention to screen for and mitigate suicide risk among veterans who identify as both Asian American and Pacific Islander may be warranted. To ensure that suicide prevention strategies optimally address their needs and experiences, research is needed to elucidate suicide drivers in this population. Considering the heterogeneity in SI and SA prevalence among different Asian American and Pacific Islander groups, continued research with larger subsamples that disaggregates analyses by race and ethnicity is essential to deliver prevention and health promotion strategies targeted to the highest-risk groups.

Precipitation variation in the northern South China Sea of the last 700 years reconstructed by lagoon sediments

Precipitation changes in the East Asia are closely linked to the monsoonal climate in this region and the hydrothermal processes in the western tropical Pacific. However, trends of reconstructed precipitation records for the past millennium are inconsistent and the influencing factors are in dispute. Here we reconstruct a 700-year precipitation record for the northern South China Sea (SCS) using grain size of lagoon sediments. Our data revealed that precipitation increased in the early to middle Little Ice Age, possibly modulated by tropical cyclones and the Walker Circulation. The East Asian Summer Monsoon and Pacific Decadal Oscillation had the major influence on the precipitation changes in the northern SCS. This study provides new insight into the processes and the underlying mechanisms of climate changes in the SCS.

Asia Pacific Journal of Tourism Research: a bibliometric analysis from 1996 to 2023

ABSTRACT Asia Pacific Journal of Tourism Research was created in 1995 and published articles in 1996. This study analyzes the journal using bibliometric methods for 1243 articles published in the journal from 1996 to 2023. It uses several indicators to demonstrate the journal's performance and contributions. The study shows that the most productive country and author are China and Rob Law, respectively. Furthermore, the collaboration, co-citation, and co-occurrence networks are created using Gephi, VOSviewer, and CiteSpace. This study provides a comprehensive overview and APJTR may later focus on topics such as tourist destinations, consumer behavior, smart tourism, and sustainable development.

Interannual variation of the westward ridge point of the Western Pacific subtropical high in boreal winter

This study adopts a novel dynamic index of the westward ridge point (WRP) of the western Pacific subtropical high (WPSH) to investigate the interannual variation of the WPSH in boreal winter. The WRP index based on the theory of gradient wind approximation is particularly suitable for boreal winters. The WRP index comprises two dimensions that depict the zonal and meridional movement of the WPSH, respectively. There is a significant positive correlation between the zonal WRP index and the meridional WRP index. When the WPSH gets stronger, the WRP and the WPSH shift equatorward while advancing westward, and vice versa. The zonal and meridional shifts of the WPSH have distinct impact on the climate anomalies in the western North Pacific and East Asia. The northward shift of the WPSH characterizes a cyclonic-anticyclonic pair over western North Pacific, whereas the eastward shift of the WPSH characterizes a cyclonic anomaly over the subtropical western North Pacific. The anomalies of precipitation and surface air temperature vary accordingly. The meridional shift of the WPSH is closely associated with the El Niño-Southern Oscillation (ENSO) Sea Surface Temperature (SST) anomalies. The WRP index also demonstrates robust predictability in the hindcast data from ENSEMBLES, suggesting its far-reaching potential for climate prediction.

Effectiveness of Technology-Delivered Psychosocial Interventions for Family Caregivers of Patients With Dementia: A Systematic Review, Meta-Analysis and Meta-Regression.

Family caregivers living with patients with dementia (PwD) face psychological challenges due to care burden. Technology-delivered psychosocial interventions (TPIs) have played a promising role in improving health outcomes among family caregivers living with PwD. This review aims to synthesise evidence of the effectiveness of TPIs on primary (burden and depression) and secondary outcomes (self-efficacy, stress and anxiety) for family caregivers living with PwD. Random-effects meta-analyses were performed to determine effect size. Using Cochran's Q and I2 tests, statistical heterogeneity was evaluated. Sensitivity, subgroup analyses and meta-regression were employed to explain statistical heterogeneity. Twenty-eight trials comprising 4160 family caregivers from eight countries were included. Our meta-analysis revealed that TPIs resulted in slight reduction in depression, probably resulted in a slight reduction in burden and anxiety and slight increase in self-efficacy. Subgroup differences were detected in geographical regions (Western Pacific and Southeast Asia) for burden. While there were no significant subgroup differences in other factors, TPIs with preventive function and mobile applications had a more prominent larger effect size. Meta-regression analysis showed that attrition rate was a significant moderator on depression. Results are limited by the high risk of bias of included trials, which may reduce certainty of evidence. This review suggest TPIs are recommended as an adjunct treatment for alleviating burden and depressive outcomes in healthcare institutions. PROSPERO Registration Number: PROSPERO (CRD42023387962).

The nexus between mineral, renewable commodities, and regional stock sectors during health and military crises

We examine the return and volatility spillover dynamics and their portfolio implications among regional stock super-sectors, mineral (Energy, Industrial, and Precious Metals), and renewable (Agricultural and Livestock) commodities. To this end, we apply the time-varying parameter-vector autoregressive (TVP-VAR) model to analyze the intersectoral-commodity linkages separately in four major regions (Europe, Eastern Europe, Asia Pacific, and North America). The empirical results show that stock market sectors dominate the spillover transmission mechanism, while commodities emerge as net recipients of shocks. Moreover, we find heterogeneous connectedness patterns between stock sectors and commodities, predominantly running from the Energy and Basic Resources stocks to the Energy and Industrial Metals commodities. Thus, energy commodities play a more vital role as a spreader of volatility shocks amid the COVID-19 pandemic and the wake of the Russia-Ukraine war. The optimal portfolio weights reflect two episodes of “flight to safety” towards all commodities except Energy, triggered by the pandemic and the war, as investors decrease their fund allocation to stocks in favor of commodities.

Promoting Diversity, Equity, and Inclusion for Asian Americans and Pacific Islanders in Speech-Language-Hearing Sciences

Purpose: The purpose of this viewpoint is to outline and describe the Asian Pacific Islander (API) Speech-Language-Hearing Caucus's initiatives to promote diversity, equity, and inclusion for Asian Americans and Pacific Islanders (AAPIs) in speech-language pathology and audiology. Specifically, we discuss the caucus's efforts through research and community advocacy. Through research, the Counter Story Project, led by Breslin et al. (2022), was a qualitative study that documented and analyzed systemic racism experienced by AAPI professionals. Thematic findings revealed microaggressions in professional settings and racial overgeneralizations on AAPIs' communication and cultural upbringing. Through community advocacy, the caucus provides a wide array of programs and events, including Anti-Racism Learning Community, API Speaker Series, Bilingual Assessment and Treatment Resources, Career Panel, API Caucus Research and Clinical Symposium, Graduate School Panel, API Scholarship, and API Mentorship Program. Conclusion: Through these initiatives, the caucus strives for recruitment and retention of AAPI audiologists and speech-language pathologists to achieve its long-term mission of providing accessible and quality speech, language, and hearing services to AAPI communities in the United States.

The changing mix of fossil fuels used and the related evolution of CO2 emissions

To limit global climate change, ultimately it will be necessary to minimize the use of all fossil fuels for energy. Because the rate of CO2 emissions per unit of primary energy varies among the fossil fuels, it is useful to focus first on reducing the use of coal, the fuel with the most CO2 per unit of energy used. Although multiple factors are involved in the choice of which fuel will be used for a given purpose, data on CO2 emissions show that over the last 25 years there has been an evolution in the fraction of emissions away from coal and toward natural gas. That is, although total emissions have continued to increase globally, the fraction attributable to coal has been decreasing in many places. This is true for the global sum of emissions, for Annex I countries, and for all regions except Asia Pacific. The fraction of emissions from oil products has varied largely with growth in the contribution of petroleum transportation fuels. Focus on decreasing the sum of all fossil fuels is needed, especially among the major energy users in the Asia Pacific region, but progress in the decreasing relative use of coal is promising.

Oceania in the Desert: A QuantCrit Analysis of the (Under)Counting of Native Hawaiian and Pacific Islander Students at an AANAPISI-HSI

Most education research uses the National Center for Education Statistics (NCES) Integrated Postsecondary Education Data System (IPEDS), often leaving the logic undergirding the IPEDS racial classification system (i.e., categorization and counting) unquestioned. Framed by Quantitative Critical Race Theory (QuantCrit) principles, this research demonstrates how the NCES IPEDS racial classification misrepresents and undercounts students. Specifically, we show how IPEDS guidance around racial classification misrepresents the number of Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) undergraduates, with particular attention to NHPI students, at a single institution. We show the ways in which IPEDS logic leads to undercounting, namely that, based on the NCES IPEDS racial classification system, most undergraduates identifying as NHPI are classified as Two or More Races and Hispanic or Latino. A similar pattern of suppression is found to varying degrees for students identifying as American Indian or Alaska Native, Asian, and Black or African American. Our findings complicate the taken-for-granted nature of IPEDS racial classification and have implications for serving racially minoritized student groups and for institutions that may qualify as enrollment-based Minority-Serving Institutions.

Exploring the Radical Potential of Queer AZN and Pasifika CRT for Clinical Social Work Praxis

ABSTRACT In the wake of the COVID-19 pandemic, the crisis in Palestine, and the continued rise in hate crimes against Asian American and Pacific Islander (AAPI) communities, clinical social work praxis centering on the intersectional identities of queer and transgender AAPI communities has never been more vital. Through the visioning of an approach that addresses these intersecting identities and our own experiences with racism, cisheterosexism, and transphobia, we propose a theoretical framework, Queer AZN and Pasifika Critical Race Theory (CRT), for clinical social work praxis. Specifically, we describe six tenets of a Queer AZN and Pasifika CRT approach, which include (1) Queer, Brown Asianization; (2) Challenging mainstream ideologies about Asians, Pacific Islanders, Queer and Transgender Pacific Islanders, and Queer and Transgender Asian Americans; (3) Global, decolonial perspectives; (4) Re-constructive histories; (5) Multidisciplinary story, practice, praxis, and voice; and (6) a Social Justice perspective. We present cases as an opportunity to explore and reflect on clinical social work practice with queer and trans AAPI people through the lens of Queer AZN and Pasifika CRT.

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021. Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs). In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates. Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions. Bill and Melinda Gates Foundation.

Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review.

Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs. The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing. Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies. Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services. This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.

Climate-Induced Migration: Conflict Resolution and Legal Efforts in Pacific, Africa, and South Asia

Climate-induced migration involves people relocating caused by detrimental climate changes affecting their living environment. Pacific, Africa, and South Asia have experienced climate-induced migration resulting from extreme weather events, sea level rise, drought and desertification, and temperature extremes. The purpose of this research is to find out in terms of conflict resolution, what legal efforts have been made by the government of the affected regions to address climate-induced migration. This study uses descriptive qualitative method and case studies. Based on the results obtained from the data, it was found that the affected governments are pursuing various legal efforts to be able to tackle climate-induced migration. Several efforts made, namely “Migration with Dignity” policy, the Pacific Adaptation to Climate Change (PACC) Project, Great Green Wall initiative, the African Union’s Regional Economic Communities (RECs), Bangladesh’s Climate Change Strategy and Action Plan (BCCSAP), the South Asian Association for Regional Cooperation (SAARC) Disaster Management Centre, and India’s National Action Plan on Climate Change (NAPCC). The regional initiatives mentioned earlier play pivotal roles in implementing these frameworks and fostering collaborative endeavors, whilst the innovative legal frameworks, guided by SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) indicators, ensure that climate-induced migration is addressed effectively. To sum up, dealing with climate-induced migration requires a holistic approach involving regional collaboration and innovative legal frameworks.

An accounting perspective on the IFRS sustainability reporting standards for greenhouse gas emissions: implications for the Asia Pacific

ABSTRACT From an accounting perspective, we critically review the IFRS sustainability standards regarding its acceptability. The sustainability standards have serious implementation issues due to (1) their lack of financial reporting framework; (2) high compliance cost issues, particularly for entities in developing countries; (3) forward-looking disclosure requirements; (4) triple cost burden for the measurement, attestation and increased audit involvement for GHG emissions; (5) the possibility of compromised audit quality; and (6) issues with financed emissions. IFRS does not have accounting standards for recognizing, measuring and presenting climate-related financial statement items. As a result, diverse methods for climate-related accounting are practiced. IFRS must set GHG-related accounting standards to culminate the goal of integrating sustainability reporting into the financial reporting framework. In the Appendix, we developed two illustrative examples as temporary guidance to help the regulated entities recognize GHG-related financial statement items until IFRS releases the standards.

Trends and Distribution of Infertility - Asia Pacific Region, 1990-2021.

Infertility represents a significant global public health concern, impacting approximately 15% of couples of reproductive age worldwide. Despite this, data on infertility prevalence in the demographically diverse Asia-Pacific region remains sparse. This study examines the trends and distribution of infertility in the Asia-Pacific region from 1990 to 2021, revealing a significant increase in female infertility. The growth rate of secondary infertility has exceeded that of primary infertility. Additionally, an increase in the prevalence of polycystic ovary syndrome (PCOS) may be a significant contributor. The research also highlights geographical variations in the prevalence and trends of infertility across different countries. The findings emphasize the significance of sexual and reproductive health services and rights in safeguarding fertility.

Serotype distribution of invasive pneumococcal disease from countries of the WHO Africa, Americas, Eastern Mediterranean, South-East Asia, and Western Pacific regions: a systematic literature review from 2010 to 2021.

Most publications on invasive pneumococcal disease (IPD) serotype distribution are from about 20 countries (Australia, Canada, China, European Union members, Japan, New Zealand, South Korea, and USA). Here, we reviewed the literature among underrepresented countries in the Americas (AMRO), Africa (AFRO), Eastern Mediterranean (EMRO), South-East Asia (SEARO), and Western Pacific (WPRO) WHO regions. We performed a systematic review of the most recent IPD serotype surveillance publications (from 01/01/2010 to 31/12/2021, Medline/Embase) in those WHO regions. Selection criteria were delineated by contemporality, within-country geographical scope, and number of samples. Reported serotype distributions for each country were stratified by age group, pneumococcal conjugate vaccine (PCV) serotype category (considering undifferentiated serotypes), and PCV program period (pre-PCV, intermediate, or PCVhv [higher valency PCV formulation]). Pre-PCV period pooled data estimated PCV serotype category distribution by age group across WHO regions, while for the PCVhv period, country-level dataset tables were prepared. Of 2,793 publications screened, 107 were included (58 pediatric, 11 adult, 37 all ages, and one comprising every age group). One-third of eligible countries (51/135) published serotype distribution, ranging from 30 to 43% by WHO region. Considering number of samples per WHO region, a few countries prevailed: AMRO (Brazil), AFRO (South Africa, Malawi, and Burkina Faso), and WPRO (Taiwan). In the pre-PCV period, PCV13 formulation serotypes predominated: ranging from 74 to 85% in children and 58-86% in adults in the different WHO regions. The PCVhv period represented half of the most recent IPD surveillance by countries (26/51). Undifferentiated serotypes represented >20% of IPD from most countries (34/51). Ubiquity of undifferentiated serotypes among the publications could constrain estimates of PCV program impact and of serotype coverage for newer PCVhv formulations; consequently, we recommend that countries favor techniques that identify serotypes specifically and, rather than reporting PCV formulation serotype distributions, provide serotype results individually. The protocol has been prospectively registered at PROSPERO, identifier: CRD42021278501. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278501.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004-2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. Among 775,289 individuals diagnosed with cancer (median age: 68years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60-0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81-0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44-0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74-0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32-2.75], P = 0.001; Hawaiian AOR 2.09, [1.20-3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21-2.43], P = 0.001; Hawaiian AOR 1.70, [1.08-2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70-2.17], P < 0.001; Hawaiian AOR 2.95, [2.5-3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34-1.96], P < 0.001). Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.

A spatially-explicit sensitivity analysis of urban definitions: Uncovering implicit assumptions in the Degree of Urbanisation

We introduce a spatially-explicit sensitivity framework to uncover potential biases in urban delineation approaches. Our starting point is that there is no broadly shared agreement on how to define or delineate urban areas, neither in terms of methods nor in terms of thresholds or criteria. Deciding on delineation criteria thus inevitably involves making certain assumptions that may unwittingly reproduce urban realities experienced by those expressing them, and have spatially unequally distributed implications. Understanding how specific criterion choices shape our understanding of ‘the urban’ and how, why, and – especially – where a definition leads to specific sensitivities is therefore key, especially when the definition is utilised beyond its intended application. Our framework to uncover these sensitivities is spatially explicit in the sense that it does not rely on aggregate statistics but instead focuses on the sensitivity of the ‘urban’ classification of individual spatial units at the finest spatial granularity. Applying the framework to the definition of the Degree of Urbanisation reveals that sensitivity is indeed not equally distributed across the world. Certain regions (e.g., areas around Dallas – Fort Worth) and specific types of urbanisation (e.g., desakota regions in Pacific Asia) exhibit higher sensitivity than others. We discuss how these sensitivities may embody certain implicit assumptions in the definition, and examine their broader theoretical implications.