Native Hawaiians And Other Pacific Islanders Research Articles

Racial and Ethnic Disparities in Hospital Mortality among Ischemic Stroke Patients in Hawaii

We evaluated disparities in in-hospital mortality rates among whites, Native Hawaiians and other Pacific Islanders (NHOPI), Filipinos, and other Asian groups in Hawaii who were hospitalized for acute ischemic stroke. Using a statewide hospital claims database, we performed a retrospective study including sequential acute ischemic stroke patients between 2010 and 2015. We compared in-hospital mortality rates among whites, NHOPI, Filipinos, other Asian groups excluding Filipinos, and other races (Blacks, Hispanics, Native Americans, mixed race). A total of 13,030 patient discharges were included in this study. The mean (±SD) age in years at the time of stroke was 63.5 ± 14.3 for NHOPI, 69.6 ± 14.4 for Filipinos, 67.8 ± 14.2 for other race, 71.4 ± 13.8 for whites, and 76.1 ± 13.5 for other Asians (P < .001). NHOPI patients had higher rates of diabetes (48.8%), obesity (18.4%), and tobacco use (31.3%) compared with patients in other racial-ethnic categories. Filipino patients had the highest rate of hemorrhagic transformation (9.7%). Age-adjusted stroke mortality rates were highest among Filipinos (15.9%; 95% confidence interval [CI] = 14.3%-17.6%), followed by other Asian groups (15.1%; 95% CI = 14.0%-16.2%), NHOPI (14.8%; 95% CI = 12.8%-16.8%), other race (14.4%; 95% CI = 11.3%-17.4%), and lowest among whites (12.8%; 11.5%-14.2%). After adjusting for other confounding variables, Filipinos had higher mortality (odds ratio = 1.22, 95% CI = 1.03-1.45), whereas other Asian groups, NHOPI, and other race patients had mortality rates that were similar to whites. In Hawaii, Filipino ethnicity is an independent risk factor for higher in-hospital stroke mortality compared with whites.

Obesity and Associated Health Disparities Among Understudied Multiracial, Pacific Islander, and American Indian Adults.

This study examined the state of obesity, diabetes, and associated health disparities among understudied multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults. Aggregated data for 184,617 adults from the California Health Interview Survey (2005 to 2011) were analyzed to determine obesity, diabetes, poor/fair health, and physical disability prevalence by racial group. Logistic regressions controlling for age, gender, and key social determinants (education, marital status, poverty, health insurance) generated multiracial, NHOPI, and AIAN adults' odds ratios (ORs) for our targeted health conditions versus non-Hispanic white adults. Obesity, diabetes, and other targeted health conditions were highly prevalent among multiracial, NHOPI, and AIAN adults, who displayed significantly greater adjusted odds than non-Hispanic white adults for obesity (ORs = 1.2-1.9), diabetes (ORs = 1.6-2.4), poor/fair health (ORs = 1.4-1.7), and, with the exception of NHOPI adults, physical disability (ORs = 1.5-1.6). Multiracial and AIAN adults with obesity also had significantly higher adjusted odds of diabetes (OR = 1.5-2.6) than non-Hispanic white adults with obesity. Multiracial, NHOPI, and AIAN adults experience striking obesity-related disparities versus non-Hispanic white adults, urging further disparities research with these vulnerable minority populations.

A randomized controlled trial to improve heart failure disparities: the Mālama Puʻuwai (caring for heart) Study

A randomized controlled trial to improve heart failure disparities: the Malama Puuwai (caring for heart) Study Marjorie K Leimomi Mala Mau,1 Eunjung Lim,1 Joseph Keawe‘aimoku Kaholokula,1 Taylor MU Loui,1 Yongjun Cheng,1 Todd B Seto1,2 1Department of Native Hawaiian Health, University of Hawai‘i at Mānoa, John A. Burns School of Medicine, 2Queens Heart Physician Practice, Queens Medical Center, Honolulu, HI, USA Objective/Background: To conduct a randomized controlled trial to test the efficacy of a culturally tailored heart failure (HF) education program, to reduce HF hospital readmissions and/or cardiovascular disease death (HF outcomes) among Native Hawaiian and Other Pacific Islander (NHOPI) patients with HF. Methods: One hundred fifty HF patients aged ≥21 years, NHOPI race, and discharged to home were enrolled and randomized to the Mālama Puʻuwai Program (MPP) or the usual care (UC). The MPP group received a culturally tailored HF program, and the UC received similar standard HF education materials. Clinical and health behavior data were measured at baseline and 12 months. HF outcomes were monitored throughout the entire study period. Two-sample t-test, chi-square, and Cox proportional hazard modeling assessed the efficacy of intervention (MPP or UC) on HF outcomes using an intention-to-treat approach. A sensitivity post hoc analysis was performed on patients who completed the full intervention (n=127). Results: Overall, 69% were men, mean age 54.4±13.4 years, 62% were Native Hawaiian, and 24% reported methamphetamine use. More UC participants reported methamphetamine use (32% vs. 16%), hypertension (81% vs. 63%), but less myocardial infarction (27% vs. 48%). HF outcomes were higher in UC (31%) compared with MPP (19%) with higher risk for HF outcomes (hazard ratio [HR] 1.74; 95% CI: 0.89–3.40). Sensitivity post hoc analysis of intervention compliance revealed that UC was at significantly higher risk for HF outcomes than MPP (HR 2.83; 95% CI: 1.19–6.72). Conclusions: Culturally tailored HF programs have the potential to reduce HF outcomes among compliant minority patients with HF such as NHOPI. Keywords: cardiomyopathy, Native Hawaiian, Pacific Islander, heart failure outcomes, culturally tailored education program

Physical activity stages of change surveillance data shows that the majority of Hawai‘i’s Keiki (Children) meet the guidelines

ABSTRACTTargeting Native Hawaiian and other Pacific Islander (NHOPI) children based on their physical activity (PA) stages of change (SOC) may improve intervention effectiveness. No known SOC surveillance system exists for NHOPI jurisdictions. The purpose was to determine the PA SOC prevalence over 5 years in children living in Hawaiʻi. Self-reported PA SOC from 5 cohorts (3–6 grade students) in Hawaiʻi were compared between cohorts and sex. The combined PA SOC distribution (n = 1726, 50.7% female) was: Precontemplation, 7.5%; Contemplation, 7.6%; Preparation, 9.9%; Action, 33.4%; Maintenance, 41.5%. There were no significant difference between cohorts 1 and 2 (n = 258), χ2 (16) = 21.75, p = 0.15; 2 and 3 (n = 129), χ2 (16) = 17.51, p = 0.35; 3 and 4 (n = 171), χ2 (16) = 17.28, p = 0.77; 4 and 5 (n = 129), χ2 (16) = 17.51, p = 0.35; and for all cohorts between males and females (p > 0.05). Most participants were in Action and Maintenance. Prevention efforts should emphasize maintaining PA levels. Extending PA behavior surveillance systems to include intention in NHOPI jurisdictions is warranted.

Abstract WP207: Ethnic Disparities in Hypertensive Heart Disease Among Young Adults with Ischemic Stroke in Hawaii

A recent study showed that Native Hawaiians and Other Pacific Islanders (NHOPI) with ischemic stroke are younger and have a higher burden of cardiovascular risk factors compared to whites and Asians. However, a detailed assessment of the degree of hypertensive heart disease using echocardiogram data among this multi-ethnic young adult population has not been studied. The objective of this study was to assess ethnic differences in the echocardiographic findings of hypertensive heart disease among young adults who were hospitalized for ischemic stroke. We hypothesized that NHOPI young adults with ischemic stroke have a higher prevalence of echocardiographic findings of hypertensive heart disease compared to whites and Asians. We conducted a retrospective study of all young adults (age ≤ 55 years) who were hospitalized at the Queen’s Medical Center in Honolulu, HI between 2008 and 2012 with an admission diagnosis of ischemic stroke. Patients with an ethnicity other than white, Asian, or NHOPI were excluded. Echocardiograms for each patient were reviewed. Left ventricular mass was estimated by the Devereux formula. Early (E) and late (A) transmitral diastolic flow, and mitral medial annulus early diastolic velocities (E’) were recorded; and E/A and E/E’ were calculated as measures of diastolic dysfunction and LV filling pressures. A total of 259 patients (44% NHOPI, 36% Asians, and 19% whites) were included in the study. The overall mean age was 47.1 ± 7.7 years with 34% women. NHOPIs had a higher LV mass (248.9 ± 94.8 g), LV mass index (121.5 ± 41.4 g/m 2 ), and mitral E/E’ values (15.5 ± 9.3) compared to whites (218.6 ± 74.6 g, 107.9 ± 34.2 g/m 2 , 11.5 ± 4.6, all P &lt;0.05) and Asians (191.3 ± 61.5 g, 106 ± 32.2 g/m 2 , 12.4 ± 5.8, all P &lt;0.01). NHOPIs had more severe diastolic dysfunction and relative wall thickness (all P &lt;0.05) compared to Asians but not whites. Overall, NHOPIs compared to whites and Asians had 8% compared to 10% and 10.6% with normal geometry, 39% compared to 50% and 47.9% with concentric remodeling, 53% compared to 40% and 41.5% with hypertrophy. Left atrial enlargement was seen in 24% of the total population. In conclusion, this study shows that among young adults with ischemic stroke, NHOPIs have a higher burden of hypertensive heart disease compared to whites and Asians.

Abstract WP172: Ethnic Disparities in the Use of Tissue Plasminogen Activator Among Young Adult Stroke Patients in Hawaii

Introduction: Minorities with ischemic strokes are younger and less likely to receive intravenous tissue plasminogen activator (IV tPA) compared to whites; However, disparities in the use of IV tPA in the multi-ethnic population of Hawaii have not been adequately studied. Hypothesis: Native Hawaiians and other Pacific Islanders (NHOPI) and Asians who are hospitalized with ischemic stroke receive less IV tPA compared to whites. Methods: We conducted a retrospective study on consecutive young adult patients (age ≤55) hospitalized for ischemic stroke at a single tertiary center on Oahu between 2006 and 2012. Clinical characteristics and the use of IV tPA among NHOPI and Asians were compared to whites. Patients without race/ethnicity data (n=28) and postoperative strokes (n=22) were excluded. Results: A total of 462 consecutive young adult (mean age 47±9 years) ischemic stroke patients (whites 16%, Asians 36%, NHOPI 43%, Other 5%) were studied. NHOPI had higher prevalence of hypertension (NHOPI 75% vs. whites 49%, p&lt;0.0001), diabetes (NHOPI 46% vs. whites 22%, p=0.0003), higher body mass index (NHOPI 33±9 cm/m2 vs. whites 28±7 cm/m2, p&lt;0.0001), and hemoglobin A1c (NHOPI 8.9 ± 2.9% vs. whites 7.2 ± 2.5%, p=0.002) compared to whites. Clinical characteristics were similar between Asians and whites. The use of IV tPA was lower among NHOPI (4.6%, p=0.01) and Asians (3.0%, p=0.002) compared to whites (13.2%). Conclusions: NHOPI represented the major ethnic group among the young adult stroke population in Hawaii and had higher instances of hypertension and diabetes compared to whites. NHOPI and Asians both had significantly lower rates of IV tPA use compared to whites. Further study is needed to assess the barriers associated with the use of IV tPA among these minority groups.

The Future of Pacific Islander America in 2040

Abstract This resource paper analyzes the growth of the Native Hawaiian and Other Pacific Islander (NHOPI) population over the next quarter century based on projections from the U.S. Census Bureau and supplementary estimates by the authors. Overall, this population will increase from about 1.5 million in 2015 to nearly 2.3 million in 2040, about three times greater than the increase for the total U.S. population. Most NHOPIs are indigenous, but immigrants comprise about a fifth of the population. This group is relatively young, but median age will increase over time. Youth comprised about a third of the population in 2015 and over a quarter in 2014. The elderly share will nearly double to about one in eight by 2040. NHOPIs are more likely to be multiracial than any other racial group, and NHOPIs of mixed-race will comprise over half the population a quarter century from now.

Disaggregated data and beyond: future queries in cancer control research.

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.

Health literacy and obesity among native Hawaiian and Pacific Islanders in the United States.

Our purpose was to describe relationships between demographic characteristics, body mass index (BMI), and health literacy among Native Hawaiians and other Pacific Islanders (NHPIs). In this cross-sectional survey, we interviewed 364 NHPI adults. We used Newest Vital Sign (NVS), a health literacy tool; measured heights and weights; and demographic questions. According to participants' NVS scores, 45.3% had at least a possibility of low health literacy. Lower NVS scores were associated with increased BMI (r = -0.12, p = .027) and increased age (r = -0.26, p < .001). Higher NVS scores were associated with higher incomes (r = 0.21, p = .001) and higher education (r = 0.27, p < .001). Women scored significantly better than men (t = -2.0, p = .05). Participants' NVS scores in Hawaii versus Utah were not significantly different (t = .26, p = .80). Pathways to health literacy are complex; however, age, income, education, and BMI explained a modest 19.95% of the combined variance in NVS scores. Public health nurses working to improve health literacy could include review of critical information on nutrition facts labels, frequently used calculations, and application of this information when making food choices.

Native Hawaiian and Pacific Islander Elders: What Gerontologists Should Know.

Native Hawaiian and other Pacific Islanders (NHOPI) experience significant health disparities compared with other racial groups in the United States. Lower life expectancy has resulted in small proportions of elders in the population distribution of NHOPI, yet the number of NHOPI elders is growing. This article presents data on NHOPI elders and discusses possible reasons for continuing health disparities, including historical trauma, discrimination, changing lifestyle, and cultural values. We outline promising interventions with NHOPI and make suggestions for future research.

A City-Based Design That Attempts to Improve National Representativeness of Asians

Abstract This article describes a case study on the potential of using smaller geographical units in an area probability design, and reports the challenges of collecting a nationally representative sample for this hard-to-reach population. The Census Integrated Communications Program Evaluation (CICPE) was designed to evaluate the promotional campaign’s effect on Decennial Census participation for six race/ethnicity groups of interest. A nationally representative Core sample was designed to collect interviews for Hispanics, non-Hispanic African-Americans, and non- Hispanic Whites. However, it was impractical to include the rarer Asian, American Indian and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander (NHOPI) populations in the Core design. For the Asian sample, we designed a separate area probability sample. Traditional area probability sampling designs use counties or metropolitan areas as first-stage units, but smaller geographical units can better target hard-to-reach populations. The CICPE Asian sample used cities as the first-stage units.

Developing a Multicultural Nutrition Education Tool: Pacific Island Food Models

Native Hawaiians and other Pacific Islanders (NHOPI) are 1 of the highestrisk US populations affected by the cardiometobolic diseases of obesity, diabetes, and heart disease, which can be improved with increased nutrition education and counseling. Barriers to health improvements through effective nutrition education include limited English proficiency, differences in social norms related to food, and limited availability of preferred food items. Development and dissemination of innovative tools, such as culturally relevant food models, are needed to address these barriers. In 2004, the Center for Native and Pacific Health Disparities Research (the Center) at the University of Hawai‘i, John A. Burns School of Medicine, conducted a health education needs assessment of community health agencies serving NHOPI. When asked what type of support the community health agencies needed to provide quality cardiovascular disease education to their population, agency representatives indicated that much of the nutrition counseling and education material currently available was not representative of a Pacific population. Food models of NHOPI ethnic foods were specifically identified as a priority to assist effective nutrition counseling and education in multilingual and low-literacy populations.

The Relationship Between Select Demographic Characteristics and Body Mass Index Among Native Hawaiian and Other Pacific Islander Caregiving Adults

Native Hawaiian and other Pacific Islanders (NHOPIs) have the highest prevalence of overweight and obesity in the world. We identified the proportion of our NHOPI sample in each body mass index (BMI) category and explored relationships between BMI and demographic characteristics. Our descriptive correlational study included 364 NHOPI caregiver adults in Utah (n = 155) and Hawaii (n = 209). We gathered demographic information with a questionnaire. Height and weight were measured for BMI calculations. According to the Centers for Disease Control and Prevention's BMI categories, 84.3% of our sample was overweight or obese. Participants in Utah had significantly higher BMIs than participants in Hawaii. Educational attainment was inversely related with BMI; however, age, gender, and income were not significantly related with BMI. NHOPIs on the U.S. mainland may be at greater risk for obesity than those in Hawaii; food price differences between locations may help explain this. NHOPIs in early adulthood had high BMIs; overtime this situation could worsen without intervention. NHOPIs with low education levels or in areas of low food prices are at increased risk for obesity. Future research should focus on culturally sensitive interventions to reduce NHOPI obesity and associated risks.

Cancer incidence trends among native Hawaiians and other Pacific Islanders in the United States, 1990-2008.

Lack of annual population estimates for disaggregated Native Hawaiian and Other Pacific Islander (NHOPI) populations limits the ability to examine cancer incidence rates and trends to understand the cancer burdens among NHOPIs. Utilizing 1990 and 2000 population census data, we estimated the annual populations by age and sex for Native Hawaiians, Samoans, and Guamanians/Chamorros for 1990-2008 in regions covered by 13 of the National Cancer Institute's SEER registries. Cancer diagnoses during 1990-2008 from these registries were used to calculate the age-adjusted (2000 US Standard) incidence rates by sex, calendar year/period, and cancer type for each population. The annual percentage change (APC) in incidence rates was estimated with the 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Statistically significant declining trends were found in Native Hawaiians, in men for lung and stomach cancers (APC = -2.3%; 95% CI = -3.3 to -1.3; and APC = -3.8%; 95% CI = -6.0 to -1.6, respectively), and in women for breast cancer (APC = -4.1%; 95% CI = -5.7 to -2.5) since 1998 and lung cancer (APC = -6.4%; 95% CI = -10.7 to -1.8) since 2001. Rising incidence trends were experienced by Samoans, especially by Samoan women for breast (APC = 2.7%; 95% CI = 0.9 to 4.5) and uterus (APC = 7.3%; 95% CI = 6.2 to 8.4) cancers. With limited data, Guamanians/Chamorros demonstrated lower, but increasing, incidence rates than other NHOPIs. Population-based cancer incidence rates for disaggregated NHOPI populations help identify disparities in cancer burden and provide valuable information to improve cancer control efforts among NHOPIs.

Sociodemographic, behavioral, and biological variables related to weight loss in native hawaiians and other pacific islanders

Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention. Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure. Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14-32.17) and participants who had more weight loss in the first 3-months (OR = 1.47; CI = 1.22-1.86) and who were in the PLP (OR = 4.50; CI = 1.50-15.14) were more likely to achieve ≥3% weight loss [model; χ(2) (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.

Abstract WP303: Disparities among Native Hawaiians and Pacific Islanders with Intracerebral Hemorrhage: Effect of Methamphetamine Abuse

Background and Purpose: Native Hawaiians and other Pacific Islanders (NHPI) with intracerebral hemorrhage (ICH) are younger and have a higher burden of cardiovascular risk factors compared to other racial groups in Hawaii. Furthermore, NHPI in Hawaii have a higher prevalence of methamphetamine abuse compared to other major racial-ethnic groups. Therefore, it is unclear whether younger age of NHPI with ICH is due to methamphetamine abuse or untreated risk factors. Methods: We conducted a retrospective study on consecutive patients hospitalized for acute ICH at a single tertiary center on Oahu between 2006 and 2010. To determine the factors associated with young ICH (age&lt;45), we performed unadjusted and multivariable logistic regressions, adjusting for methamphetamine abuse, untreated hypertension and whether they were transferred from another hospital to account for a potential referral bias. Non-Hispanic whites were the reference group. Results: A total of 384 consecutive ICH patients (NHPI 19%, Asians 65% and non-Hispanic whites 16%) were studied. Compared to non-Hispanic whites, NHPI were younger (mean ages, NHPI 54±16 vs. whites 68±16, p &lt; 0.0001), and had higher prevalence of diabetes (NHPI 36% vs. whites 19%, p = 0.03) and untreated hypertension (NHPI 32% vs. whites 15%, p = 0.02). Young ICH (age&lt;45) was more common among NHPI (26%) than Asians (9%) and non-Hispanic whites (6%) (p &lt;0.05). Methamphetamine abuse was slightly more common among NHPIs than whites and Asians (10% vs. 3% vs. 6%, p = NS for all comparison). After controlling for potential confounders, young ICH (age&lt;45) was independently associated with NHPI race (OR 5.07, 95% CI 1.55 to 16.62), methamphetamine abuse (OR 4.17, 95% CI 1.56 to 11.20) and being transferred from another hospital (OR 3.37, 95% CI 1.66 to 6.84). Conclusions: Native Hawaiian and other Pacific Islander race and methamphetamine abuse are independently associated with young ICH in Hawaii. Further studies are needed to determine factors other than methamphetamine abuse that are contributing to the young age of ICH presentation in this unique racial group.

Disparities among Asians and Native Hawaiians and Pacific Islanders with ischemic stroke

To evaluate disparities in cardiovascular risk factors among Asians and Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with ischemic stroke. We performed a retrospective study on consecutive patients hospitalized for ischemic stroke at a single tertiary center in Honolulu between 2004 and 2010. The prevalence of cardiovascular risk factors was compared for NHPI, Asians, and whites who were hospitalized for ischemic stroke. A total of 1,921 patients hospitalized for ischemic stroke were studied. NHPI were less likely to be older (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.94-0.96), more likely to be female (OR 1.55, 95% CI 1.07-2.24), and more likely to have diabetes (OR 2.74, 95% CI 1.87-4.00), hypertension (OR 1.98, 95% CI 1.27-3.10), and obesity (OR 1.82, 95% CI 1.25-2.65) than whites. NHPI had higher low-density lipoprotein levels (114 ± 50 mg/dL vs 103 ± 45 mg/dL, p = 0.001) and lower high-density lipoprotein levels (38 ± 11 mg/dL vs 45 ± 15 mg/dL, p < 0.0001) than whites. Compared with Asians, NHPI were less likely to be older (OR 0.95, 95% CI 0.94-0.97) and more likely to have diabetes (OR 1.88, 95% CI 1.35-2.61), previous stroke or TIA (OR 1.57, 95% CI 1.09-2.25), and obesity (OR 6.05, 95% CI 4.31-8.48). Asians, NHPI, and whites with ischemic stroke have substantially different cardiovascular risk factors. Targeted secondary prevention will be important in reducing disparities among these racial groups.

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

To evaluate disparities in stroke risk factors and outcome among the Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with intracerebral hemorrhage (ICH). We performed a retrospective study on consecutive patients hospitalized for acute ICH at a single tertiary center on Oahu between 2004 and 2010. Clinical data were obtained from the Get With the Guidelines-Stroke database. Multivariable logistic regression was used to assess the predictors for young ICH (age <45). A total of 562 patients hospitalized for acute ICH (Asian 63%, NHPI 18%, white 16%, other 3%) were studied. The NHPI were younger (mean ages, NHPI 55 ± 16 vs white 66 ± 16 years, p < 0.0001), and had higher prevalence of diabetes (NHPI 35% vs white 20%, p = 0.01) and history of hypertension (NHPI 77% vs white 64%, p = 0.04) compared to white patients. Independent predictors for young ICH were NHPI race (odds ratio [OR] 3.55; 95% confidence interval [CI] 1.33-9.45), being transferred from another hospital (OR 2.03; 95% CI 1.05-3.93), hypertension (OR 0.49; 95% CI 0.27-0.91), previous stroke or TIA (OR 0.21; 95% CI 0.05-0.91), and dyslipidemia (OR 0.15; 95% CI 0.05-0.50). NHPI with ICH are younger and have higher burden of risk factors compared to white patients. Further studies controlling for socioeconomic modifiers are needed to determine factors contributing to the younger age at presentation in this racial group.

Abstract 2623: Racial Disparities in Hospital Length of Stay among Native Hawaiians and other Pacific Islanders with Ischemic Stroke

Introduction: Native Hawaiians and other Pacific Islanders (NHPI) with ischemic stroke are younger and have more comorbidities compared to other major racial-ethnic groups. However, their impact on hospital length of stay (LOS) after ischemic stroke has not been studied. Hypothesis: We assessed the hypothesis that NHPI race is associated with a longer hospital LOS after ischemic stroke. Methods: Data from 2004 to 2010 were retrospectively obtained from the Get With the Guidelines-Stroke (GWTG-Stroke) database from The Queen’s Medical Center, the only primary stroke center for the state of Hawaii. Multivariable analyses were performed using a stepwise linear regression model to identify factors predictive of hospital LOS after ischemic stroke. Results: A total of 1921 patients hospitalized for ischemic stroke (NHPI 20%, Asians 53%, whites 24%, blacks 0.8%, others 2%) were studied. Univariate analyses showed that NHPI were younger (mean ages, NHPI 60±14 vs. Asians 72±14, p &lt;0.0001; vs. whites 71±14, p &lt;0.0001) and had higher prevalence of diabetes (NHPI 53% vs. Asians 67%, p &lt;0.0001; vs. whites 22%, p &lt;0.0001), hypertension (NHPI 82% vs. whites 22%, p &lt;0.0001), prior stroke or TIA (NHPI 30% vs. Asians 23%, p =0.01), smoking (NHPI 19% vs. Asians 14%, p =0.01), dyslipidemia (NHPI 43% vs. whites 34%, p &lt;0.01), and longer hospital LOS (NHPI 11±17 days vs. Asians 7±9 days, p &lt;0.0001; whites 8±17 days, p &lt;0.05). After adjusting for age, race, gender, and risk factors with predefined significance ( p &lt;0.1), independent predictors for hospital LOS were NHPI race (parameter estimate, 2.67; 95% CI, 1.09 - 4.22, p =0.001), atrial fibrillation/atrial flutter (parameter estimate, 2.22; 95% CI, 0.53 - 3.90, p =0.01), and age (parameter estimate, -0.04; 95% CI, -0.09 - -0.002, p =0.04). Conclusions: Native Hawaiians and other Pacific Islanders with ischemic stroke have a longer hospital length of stay compared to Asians and whites. Further studies are needed to assess if other socioeconomic factors contribute to the observed differences.

Prenatal Care, Childhood Obesity, and Ethnic Health Disparities: Analyses from a Unique Population Database

This paper explores the association between prenatal care and childhood obesity across racial/ethnic groups, with special focus on Asians, Native Hawaiian and other Pacific Islanders (NHOPI), and non-Hispanic Whites. Data were drawn from a statewide population-based data source that linked vital and administrative records for a large cohort of children (n=227,032). Multivariate logistic regression was used to estimate odds of overweight and obesity among children whose mothers received first trimester prenatal care versus those who did not. Compared with White and Asian women, NHOPI women had later initiation of prenatal care. However, NHOPI women who initiated early prenatal care had children with significantly lower risks of obesity and overweight than their counterparts who delayed such care. Timely prenatal care may be associated, with lower childhood obesity through focused monitoring and counseling on pregnancy-related weight gain as well as through reducing other potentially deleterious prenatal behaviors for this high-risk and underserved population.