Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California.
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ABSTRACT: Objective
To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.Methods
Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n = 904,232).Results
AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age <20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors.Conclusions
Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into "AANHPI" is not appropriate for outcome reporting.
SUBMITTER: Bane S
PROVIDER: S-EPMC10144523 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California.
Bane Shalmali S Abrams Barbara B Mujahid Mahasin M Ma Chen C Shariff-Marco Salma S Main Elliott E Profit Jochen J Xue Aileen A Palaniappan Latha L Carmichael Suzan L SL
Annals of epidemiology 20220915
<h4>Objective</h4>To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.<h4>Methods</h4>Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compare ...[more]
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Project description:BackgroundAsian American and Native Hawaiian/Pacific Islanders (AANHPI) are the fastest growing minority in the United States. Cancer is the leading cause of death for AANHPIs, despite relatively lower cancer morbidity and mortality. Their recent demographic growth facilitates a detailed identification of AANHPI populations with higher cancer risk.MethodsAge-adjusted, sex-stratified, site-specific cancer mortality rates from California for 2012 to 2017 were computed for AANHPI groups: Chinese, Filipino, South Asian, Vietnamese, Korean, Japanese, Southeast Asian (i.e., Cambodian, Hmong, Laotian, Thai), and Native Hawaiian and Other Pacific Islander (NHOPI). Regression-derived mortality rate ratios (MRR) were used to compare each AANHPI group to non-Hispanic whites (NHW).ResultsAANHPI men and women (total 40,740 deaths) had lower all-sites-combined cancer mortality rates (128.3 and 92.4 per 100,000, respectively) than NHWs (185.3 and 140.6) but higher mortality for nasopharynx, stomach, and liver cancers. Among AANHPIs, both NHOPIs and Southeast Asians had the highest overall rates including for colorectal, lung (men only), and cervical cancers; South Asians had the lowest. NHOPI women had 41% higher overall mortality than NHWs (MRR = 1.41; 95% CI, 1.25-1.58), including for breast (MRR = 1.33; 95% CI, 1.08-1.65) and markedly higher for endometrial cancer (MRR = 3.34; 95% CI, 2.53-4.42).ConclusionsAANHPI populations present with considerable heterogeneous cancer mortality patterns. Heightened mortality for infection, obesity, and tobacco-related cancers in Southeast Asians and NHOPI populations highlight the need for differentiated priorities and public health interventions among specific AANHPI populations.ImpactNot all AANHPIs have favorable cancer profiles. It is imperative to expand the focus on the currently understudied populations that bear a disproportionate cancer burden.
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Project description:BackgroundAsian American, Native Hawaiian, and Pacific Islander individuals have increased risks for episiotomy and severe perineal laceration during vaginal delivery. The Asian American, Native Hawaiian, and Pacific Islander population in the US is diverse yet few studies disaggregate results within specific ethnicity populations.ObjectiveThis study investigated the variability in risks for episiotomy and severe perineal laceration among 16 disaggregated Asian American, Native Hawaiian, and Pacific Islander groups, compared to Non-Hispanic White nulliparous individuals, and assessed what factors may explain the variability in risk.Study designBirth and fetal death certificate files linked to hospital discharge records were used to identify nulliparous, term, singleton, vertex vaginal deliveries among California births, 2007 to 2020. Poisson regression models were used to examine risks of episiotomy and severe perineal laceration among 16 Asian American, Native Hawaiian, and Pacific Islander ethnicity subgroups compared with Non-Hispanic White individuals. Sequential adjustment was utilized to assess if maternal social, health-related, and delivery-related factors may explain the variability in risk for episiotomy and severe perineal laceration.ResultsAmong the 224,964 Asian American, Native Hawaiian, and Pacific Islander individuals in this study cohort, the overall prevalence of episiotomy was 18.5% (N = 41,559) and prevalence of severe perineal laceration was 8.9% (N = 20,013); the prevalence of both outcomes declined during the study period. Within subgroups, prevalence of episiotomy ranged from 9.8% among Other-Pacific Islander individuals to 24.5% among Korean individuals. Prevalence of severe perineal laceration ranged from 3.4% in Guamanian individuals to 15.2% in Indian individuals. In fully adjusted models, risk ratios were greater than 1.0 (with confidence intervals excluding 1.0) for 6 subgroups for episiotomy and 9 subgroups for severe perineal laceration, compared to Non-Hispanic White individuals. After adjustment, Korean individuals were at highest risk of episiotomy (adjusted risk ratio 1.80 [95% CI 1.75, 1.85]), and Indian individuals were at highest risk of severe perineal laceration (adjusted risk ratio 2.14 [95% CI 2.07, 2.21]). Adjustment for social factors (nativity; education; payer) tended to attenuate risk ratios; subsequent adjustment for maternal health and delivery-related factors including maternal age, height, pre-pregnancy body mass index, hypertension, diabetes, gestational weight gain, fetal stress/incomplete fetal head rotation (occiput transverse or posterior), large infant size or shoulder dystocia, and forceps/vacuum did not impact risk ratios substantially.ConclusionPrevalence and risks of episiotomy and severe perineal laceration varied widely among Asian American, Native Hawaiian, and Pacific Islander births in California from 2007 to 2020. The variability in risks was more influenced by differences in social rather than maternal health and delivery-related factors. This study adds to the growing understanding of disparities in health outcomes among Asian American, Native Hawaiian, and Pacific Islander subgroups.
| S-EPMC11909455 | biostudies-literature
Project description:ImportanceSuicide is one of the leading causes of death for Asian American, Native Hawaiian, and Pacific Islander adolescents, but because these individuals are analyzed in aggregate, potentially important differences in suicide risk are obscured.ObjectiveTo disaggregate Asian and Native Hawaiian or Pacific Islander adolescents into racial and ethnic subgroups and compare risks of suicidal ideation between and within the subgroups.Design, setting, and participantsThis cross-sectional study used pooled data from 4-year public high school students (9th and 11th grade) participating in the 2017-2018 and 2018-2019 California Healthy Kids Survey. Data were analyzed between January 5, 2023, and March 31, 2024.ExposuresSelf-reported race and ethnicity, including American Indian or Alaska Native, Asian, Black, Hispanic or Latinx, Native Hawaiian or Pacific Islander, and White, and 9 Asian and Native Hawaiian or Pacific Islander subgroups, including Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian or Pacific Islander, other Asian, Southeast Asian (ie, Cambodian, Hmong, Laotian), and Vietnamese.Main outcome and measuresPast-year suicidal ideation was the primary outcome. Analyses compared an aggregated Asian and Native Hawaiian or Pacific Islander group with subgroups disaggregated by ethnicity and by monoethnic or monoracial, multiethnic, and multiracial identifications. Logistic regression models were used to test between- and within-group differences.ResultsAmong 547 816 California adolescents in 9th or 11th grade surveyed (50.3% girls), 77 735 (14.2%) identified as Asian or Native Hawaiian or Pacific Islander. The prevalence of suicidal ideation was 17.5% (95% CI, 17.1%-17.9%) among adolescents in the combined Asian and Native Hawaiian or Pacific Islander group. After disaggregation into subgroups, prevalence of suicidal ideation ranged from 13.3% (95% CI, 12.3%-14.4%) for monoethnic Asian Indian adolescents to 21.2% (95% CI, 20.4%-21.9%) for monoethnic Filipino adolescents. Multiethnic and multiracial identity was associated with elevated risk of suicidal ideation for all groups, from 2.3 percentage points (from 21.2% [95% CI, 20.4%-21.9%] among monoethnic to 23.5% [95% CI, 22.8%-24.2%] among multiracial Filipino adolescents) to 9.4 percentage points (from 13.7%, [95% CI, 13.0%-14.4%] among monoethnic to 23.1% [95% CI, 22.1%-24.1%] among multiracial Chinese adolescents). Compared with a mutually exclusive approach, an additive model allowing for self-report of multiple identities had the best fit and showed a higher prevalence of suicidal ideation among multiethnic and multiracial Asian and Native Hawaiian or Pacific Islander adolescents compared with monoethnic Chinese adolescents.Conclusions and relevanceThe results from this cross-sectional study provide evidence for disaggregation of heterogeneous ethnoracialized groups as a data equity strategy that may illuminate hidden disparities in adolescent suicidal ideation risk. Further research is imperative to understand suicide risk among Asian, Native Hawaiian, and Pacific Islander adolescents who identify with multiple ethnic or racial groups.
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Project description:BackgroundAlthough lung cancer incidence rates according to smoking status, sex, and detailed race/ethnicity have not been available, it is estimated that more than half of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked.MethodsWe calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race/ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial/ethnic groups. We used a large-scale dataset that integrates data from electronic health records from 2 large health-care systems-Sutter Health in Northern California and Kaiser Permanente Hawai'i-linked to state cancer registries for incident lung cancer diagnoses between 2000 and 2013. The study population included 1 222 694 females (n = 244 147 AANHPI), 3297 of which were diagnosed with lung cancer (n = 535 AANHPI).ResultsIncidence of lung cancer among never-smoking AANHPI as an aggregate group was 17.1 per 100 000 (95% confidence interval [CI] = 14.9 to 19.4) but varied widely across ethnic groups. Never-smoking Chinese American females had the highest rate (22.8 per 100 000, 95% CI = 17.3 to 29.1). Except for Japanese American females, incidence among every never-smoking AANHPI female ethnic group was higher than that of never-smoking non-Hispanic White females, from 66% greater among Native Hawaiian females (incidence rate ratio = 1.66, 95% CI = 1.03 to 2.56) to more than 100% greater among Chinese American females (incidence rate ratio = 2.26, 95% CI = 1.67 to 3.02).ConclusionsOur study revealed high rates of lung cancer among most never-smoking AANHPI female ethnic groups. Our approach illustrates the use of innovative data integration to dispel the myth that AANHPI females are at overall reduced risk of lung cancer and demonstrates the need to disaggregate this highly diverse population.
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Project description:BackgroundDisparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher uninsurance rates among AANHPI patients. Less is known about variation among individuals with Medicaid health insurance coverage and among AANHPI subgroups.ObjectiveThe objective of this study was to examine differences in access to care between White and AANHPI adult Medicaid beneficiaries, both in the aggregate and disaggregated into 9 ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, Native Hawaiian, and Pacific Islander).Research designNationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems data (2014-2015), a cross-sectional survey representative of all Medicaid beneficiaries.SubjectsA total of 126,728 White and 10,089 AANHPI Medicaid beneficiaries were included.MeasuresThe study outcomes were: (1) having a usual source of care; and (2) reporting a health center or clinic as the usual site of care. Multivariable linear probability models assessed the relationship between race/ethnic subgroup and our outcomes, adjusting for sociodemographic characteristics and health status.ResultsCompared with White beneficiaries, Korean beneficiaries were significantly less likely to report having a usual source of care [difference=-8.9 percentage points (PP), P =0.01], and Chinese (difference=8.4 PP, P =0.001), Native Hawaiian (difference=25.8 PP, P <0.001), and Pacific Islander (difference=22.2 PP, P =0.001) beneficiaries were significantly more likely to report a health center or clinic as their usual site of care.ConclusionsDespite similar health insurance coverage, significant differences in access to care remain between White and AANHPI Medicaid beneficiaries. Disaggregated AANHPI data may reveal important variation in access to care and inform more targeted public policies.
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Project description:BackgroundThe burden of cardiovascular disease (CVD) is increasing in the aging population. However, little is known about CVD risk factors and outcomes for Asian American, Native Hawaiian, and Other Pacific Islander (NH/PI) older adults by disaggregated subgroups.MethodsData were from the Centers for Medicare and Medicaid Services 2011-2015 Health Outcomes Survey, which started collecting expanded racial/ethnic data in 2011. Guided by Andersen and Newman's theoretical framework, multivariable logistic regression analyses were conducted to examine the prevalence and determinants of CVD risk factors (obesity, diabetes, smoking status, hypertension) and CVD conditions (coronary artery disease [CAD], congestive heart failure [CHF], myocardial infarction [MI], other heart conditions, stroke) for 10 Asian American and NH/PI subgroups and White adults.ResultsAmong the 639 862 respondents, including 26 853 Asian American and 4 926 NH/PI adults, 13% reported CAD, 7% reported CHF, 10% reported MI, 22% reported other heart conditions, and 7% reported stroke. CVD risk factors varied by Asian American and NH/PI subgroup. The prevalence of overweight, obesity, diabetes, and hypertension was higher among most Asian American and NH/PI subgroups than White adults. After adjustment, Native Hawaiians had significantly greater odds of reporting stroke than White adults.ConclusionsMore attention should focus on NH/PIs as a priority population based on the disproportionate burden of CVD risk factors compared with their White and Asian American counterparts. Future research should disaggregate racial/ethnic data to provide accurate depictions of CVD and investigate the development of CVD risk factors in Asian Americans and NH/PIs over the life course.
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Project description:BackgroundThe risk of diabetes among Asian, Native Hawaiian, and Pacific Islander (ANHPI) women after breast cancer is unclear. This study estimated the risk of incident type II diabetes in older ANHPI and older non-Hispanic White (NHW) women with breast cancer from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Medicare linked claims.MethodsA matched cohort of 7122 older ANHPI and 21 365 older NHW women with breast cancer were identified from SEER-Medicare between 2000 and 2017. To assess the risk of incident type II diabetes after breast cancer, hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using the Cox proportional-hazards regression model.ResultsDuring the mean 8 years of follow-up, 9.3% of older women with breast cancer developed incident type II diabetes. In comparison with older NHW women, older ANHPI women without a known history of diabetes had an elevated risk of diabetes after breast cancer, with strong associations observed for Pacific Islander (HR = 3.09, 95% CI = 1.43 to 6.67), Vietnamese (HR = 2.12, 95% CI = 1.33 to 2.36), and Filipino (HR = 2.02, 95% CI = 1.57 to 2.59) women with breast cancer, adjusting for potential confounders. Among ANHPI women with breast cancer, more baseline comorbidities and obesity were risk factors for developing incident type II diabetes.ConclusionANHPI women diagnosed with breast cancer had an elevated risk of type II diabetes compared with older NHW women with breast cancer. Routine monitoring and management of diabetes are warranted in older ANHPI women with breast cancer.
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