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Cited by 232Diabetes, Cardiovascular Risks, and LipoproteinsHealth disparities and outcomesAsian American and Pacific Histories

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

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Gordon, Nancy P., Lin, Teresa Y., Rau, Jyoti, Lo, Joan C.·2019·BMC Public Health
DOI 10.1186/s12889-019-7683-3PMC PMC6876105
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Abstract

Background: Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group. Methods: This study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos. Results: We found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI ≥ 27.5 kg/m 2 threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks. Conclusions: In a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.

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  • Knowledge gaps about the health of single and multiracial Asian and Pacific Islander populations have persisted in part due to the problematic practice of aggregating broad and diverse Asian and Pacific Islander populations for research purposes.

    “Knowledge gaps about the health of single and multiracial Asian and Pacific Islander populations have persisted in part due to the problematic practice of aggregating broad and diverse Asian and Pacific Islander populations for research purposes.”

    From Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California (2023) · cites this paper as [10]

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  • Aggregating broad and diverse Asian and Pacific Islander populations for research purposes can result in masking the extent of health disparities across these populations, and limit efforts to identify underlying drivers of health inequity.

    “This practice can result in masking the extent of health disparities across these populations, and limit efforts to identify underlying drivers of health inequity [9-11].”

    From Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California (2023) · cites this paper as [10]

    The Conclusions (page not provided) state that aggregated Asian-American statistics mask meaningful differences between ethnic subgroups, and the Discussion reports that aggregated Asian/PI estimates underestimated prevalence for Pacific Islanders. The paper does not establish the further claim that aggregation limits efforts to identify the underlying drivers of health inequity. (LLM, conf=0.82)

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References 31 · Cited by 232

Research works printed but not linked: 28

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Authors
Gordon, N. P., Lin, T. Y., Rau, J., & Lo, J. C.
Affiliations
  • Kaiser Permanente (US)
  • Kaiser Permanente Santa Clara Medical Center (US)
Corresponding author
Gordon, Nancy P.
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2019-11-25
Volume
19
Issue
1
Pages
1551-1551
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-019-7683-3
PMC
PMC6876105
OpenAlex
W2990820413
Cited by
232
References
31
Citations by year
2026: 23 · 2025: 37 · 2024: 30 · 2023: 40 · 2022: 38 · 2021: 30 · 2020: 33 · 2018: 1
FWCI
20.48
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Kaiser Permanente (n/a)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Cultural Studies › Asian American and Pacific Histories
Keywords
Native Hawaiians and Pacific Islanders, diabetes prevalence, hypertension prevalence, coronary artery disease prevalence, obesity prevalence, smoking prevalence, chronic cardiovascular disease, middle-aged and older adults, health disparities, Kaiser Permanente Northern California
MeSH terms
Aged, Aged, 80 and over, Asian, California, Chronic Disease, Female, Humans, Male, Middle Aged, Risk Factors, Cohort Studies, Prevalence, Native Hawaiian or Pacific Islander, Native Hawaiian or Other Pacific Islander, Electronic Health Records

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