Neighborhood-level Asian American Populations, Social Determinants of Health, and Health Outcomes in 500 US Cities

Abstract

Introduction: The US Asian American (AA) population is projected to double by 2050, reaching ~43 million, and currently resides primarily in urban areas. Despite this, the geographic distribution of AA subgroup populations in US cities is not well-characterized, and social determinants of health (SDH) and health measures in places with significant AA/AA subgroup populations have not been described. Our research aimed to: 1) map the geographic distribution of AAs and AA subgroups at the city- and neighborhood- (census tract) level in 500 large US cities (population ≥66,000); 2) characterize SDH and health outcomes in places with significant AA or AA subgroup populations; and 3) compare SDH and health outcomes in places with significant AA or AA subgroup populations to SDH and health outcomes in places with significant non-Hispanic White (NHW) populations.Methods: Maps were generated using 2019 Census 5-year estimates. SDH and health outcome data were obtained from the City Health Dashboard, a free online data platform providing more than 35 measures of health and health drivers at the city and neighborhood level. T-tests compared SDH (unemployment, high-school completion, childhood poverty, income inequality, racial/ ethnic segregation, racial/ethnic diversity, percent uninsured) and health outcomes (obesity, frequent mental distress, cardiovas­cular disease mortality, life expectancy) in cities/neighborhoods with significant AA/AA subgroup populations to SDH and health outcomes in cities/neighborhoods with sig­nificant NHW populations (significant was defined as top population proportion quin­tile). We analyzed AA subgroups including Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other AA.Results: The count and proportion of AA/ AA subgroup populations varied sub­stantially across and within cities. When comparing cities with significant AA/AA subgroup populations vs NHW populations, there were few meaningful differences in SDH and health outcomes. However, when comparing neighborhoods within cities, areas with significant AA/AA subgroup vs NHW populations had less favorable SDH and health outcomes.Conclusion: When comparing places with significant AA vs NHW populations, city-level data obscured substantial variation in neighborhood-level SDH and health outcome measures. Our findings empha­size the dual importance of granular spatial and AA subgroup data in assessing the influence of SDH in AA populations.Ethn Dis. 2021;31(3):433-444; doi:10.18865/ed.31.3.433