Intended for healthcare professionals


Asians and Pacific islanders in US need greater prominence in research

BMJ 2010; 340 doi: (Published 07 May 2010) Cite this as: BMJ 2010;340:c2495
  1. Bob Roehr
  1. 1Washington, DC

    US researchers have called for Asian and Pacific islander groups in the United States to feature more prominently in research to help tackle health disparities.

    A May theme issue of the American Journal of Public Health hopes to provide a research cornerstone for policies and practices concerning Asians and Pacific islanders in the US. It was released at a 6 May news conference in Washington, DC.

    These groups “are inevitably represented as dots, dashes, and stars due to the small number of cases in any given study,” said Sela Panapasa, a native of Hawaii and a social researcher at the University of Michigan. She is not surprised that they are largely ignored in discussions of health disparities.

    As a whole these populations comprise 14.6 million people, about 4.5% of the US population. Over the past decade the group has grown by 23%, the fastest of any racial group. About a third of them live in California, which is often the only state that gathers usable data on them.

    But the group is fragmented along geographical, genetic, immigration, and socioeconomic lines that can hide pockets of medical need behind often higher than average group performance on scales such as education and income. For example, Asian American adults are 50% less likely to die from heart diseases than non-Hispanic white adults, but native Hawaiians and Pacific islanders are about 40% more likely than white people to be given a diagnosis of heart disease.

    Scarlett Lin Gomez, of the Cancer Prevention Institute of California, found that Vietnamese born women now living in the US are four times more likely to die of breast cancer than their US born Vietnamese counterparts. That, he says, is because of late diagnosis, in part because their doctors mistakenly believe that Asian women do not develop breast cancer and therefore are poor at recommending mammography.

    Dr Gomez said, “My hope is to move beyond the individual level to acknowledge the complex multidimensional nature by which disparities do occur and then to derive an evidence base that will more fully inform policies and practices.”

    Winston Wong, a physician with Kaiser Permanente in Oakland, California, said that the health maintenance organisation has been able to completely eliminate any disparities in rates of mammography among its female Asian members. Electronic medical records with built-in prompts on such matters have been a key reason for the group’s success.

    Asian and Pacific islander Americans seem to suffer discrimination at rates roughly similar to other ethnic minorities, and the stress associated with discrimination can have the same deleterious effect on health. Lack of proficiency in English can make it more difficult for immigrants to access health care, as translation services are often patchy and limited to a few languages.

    The prevalence of hepatitis B among Asians is disproportionately high, at one case in 10 people, representing roughly half the caseload in the US despite being only 4.5% of the population. Yet two thirds do not even know they are infected. Mike Honda and Judy Chu, members of Congress for California, are among those sponsoring legislation to address the problem.


    Cite this as: BMJ 2010;340:c2495

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