31.05.2024 By Jacelyn Seng

How a Few Small Boxes Can Make a Big Difference in Healthcare Communications.

As May comes to a close and summer beckons, I’m reminded of the various areas of progress – big and small – that we’ve made in diversity, equity and inclusion as a nation in the last five years. This is particularly true for the Asian American, Native Hawaiian and Pacific Islander (AANHPI) community.

As with so many things that make being American unique, one of the most interesting about the AANHPI community is that no single story represents our collective experience – instead, it is the diversity within this cluster of 50 ethnicities speaking over 100 languages that enriches the tapestry of American culture and society.

That’s why a recent, seemingly mundane and administrative development has gotten some of us excited.

Here’s the gist: By 2029, all federal demographic data collection will include more detailed options for recording race and ethnicity:

• The Asian category will include Chinese, Asian Indian, Filipino, Vietnamese, Korean and Japanese, or another group.
• The Native Hawaiian and Pacific Islander category will include Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, or another group.

Why is this important? Currently, when data is collected by both the government and private entities, we are often boiled down to a single box that reads “Asian or Pacific Islander.” But in addition to its incredible diversity, the AANHPI community is both the fastest growing and the most understudied racial group in the United States. That’s why the shift, carried out in response to “large societal, political, economic and demographic shifts in the United States,” is a big deal.

You may ask, is this really enough – why not all the 100 ethnicities within the AANHPI community? When it comes to data collection, the goal is to balance precision with efficiency and effectiveness, and a feedback mechanism to refine the process over time. While imperfect, this recent step in improving data gathering for the largest population groups would account for more than 80% of the AANHPI community. It’s an important move in the right direction and has the potential to positively impact the community in so many ways.

So, how can collecting more granular AANHPI ethnicity data improve healthcare?

Extensive scientific research shows that an individual’s ethnicity can put them at higher risk of certain diseases. Ethnicity can also affect the trajectory of disease progression and the overall prognosis. Within the AANHPI community, some of these health conditions include certain types of cancers (including liver and stomach cancer), cardiovascular disease (including hypertension and diabetes), infectious diseases such as tuberculosis, and mental health conditions.

Yet, when you sort the data into smaller ethnicity categories, the story is a lot more complex. For instance, among the AANHPI community:

• Compared with non-Hispanic white women with breast cancer, NHPI women had worse survival, while East Asian, South Asian and Southeast Asian subpopulations had improved survival.¹
• While Asian American men are 60 percent more likely to die from liver cancer than non-Hispanic white men, the Asian male subgroups have different mortality rates, with Vietnamese men having the highest and Japanese men having the lowest.²
• Stomach cancer claims more AANHPI lives than non-Hispanic white lives. In California, the risk of this cancer is 13 times higher among Koreans and 5 times higher among Chinese and Japanese than non-Hispanic whites.³
• South Asians are also at higher risk of developing type 2 diabetes, even if they are considered a healthy weight.⁴
• Southeast Asian refugees are at high risk for PTSD.⁵

By unpacking “AANHPI” into its smaller groups, we increase our understanding of the entire community, inform policy decisions that have historically overlooked whole ethnic groups, and tailor health messaging to be most relevant for each.

And this is just the beginning. Beyond inherent genetic differences, health disparities in access to care exist within the many AANHPI subpopulations – in the form of health coverage as well as culturally and linguistically accessible experts and resources. Variations in lifestyle, such as alcohol and tobacco use, may also play a role in such disparities.

To move the needle within this complex and diverse group that is AANHPI, we must be deliberate and patient, and stay the course in championing tailored communications over the long term. Only then do we have the chance to effect change for patients and their communities in meaningful ways.

 

References:
1. Taparra K, Dee EC, Dao D, Patel R, Santos P, Chino F. Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017. JCO Oncol Pract. 2022;18(8):e1255-e1264. doi:10.1200/OP.22.00001

2. CDC 2008. Health characteristics of the Asian adult population: United States, 2004–2006, page 2.

http://www.cdc.gov/nchs/data/ad/ad394.pdf

3. Lee E et al. Stomach Cancer Disparity among Korean Americans by Tumor Characteristics: Comparison with Non-Hispanic Whites, Japanese Americans, South Koreans, and Japanese. Cancer Epidemiol Biomarkers Prev. 2017 Apr;26(4):587-596. doi: 10.1158/1055-9965.EPI-16-0573.
4. Gujral UP et al. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013 Apr;1281(1):51-63. doi: 10.1111/j.1749-6632.2012.06838.x.
5. NIH, National Diabetes Education Program, 2006. Silent Trauma: Diabetes, Health Status, and the Refugee: Southeast Asians in the United States. http://ndep.nih.gov/media/SilentTrauma.pdf