Findings suggest value in identifying Asian patients’ ethnic backgrounds in medical records
Oakland, Calif. — Asian-Americans from different parts of Asia have very different cardiovascular risk factors and chronic conditions such as diabetes, hypertension, and heart disease, research from the Kaiser Permanente Division of Research suggests.
Nancy Gordon, PhD, research scientist with the Division of Research
“Based on a relatively small body of previous research, we suspected that we would see differences,“ said lead author Nancy Gordon, ScD, a research scientist with the Kaiser Permanente Division of Research. “But we didn’t expect them to be so large. For instance, Filipino-Americans in the study were twice as likely to have diabetes than those of Chinese ethnicity.”
The study, published in BMC Public Health November 25, used electronic health record (EHR) data for 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California members during 2016. The researchers identified 274,910 Asian-Americans using race and ethnicity information from the EHR and patient surveys.
They assigned the patients to Asian subgroups, including Chinese, Filipino, Japanese, Korean, Southeast Asian and South Asian. They also studied Native Hawaiians and Pacific Islanders, who are grouped together separately in epidemiological research.
The study examined prevalence of smoking, obesity (using both standard and Asian-specific classifications), and diagnoses of diabetes, hypertension, and coronary artery disease.
Overall, Filipinos and Native Hawaiians/Pacific Islanders had significantly more risk factors and chronic disease prevalence than other Asian-American ethnic groups. Prevalence among Filipinos and Native Hawaiians/Pacific Islanders was similar to that for blacks and Latinos, two groups that have been the focus of health disparities research.
Specifically, the study found:
–Diabetes prevalence ranged from a low of 15.6% for Chinese to 31.9% for Filipinos and 34.5% for Native Hawaiians and Pacific Islanders.
–Obesity using standard BMI measurement ranged from 7.6% among Koreans and Southeast Asians to 43.6% among Native Hawaiians and Pacific Islanders, 20.8% among Filipinos, 20% among South Asians, and 19.7% among Japanese.
–Using a separate BMI threshold recommended for Asians, obesity prevalence ranged from 19% among Southeast Asians, Koreans, and Chinese to 36% to 40% among Japanese, South Asians, and Filipinos; it was 60% among Native Hawaiian/Pacific Islanders. Prevalence was higher among men than women in most subgroups, except South Asian and Native Hawaiian/Pacific Islanders.
–Smoking rates were 3% for South Asians, 4.8% for Chinese, 7.3% for Southeast Asian and Filipino, 7.7% for Korean, and 10.4% for Native Hawaiian/Pacific Islanders.
Joan Lo, MD, senior physician and research scientist with the Division of Research
The research team didn’t attempt to explain the reasons for the differences. The authors plan to further study issues such as the role of obesity in varying diabetes prevalence and how social determinants of health and psychosocial risk factors relate to differences in chronic illness prevalence among Asian ethnicities.
The information could identify patients who are more likely to have cardiovascular risks and chronic conditions, allowing physicians to carry out earlier screening and more frequent monitoring, said coauthor Joan Lo, MD, a research scientist with the Division of Research. “This could become even more important as physicians increasingly see patients by video or phone visits that don’t involve collection of vital signs that can track small changes in health status,” she said.
The findings could also be of interest to health researchers and population health managers, Gordon said. Having more granular Asian ethnicity data in the EHR would allow health systems to track quality metrics specific to Asian ethnic groups.
Asian ethnicity information could also help organizations enhance delivery of equitable and culturally competent care by offering ethnicity-tailored dietary assessments and patient education resources, Gordon said. They could also use it to build a workforce whose ethnic diversity mirrors the patient population, she added.
The study was funded by the Kaiser Permanente Northern California Community Benefit Program.
Authors also included Teresa Y. Lin, MPH, of the Division of Research and Jyoti Rau, MD, from the Kaiser Permanente Santa Clara Medical Center.
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 600-plus staff is working on more than 350 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.