Healthy People 2010 and Asian Americans and Asian Americans and Pacific Islanders: Defining a...

Healthy People 2010Healthy People 2010 andand

Asian Americans and Asian Americans and Pacific Islanders:Pacific Islanders:

Defining a Baseline of Defining a Baseline of InformationInformation

Chandak Ghosh, MD, MPHChandak Ghosh, MD, MPHMedical Consultant Medical Consultant

Health Resources and Services AdministrationHealth Resources and Services Administration

Addressing Needs of API’sAddressing Needs of API’s

U.S. Population 2050

API11%

Latino21%

Native American

1%Black14%

White53%

White HouseWhite House Initiative on API’s:Initiative on API’s: Executive OrderExecutive Order June, 1999June, 1999

Initiative on RaceInitiative on Race::

Elimination of Health Elimination of Health Disparities Disparities Infant MortalityInfant Mortality CancerCancer ImmunizationsImmunizations DiabetesDiabetes Cardiovascular DiseaseCardiovascular Disease HIV/AIDSHIV/AIDS

API CharacteristicsAPI Characteristics

More than 2 million uninsured More than 2 million uninsured (17% of API’s)(17% of API’s)

Poverty rate higher than Poverty rate higher than non-Hispanic Whites (14% vs. 8%)non-Hispanic Whites (14% vs. 8%)

Largest percentage of immigrants of any Largest percentage of immigrants of any minority group (61%)minority group (61%)

Limited English proficiency (40%)Limited English proficiency (40%)

Diabetes Diabetes Northern MarianasNorthern Marianas Native HawaiiansNative Hawaiians

Infant MortalityInfant Mortality All Pacific IslandersAll Pacific Islanders

CancerCancer Chinese (Nasopharyngeal)Chinese (Nasopharyngeal) Vietnamese (Cervical)Vietnamese (Cervical)

Infectious DiseaseInfectious Disease

API Health Burden

HP2010HP2010 Goals and Goals and White House InitiativeWhite House Initiative

Define a Baseline of Current DataDefine a Baseline of Current Data

HP2010 HP2010 DataData for API’sfor API’s:: ““Data Not Collected”Data Not Collected” ““Data Statistically Unreliable”Data Statistically Unreliable” API treated as an aggregateAPI treated as an aggregate

Data Limited on API’s:Data Limited on API’s: Small Numbers and Diversity of API’sSmall Numbers and Diversity of API’s ““Model Minority”Model Minority” ““Over-represented Minority”Over-represented Minority” FewFew Healthy People 2000 Healthy People 2000 Goals Goals

Study Study ObjectiveObjectiveTo Examine Existing API Health Data More To Examine Existing API Health Data More

Comprehensively By: Comprehensively By: Sub-PopulationSub-Population Healthy People 2010Healthy People 2010 Objectives Objectives

Potential API Data Sources:Potential API Data Sources: Grants/InitiativesGrants/Initiatives GovernmentGovernment OrganizationsOrganizations FoundationsFoundations

FederalFederal Community Community StateState TradeTrade LocalLocal ProfessionalProfessional

Research PublicationsResearch Publications

MethodsMethods Federal GrantsFederal Grants (1986-2000) (1986-2000)

API Sub-PopulationsAPI Sub-Populations Six Health AreasSix Health Areas

Computer Retrieval of Information on Specific Projects (C.R.I.S.P.)Computer Retrieval of Information on Specific Projects (C.R.I.S.P.) NIH NIH FDAFDA OASH OASH SAMHSASAMHSA CDCCDC HRSA HRSA AHRQ AHRQ

Research PublicationsResearch Publications (1966-2000) (1966-2000) API Sub-PopulationsAPI Sub-Populations Six Health areasSix Health areas

Medline Medline

Federal Grant ResultsFederal Grant Results

150369

34283

0

20000

40000

60000

80000

100000

120000

140000

160000

total grants all API grants API grants in6 health areas

CRISP Grants (1986 - 2000)

In CRISP:In CRISP:

0.2%0.2%of Federal grants relate to of Federal grants relate to

API healthAPI health


5 Grants 5 Grants 3 of 23 3 of 23 HP2010HP2010 Goals Goals::

Fetal and Infant Fetal and Infant DeathsDeaths

API Chinese FilipinoAPI Chinese Filipino

Low Birth WeightLow Birth Weight API Chinese FilipinoAPI Chinese Filipino

BreastfeedingBreastfeeding MalaysianMalaysian

ImmunizationsImmunizations1 Grant1 Grant

2 of 31 2 of 31 HP2010HP2010 Goals: Goals:

Hepatitis B in Infants Hepatitis B in Infants and Young Childrenand Young Children

VietnameseVietnamese

Hepatitis B in Adults Hepatitis B in Adults and High-Risk Groupsand High-Risk Groups

VietnameseVietnamese

Infant Mortality


DiabetesDiabetes9 Grants9 Grants3 of 17 goals:3 of 17 goals:

Prevent DiabetesPrevent Diabetes APIAPI

Reduce DiabetesReduce Diabetes APIAPI

Reduce Diabetes Reduce Diabetes Death RateDeath Rate

API Cambodian API Cambodian

FilipinoFilipino

Cardiovasc DiseaseCardiovasc Disease7 Grants7 Grants3 of 16 goals:3 of 16 goals:

Coronary Heart Coronary Heart Disease DeathsDisease Deaths

APIAPI

Stroke DeathsStroke Deaths APIAPI

High Blood High Blood CholesterolCholesterol

APIAPI


HIV/AIDSHIV/AIDS9 Grants9 Grants5 of 17 goals:5 of 17 goals:

New HIV CasesNew HIV Cases South AsiansSouth Asians PIPI

Condom UseCondom Use South AsiansSouth Asians APIAPI

Knowledge of Sero-Knowledge of Sero-statusstatus

South AsiansSouth Asians

Counseling for Counseling for Substance AbusersSubstance Abusers

API FilipinoAPI Filipino Chinese VietnameseChinese Vietnamese

Treatment According Treatment According to Guidelinesto Guidelines

API Chinese API Chinese Japanese FilipinoJapanese Filipino


CancerCancer 52 Grants52 Grants9 of 15 goals:9 of 15 goals: Cancer DeathsCancer Deaths API (Aggregate and Disaggregate)API (Aggregate and Disaggregate) Chinese Filipino Japanese Chinese Filipino Japanese N. HawaiianN. Hawaiian

Breast Cancer Breast Cancer DeathsDeaths

API Korean Chinese Japanese API Korean Chinese Japanese N. Hawaiian Filipino Vietnamese N. Hawaiian Filipino Vietnamese

IndianIndian

Cervical Cancer Cervical Cancer Deaths Deaths

Korean Cambodian Chinese Korean Cambodian Chinese Filipino Japanese N. Hawaiian Filipino Japanese N. Hawaiian SamoanSamoan

Prostate Cancer Prostate Cancer DeathsDeaths

API Chinese Japanese Vietnamese API Chinese Japanese Vietnamese IndianIndian

Lung Cancer DeathsLung Cancer Deaths Vietnamese Vietnamese


CancerCancer (Continued)(Continued)

Colorectal Cancer Colorectal Cancer DeathsDeaths

API Chinese Vietnamese IndianAPI Chinese Vietnamese Indian

Mammograms Mammograms API API

Counseling about Counseling about Prevention Prevention

API Korean Japanese Chinese API Korean Japanese Chinese Filipino N. HawaiianFilipino N. Hawaiian

Cancer SurvivalCancer Survival Chinese Filipino Japanese Chinese Filipino Japanese N. HawaiianN. Hawaiian

In CRISP:In CRISP:

0.2%0.2%of Federal grants relate to of Federal grants relate to


Research Publication ResultsResearch Publication Results

10 million

1499332

0100000020000003000000400000050000006000000700000080000009000000

10000000

total publs. total API API in 6health areas

Medline (1966 - 2000)

In MEDLINE:In MEDLINE:

0.01%0.01%

of articles deal with of articles deal with



Infant MortalityInfant Mortality 21 Studies21 Studies4 of 23 goals4 of 23 goals: :

Fetal and Infant DeathsFetal and Infant Deaths API Chinese JapaneseAPI Chinese Japanese

Low Birth WeightLow Birth Weight API Chinese Filipino Indian Samoan API Chinese Filipino Indian Samoan

Japanese N. HawaiianJapanese N. Hawaiian

Prenatal CarePrenatal Care Japanese N. Hawaiian FilipinoJapanese N. Hawaiian Filipino

Maternal IllnessMaternal Illness Cambodian Cambodian

ImmunizationsImmunizations23 Studies23 Studies4 of 31 goals:4 of 31 goals:

Hepatitis B in infantsHepatitis B in infants API SE Asians Chinese VietnameseAPI SE Asians Chinese Vietnamese

Hepatitis B in adults Hepatitis B in adults APIAPI

Vaccines Vaccines API Chinese LaotiansAPI Chinese Laotians

TuberculosisTuberculosisAPI Vietnamese Filipino Chinese KoreanAPI Vietnamese Filipino Chinese Korean


DiabetesDiabetes43 Studies43 Studies

6 of 17 goals6 of 17 goals::

Prevent DiabetesPrevent Diabetes

API JapaneseAPI Japanese

Reduce DiabetesReduce Diabetes

API API

Gestational DiabetesGestational Diabetes

PI FilipinoPI Filipino

Diagnosis of DiabetesDiagnosis of Diabetes Japanese ChineseJapanese Chinese

CV Deaths in CV Deaths in DiabeticsDiabetics

Japanese IndianJapanese Indian

Foot UlcersFoot Ulcers Japanese Japanese


Cardiovascular DiseaseCardiovascular Disease

51 Studies51 Studies7 of 16 goals:7 of 16 goals:

Coronary Heart Coronary Heart Disease DeathsDisease Deaths

API Samoan Japanese FilipinoAPI Samoan Japanese Filipino Chinese N. Hawaiian IndianChinese N. Hawaiian Indian

Stroke DeathsStroke Deaths API Japanese ChineseAPI Japanese Chinese

Artery-opening Artery-opening TherapyTherapy

APIAPI

High Blood High Blood CholesterolCholesterol

API Japanese Chinese FilipinoAPI Japanese Chinese Filipino

High BloodHigh Blood PressurePressure Japanese Filipino Japanese Filipino N. HawaiianN. Hawaiian

Mean Total Mean Total CholesterolCholesterol

JapaneseJapanese

LDL-Cholesterol LDL-Cholesterol Level in CHDLevel in CHD

API FilipinoAPI Filipino


HIV/AIDSHIV/AIDS

9 Studies9 Studies7 of 17 goals:7 of 17 goals:

New HIV CasesNew HIV Cases APIAPI

Condom UseCondom Use API Vietnamese Filipino API Vietnamese Filipino

Cambodian Korean ChineseCambodian Korean Chinese

Knowledge of Sero-Knowledge of Sero-statusstatus

Chinese Filipino Indian Chinese Filipino Indian Vietnamese Korean JapaneseVietnamese Korean Japanese

New AIDS CasesNew AIDS Cases APIAPI

AIDS Among MSMAIDS Among MSM AA SE Asian Japanese Filipino AA SE Asian Japanese Filipino

Chinese PIChinese PI

HIV Testing in TB HIV Testing in TB Patients Patients

APIAPI

Treatment According to Treatment According to GuidelinesGuidelines

AAAA


CancerCancer185 Studies185 Studies13 of 15 goals:13 of 15 goals:

Cancer DeathsCancer Deaths Chinese Filipino Japanese Chinese Filipino Japanese N. HawaiianN. Hawaiian

Breast Cancer Breast Cancer DeathsDeaths

API Pakistani Indian Filipino API Pakistani Indian Filipino Chinese Japanese Samoan Chinese Japanese Samoan

Vietnamese Islamic South AsianVietnamese Islamic South Asian

Cervical Cancer Cervical Cancer DeathsDeaths

Korean Cambodian Chinese Korean Cambodian Chinese Filipino N. Hawaiian Samoan Filipino N. Hawaiian Samoan Vietnamese APIVietnamese API

Prostate Cancer Prostate Cancer DeathsDeaths

API Chinese Japanese Vietnamese API Chinese Japanese Vietnamese Indian Indian

Lung Cancer DeathsLung Cancer Deaths

Vietnamese Samoan Japanese Vietnamese Samoan Japanese Chinese API Chinese API


Colorectal Cancer Colorectal Cancer DeathsDeaths

API Chinese Japanese API Chinese Japanese N. Hawaiian Korean SamoanN. Hawaiian Korean Samoan

MammogramsMammograms Filipino Korean Vietnamese Filipino Korean Vietnamese

Chinese Cambodian South AsianChinese Cambodian South Asian

Colorectal Cancer Colorectal Cancer ScreeningScreening

Chinese N. Hawaiian Japanese Chinese N. Hawaiian Japanese APIAPI

Oropharyngeal Oropharyngeal CancerCancer

Korean Samoan ChineseKorean Samoan Chinese

Pap TestsPap Tests Korean Chinese Vietnamese API Korean Chinese Vietnamese API

Cambodian Cambodian

Sun ExposureSun Exposure Japanese ChineseJapanese Chinese Filipino N. HawaiianFilipino N. Hawaiian

Melanoma Cancer Melanoma Cancer DeathsDeaths

SamoansSamoans

Statewide Cancer Statewide Cancer RegistriesRegistries

Vietnamese Vietnamese


0.01%0.01%

of articles deal with of articles deal with


Preliminary Results from Preliminary Results from 2000- Current2000- Current

Marked increase in MEDLINE articles Marked increase in MEDLINE articles concerning API’S. concerning API’S.

Very small increase in CRISP grants Very small increase in CRISP grants concerning API’s.concerning API’s.

Most research coming out of community-Most research coming out of community-based organizations and academia.based organizations and academia.

Most study funding from local and state Most study funding from local and state governments, cbo’s, academia.governments, cbo’s, academia.

No order or consistency to types of API data No order or consistency to types of API data

ConclusionsConclusions Current health data remain inadequate for API’s.Current health data remain inadequate for API’s.

To reach To reach HP2010HP2010 goals, the health community goals, the health community needs baseline data on disaggregated API sub-needs baseline data on disaggregated API sub-groups.groups.

RecommendationsRecommendations Projects that serve to fill in Projects that serve to fill in HP2010HP2010 gaps should gaps should

be funded.be funded.

Investigation of other sources of API data should Investigation of other sources of API data should be started.be started.

Evaluation of the quality of the data should be Evaluation of the quality of the data should be performed.performed.

OH WAIT!!!!OH WAIT!!!!

I ALMOSTI ALMOST

FORGOT !!!!!!FORGOT !!!!!!

In CRISP:In CRISP:

0.2%0.2% of Federal grants relate to of Federal grants relate to API health.API health.


0.01%0.01% of articles deal with of articles deal with API health.API health.

CHANDAK GHOSH, MD, MPHCHANDAK GHOSH, MD, MPHMedical ConsultantMedical Consultant

HRSAHRSA

26 Federal Plaza, 333726 Federal Plaza, 3337

New York, NY 10278New York, NY 10278

(212) 264-2545(212) 264-2545

[email protected]@HRSA.gov

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