The Feasibility of Using Electronic Health Data for Research on Small Populations. Population #1: Asian-American Subpopulations


“Asians” are one of the five race categories that must be used in the federal government’s surveys and administrative forms under rules of the Office of Management and Budget, but the Asian-American population is quite internally diverse. The 15.5 million Asian Americans who compose about 4.4 percent of the American population include more than 50 different Asian ethnicities and 100 languages. Asian Americans are concentrated in urban areas, particularly in California, New York, and Texas. Which Asian-American subpopulations are found in particular areas varies. Urban areas in California like Los Angeles and San Francisco, as well as eastern areas like New York City have larger Chinese populations than any other Asian subpopulation, while urban areas in Texas have higher concentrations of Asian Indians and Vietnamese.26 Other local concentrations of Asian subpopulations can increasingly be found throughout the country.27 Between 2000 and 2010, there was a 46 percent increase in the Asian-American population, making them the fastest growing racial group.28

It has been well documented that racial and ethnic minorities receive lower quality health care than non-minorities even after accounting for access-related factors,29 but little of the research on racial/ethnic disparities has focused on Asian Americans. Their health care needs remain poorly understood due to inconsistent definitions used in data collection, lack of disaggregated data about ethnic subgroups, and the uneven geographic distribution of the Asian-American population.30

The commonplace view of Asian Americans as self-sufficient, educated, and upwardly mobile fails to recognize the health needs of Asians overall, as well as their diversity in terms of ethnic background, country of origin, length of time in the United States, and other factors that may affect health and health care.31

Figure I.1, which comes from the Palo Alto Medical Foundation Research Institute’s Pan Asian Cohort Study (National Institutes of Health, National Institute of Diabetes and Digestive Kidney Diseases grant 5R01DK81371), which primarily utilizes electronic health record (EHR) data, shows diabetes prevalence among men in the San Francisco Bay area and provides a vivid example of the differences in health problems among sub-groups of the Asian-American population.32 The prevalence rate among Filipino men is more than three times that of Japanese men. It is apparent from these and other data, that health needs vary greatly within what is often treated in research as a single racial population.33

Figure I.1. Pan Asian Cohort Study—Preliminary Findings for Diabetes Prevalence

Figure I.1. Pan Asian Cohort Study—Preliminary Findings for Diabetes Prevalence

Source: Pan Asian Cohort Study. “Preliminary Findings for Diabetes Prevalence.” Palo Alto Medical Foundation. Accessed March 1, 2013.

There is also evidence of health care–related differences within the Asian-American population. Asian immigrants to the United States are less likely than U.S.-born Asians to have health insurance and use health care services.34 Linguistic isolation (living in a household in which no one above age 14 speaks English) may contribute to this. About one-quarter of Asian Americans live in linguistically isolated households, with rates ranging from 10 percent among Filipinos to 45 percent of the Vietnamese.35 Not surprisingly, linguistically isolated households tend to be of low socioeconomic status and have poorer access to care and more depravation of various kinds than do households in which English is spoken. New immigrants from all countries tend to locate near earlier immigrants. This pattern may facilitate access to various kinds of culturally specific goods and services but may produce isolation from the larger society as well as shared exposure to any environmental risk factors that are proximate to their locale.36

The language barriers and cultural differences associated with immigrant status create various complexities, including communications difficulties with health care providers, advice that is inconsistent with cultural beliefs and practices, and dissatisfaction with or distrust of medical advice.37 Imperfect language translation and nuance can create confusion. Language and cultural isolation of immigrant or non-English speaking groups may present barriers to care-seeking and treatment.38 Behavioral health issues—stress, smoking, domestic violence, alcohol abuse—may also be associated with these factors.

There is need for better information about subpopulations of Asian Americans, as can be can be illustrated by considering the examples of Vietnamese and Filipinos in the United States.

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