Wisconsin Department of Health Services

January 2014 P-00522S

Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Asian Population

ASIAN POPULATION

Chapter Outline

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Key points

Data• Demographic and socioeconomic data• Access to health services; health risks and outcomes

References

Links to additional reports and resources

Contacts

2

Chapter outline

ASIAN POPULATION

Report Overview

• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.

• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.

• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

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Report Format

Full Report• Format: PDF • Intended use: reference document

Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to

– Decision-makers– Service providers– Community leaders– The public

Sample annotated slide

Report overview

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Report Outline

Executive Summary

Section 1: Introduction

Section 2: Demographic overview

Section 3: Health focus areas

Section 4: Infrastructure focus areas

Section 5: Data summaries by population

Section 6: Technical notes

Report overview

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Report Outline: Detail

Section 3: Health focus areas

• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure

Section 4: Infrastructure focus areas• Access to health services

Report overview

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Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography

Report overview

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Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.

• Population estimates that are considered unreliable are excluded.

• Misclassification of racial/ethnic groups may affect the accuracy of rates.

• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

Report overview

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Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

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Historical trauma• Historical trauma is the cumulative exposure to traumatic events

that not only affect the individual exposed, but continue to affect subsequent generations.

• Descendants of those who experienced the traumatic stressor may still exhibit symptoms.

• Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty.

• Current manifestations may include:• Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse,

suicide, homicide, and domestic violence; and • Higher rates of chronic diseases.

Report overview

Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp

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Key Points: Asian Population

• The Asian population in Wisconsin is young, widely distributed geographically, diverse in ethnicity, and increasing in size. A majority of Asians in Wisconsin are foreign-born.

• Asians in Wisconsin, particularly Laotians/Hmong, are more likely to live in poverty compared to Whites.

• Asians have a higher prevalence of certain communicable diseases compared to other racial/ethnic groups because many Asians are foreign-born, having come from areas where these diseases are endemic.

Key points

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• Asians are less likely to receive first-trimester prenatal care.

• Asians have a higher rate of obesity among children ages 2-4 in WIC but a lower rate of overweight or obesity among adults. A higher proportion of stroke deaths among Asians occur before the age of 75.

• Asian youth have higher rates of depression and planning for suicide compared to White students.

• Better data on Asians are needed to address small sample sizes and the diversity of the population. Aggregate data may mask significant disparities among subpopulations.

Key Points: Asian Population

Key points

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Data Quality Issues: Asian Population

Major limitations of data for Asians include:

• Small sample sizes: A majority of Wisconsin BRFS measures cannot be shown for Asians due to small sample sizes.

• Diversity of the Asian population in terms of ethnicities, nationalities, religions, and foreign- versus U.S.-born status.

• Aggregate data for all Asians may mask significant disparities among sub-populations.

Data Issues

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Demographic data

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Demographic Characteristics

Wisconsin’s Asian population is increasing in size, young, and diverse in terms of country of origin. More than half are foreign-born.

• Wisconsin's Asian population, 2010: 128,052; 2.3% of state total

• Change in the Asian population, 2000 to 2010: 42% increase

• Median age, 2010: Asian, 26 years (Whites, 41.5 years) The median age is the age at which half the population is older and half is younger.

• Percent of Asians who were foreign-born, 2010: 58%

Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.

Demographic and socioeconomic data

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China13%

Korea11%

Other E Asia4%

India22%

Pakistan5%

Other S Asia2%

Laos19%

Thailand15%

Philippines8%

Other SE Asia4%

Source: American Community Survey, 2010.

Southeast Asia, 45%

East Asia, 27%

South Asia, 28%

Country of origin of foreign-born Asians, Wisconsin, 2010

Demographic and socioeconomic data

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Asian population by county, Wisconsin, 2010

Source: U.S. Census, 2010.

Racial/ethnic minority populations

Asian population

Asians as a percent of total population

1 - 1,041

1,042 - 3,847

3,848 - 10,792

10,793 - 32,303

0% - 0.7%

0.8% - 1.8%

1.9% - 3.4%

3.5% - 5.3%

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Level of urbanization of Wisconsin residents, by race/ethnicity, 2007-2011

Geography

Source: American Community Survey, 2007-2011..

White Black American Indian Asian Hispanic0%

10%

20%

30%

40%

50%

60%

70%

80%

11% 67% 12% 24% 37%59% 28% 39% 66% 48%30% 4% 49% 10% 15%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

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Socioeconomic data Wisconsin’s Asian population has higher education rates than Whites. However, Wisconsin’s Asian population has a higher poverty rate than Whites, with the Laotian/Hmong population having a higher poverty rate than other Asian groups.

• Median household income in Wisconsin, 2008-2010: Asians, $53,600 (Whites, $53,000).

• Living in poverty, 2008-2010: Laotian/Hmong, 25%; Other Asians 17% (Whites, 9%).

• Bachelor’s degree or more education (age 25 and older), 2007-2010: Asians, 46% (Whites, 27%)

• Married-couple households as a percent of family households, 2008-2010: Asians: 79% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%)

Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau, American Community Health Survey

Demographic and socioeconomic data

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Access to health services; health risks and outcomes

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Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, 2008-2011

Did not have a doctor's visit in past year

Do not have a personal doctor Unable to obtain medical care due to cost

0%

10%

20%

30%

40%

50%

60%

35% 16% 10%21% 16% 18%33% 20% 20%25% 17% 21%33% 16%

White Black

Hispanic Asian

American Indian

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Access to health care

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Percentage of births to mothers who received prenatal care during the first trimester, by race/ethnicity, Wisconsin, 2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates.

Prenatal care during first trimester0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

88% 74% 75% 66% 72%

WhiteBlackHispanicLaotian/HmongAmerican Indian

Access to health care

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Obesity among children (ages 2-4 years) enrolled in the Supplemental Nutrition Program for Women, Infants, and Children (WIC), by race/ethnicity, Wisconsin, 2001 and 2010

White Black Hispanic Asian American Indian0%

5%

10%

15%

20%

25%

30%

35%

40%

10% 8% 16% 18% 18%12% 11% 18% 17% 27%

2001

2010

Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey, 2010.Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.

Nutrition

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Age-adjusted rates of overweight and obesity among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Overweight or Obese Obese0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

63% 27%78% 44%67% 29%45% 71% 38%

WhiteBlackHispanicAsianAmerican Indian

Nutrition

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Percentage of third-grade students with untreated decay and dental sealants, by race/ethnicity, Wisconsin, 2007-2008 school year

Source: Wisconsin Department of Health Services, Make Your Smile Count Survey.

Untreated decay Dental sealants0%

10%

20%

30%

40%

50%

60%

70%

80%

15% 55%31% 32%35% 48%35% 44%

White Black

Hispanic Asian

Oral health

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Depression among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

Felt sad/hopeless for at least 2 weeks and stopped doing usual activities

-10%

0%

10%

20%

30%

40%

50%

60%

20% 28% 28% 32% 32%

White Black

Hispanic Asian

American Indian

Mental health

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Suicide risk during past 12 months among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Mental health

Considered suicide

Planned suicide Attempted suicide Suicide attempt with injury

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

13% 10% 5%17% 15% 12%14% 10%20% 13% 9%25% 22% 16%

White Black

Hispanic Asian

American Indian

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Cancer incidence and mortality (all sites) by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2010

Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013.Note: Racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

Incidence Mortality0

100

200

300

400

500

600

437 171532 244323 95288 106504 230

White Black

Hispanic Asian

American Indian

Age-

adju

sted

rate

per

100

,000

pop

ulati

onChronic diseases

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Stage of disease at diagnosis, all cancers, White and Hmong populations, Wisconsin, 1995-2010

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2013 .Note: Percentages exclude cases for which stage was unknown or that were not staged.

Localized Regional Distant/Systemic0%

10%

20%

30%

40%

50%

60%

70%

52% 24% 24%31% 29% 40%

WhiteHmong

Stage at diagnosis

Chronic diseases

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Percentage of stroke deaths under age 75, by race/ethnicity and sex, Wisconsin, 2006-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

Male Female0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

28% 15%66% 53%59% 46%68% 43%64% 40%

White Black

Hispanic Asian

American Indian

Chronic diseases

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Chronic hepatitis B cases by race/ethnicity, Wisconsin, 2010-2012

Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010-2012.Note: Includes chronic hepatitis B virus cases, confirmed or probable.

American Indian, 0.3%

Asian; 42.8%Black, 15.7%

Hispanic; 2.3%

White; 18.4%

Communicable diseases

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Tuberculosis cases by race/ethnicity and foreign-born status, Wisconsin, 2006-2012

Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010-2012.

Communicable diseases

White Black Hispanic Asian American Indian0

20

40

60

80

100

120

140

160

180

Foreign-Born, Not RefugeeForeign-Born RefugeeU.S. Born

Num

ber o

f cas

es

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References1. 2010 Census Briefs: The Asian Population. http://

www.census.gov/prod/cen2010/briefs/c2010br-11.pdf2. 2010 Census Briefs: The Native Hawaiian and Other Pacific Islander Population. http

://www.census.gov/prod/cen2010/briefs/c2010br-12.pdf3. University of Wisconsin Population Health Institute. County Health Rankings, 2013.

http://www.countyhealthrankings.org/our-approach 4. Center for Urban Population Health. Milwaukee Health Report, 2011.

http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 5. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health

Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

6. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

7. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

8. Greenberg RS (1983). The impact of prenatal care in different social groups. American Journal of Obstetrics and Gynecology. 145(7):797-801.

9. CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm

References

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10. CDC. Youth Risk Behavior Surveillance System. http://apps.nccd.cdc.gov/youthonline/App/Default.aspx

11. Office of Adolescent Health. Mental Health. http://www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/home.html

12. Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034364/

13. CDC. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. http://www.cdc.gov/nchs/data/databriefs/db37.htm

14. National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care. 2012. http://www.nimh.nih.gov/news/science-news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental-health-care.shtml

15. National Cancer Institute. Cancer Staging. http://www.cancer.gov/cancertopics/factsheet/detection/staging

16. DHS. Wisconsin Minority Health Report, 2001-2005 (PPH-5716), pages 79-108 (“Asians”). http://www.dhs.wisconsin.gov/health/minorityhealth/ReportPDF/asians.pdf

17. Foote M, Matloub J. Comprehensive Cancer Control Program Surveillance Brief. Determining Practices for Reporting Hmong Cancer Cases in Wisconsin. Special Supplement: Cancer Incidence Data for Hmong. http://www.wicancer.org/uploads/pub_34566.pdf

References

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18. World Health Organization (WHO). Hepatitis B. http://www.who.int/mediacentre/factsheets/fs204/en/

19. WHO. Tuberculosis (TB). http://www.who.int/topics/tuberculosis/en/

References

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Links to additional reports and resources

• Centers for Disease Control and Prevention, Minority Health, Asian American Populations: http://www.cdc.gov/minorityhealth/populations/REMP/asian.html

• Centers for Disease Control and Prevention, Immigrant and Refugee Health: http://www.cdc.gov/immigrantrefugeehealth/

Links

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Contacts

Evelyn Cruz, Minority Health OfficerWisconsin Division of Public Health, Office of Policy and Practice AlignmentE-mail: Evelyn2.Cruz@dhs.wisconsin.gov

Karl Pearson, DemographerWisconsin Division of Public Health, Office of Health InformaticsE-mail: KarlT.Pearson@dhs.wisconsin.gov

Savitri Tsering, CoordinatorWisconsin Division of Public Health, Refugee Health ServicesE-mail: Savitri.Tsering@dhs.wisconsin.gov

Contacts

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