healthy people 2010 and asian americans and asian americans and pacific islanders: defining a...
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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
Asia
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
Federal Grant ResultsFederal Grant Results
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
Federal Grant ResultsFederal Grant Results
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
Federal Grant ResultsFederal Grant Results
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
Federal Grant ResultsFederal Grant Results
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
Federal Grant ResultsFederal Grant Results
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
API healthAPI health
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
API healthAPI health
Research Publication ResultsResearch Publication Results
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
Research Publication ResultsResearch Publication Results
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
Research Publication ResultsResearch Publication Results
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
Research Publication ResultsResearch Publication Results
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
Research Publication ResultsResearch Publication Results
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
Research Publication ResultsResearch Publication Results
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
In MEDLINE:In MEDLINE:
0.01%0.01%
of articles deal with of articles deal with
API healthAPI health
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.
In MEDLINE:In MEDLINE:
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