Asian and NHPI health equity is elusive without disaggregated data

Kaiser Family Foundation health equity researchers took a deep dive into 2021 American Community Survey data to examine how demographics, health coverage and other social determinants of health drive health and healthcare for Asian and Native Hawaiian and Other Pacific Islanders overall, and by subgroups. 

Existing data limits understanding of disparities

Each year, the KFF researchers look at the latest federal data to identify disparities that directly impact the health and mortality of racial groups – from food and health insurance access to flu vaccine rates – in order to help policymakers develop interventions and direct resources toward achieving greater equity.

“When the same or similar measures are available in multiple datasets, we use the data that allows us to disaggregate for the largest number of racial/ethnic groups,” the KFF researchers said in a statement about their health and healthcare by race and ethnicity research methodologies.

They say that broad data for Asian and NHPI people often masks underlying disparities among subgroups. 

“Their race categories are often combined where they cannot be separately identified,” the researchers said.

According to their new report released in late May, disaggregated data is largely unavailable or reported at all for NHPI people, and nearly 700,000 individuals in the U.S. identify with one or more of the race’s subgroups. 

In addition, the Asian population is the fastest-growing racial or ethnic group in the country, with numbers almost doubling from 10.5 million in 2000 to almost 20 million in 2020, researchers say.

However, historical actions, like the adverse social impacts of colonization, have contributed to their “ongoing trauma and negative health outcomes” today. 

“Asian and NHPI people have faced ongoing stresses associated with the perpetual foreigner and model minority stereotypes, and acculturation,” the researchers said.

Urgent need to disaggregate Asian and NHPI datasets

COVID-19 highlighted the urgency to address racism and the lack of data that would better assure Asian and NHPI health equity, according to the new KFF report.

“Understanding the experiences of Asian and NHPI people is particularly important at this time given growing concerns about mental health and well-being amid a significant uptick in anti-Asian hate incidents since the pandemic, an increased focus on advancing health equity,” the researchers said.

Dr. Lan Ðoàn, assistant professor in the Department of Population Health, Section for Health Equity at New York University’s Grossman School of Medicine, agreed that the public health emergency shined a light on the level of data needed to dissect barriers to health equity for both Asian and NHPI populations.

“One of the major lessons learned from the last several years is that the current public health systems and data infrastructure we have now are not prepared or sufficient to respond to public health emergencies and that data weren’t available to our communities in a timely manner,” he told Healthcare IT News this week over email.

The KFF researchers found an array of basic disparities and differences between Asian and NHPI subgroups:

• The share of people who are noncitizens varies based on differences in U.S. birth citizenship rights across locations to which NHPI people trace their origins.
• Among the nonelderly population, 6% of Asian people and 11% of NHPI people were uninsured.
• There are wide variations in uninsured rates among Asian and NHPI subgroups.

“While as a broad group Asian people often fare similar to or better than White people across many of these measures, some subgroups fare worse,” the researcher noted. 

“On the other hand, NHPI people generally fare worse than their White counterparts across a range of social and economic measures.”

Rising suicide rates, low use of mental health services

When the KFF researchers looked at mental health and suicide, the revelations for both populations are grim, particularly for adolescents.

The latest data showed rising rates of suicide death among ages 12-17 across both larger ethnic groups, and although the rates of of suicide deaths are lower than their White peers, suicide was the leading cause of death among Asian and Pacific Islander children ages 10-14 and the second leading cause among those between the ages of 15 and 35. 

“Suicide death rates more than doubled among this population from 2010 (2.2 per 100,000) to 2020 (5.0 per 100,000),” according to researchers.

Two tragic mass shootings that occurred around the most recent Lunar New Year also highlight the importance of understanding and addressing mental health needs among Asian and NHPI people, the researchers say.

“Although overall rates of mental illness are generally lower among Asian people compared to White people, this finding may reflect underdiagnosis and underreporting,” they reflected. 

“It also may mask variations in mental health among subgroups of the population.” 

Researchers found that among people with mental illness, Asian people are less likely to utilize mental health services compared to other groups.

“In 2021, among adults with any mental illness in the past year, only 25% of Asian adults reported receiving mental health services compared to 52% of White adults,” they said.

Data on mental health utilization for NHPI people is unavailable, according to their study report.

Ðoàn says that to further understand how the experiences of being racialized impacts health outcomes, only “robust disaggregated racial/ethnic data” can enable policymakers and public health administrators to “appropriately address” the needs.

“Data reports like this highlight how unique Asian American and [NHPI] communities are from each other, as well as the diversity of experiences within each ethnic group,” Ðoàn said. 

Political action on improving Asian and NHPI datasets

Executive Order 14031 – Advancing Equity, Justice, and Opportunity for Asian Americans, Native Hawaiians and Pacific Islanders – established the White House Initiative on Asian Americans, Native Hawaiians and Pacific Islanders as a response to the anti-Asian violence spurred by the pandemic and national political discussions.

The aim of the initiative is to advance health equity for AA and NHPI people in the U.S. by investing in their communities and responding to the spikes in anti-Asian violence peppered throughout the country. 

It’s part of the Biden Administration’s National Strategy to Advance Equity, Justice and Opportunity for Asian American, Native Hawaiian and Pacific Islander Communities, which ordered multiple federal agencies to come up with multiple plans to assure the safety of AA and NHPI and recalibrate their SDoH.

The first goal of the U.S. Agency for Health and Human Services’ plan under the initiative is to “enhance the availability, quality, collection and use of disaggregated data on AANHPI populations: The Equity Subcommittee of the HHS Data Council has reviewed HHS service programs about the availability and use of vital statistics, health survey and administrative data.” 

Over the next two years, HHS says this subcommittee will develop “department-wide recommendations to address challenges faced by HHS-funded service programs in collecting, using and reporting equity-related data elements in program evaluation.”

For Ðoàn, “Improving the availability of disaggregated race/ethnicity data needs to include an examination of the current quality of race/ethnicity data available, evaluation of if the race/ethnicity questions being asked are truly representative of the communities and if the availability of disaggregated race/ethnicity data are easily accessible to community members and researchers.”

Because “racialized and minoritized communities are often the people who are both experiencing and having to prove their health disparities,” he said noting, “This is coupled with a demonstrated lack of racialized populations in clinical trials and population-based cohorts.”

IT, funding needed for Asian and NHPI equity

Ðoàn says there are a lot of opportunities for how technology “can strengthen and sustain data collection and data disaggregation practices at the national, state and local levels” to address and eliminate Asian and NHPI health disparities.

However, he added the caveat that “this is only possible with if there is agreement from public health and healthcare systems, health professionals and relevant stakeholders that disaggregated data is important and must be improved – and that there is the actual financial investment and multidisciplinary expertise guiding the public health data infrastructure and data systems updates.

“Our current systems were not designed with health equity in mind and have not historically centered on the communities we serve,” Ðoàn added. “So if we want high-quality data to track and eliminate health disparities, there must be the development and implementation of equity-specific medical and public health approaches.”

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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