Heart disease

A recent Oregon State University study on cardiovascular disease among Asian Americans, Native Hawaiians and Pacific Islanders revealed more about the lack of scientific literature on racial and ethnic groups with small populations than about the overall risk factors and heart disease rates.

The results come at a time when researchers and policymakers are paying closer attention to the specific needs of individual Asian American communities, as disparities among different ethnicities have become more obvious amid the COVID-19 pandemic and heightened racism toward people of Asian descent.

“If we look at Asian Americans and Native Hawaiians/Pacific Islanders together, we are really misrepresenting the two racial groups. They are racially, ethnically and culturally different,” said Lan Doan, lead author on the paper and a recent doctoral graduate from OSU’s College of Public Health and Human Sciences. “We are hiding and masking disparities in smaller but growing populations in the U.S.”

The study, published in the Journals of Gerontology, examined self-reported data on heart disease risk factors and prevalence from the Medicare Health Outcomes Survey from the years 2011-2015, which included responses from close to 640,000 Medicare Advantage enrollees ages 65 and older nationwide. Of that number, 26,853 respondents identified as Asian American and 4,926 identified as Native Hawaiian or Pacific Islander.

Out of those groups, the study found that Native Hawaiians and Pacific Islanders experienced the greatest burden of heart disease risk factors, including diabetes, hypertension and smoking, compared to white and Asian American adults. Similarly, Asian Americans reported diabetes more often than white adults, and Filipino, Vietnamese and multiracial Asians reported hypertension more than whites.

But the results are hampered by limitations in the data, said Doan and co-author Veronica Irvin, an associate professor at OSU.

Ethnic groups with smaller populations such as Pakistanis, Thais, Cambodians or Chamorros may have vastly different levels of cardiovascular risk, mortality and morbidity, but that level of detail is flattened under the big umbrellas of “Asian American” and “Pacific Islander,” where the larger ethnic groups are usually Korean, Japanese and Chinese for Asian Americans and Native Hawaiians for Pacific Islanders.

And in many areas of health research, data is not collected on groups with a small sample size, or they end up being left out of research results altogether because of concern for the anonymity of individuals within those small groups and because small sample sizes are more easily skewed by outliers.

Without specific data on those groups, it is difficult to identify major issues and develop specific interventions to address health risks, researchers said.

“There’s limited data collection and reporting for small populations and by disaggregated race and ethnicity. It’s a continuous cycle where year after year, no or limited data is collected and reported, and if there is a disparity, it remains invisible,” Doan said.

That invisibility translates into lack of funding for health interventions or further research, Irvin said.

“You can’t get the funding if you can’t justify the need, and if there’s no data to demonstrate the need, then it’s not a priority,” Irvin said.

Even finding existing data is challenging: In order to break out smaller ethnic groups from the Medicare survey for this study, Doan and Irvin spent nearly a year working on the paperwork required to access those datasets and needed specific statistical software to open them. Very few people have the time and resources to go through that process, they said.

“For a community organization that just wants to know ‘What’s the rate of heart disease in Native Hawaiians,’ it’s not impossible, but it’s this major hurdle to even get this data,” Irvin said.

The lack of data on Asian American and Native Hawaiian/Pacific Islander subgroups also perpetuates the “model minority” myth that Asian Americans and immigrants of Asian descent don’t have any health problems, Doan said. The model minority myth often portrays all Asian Americans as being highly educated, wealthy and successful, which serves to both discourage honest conversations about real struggles within Asian communities and to portray other racial minorities in the U.S., especially Black people, as unfavorable in comparison, she said.

“More recently, the model minority stereotype where all Asians are healthy extends to, ‘They don’t need any social services or public benefits,’” Doan said.

She pointed to the March shooting deaths of six Asian women in Atlanta as the moment when more funding finally started being directly allocated to address needs in Asian American-serving community-based organizations and to address anti-Asian hate.

Overall, the researchers concluded that more attention needs to be focused on Native Hawaiian and Pacific Islander groups, as well as Asian Americans, due to their higher likelihood of cardiovascular disease risk factors compared to their white counterparts.

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