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Challenges of Data Collection to Inform Health Disparities, Access, and Outcomes between and within the Asian American Population
Socioeconomic Indicators Influencing Asian American Health Status
In July of 2003, the U.S. Census Bureau released disaggregated socio-demographic information for more than
sixteen different Asian American (AA) and five Native Hawaiians and Other Pacific Islanders (NHOPI) groups
and found the following six socioeconomic indicators influencing health status:
- Language Income and Poverty Educational Attainment
- Immigration and Citizenship
- Health Workforce
- Other Household Indicators (i.e., housing tenure, median household income, household or family size, etc.)
Reducing Health Disparities in Asian American and Pacific Islander Populations
According to the study Reducing Health Disparities in Asian American and Pacific Islander Populations
conducted by Management Sciences for Health (MSH) and the U.S. Department of Health and Human Services,
“Health Disparities are the difference in the incidence, prevalence, mortality, and burden of disease
among specific population groups.”
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As in both white and black populations, the three leading causes of death in Asian American and Pacific
Islander (AAPI) populations are cancer, coronary artery disease, and cerebral vascular disease. For AAPIs,
cancer is the leading cause of death.
- While Asian Americans and Pacific Islanders experience lower cancer rates overall compared with other
minority groups, they do experience higher incidence and death rates for certain cancers.
Two Ohio Surveys Address Behavioral Risk Factors
Access to Health Care Issues
The Ohio Behavioral Risk Factor Surveillance System
Since 1984, the Ohio Department of Health (ODH), with the Centers for Disease Control and Prevention (CDC),
develop and implement the Behavioral Risk Factor Surveillance System (BRFSS) survey in Ohio. The BRFSS
obtains data regarding the prevalence of selected behaviors among 355,710 adults nationally and 5,835 adults
in Ohio that increase the risk of certain diseases and injuries.
The Ohio BRFSS uses telephone surveys to collect data from a sample of Ohio adults similar to
the age, income and racial distribution of the population of Ohio. Most counties did not provide a
sufficient sample size to calculate specific adult county resident prevalence for the total population,
much less groups within the population.
The Ohio Family Health Survey
The Ohio Family Health Survey (OFHS) also collects detailed data regarding Ohio residents’ access to
health insurance coverage, general health status, and their perceptions about, and access to, health care.
Last conducted in 2003-2004, the OFHS is a follow-up survey to the 1998 OFHS and conducted every five years.
The sampling design was developed to obtain a sample of 29,685 interviews among Ohio’s general population
similar to the age, income and racial distribution of the population of Ohio; 2,311 additional interviews
with African Americans; 400 additional interviews with Hispanics; and 690 additional interviews with Asian
Americans.
Data Challenges to Studying Asian American Health Disparities
Is every five years sufficient? What can we learn from an oversample of Asian Americans? If “health disparities
are the difference in the incidence, prevalence, mortality, and burden of disease among specific population
groups,” can a survey of 690+ Asian Americans tell us about the disparities among specific Asian American
populations (i.e. Chinese, Vietnamese, Asian-Indians, Filipinos, etc.)?
The bulk of research on healthcare disparities has focused on black-white differences – more research is
needed to understand disparities among other racial and ethnic minority groups.
Even though an over sample for Asians was drawn for the OFHS, the number of interviews obtained was not
large enough to allow county-level analysis. Even if the number of Asian interviews were increased, there
would not be a large enough sample to conduct meaningful analysis at the county, or county-cluster level,
except for possibly a few counties.
What are potential sources of disparities in care?
Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995)
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Access (e.g., insurance status, ability to pay for healthcare) is the most important
predictor of the quality of healthcare across racial and ethnic groups
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Disparities are consistently found across a wide range of disease areas and clinical services
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Cultural and linguistic barriers – many non-English speaking patients report having
difficulty accessing appropriate translation services
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Lack of stable relationships with primary care providers – minority patients, even when
insured at the same level as whites, are more likely to receive care in emergency rooms and
have less access to private physicians
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Financial incentives to limit services – may disproportionately and negatively affect minorities
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Health systems-level factors – financing, structure of care; cultural and linguistic barriers
- Patient-level factors – including patient preferences, refusal of treatment, poor adherence,
biological differences
- Disparities arising from the clinical encounter
Reccomendations
General Reccomendations
Increase awareness of racial and ethnic disparities in health care among the
general public and key stakeholders, and increase health care providers’ awareness of disparities.
Education
Patient education programs should be implemented to increase patients’ knowledge of how to best access
care and participate in treatment decisions.
Integrate cross-cultural education into the training of all current and future health professionals.
Needed Research
Conduct further research to identify sources of racial and ethnic disparities and
assess promising intervention strategies, and
Conduct research on ethical issues and other barriers to eliminating disparities.
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