Abstract
Aims
To explore the association between known risk factors for diabetes and diabetes prevalence among disaggregated Asian American sub-ethnic groups and to highlight the importance of looking at data in disaggregated form.
Methods
Ten years of data collected by the California Health Interview Survey were pooled and analyzed. Logistic regression models, controlling for age, gender, and marital status, were used for the analysis. Comparisons were made among an aggregated sample of Asian Americans (N = 21,267) and a disaggregated sample of Asian Americans (i.e., Chinese, Japanese, Koreans, Filipinos, South Asians, and Vietnamese).
Results
Disaggregated data showed that Korean Americans who smoked had three times the odds of having diabetes compared to non-smoking Korean Americans [OR = 3.02 (95% CI 1.43, 6.39)]. High blood pressure puts both Japanese and Filipino Americans at twice the odds of having diabetes as those who do not have high blood pressure ([OR = 2.23 (95% CI 1.09, 4.54) and [OR = 2.82 (95% CI 1.82, 4.36)], respectively). Although close to 10% of Vietnamese Americans in the sample were current smokers, smoking status was not associated with diabetes.
Conclusions
The association between diabetes and known risk factors differ across Asian American sub-ethnic groups. Findings highlight the importance of disaggregated data and discourage a one-size-fits-all approach to diabetes care strategies.
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Availability of data and material
The data underlying this article is part of the California Health Interview Survey and accessed from the University of California Los Angeles’ Center for Health Policy Research [https://healthpolicy.ucla.edu/chis/data/Pages/GetCHISData.aspx]. Public Use Data Files can be obtained directly from the Center for Health Policy Research. Confidential Data files used for this secondary analysis may be shared upon reasonable requests.
References
Araneta MR (2019) Engaging the ASEAN diaspora: type 2 diabetes prevalence, pathophysiology, and unique risk factors among Filipino migrants in the United States. Journal of the ASEAN Federation of Endocrine Societies 34(2):126
Budiman A, Ruiz NG (2021a) Key facts about Asian Americans, a diverse and growing population. Retrieved from https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-americans/
California Department of Public Health (2020) Chronic Disease Control Branch: COVID-19 and Diabetes. Retrieved from https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/pages/diabetesprevention.aspx
California Health Interview Survey (2009) CHIS 2007 methodology series: report 4 – response rates. UCLA Center for Health Policy Research, Los Angeles
California Health Interview Survey (2011) CHIS 2009 methodology series: report 4 – response rates. UCLA Center for Health Policy Research, Los Angeles
California Health Interview Survey (2014) CHIS 2011–2012 methodology series: report 4 – response rates. UCLA Center for Health Policy Research, Los Angeles
California Health Interview Survey (2016) CHIS 2013–2014 methodology series: report 4 – response rates. UCLA Center for Health Policy Research, Los Angeles
California Health Interview Survey (2017) CHIS 2015–2016 methodology series: report 4 – response rates. UCLA Center for Health Policy Research, Los Angeles
California Health Interview Survey (2019) CHIS 2017–2018 methodology series: report 4 – response rates. UCLA Center for Health Policy Research, Los Angeles
California Health Interview Survey (2020) CHIS 2019 methodology series: report 1 – sample design. UCLA Center for Health Policy Research, Los Angeles
CDC (2019) Type 2 diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/type2.html
CDC (2020) National diabetes statistics report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services, pp 12–15. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Chen JY, Diamant AL, Kagawa-Singer M, Pourat N, Wold C (2004) Disaggregating data on Asian and Pacific Islander women to assess cancer screening. Am J Prev Med 27(2):139–145. https://doi.org/10.1016/j.amepre.2004.03.013
Chishti M, Hipsman F, Ball I (2015) Fifty years on, the 1965 Immigration and Nationality Act continues to reshape the United States. Retrieved from
Cox DR (1958) The regression analysis of binary sequences. J Roy Stat Soc: Ser B (methodol) 20(2):215–232. https://doi.org/10.1111/j.2517-6161.1958.tb00292.x
Cuasay LC, Lee ES, Orlander PP, Steffen-Batey L, Hanis CL (2001) Prevalence and determinants of type 2 diabetes among Filipino-Americans in the Houston, Texas metropolitan statistical area. Diabetes Care 24(12):2054–2058. https://doi.org/10.2337/diacare.24.12.2054
Dolly Nguyen BM, Hoa Nguyen M, Teranishi RT, Hune S (2015) The hidden academic opportunity gaps among Asian Americans and Pacific Islanders: What disaggregated data reveals in Washington State. https://files.eric.ed.gov/fulltext/ED573771.pdf
Fuller-Thomson E, Roy A, Chan KT-K, Kobayashi KM (2017) Diabetes among non-obese Filipino Americans: findings from a large population-based study. Can J Public Health, 108(1):e36-e42. https://doi.org/10.17269/CJPH.108.5761
Gomez SL, Kelsey JL, Glaser SL, Lee MM, Sidney S (2004) Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization. Am J Public Health 94(11):1977–1984. https://doi.org/10.2105/ajph.94.11.1977
Hastings KG, Jose PO, Kapphahn KI, Frank AT, Goldstein BA, Thompson CA, Eggleston, K, Cullen MR, Palaniappan LP (2015) Leading causes of death among Asian American subgroups (2003–2011). PloS one 10(4):e0124341. https://doi.org/10.1371/journal.pone.0124341
Hing BO (1993) Making and remaking Asian America through immigration policy. Stanford Press, Palo Alto
Hsu WC, Araneta MRG, Kanaya AM, Chiang JL, Fujimoto W (2015) BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care 38(1):150–158. https://doi.org/10.2337/dc14-2391
Ichioka Y (1988) The Issei: The world of the first generation Japanese immigrants, 1885–1924. Free Press, New York
Islam NS, Zanowiak JM, Wyatt LC, Chun K, Lee L, Kwon SC, Trinh-Shevrin C (2013) A randomized-controlled, pilot intervention on diabetes prevention and healthy lifestyles in the New York City Korean community. J Community Health 38(6):1030–1041. https://doi.org/10.1007/s10900-013-9711-z
Ivey SL, Tseng W, Kurtovich E, Weir RC, Liu J, Song H, . . . Hubbard A (2012) Evaluating a culturally and linguistically competent health coach intervention for Chinese-American patients with diabetes. Diabetes Spectrum, 25(2):93–102. https://doi.org/10.2337/diaspect.25.2.93
Kanaya AM, Adler N, Moffet HH, Liu J, Schillinger D, Adams A, Ahmed AT, Karter AJ (2011) Heterogeneity of diabetes outcomes among asians and pacific islanders in the US: the diabetes study of northern california (DISTANCE). Diabetes Care, 34(4):930–937. https://doi.org/10.2337/dc10-1964
Karter AJ, Schillinger D, Adams AS, Moffet HH, Liu J, Adler NE, Kanaya AM (2013) Elevated rates of diabetes in Pacific Islanders and Asian subgroups: the Diabetes Study of Northern California (DISTANCE). Diabetes Care 36(3):574–579. https://doi.org/10.2337/dc12-0722
Kim MT, Kim KB, Huh B, Nguyen T, Han HR, Bone LR, Levine D (2015) The effect of a community-based self-help intervention: Korean Americans with type 2 diabetes. Am J Prev Med 49(5):726–737
Le TN, Arifuku I (2005) Asian and Pacific Islander youth victimization and delinquency: A case for disaggregate data. Amerasia J 31(3):29–42. https://doi.org/10.17953/amer.31.3.y1483q3v35045255
Lee C (2015) Family reunification and the limits of immigration reform: Impact and legacy of the 1965 Immigration Act. Paper Presented at the Sociological Forum. https://doi.org/10.1111/socf.12176
Leung AYM, Bo A, Hsiao H-Y, Wang SS, Chi I (2014) Health literacy issues in the care of Chinese American immigrants with diabetes: a qualitative study. BMJ Open 4(11):e005294
Lindström J, Tuomilehto J (2003) The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care 26(3):725–731. https://doi.org/10.2337/diacare.26.3.725
NCES (2019) Indicator 27 Snapshot: Attainment of a Bachelor's or Higher Degree for Racial/Ethnic Subgroups. Retrieved from https://nces.ed.gov/programs/raceindicators/indicator_RFAS.asp
Ngo F, Sablan J (2019) Southeast Asian and Pacific Islander student progression through community college: a disaggregated transcript analysis. Teach Coll Rec 121(8):1–32. https://doi.org/10.1177/016146811912100807
Nguyen AB (2019) Disaggregating Asian American and Native Hawaiian and other Pacific Islander (AANHOPI) adult tobacco use: findings from wave 1 of the population assessment of Tobacco and Health (PATH) Study, 2013–2014. J Racial Ethn Health Disparities 6(2):356–363. https://doi.org/10.1007/s40615-018-00532-1
Nguyen AB, Chawla N, Noone A-M, Srinivasan S (2014) Disaggregated data and beyond: future queries in cancer control research. AACR. https://doi.org/10.1158/1055-9965.EPI-14-0387
Nguyen B-MD, Nguyen MH, Nguyen T-LK (2013) Advancing the Asian American and Pacific Islander data quality campaign: data disaggregation practice and policy. Asian American Policy Rev 24:55. Retrieved from https://libproxy.csun.edu/login?url=https://www.proquest.com/scholarly-journals/advancing-asian-american-pacific-islander-data/docview/1786882319/se-2
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A (2012) Trends in prevalence of diabetes in Asian countries. World J Diabetes 3(6):110
Srinivasan S, Guillermo T (2000) Toward improved health: disaggregating Asian American and Native Hawaiian/Pacific Islander data. Am J Public Health 90(11):1731. https://doi.org/10.2105/2Fajph.90.11.1731
StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP
Suzuki M, Murashima M, Hoerr SL & with the WHO Expert Consultation Panel (2007) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Nutr Diet 64:157–163
Taylor KB (2013) Indochina migration and refugee assistance act (1975). In C E Cortés, M A A m e (Ed.) (Eds.), Multicultural America: a multimedia encyclopedia, vol. 1. Sage, London, pp 1190–1191
Tran C (2020) Multifaceted: the cultural diversity of Asian America. Retrieved from https://www.kcet.org/shows/asian-americans/multifaceted-the-cultural-diversity-of-asian-america
US Census (2020) Asian American and Pacific Islander Heritage Month: May 2020. Retrieved from https://www.census.gov/newsroom/facts-for-features/2020/aian.html
US Census Bureau (2016–2020) American Community Survey 5-Year Estimates
Vargas P (2018) Dietary intake and obesity among Filipino Americans in New Jersey. J Environ Public Health, 2018
Varma R, Wen G, Jiang X, Hsu C, Torres M, Klein R, Azen SP, McKean-Cowdin R, Chinese American Eye Study Group (2016) Prevalence of diabetic retinopathy in adult Chinese American individuals: the Chinese American Eye Study. JAMA Ophthalmology 134(5):563–569
Võ LT (2000) The Vietnamese American experience: from dispersion to the development of post-refugee communities. In: Wu JY-WS, Song M (eds) Asian American studies: a reader. Rutgers University Press, New Brunswick, pp 290–305
Acknowledgements
The authors would like to acknowledge and thank the University of California Los Angeles’ Center for Health Policy Research and California State University, Northridge.
Funding
This research is supported through a grant from the National Institute of Minority Health and Health Disparities, National Institutes of Health R15 Academic Research Enhancement Award (Grant Number: 1R15MD011666-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD. Additional support for this research was funded by the National Institute of General Medical Sciences (NIGMS) BuildingInfrastructure Leading to Diversity (BUILD) Initiative, grant numbers TL4GM118977, UL1GM118976, and RL5GM118975. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIGMS.
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Patchareeya Pumpuang Kwan, Role: Writing – Original draft, Writing – Review and Editing.
Jonathan Watts, Role: Data curation, Methodology, Formal analysis.
Jamie Michelle Prudencio, Role: Writing – Review and Editing, Visualization.
Lawrence Chu, Role: Data curation, Methodology, Funding acquisition.
Danielle Erika Co, Role: Formal analysis, Writing – Review and Editing.
Edith Chen, Role: Conceptualization, Funding acquisition, Writing – Review and Editing.
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Kwan, P.P., Watts, J., Prudencio, J.M. et al. Differences in diabetes risk factors among Asian Americans. J Public Health (Berl.) 32, 1–8 (2024). https://doi.org/10.1007/s10389-022-01779-z
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DOI: https://doi.org/10.1007/s10389-022-01779-z