Associations between everyday and major discrimination and health status among a diverse national sample of ten Asian ethnic subgroups

Asian Hate, religion, and perceived changes in physical health: exploring the flip side of minority stress during the COVID-19 pandemic

OBJECTIVES

Prior research suggests that racism is associated with adverse mental health outcomes for Asians in the United States. Relatively less research has been conducted to examine the effects of racism on physical health, particularly the changes in physical health among Asians and Asian Americans. This study aims to fill in this gap in prior research.

DESIGN

Survey was conducted via Qualtrics in March 2023. A panel sample of 356 Asian and Asian American adults from across the US was collected. Ordinary Least Squares Regression was employed to examine the interrelationships among racism, religion, and perceived changes in physical health during the COVID-19 pandemic.

RESULTS

Contrary to conventional wisdom, more frequent experience with blatant racism was associated with a perceived improvement in physical health after controlling for subtle racism, anxiety, acculturation, and various sociodemographic variables. Interestingly, this robust relationship was more significant among Asians who attended religious services more frequently. Additional three-way interactions revealed that the interaction between blatant racism and religious service attendance on perceived changes in physical health was more significant for US-born Asians and Asians of Indian or Japanese ethnicity.

CONCLUSION

Racism exerts a significant influence on physical health outcomes among Asians and Asian Americans. However, this relationship was contingent upon the specific aspect of racism and intersected with religiosity, acculturation, and ethnic identity.

Racism, self-rated general health status, and health-related quality of life among Black and Asian Americans

Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities. Extant research shows significant health inequities between white and Black people. However, little is known about health gaps between or among other racial groups. This study investigated how Blacks and Asian Americans perceive and experience racism in healthcare settings and in general daily life situations, and how these factors relate to their self-rated general health status and health-related quality of life. Findings from an online survey suggest strong similarities and subtle differences between the two racial groups and within the Asian subgroups.

Variations in racial and ethnic groups' trust in researchers associated with willingness to participate in research

Low enrollment in U.S. biomedical research by non-White adults has historically been attributed to mistrust, but few studies have simultaneously examined dimensions of trust in three or more racial/ethnic groups. Leveraging the racial/ethnic diversity of New Jersey, we prospectively recruited 293 adults (72% women, 38% older than 54 years of age) between October 2020 and February 2022 to complete two anonymous surveys in English or one of the common languages (e.g., Spanish, Mandarin Chinese). The first consisted of 12 Likert Scale questions related to trust in biomedical researchers (according to safety, equity, transparency), and the second assessed willingness to consider participation in eight common research activities (health-related survey, blood collection, genetic analysis, medication study, etc). Participants self-reported as Hispanic (n=102), Black (n=49), Chinese (n=48), other Asian (n=53), or White (n=41) race/ethnicity. Factor analysis showed three aspects related to trust in researchers: researchers as fiduciaries for research participants, racial/ethnic equity in research, and transparency. Importantly, we observed differences in the relationship between mistrust and willingness to participate. Whereas Chinese respondents' low trust in researchers mediated their low interest in research involving more than health-related surveys, Hispanic respondents' low trust in research equity did not deter high willingness to participate in research involving blood and genetic analysis. We caution that a generic association between trust and research participation should not be broadly assumed, and biomedical researchers should prospectively assess this relationship within each minoritized group to avoid hasty generalization.

Leading Predictors of COVID-19-Related Poor Mental Health in Adult Asian Indians: An Application of Extreme Gradient Boosting and Shapley Additive Explanations

During the COVID-19 pandemic, an increase in poor mental health among Asian Indians was observed in the United States. However, the leading predictors of poor mental health during the COVID-19 pandemic in Asian Indians remained unknown. A cross-sectional online survey was administered to self-identified Asian Indians aged 18 and older (N = 289). Survey collected information on demographic and socio-economic characteristics and the COVID-19 burden. Two novel machine learning techniques-eXtreme Gradient Boosting and Shapley Additive exPlanations (SHAP) were used to identify the leading predictors and explain their associations with poor mental health. A majority of the study participants were female (65.1%), below 50 years of age (73.3%), and had income ≥ $75,000 (81.0%). The six leading predictors of poor mental health among Asian Indians were sleep disturbance, age, general health, income, wearing a mask, and self-reported discrimination. SHAP plots indicated that higher age, wearing a mask, and maintaining social distancing all the time were negatively associated with poor mental health while having sleep disturbance and imputed income levels were positively associated with poor mental health. The model performance metrics indicated high accuracy (0.77), precision (0.78), F1 score (0.77), recall (0.77), and AUROC (0.87). Nearly one in two adults reported poor mental health, and one in five reported sleep disturbance. Findings from our study suggest a paradoxical relationship between income and poor mental health; further studies are needed to confirm our study findings. Sleep disturbance and perceived discrimination can be targeted through tailored intervention to reduce the risk of poor mental health in Asian Indians.

The role of discrimination in the relation between COVID-19 sequelae, psychological distress, and work impairment in COVID-19 survivors

Perceived discrimination and work impairment are commonly observed in COVID-19 survivors, but their relationship has not been well understood. We aimed to evaluate the role of discrimination in the development of psychological distress and work impairment in COVID-19 survivors. From April 2020 to November 2021, 309 patients were recruited at two designated COVID-19 hospitals in Japan. Participants completed a standardized questionnaire including COVID-19 sequelae, psychological distress, impairments in work performance and perceived discrimination. The majority of participants (62.5%) experienced one or more COVID-19 sequelae. Psychological distress was observed in 36.9% and work impairment in 37.9%. In multivariate logistic regression analyses, COVID-19 sequelae and discrimination were associated with both psychological distress and work impairment. Mediation analysis demonstrated that the direct effect of sequelae on work impairment was non-significant after accounting for psychological distress, suggesting that the effect of sequelae on work impairment was mainly mediated through psychological distress. These findings were replicated in a subgroup analysis limited to patients with mild COVID-19. We conclude that discrimination plays an important role in the development of psychological distress and work impairment, and that both discrimination and psychological distress should be targets of intervention in COVID-19 survivors.

Disaggregating the data: Diversity of COVID-19 stressors, discrimination, and mental health among Asian American communities

Much of the public discourse as well as research regarding the negative impact of COVID-19-related anti-Asian discrimination has been conducted at the broad racial group level, yet data aggregation masks critical points of diversity among Asian Americans. We conducted an online survey of 620 Asian American adults in December 2020 and examined whether there were any demographic differences-including by ethnic subgroup and Chinese street race (being Chinese or being mistaken as Chinese)-in their experiences of COVID-19-related stress, direct and vicarious discrimination, and psychological outcomes. Our analyses found that younger age was correlated with higher reports of pandemic stress, discrimination, distress, and worry. Female and U.S.-born participants reported higher levels of pandemic stress and vicarious discrimination, but there were no gender or nativity differences in levels of direct discrimination. Being uninsured was also related to higher levels of pandemic stress, discrimination, and distress. East Asian Americans reported significantly lower frequencies of direct anti-Asian discrimination than did South Asian or Southeast Asian Americans, but the ethnic subgroups did not differ in their reports of vicarious discrimination. Of note, Chinese street race was not associated with either direct or vicarious discrimination. Separate hierarchical regression analyses for East Asian, South Asian, and Southeast Asian participants revealed that, regardless of ethnicity, racial discrimination significantly contributed to psychological distress and worry beyond the effects of pandemic stress. However, the three groups varied in the demographic indicators and COVID-19 stressors that were associated with psychological outcomes. Pandemic stress was more strongly associated with negative outcomes among South Asian Americans than East Asian and Southeast Asian Americans, and neither direct nor vicarious discrimination were associated with mental health among South Asian Americans. Direct discrimination, compared to vicarious discrimination, was a particularly robust predictor of both distress and worry among East Asian Americans. For Southeast Asian Americans, direct discrimination significantly predicted higher levels of distress, whereas vicarious discrimination predicted higher levels of worry. Vicarious discrimination was not significantly related to distress across ethnic subgroups. Results suggest that practitioners and policy makers would benefit from attending to these within-group differences in Asian Americans' experiences during the pandemic.

The correlations among racial/ethnic groups, hypertriglyceridemia, thrombosis, and mortality in hospitalized patients with COVID-19

Reports of racial and ethnic disparities regarding both rates of infection of the SARS-CoV-2 virus and morbidity of the coronavirus disease-19 (COVID-19) contain profound differences depending on the population. Our previous study has shown that patients with COVID-19 who developed hypertriglyceridemia during hospitalization have a 2.3 times higher mortality rate. However, whether the correlation between hypertriglyceridemia and mortality has disparity among different racial and ethnic groups is unknown. In this study, we investigated the impact of race/ethnicity on the correlation between hypertriglyceridemia and mortality in hospitalized patients with COVID-19. De-identified information from 904 hospitalized patients diagnosed with COVID-19 between March 2020 and June 2021 were extracted from the Medical College of Wisconsin Clinical Data Warehouse. A multivariable regression analysis suggested that the Asians and non-White Hispanics had 4 or 3.9 times higher mortality rate, respectively, after adjusting for age, morbid obesity (BMI ≥40), and gender. The hypertriglyceridemia (≥150 mg/dL) was associated with higher mortality, after adjusting for age, gender, and morbid obesity. The baseline hypertriglyceridemia occurrence had relevantly more consistent percentages among all racial/ethnic groups. However, non-White Hispanic and Asian patients had the highest frequencies of peak hypertriglyceridemia occurrence during hospitalization. The peak hypertriglyceridemia developed during hospitalization correlates with the incidence of thrombosis after adjusting for morbid obesity, age, and sex. In summary, in this retrospective study of 904 hospitalized COVID-19 patients, Asians and non-White Hispanics had a greater likelihood of developing hypertriglyceridemia during hospitalization and mortality than White patients.

Asian Ethnic Subgroup Disparities in Delays of Surgical Treatment for Breast Cancer

Background

As Asian American breast cancer incidence rises, it is necessary to investigate the origins of differential breast cancer outcomes among Asian ethnic subgroups. This study aimed to examine disparities in delays of breast cancer surgery among Asian ethnic subgroups.

Methods

We obtained California Cancer Registry data on female breast cancer diagnoses and treatment from 2012 to 2017. Our main independent variable was patient race and ethnicity, including 6 Asian ethnic subgroups. Dependent variables included time to surgical treatment for breast cancer and receipt of surgical treatment within 30 and 90 days of diagnosis. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of prolonged time to surgery.

Results

In our cohort of 93 168 breast cancer patients, Hispanic (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.82 to 0.89) and non-Hispanic Black (OR = 0.83, 95% CI = 0.78 to 0.88) patients were statistically significantly less likely than non-Hispanic White patients to receive surgery within 30 days of breast cancer diagnosis, whereas Asian Indian or Pakistani (OR = 1.23, 95% CI = 1.09 to 1.40) and Chinese (OR = 1.30, 95% CI = 1.20 to 1.40) patients were statistically significantly more likely to receive surgery within 30 days of diagnosis.

Conclusions

This large, population-based retrospective cohort study of female breast cancer patients is the first, to our knowledge, to demonstrate that time to surgical treatment is not equal for all Asians. Distinct differences among Asian ethnic subgroups suggest the necessity of further investigating breast cancer treatment patterns to fully understand and target disparities in breast cancer treatment.