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Shah NS, Xi K, Kapphahn KI, Srinivasan M, Au T, Sathye V, Vishal V, Zhang H, Palaniappan LP. Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups. Circ Cardiovasc Qual Outcomes 2022; 15:e008651. [PMID: 35535589 PMCID: PMC9117444 DOI: 10.1161/circoutcomes.121.008651] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. METHODS Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. RESULTS Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). CONCLUSIONS There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.
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Affiliation(s)
- Nilay S Shah
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Cardiology) (N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Preventive Medicine (N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kevin Xi
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | | | - Malathi Srinivasan
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Primary Care and Population Health) (M.S., L.P.P.), Stanford University School of Medicine, CA
| | - Timothy Au
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Vedant Sathye
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Vaibhav Vishal
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Han Zhang
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA
| | - Latha P Palaniappan
- Center for Asian Health Research and Education (N.S.S., K.X., M.S., T.A., V.S., V.V., H.Z., L.P.P.), Stanford University School of Medicine, CA.,Department of Medicine (Primary Care and Population Health) (M.S., L.P.P.), Stanford University School of Medicine, CA
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Ma KPK, Bacong AM, Kwon SC, Yi SS, Ðoàn LN. The Impact of Structural Inequities on Older Asian Americans During COVID-19. Front Public Health 2021; 9:690014. [PMID: 34490181 PMCID: PMC8417937 DOI: 10.3389/fpubh.2021.690014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022] Open
Abstract
Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Adrian Matias Bacong
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Simona C. Kwon
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Stella S. Yi
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Lan N. Ðoàn
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
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Obra JK, Lin B, Đoàn LN, Palaniappan L, Srinivasan M. Achieving Equity in Asian American Healthcare: Critical Issues and Solutions. JOURNAL OF ASIAN HEALTH 2021; 1:e202103. [PMID: 37872960 PMCID: PMC10593109 DOI: 10.59448/jah.v1i1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Equity is a fundamental goal of the US health care system. Asians comprise 6% of the US population, and 60% of the world's population. Less than 1% of National Institutes of Health funding is directed toward Asian health. Asian health outcomes are often worse than non-Hispanic Whites (NHWS) in America. Increasing federal and foundation resources and funding toward Asian health research could illuminate these risks and develop precision interventions to reduce known health disparities. When disaggregated by race/ethnicity, Asian health risks are even more apparent. Here, we discuss critical health outcome differences between the six major Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) comprising 80% of the US Asian population, highlighting demographic, pharmacologic, disease prevalence, and mortality outcomes. We then outline seven critical issues contributing to Asian American health disparities, including aggregated Asian health data, undersampling, invalid extrapolations, underrepresentation in clinical trials, lack of funding and awareness of disparities, and the model minority myth. Building on the successes of national public health initiatives, we propose nine leverage points to improve Asian American health including the following: obtaining disaggregated Asian health data, improved Asian health research (oversampling Asians, improving clinical trial participation, and increasing research funding), stakeholder collaboration (national and with Asian nations), community engagement, providing culturally precise health care, and expansion of the Asian American research ecosystem. Achieving health equity takes deliberate practice and does not occur by accident. By addressing critical issues that perpetuate Asian health disparities, we grow closer to understanding how to effectively improve Asian health and build a nationally unified mindset toward action that emphasizes equitable care for all.
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Affiliation(s)
- Jed Keenan Obra
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Neurobiology, Physiology, and Behavior, University of California Davis; Davis, CA
| | - Bryant Lin
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Medicine, Stanford University School of Medicine; Palo Alto, CA
| | - Lan N. Đoàn
- Department of Population Health, NYU Grossman School of Medicine; New York, NY
| | - Latha Palaniappan
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Medicine, Stanford University School of Medicine; Palo Alto, CA
| | - Malathi Srinivasan
- Stanford Center for Asian Research and Education, Stanford University School of Medicine; Palo Alto, CA
- Department of Medicine, Stanford University School of Medicine; Palo Alto, CA
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Tsui J, Yang A, Anuforo B, Chou J, Brogden R, Xu B, Cantor JC, Wang S. Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care. Front Public Health 2021; 9:674035. [PMID: 34123992 PMCID: PMC8192797 DOI: 10.3389/fpubh.2021.674035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients. Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening. Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions. Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.
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Affiliation(s)
- Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Annie Yang
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Bianca Anuforo
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Jolene Chou
- Rutgers Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
| | - Ruth Brogden
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
| | - Binghong Xu
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
| | - Joel C. Cantor
- Rutgers Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
- Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, United States
| | - Su Wang
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
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Al-Moujahed A, Vail D, Do DV. Racial Differences in Anti-VEGF Intravitreal Injections Among Commercially Insured Beneficiaries. Ophthalmic Surg Lasers Imaging Retina 2021; 52:208-217. [PMID: 34039186 DOI: 10.3928/23258160-20210330-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This study assessed racial and ethnic differences in receiving anti-vascular endothelial growth factor (VEGF) intravitreal injections among commercially insured patients. PATIENTS AND METHODS A retrospective cohort study of 104,430 patients diagnosed with wet age-related macular degeneration (AMD), diabetic retinopathy, central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO) in the Optum Research Database between 2011 and 2016. Main outcomes included receiving an intravitreal anti-VEGF treatment; the first type of treatment received, if any; and subsequent treatment with ranibizumab or aflibercept among patients who were first treated with bevacizumab. RESULTS In a logistic regression model in all 104,430 patients, Asian patients were significantly less likely to receive an anti-VEGF treatment compared to white patients (odds ratio [OR] = 0.725; 95% confidence interval [CI], 0.667-0.789; P < .001), but Black and Hispanic patients were not. Overall, 19.9% (n = 20,753) of all included patients received treatment with intravitreal injections of anti-VEGF or steroids. In multinomial logistic models of treatment type among all patients who received intravitreal injections, Hispanic patients were less likely than white patients to initially be treated with ranibizumab (relative risk ratio [RRR] = 0.776; 95% CI, 0.647-0.929; P = .006) or aflibercept (RRR = 0.794; 95% CI, 0.654-0.964; P = .020). Black and Asian patients were not significantly more or less likely to receive different types of first-line injections compared to white patients. Among 17,092 patients who received bevacizumab as first-line therapy, Hispanic patients were less likely to subsequently transition to aflibercept than their white counterparts (RRR = 0.756; 95% CI, 0.634-0.903; P = .002). CONCLUSIONS The authors found minimal racial and ethnic differences in receiving anti-VEGF treatment among commercially insured patients with wet AMD, diabetic retinopathy, CRVO, and BRVO. These results are limited by the fact that all of the patients included were commercially insured, and there are limited data on the socioeconomic status of the patients in their sample. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:208-217.].
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Lau J, Lim TZ, Jianlin Wong G, Tan KK. The health belief model and colorectal cancer screening in the general population: A systematic review. Prev Med Rep 2020; 20:101223. [PMID: 33088680 PMCID: PMC7567954 DOI: 10.1016/j.pmedr.2020.101223] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer screening saves lives and is cost-effective. It allows early detection of the pathology, and enables earlier medical intervention. Despite clinical practice guidelines promoting screening for average risk individuals, uptake remains suboptimal in many populations. Few studies have examined how sociobehavioural factors influence screening uptake in the context of behaviour change theories such as the health belief model. This systematic review therefore examines how the health belief model’s constructs are associated with colorectal cancer screening. Four databases were systematically searched from inception to September 2019. Quantitative observational studies that used the health belief model to examine colorectal screening history, intention or behaviour were included. A total of 30 studies met the criteria for review; all were of cross-sectional design. Perceived susceptibility, benefits and cues to action were directly associated with screening history or intention. Perceived barriers inversely associated with screening history or intention. The studies included also found other modifying factors including sociodemographic and cultural norms. Self-report of screening history, intention or behaviour, convenience sampling and lack of temporality among factors were common limitations across studies. The health belief model’s associations with colorectal cancer screening uptake was consistent with preventive health behaviours in general. Future studies should examine how theory-based behavioural interventions can be tailored to account for the influence of socioecological factors.
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Affiliation(s)
- Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tian-Zhi Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lai DW, Li J, Lee VW, Dong X. Environmental Factors Associated with Chinese Older Immigrants' Social Engagement. J Am Geriatr Soc 2019; 67:S571-S576. [DOI: 10.1111/jgs.15899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Daniel W.L. Lai
- Department of Applied Social SciencesThe Hong Kong Polytechnic University Kowloon Hong Kong
| | - Jia Li
- Department of Applied Social SciencesThe Hong Kong Polytechnic University Kowloon Hong Kong
| | - Vincent W.P. Lee
- Department of Applied Social SciencesThe Hong Kong Polytechnic University Kowloon Hong Kong
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging ResearchRutgers University, The State University of New Jersey New Brunswick New Jersey
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Kong D, Solomon P, Dong X. Depressive Symptoms and Onset of Functional Disability Over 2 Years: A Prospective Cohort Study. J Am Geriatr Soc 2019; 67:S538-S544. [PMID: 31403199 PMCID: PMC9942515 DOI: 10.1111/jgs.15801] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/23/2018] [Accepted: 01/04/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This prospective cohort study examined the relationship between depressive symptoms and onset of functional disability over 2 years among US Chinese older adults, a rapidly growing minority older adult population. DESIGN AND SETTING This study used survey data from 2713 Chinese older adults who completed both baseline (2011-2013) and follow-up (2013-2015) interviews of the Population Study of Chinese Elderly in Chicago. Depressive symptoms were assessed at baseline by the nine-item Patient Health Questionnaire. Functional disability was measured by three validated scales, Katz Index of Independence in Activities of Daily Living (ADLs), the Lawton Instrumental Activities of Daily Living (IADLs) scale, and the Rosow and Breslau mobility scale. Multivariate logistic regression was conducted to examine the relationship between baseline depressive symptoms and the development of functional disability (ADLs, IADLs, mobility) at 2-year follow-up while adjusting for covariates. RESULTS Of the 2713 participants, 5.2% experienced ADL disability onset, 35.6% experienced IADL disability onset, and 23.3% experienced mobility disability onset over 2 years. After adjusting for covariates, the odds of ADL disability onset (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02-1.11), IADL disability onset (OR = 1.05; 95% CI = 1.01-1.09), and mobility disability onset (OR = 1.05; 95% CI = 1.01-1.09) were consistently higher in US Chinese older adults with higher levels of depressive symptoms than their less-depressed counterparts. Other significant risk factors included older age and more chronic physical conditions. CONCLUSION Study findings underscore a significant relationship between depressive symptoms and onset of functional disability. Screening and, subsequently, treating depressive symptoms have the potential to reduce disability among US Chinese older adults. Culturally relevant depressive symptom screening may help identify Chinese older adults who are at greater risks for the development of functional disability. J Am Geriatr Soc 67:S538-S544, 2019.
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Affiliation(s)
- Dexia Kong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
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Dong X. Achieving Health Equity in Asian Populations. Gerontol Geriatr Med 2018; 4:2333721418778169. [PMID: 30014006 PMCID: PMC6042021 DOI: 10.1177/2333721418778169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/06/2018] [Accepted: 04/19/2018] [Indexed: 11/24/2022] Open
Abstract
Research about Asian Americans and Asian health equity issues have significant gaps, in part, due to lack of funding and support for minority investigators and examinations of health in this population. This special issue is designed to further our understanding of Asian health equity, especially within the context of global Chinese populations to examine how sociocultural contexts impact aging and health. Through the findings reported in this special issue, we call for increased funding and support to minority research scholars to conduct research toward improving Asian health equity, with an emphasis on nuanced cultural contexts of this population.
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