Cost Burden of Potentially Preventable Hospitalizations for Cardiovascular Disease and Diabetes for Asian Americans, Pacific Islanders, and Whites in Hawai'i

We compared the cost burdens of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2007-2012 inpatient data. The cost burden of the 27,894 preventable hospitalizations over six years (total cost: over $353 million) fell heavily on Native Hawaiians who had the largest proportion (23%) of all preventable hospitalizations and the highest unadjusted average costs (median: $9,117) for these hospitalizations. Diabetes-related amputations (median cost: $20,167) were the most expensive of the seven preventable hospitalization types. After adjusting for other factors (including age, insurance, and hospital), costs for preventable diabetes-related amputations were significantly higher for Native Hawaiians (ratio estimate:1.23; 95%CI:1.05-1.44), Japanese (ratio estimate:1.44; 95%CI:1.20-1.72), and other Pacific Islanders (ratio estimate:1.26; 95%CI:1.04-1.52) compared with Whites. Reducing potentially preventable hospitalizations would not only improve health equity, but could also relieve a large and disproportionate cost burden on some Pacific Islander and Asian American communities.

Stroke Disparities: Disaggregating Native Hawaiians from other Pacific Islanders

OBJECTIVES

To compare the clinical characteristics of Native Hawaiians (NH) and other Pacific Islanders (PI) who are hospitalized with ischemic stroke.

DESIGN

Retrospective, cross-sectional analysis of medical records.

SETTING

Tertiary, Primary Stroke Center in Honolulu, Hawaii.

PATIENTS

Consecutive patients with race/ethnicity identified as NH or PI who were hospitalized for ischemic stroke between January 2006 and December 2012.

OUTCOME MEASURES

Age, sex, cardiovascular risk factors, intravenous tissue plasminogen activator (IV-tPA) utilization rate and hospital length of stay.

RESULTS

A total of 561 patients (57% NH and 43% PI) were studied. PI were younger (59 ± 13 years vs 62 ± 14 years, P = .002), had higher prevalence of diabetes mellitus (58% vs 41%, P < .0001) and prosthetic valve (6% vs 2%, P = .007), lower prevalence of smoking (14% vs 21%, P = .03), lower HDL cholesterol (38 ± 11 mg/dL vs 41 ± 13 mg/dL, P = .004), and higher discharge diastolic blood pressure (79 ± 15 vs 76 mm Hg ± 14 mm Hg, P = .04) compared to NH. No difference was seen in other cardiovascular risk factors. The IV-tPA utilization rate (5% vs 6%, P = .48) and the hospital length of stay (10 ± 17 days vs 10 ± 49 days, P = .86) were not different between the two groups.

CONCLUSION

Native Hawaiians and other Pacific Islanders with ischemic stroke have modestly different age of stroke presentation and burden of risk factors compared to each other. Disaggregating these two racial groups may be important to unmask any potential clinical differences in future studies.

Trauma, socioeconomic resources, and self-rated health in an ethnically diverse adult cohort

OBJECTIVES

To evaluate ethnic group differences in the association between trauma exposure and health status among an ethnically diverse sample originating in Hawai'i.

DESIGN

Across a 10-year period (1998-2008), participants (N=833) completed five waves of questionnaire assessments. Trauma exposure was measured retrospectively at the most recent assessment (wave 5), socioeconomic resources (educational attainment and employment status) were measured at wave 1, and self-rated health was measured at each of the five waves.

RESULTS

Results indicated that greater exposure to trauma was associated with poorer self-rated health, as were lower educational attainment and lower work status. In addition, there was ethnic group variation in health ratings, as well as in how strongly trauma exposure predicted health status. Specifically, within Filipino American and Native Hawaiian ethnic groups, there was a stronger negative association between trauma exposure and self-rated health.

CONCLUSION

These results suggest complex interrelations among trauma, ethnicity, socioeconomic status, and physical health. Further understanding these relations may have implications for medical and behavioral interventions in vulnerable populations.

Ethnoracial disparities in sexual assault among Asian Americans and Native Hawaiians/other Pacific Islanders

CONTEXT

Ethnoracial differences may exist in exposure to trauma and posttraumatic outcomes. However, Asian Americans and Native Hawaiians/other Pacific Islanders (NHOPIs) are vastly underrepresented in research pertaining to trauma and health status sequelae.

OBJECTIVE

To determine whether there are ethnoracial disparities in sexual trauma exposure and its sequelae for health and functioning among Asian Americans and NHOPIs.

METHOD

We examined data on sexual assault exposure from the 2006-2007 Hawaii Behavioral Risk Factor Surveillance System (H-BRFSS), which yielded a cross-sectional, adult, community-based probability sample (N = 12,573). Data were collected via computer-assisted random-digit landline telephone survey. Survey response rate was found to be about 48% in 2006 and 52% in 2007. The main outcome measures were demographic information, the sexual violence module of the H-BRFSS regarding unwanted sexual experiences, and questions about health lifestyles, chronic diseases and disability, and health status and quality of life.

RESULTS

Participants (N = 12,573) were 44.1% white, 15.0% NHOPI, and 40.9% Asian American. The NHOPIs had a higher 12-month period prevalence (2.24 per 100; 95% CI, 1.32-3.78) for any unwanted sexual experience but had a lower prevalence estimate and odds ratio for any lifetime unwanted sexual experience (prevalence: 9.38 per 100 [95% CI, 7.59-11.55]; odds ratio: 0.61 [95% CI, 0.47-0.81]) relative to whites, after adjusting for age, gender, income, and education level. Asian Americans had lower prevalence estimates for 12-month period prevalence (0.78 per 100; 95% CI, 0.44-1.39) and lower lifetime prevalence estimates and odds ratios (prevalence: 3.91 per 100 [95% CI, 3.23-4.72]; odds ratio: 0.27 [95% CI, 0.21-0.34]). The 12-month and lifetime prevalence estimates for any unwanted sexual experiences for whites were 0.71 per 100 (95% CI, 0.45-1.12) and 12.01 per 100 (95% CI, 10.96-13.14), respectively. Sexual assault experiences were highly associated with adverse health status sequelae (eg, disability, poor general health), but there were no significant ethnoracial disparities on self-reported health outcomes among those with a lifetime history of unwanted sexual experiences.

CONCLUSIONS

Data revealed significant ethnoracial differences between whites, Asian Americans, and NHOPIs on unwanted sexual experiences, with relative risk differing by time period. This pattern of disparity could represent early stages of a new trend in local assaultive behaviors toward NHOPIs and merits attention. Across all ethnoracial groups, a lifetime history of any unwanted sexual experience is associated with a wide range of adverse health status sequelae.

Testing the feasibility of a culturally tailored breast cancer screening intervention with Native Hawaiian women in rural churches

The authors report on the feasibility of delivering a church-based breast cancer screening intervention tailored on the cultural strengths of rural-dwelling Hawaiians. Native Hawaiian women are burdened by disproportionately high mortality from breast cancer, which is attributed to low participation in routine mammography. Mammography is proven to be an effective means for detecting disease at its earliest stages, when treatments are most likely to be successful. Culturally tailored screening programs may increase participation. Hawaiian initiatives call for screening innovations that integrate Hawaiian cultural strengths, including those related to spirituality and the extended family system. Before full-scale testing of tailored interventions, it is important to conduct feasibility studies that gauge community receptiveness to the proposed intervention and research methods. Study results establish the attractiveness and potential effectiveness of the authors' screening intervention. Recruitment exceeded targets, and retention rates were comparable to those of other randomized behavioral trials, confirming the value of reaching rural Hawaiian women through churches. Women appreciated the integrative approach of Hawaiian and faith-based values, and positive outcomes are suggested.This article may be relevant to social workers interested in culturally responsive, community-based interventions and to researchers conducting pilot studies and controlled trials of interventions adapted from evidence-based programs.

All-cause and CVD mortality in Native Hawaiians

AIMS

Cardiovascular disease (CVD) is the leading cause of death among Native Hawaiians. In this article, all-cause and cardiovascular mortality rates among Native Hawaiians are examined, along with associated CVD risk factors.

METHODS

A total of 855 Native Hawaiians (343 men and 512 women, ages 19-88) were examined as participants of the Cardiovascular Risk Clinics program (1992-1998) and underwent surveillance through September 2007. Cause of each death was determined by review of medical records, death certificates, newspapers, and through queries to community members.

RESULTS

CVD accounted for 55% of deaths. Coronary heart disease (CHD) accounted for the majority of CVD deaths. CVD increased with age and was higher in those with diabetes, hypertension, or high low-density lipoprotein cholesterol (LDL-C). CVD rates were higher in men than in women and fourfold higher in those with diabetes. In addition to age, diabetes, hypertension, and elevated LDL-C were major risk factors.

CONCLUSIONS

Diabetes is a major determinant of CVD in this population and most of the CVD is occurring in those with diabetes. Strategies to prevent diabetes and manage blood pressure and lipids should reduce CVD rates in Native Hawaiians.

Coping With Breast Cancer at the Nexus of Religiosity and Hawaiian Culture: Perspectives of Native Hawaiian Survivors and Family Members

This article describes research to develop a breast health intervention for women in Hawaiian churches. Native Hawaiian women are disproportionately burdened by breast disease and tend to be diagnosed at advanced stages when treatment options are more limited. Research suggests that cultural conflict may be a factor in Hawaiian women's underutilization of conventional health services. Phenomenological approaches guided data collection and analysis to explore the influence of religiosity and ethnocultural tradition in coping with breast cancer. The overarching theme was kakou (we or us), which emphasized ways of coping oriented to the family collective and focused on family well-being. Findings offer a portal for understanding the lived experience of survivors and families in Hawaiian churches. Considerations are suggested for those practitioners assisting clients from collectivist-oriented cultures.

Na Liko Noelo: a program to develop Native Hawaiian researchers

Native Hawaiians are underrepresented in health research. They also have expressed dissatisfaction with the way in which many non-native researchers have formulated research questions, conducted research, and disseminated findings about Native Hawaiians. 'Imi Hale - Native Hawaiian Cancer Network was funded by the National Cancer Institute to increase research training and mentorship opportunities for Native Hawaiians. To this end, 'Imi Hale has followed principles of community-based participatory research to engage community members in identifying research priorities and assuring that research is beneficial, and not harmful, to Native Hawaiians. Developing indigenous researchers is a cornerstone of the program and, in its first 4 years 'Imi Hale enrolled 78 Native Hawaiian "budding researchers (called Na Liko Noelo in Hawaiian), of which 40 (68%) have participated in at least one training and 28 (36%) have served as investigators, 40 (51%) as research assistants, and 10 (13%) as mentors on cancer prevention and control studies. The major challenge for Nă Liko Noelo is finding the time needed to devote to research and writing scientific papers, as most have competing professional and personal obligations. Program evaluation efforts suggest, however, that 'Imi Hale and its Na Liko Noelo program are well accepted and are helping develop a cadre of community-sensitive indigenous Hawaiian researchers.