Why Are Native Hawaiians Underrepresented in Hawai'i's Older Adult Population? Exploring Social and Behavioral Factors of Longevity.

Native Hawaiians comprise 24.3% of Hawai'i's population, but only 12.6% of the state's older adults. Few published studies have compared health indicators across ethnicities for the state's older adult population or focused on disparities of Native Hawaiian elders. The current study examines data from two state surveillance programs, with attention to cause of death and social-behavioral factors relevant to elders. Findings reveal that Native Hawaiians have the largest years of productive life lost and the lowest life expectancy, when compared to the state's other major ethnic groups. Heart disease and cancer are leading causes of premature mortality. Native Hawaiian elders are more likely to report behavioral health risks such as smoking and obesity, live within/below 100-199% of the poverty level, and find cost a barrier to seeking care. Indicated is the need for affordable care across the lifespan and health services continuum. Future research might explain behavioral factors as influenced by social determinants, including historical trauma on Native Hawaiian longevity.

Longevity disparities in multiethnic Hawaii: an analysis of 2000 life tables.

OBJECTIVE: We examined differences among seven major ethnic groups in Hawaii in life expectancy at birth (e[0]) and mortality at broad age groups. METHODS: We constructed life tables for 2000 for Caucasian, Chinese, Filipino, Hawaiian, Japanese, Korean, and Samoan ethnic groups in Hawaii. We partitioned overall mortality into broad age groups: <15 (representing premature mortality), 15-65 (representing working age), and 66-84 and > or =85 (representing senescent mortality). RESULTS: The overall e(O) in Hawaii was 80.5 years, but the difference between the longest-living group (Chinese) and the shortest-living group (Samoan) was 13 years. Chinese had the lowest mortality rates in each age group except the > or =85 category. In this last age group, we observed anomalously low rates for some new immigrant groups (especially Samoan males) suggesting, as a cause, that elders in these immigrant groups may return to natal countries in their old age and die there. In the <15 age group, mortality rates for Samoans and Koreans were highest, especially for Korean girls, suggesting some continuance in the U.S. of a preference for boy children. Outside of these anomalies, ethnic differences in e(O) were likely explained by socioeconomic and behavioral variables known to affect mortality levels, which are closely associated with ethnicity in Hawaii. CONCLUSIONS: These findings confirm the need to disaggregate Asian and Pacific Islander data, to conduct ethnic-specific research, and to address socioeconomic disparities.

Ethnicity, birth weight, and maternal age in infant mortality: Hawaiian experience.

To investigate the role of ethnicity, birth weight, and maternal age in infant mortality, separately in neonatal and postneonatal phases, this study used linked birth and infant death certificates for a 10-year period, 1979-1988, in the State of Hawaii. Log-linear analysis was applied to the cross-classified tables generated from the two files. Birth weight was a strong factor both in neonatal and postneonatal phases, but ethnicity was a factor only in the latter phase. Maternal age was not significant in infant survival in either phase, but it was strongly associated with the other two factors. Among the nine major ethnic groups residing in the state, black and Hawaiian women were more likely to have infants dying during the postneonatal period. © 1993 Wiley-Liss, Inc.