Disparities in diabetes-related preventable hospitalizations among working-age Native Hawaiians and Asians in Hawai'i.

Elderly (65+) Native Hawaiian, Filipino, and Japanese men and Filipino women have a higher risk of diabetes-related potentially preventable hospitalizations than Whites even when demographic factors and the higher diabetes prevalence in these populations is considered. The study objective was to determine if similar disparities are seen among the non-elderly (< 65). We used discharge data for all non-maternity hospitalizations by working-age adults (18-64 years) in Hawai'i from December 2006 to December 2010. Annual diabetes-related preventable hospitalization rates (by population diabetes prevalence) were compared by race/ethnicity (Japanese, Chinese, Native Hawaiian, Filipino, and White) and gender. Adjusted rate ratios (aRR) were calculated relative to Whites using multivariable models controlling for insurer, comorbidity, residence location, and age. After adjusting for ethnic-specific prevalence of diabetes and demographic factors, preventable hospitalizations rates were significantly higher for Native Hawaiians males (aRR:1.48; 95%CI:1.08-2.05) compared to Whites, but significantly lower for Chinese men (aRR:0.43;95%CI:0.30-0.61) and women (aRR:0.18;95%CI: 0.08-0.37), Japanese men (aRR:0.33;95%CI: 0.25-0.44) and women (aRR:0.34; 95%CI:0.23-0.51), and Filipino men (aRR:0.35;95%CI:0.28-0.43) and women (aRR:0.47;95%CI: 0.36-0.62). Rates for Native Hawaiian females did not differ significantly from Whites. Disparities in diabetes-related preventable hospitalizations were seen for working-age (18-64) Native Hawaiian men even when their higher population-level diabetes prevalence was considered. Further research is needed to determine factors affecting these disparities and to develop targeted interventions to reduce them. Significantly lower preventable hospitalization rates were seen among Asian groups compared to Whites. A better understanding of these findings may provide guidance for improving rates among Asian elderly as well as other non-elderly groups with disparities.

Comparison of potentially preventable hospitalizations related to diabetes among Native Hawaiian, Chinese, Filipino, and Japanese elderly compared with whites, Hawai'i, December 2006-December 2010.

INTRODUCTION: Approximately 25% of individuals aged 65 years or older in the United States have diabetes mellitus. Diabetes rates in this age group are higher for Asian American and Pacific Islanders (AA/PI) than for whites. We examined racial/ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH) among people aged 65 years or older for Japanese, Chinese, Filipinos, Native Hawaiians, and whites. METHODS: Discharge data for hospitalizations in Hawai'i for people aged 65 years or older from December 2006 through December 2010 were compared. Annual rates of DRPH by patient were calculated for each racial/ethnic group by sex. Rate ratios (RRs) were calculated relative to whites. Multivariable models controlling for insurer, comorbidity, diabetes prevalence, age, and residence location provided final adjusted rates and RRs. RESULTS: A total of 1,815 DRPH were seen from 1,515 unique individuals. Unadjusted RRs for DRPH by patient were greater than 1 in all AA/PI study groups compared with whites, but were highest among Native Hawaiians and Filipinos [corrected]. In fully adjusted models accounting for higher diabetes prevalence in AA/PI groups, Native Hawaiian (adjusted rate ratio [aRR] = 1.59), Filipino (aRR = 2.26), and Japanese (aRR = 1.86) men retained significantly higher rates of diabetes-related potentially preventable hospitalizations than whites, as did Filipino women (aRR = 1.61). CONCLUSION: Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older have a higher risk than whites for DRPH. Health care providers and public health programs for elderly patients should consider effective programs to reduce potentially preventable hospitalizations among Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older.

Adult informal caregivers reporting financial burden in Hawaii, Kansas, and Washington: Results from the 2007 Behavioral Risk Factor Surveillance System.

BACKGROUND: Given the unpaid nature of the work, informal caregiving can create a financial burden for caregivers. Little has been done to identify specific predictors of experiencing financial burden. This study investigated demographic and health factors comparing caregivers who reported having or not having financial burden. METHODS: Data are derived from adult caregivers (N = 3,317) as part of the 2007 Behavioral Risk Factor Surveillance System in Hawaii, Kansas, and Washington. The adjusted odds ratios for reporting a financial burden were estimated for demographic and other risk factors. RESULTS: Caregivers who reported a financial burden were younger, had lower incomes, were more likely to be current smokers, have had a stroke, and rate their health as fair or poor compared to caregivers who did not report a financial burden. Caregivers who were younger (ages 18-34), resided with care recipients, spent 20-39 hours per week providing care, and reported having a disability were at a statistically significantly higher odds of reporting a financial burden. CONCLUSIONS/IMPLICATIONS: Given the current economic difficulties faced by many Americans, further insights into the perceived financial burdens experienced by informal caregivers as well as linkages to policy and programs designed to support caregivers are critical for public health professionals to address the expanding needs in states and communities.

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.

Obesity and self-reported general health, Hawaii BRFSS: are Polynesians at higher risk?

OBJECTIVE: This study compared the relationship between fair/poor general health status among overweight and obese Polynesians with that among other overweight and obese persons in Hawaii. METHODS AND PROCEDURES: Data were pooled from the 1998-2003 Hawaii Behavioral Risk Factor Surveillance System (BRFSS) and logistic regression used to examine the predictors of fair/poor health status. RESULTS: Polynesians were significantly more likely to be obese than non-Polynesians; overweight Polynesians were more likely than other overweight individuals to report fair/poor health status. After adjusting for confounders, among Polynesians, being obese was no longer associated with fair/poor health. Non-Polynesians who were obese (odds ratio 1.9; 95% confidence interval: 1.4-2.6), older, less educated, smokers, diabetic, hypertensive, and physically inactive were more likely to report fair/poor health. DISCUSSION: Although Polynesians were significantly more obese than the rest of the Hawaii population, their weight was not independently associated with their odds for fair/poor health as it was with non-Polynesians. The difference may be that, for Polynesians, hypertension and diabetes overrode the effect of obesity on general health status or this group maintains different cultural perceptions of body size. Regardless, these findings show a major health risk among Polynesians and suggest the need for culturally specific health interventions.