Work

Understanding and Addressing Unique Needs of Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders

Year: 2012

Type: review

Abstract: he Asian American (AA) population is currently the fastest growing population in the U.S., having expanded six times faster than the general population in the 1990s (1).In addition, diabetes prevalence continues to rise in this population, as observed for other populations around the world.However, given the diverse natures, cultures, and physiologies among the AA, Native Hawaiian (NH), and Pacific Islander (PI) (AANHPI) populations, and in particular the distinct diabetes profiles, an understanding of these factors can provide important clues to understand the genesis, pathophysiology, and treatment response of diabetes, as well as characterize community outreach programs needed for the wider net of diverse communities throughout the U.S. In this regard, a meeting, whose theme was "Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action," was held in Honolulu, Hawaii, in September 2011 by a coalition of health care organizations and scientists with strong interests in the topic and in the health of AANHPI populations.There was consensus that there is a great need to understand the prevalence and pathophysiology and discuss potential intervention strategies regarding diabetes in AANHPI populations given the unique characteristics of this population.This information may help health care providers understand and improve diabetes prevention, treatment outcomes, and complications in AANHPI populations.In this review, we examine diabetes prevalence in different AANHPI populations to highlight the similarities and differences. AANHPI POPULATIONOVERVIEWdThe various groups that comprise AANHPI populations are hugely diverse geographically, culturally, and genetically.The U.S. census defines AAs as persons who have origins in the East, Southeast, or South Asia.NHs and PIs are people who have origins in Hawaii, Samoa, or any other Pacific island (2,3).Diversity within each of these groups is also large.For example, although grouped as AAs, the language, culture, and genetics of someone originating in India are very different than a person from Japan or the Philippines.According to the 2010 census, 4.8% of the U.S. population describe themselves as being AAs alone, and about 0.2% identify themselves as NHs or PIs (4).The largest subgroup of AAs are Chinese at 23.8%, followed by Filipinos at 18.3%, Asian Indians at 16.2%, Vietnamese at 10.9%, Koreans at 10.5%, and Japanese at 7.8% (4,5).Approximately 31% of AAs were born in the U.S., but this number varies greatly depending on the country of origin because of immigration laws that limited the entrance of Asians from the 1920s to the 1960s.Before the 1920s, most Asian immigrants were from Japan and China.Since the immigration law reforms after World War II, there has been a large influx of immigration from many Asian countries, with the exception of Japan, mostly due to socioeconomic and geopolitical reasons.Thus, most Japanese Americans and many Chinese Americans (CAs) come from families that have resided in the U.S. for several generations, whereas other Asian subgroups are more recent immigrants.For example, 60% of Japanese Americans were born in the U.S. compared with 22% of Thai Americans.As a result, 80% of AAs report speaking a language other than English at home, and only ;60% of AAs report that they speak English very well (6).Sociodemographic differences among various Asian groups, such as recent immigration, acculturation to lifestyle, and age distribution, can be large.For example, Japanese Americans have an older age distribution, with 31% aged older than 65 years, compared with just 5% of the Asian Indian population (5).Among AAs, ;45% have a bachelor degree or higher; however, among NHs and PIs, only 25% have attained this level of education (5).More than 75% of Japanese, Filipino, and Asian Indian adults have income 200% above the poverty threshold or greater, which is a higher proportion than other ethnic groups (5).Discussions regarding disease and prevalence rate compared with other ethnic groups need to take these factors into consideration. GENERAL CHARACTERISTICS OF DIABETES IN AANHPIdTheprevalence rate of diabetes has been increasing very rapidly in developed nations, from 1 to 2% and reaching a prevalence rate of 5 to 7% in the adult population of most developed nations (7).In 2010, the world prevalence of diabetes among adults aged

Source: Diabetes Care

DOI: 10.2337/dc12-0210