How Pharmacists Can Help Address Health Disparities Among Asian Americans

Although experts have long believed that Asian Americans face fewer health conditions compared to other minority groups, new research suggests that they are at a higher risk for some specialty pharmacy-related health conditions.

According to the United States Census Bureau, Asian Americans constitute approximately 5% of the US population as of 2003.¹ Recent research has shown that Asian Americans are at higher risk for various specialty pharmacy-related health conditions such as diabetes;^2,4 hepatitis B virus (HBV);^3,4 chronic liver disease;⁵ organ or tissue transplantation;⁶ and some cancers.⁷

This higher risk of certain health conditions is likely due to significant barriers to accessing health programs and services, often related to cultural and linguistic differences, health insurance status, and attitudes towards the Western health care system.⁸

According to the US Department of Health and Human Services (DHHS) Office of Minority Health (OMH), Asian Americans are 40% more likely to be diagnosed with diabetes and 60% more likely to be diagnosed with renal disease compared to non-Hispanic whites.² Barriers specific to diabetes control in this minority group include a lack of diabetes health awareness, knowledge, and literacy to effectively manage this chronic condition.²

Roughly 500,000 individuals with chronic HBV infection in the United States are Asian, although most became infected with HBV before arriving to the United States. Between 2013 and 2016, Asian Americans were twice as likely to develop chronic HBV compared to whites.^3,4

As of 2018, Asian Americans were roughly 8 times more likely to die from HBV than non-Hispanic whites.^3,4 HBV-related disparities within this group may be due to key differences in health practices between the United States and some Asian countries.

These include hepatitis education and prevention, immunization practices, and protocols for early detection in order to prevent the onset of serious liver disease in those who are chronically infected with HBV.

Chronic liver disease was the sixth leading cause of death for Asian Americans and Pacific Islanders between 25 and 44 years of age.⁵ This can be caused by conditions such as chronic alcoholism, obesity, and HBV and hepatitis C infections.⁵

The incidence rate for liver and bowel cancer is twice as high for Asian American women compared to white women.⁵ Furthermore, liver disease is known to put patients at risk for organ failure, requiring transplantation.

Asian Americans also face significant disparities when they need organ transplants, however. In 2019, the number of organ transplants performed on Asian Americans was only 23.8% of the total number of Asians waiting for transplant, compared to 47.6% of Americans waiting for a transplant.⁶

Although they are at decreased risk for some cancers, Asian Americans are twice as likely to have stomach cancer and have almost twice the incidence of liver and inflammatory bowel disease cancer compared to non-Hispanic whites.⁷

Furthermore, Asians are between 2 and 2.8 times as likely to die from stomach cancer, and Asian American men have higher incidence rates of liver cancer compared to Hispanic, non-Hispanic white, or native Asian men.⁷

Overall, Asian American health disparities have only gained focus in the past decade, with policy initiatives geared towards promoting health care access to Asian Americans becoming more prominent in recent years. These health disparities—along with socioeconomic status, language barriers affecting access to quality health care, and living in low-income communities with a dense refugee population—all impact social determinants of health and can affect any one of the health conditions discussed.⁸

Despite the relatively small size of this minority group, the Asian American population can hardly be described as homogenous. The term Asian American is applied to a collective of various subgroups classified as a single group due to similar appearances, cultural values, and ethnic backgrounds.

The Asian Americans more commonly studied have been limited primarily to individuals of Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Lao, Mien, or Vietnamese descent, which therefore does not adequately represent the more than 25 subgroups included in the collective.

With this in mind, taking a closer look into the specific subgroups of Asian and Pacific Islander populations may reveal significant health disparities, as cultural differences may vary widely among the subgroups. For instance, one of the highest risk groups for breast cancer is Vietnamese American women, who are 4 times more likely to die of breast cancer than any other Asian and Pacific Islander group.⁹

Similarly, native Hawaiians are twice as likely to be obese compared to whites and experience significantly higher rates of diabetes and obesity compared to others.¹⁰ Korean American children are 4 times less likely to have health insurance compared to others.¹¹

It is apparent that studies exploring health disparities among specific subgroups of the Asian American minority group are scarce. Therefore, future studies and statistical analyses including additional subtypes of Asian Americans compared to either non-Asian Americans or native Asians may strengthen current health data or reveal dissimilar health data.

Until this can be accomplished, it is key for Asian American subgroups to understand the importance of annual physician visits and routine preventive care. They should be encouraged to find health care providers who understand specific cultural barriers, utilize professional interpreter services, or bring a trusted family member or friend to medical visits.

In our multicultural society, it is imperative for interdisciplinary teams to practice cultural competency with respect to understanding health disparities unique to different cultures. It is the responsibility of the health care team to incorporate this knowledge into their daily patient-centric approach in order to bridge the existing gaps and ensure continuity of care.

REFERENCES

1. Asian American. U.S Department of Health and Human Services Office of MinorityHealth.https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=63.AccessedMay9, 2021.
2. DiabetesandAsianAmericans.U.SDepartmentofHealthandHumanServicesOfficeofMinority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=48.AccessedMay 9, 2021.
3. HepatitisandAsianAmericans.U.SDepartmentofHealthand HumanServicesOfficeofMinority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=50.AccessedMay 9, 2021.
4. Chronic & Infectious Diseases. Asian Health Coalition.https://www.asianhealth.org/chronic-infectious-diseases.AccessedMay9,2021.
5. Chronic Liver Disease and Asian Americans. U.S Department of Health and HumanServices Office of Minority Health.https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=47.AccessedMay9,2021.
6. Organ Donation and Asian Americans. U.S Department of Health and Human ServicesOffice of Minority Health.https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=57.AccessedMay9,2021.
7. CancerandAsianAmericans.U.S.DepartmentofHealthandHumanServicesOfficeofMinority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlID=46.AccessedMay 9, 2021.
8. Ngo-MetzgerQ,MassagliMP,ClarridgeBR,etal.Linguisticandculturalbarrierstocare. Journal of general internal medicine.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494812/. Published January 2003.AccessedMay 9, 2021.
9. Gomez SL, Clarke CA, Shema SJ, Chang ET, Keegan TH, Glaser SL. Disparities inBreast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: APopulation-Based Study. American Journal of Public Health. 2010;100(5):861-869.doi:10.2105/ajph.2009.176651
10. Obesity and Native Hawaiians/Pacific Islanders. U.S Department of Health and HumanServices Office of Minority Health.https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=85#:~:text=Native%20Hawaiian%2FPacific%20Islander%20adolescents,Hispanic%20white%20adolescents%20in
11. %202017.&text=In%202014%2C%20Samoans%20were%205.6,the%20overall%20Asia n%20American%20population.Accessed May 10,2021.
12. YuSM,HuangZJ,SinghGK.HealthStatusandHealthServicesAccessandUtilizationAmong Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese Children inCalifornia. American Journal of Public Health. 2010;100(5):823-830.doi:10.2105/ajph.2009.168948