Major gaps in our understanding of health disparities and their causes still exist, and one population often overlooked is Asian Americans. Now, a 5-year, $2 million grant will allow local researchers to investigate disparities in health and mortality among Asians in the U.S. Stanford's Mark Cullen, MD, and Latha Palaniappan, MD, of the Palo Alto Medical Foundation are leading the study.
The team will comb through census and CDC data to compare major Asian sub-populations and look for health differences between recent immigrants, their children and subsequent generations. Cullen said they hope to uncover social and environmental factors that influence health disparities, and he recently spoke with me more in-depth about the work:
What kind of patterns might you find in the study of Asian Americans?
We have some reason to believe that, for example, the Japanese population has a uniquely low risk for heart disease, a somewhat higher risk for stroke, and a higher risk for cancer. Likewise the rates of cancer are somewhat high among Chinese and Vietnamese people. Conversely, we expect extremely high rates of cardiovascular disease in South Asia because this population's rate of diabetes seems to be quite high. But these are just suspicions based on incomplete data we have.
It's evident that some of what we think about the various populations is somewhat stereotypical and not necessarily completely right. One of the things we're going to be trying to do is look at the complete picture. In one part of our study, we'll be doing more analysis to understand patterns.
What are some of the difficulties involved in separating out the underlying racial or ethnic and socioeconomic factors involved in health disparities?
The number of counties where Asians reside in large numbers is still small, and the data have been available for them for only a few years, hence there are data limitations. In our last study [which examined premature mortality among whites and African Americans] we were dealing with tens and maybe hundreds of millions. Now, we are dealing with hundreds of thousands or one million - much smaller populations. And these populations also tend to live in relatively limited areas. Although places like the Bay Area, Southern California, New York and a few other large metropolitan areas are rich in these populations, many parts of the country are not. So, some questions are going to be harder to answer.
A second problem is that Asians have immigrated to the U.S. in waves so that, for example, the South Asian Americans are mostly fairly recent and there may not yet be a large enough experience to estimate premature mortality, or to compare first and later generations yet.
Why have so few studies focused on differences between Asian American subgroups?
Prior to ten years ago the census and other standard data collection forms treated "Asians" as one group... This of course is a terrible confusion that resulted in an inability to study the populations at all! By the way, this same problem arose for Hispanics.
How might this study direct future research and improve Asian American health?
Of course once we understand the patterns of mortality and the social/environmental determinants we can devise increasingly better interventions to improve outcomes. Dr Palaniappan is already doing a long-term study of Asian patients at PAMF to study the role of diet and behavior of Asian groups in the region.
And I should mention finally that these questions are so dear to California because it is a place that has enjoyed a large Asian population for decades. And there has been a very active effort on the part of both the state and county health departments in the State of California, so we will have some additional data to re-look at some of these questions in a California context.