This study used recent nationally representative survey data to compare self-reported measures of health risk factors, chronic disease, and access to care in Pacific Islanders relative to Asian Americans and whites. We found that Pacific Islanders were significantly more likely than Asian Americans to report some important health risks, including elevated body mass index, current smoking, and high alcohol intake, as well as related chronic diseases including diabetes, hypertension, asthma, and arthritis as well as higher rates of fair or poor health. Several of these differences were mediated by higher rates of overweight and obesity, but not higher rates of smoking, among Pacific Islanders. Differences in smoking, diabetes, and hypertension were more pronounced among Pacific Islander women than men. Measures of access to care did not differ significantly between Pacific Islanders and Asian Americans.
Compared to whites, Pacific Islanders had strikingly similar health risk factors, chronic diseases, and access to care, with non-significant odds ratios ranging from 0.78 to 1.24. The only significant differences were higher odds of diabetes and reduced odds of arthritis among Pacific Islanders compared to whites. These findings suggest that Pacific Islanders and whites may have similar patterns of health risk factors and many chronic diseases, although other research has found elevated all-cause and site-specific cancer mortality for Pacific Islanders (especially Samoans) compared to non-Hispanic whites in the US.9
Our findings have five important policy implications. First, future federal surveys should follow OMB guidelines where and when possible to disaggregate data for Pacific Islander and Asian American given the large sociodemographic and health differences between these groups. In some studies, such as NHIS and NHANES, this will require over-sampling of Pacific Islander communities (primarily in Western US states, Hawaii, and Pacific territories) to attain sample sizes large enough for meaningful analyses. We recognize the potential difficulty and costs of this disaggregation, but note that states and territories with large Pacific Islander communities often have many Asian American residents, underscoring the need to measure the health of both of these important subgroups accurately.
Second, we found significantly greater rates of key health risks and chronic diseases among Pacific Islanders compared to Asian Americans. Taulii found similar results in a smaller cohort, and together with our study, these findings point to the need for targeting obesity, alcohol, and smoking as important risk factors for key chronic diseases such as diabetes and hypertension.4
Third, the recognition of these “diabesity”-related health disparities among Pacific Islanders can inform future disparity interventions aimed at this community.10
To date, disparity studies and interventions in the US have largely focused on cancer screening and prevention in both Pacific Islander and Asian American communities.9,11–14
While these may continue to be important disparities in these groups, increased recognition of the linked epidemics of obesity and diabetes in Pacific Islanders, similar to that in many nations across the Pacific where these communities originate,15,16
underscores the need for interventions aimed at reducing these specific Pacific Islander disparities in the US. In particular our finding that BMI, but not smoking, largely mediates the differences in reporting chronic diseases between Pacific Islanders and Asian Americans highlights the specific disparity-promoting impact that obesity may have for Pacific Islanders in the US. Both communities appear to exhibit increased risk for obesity as a function of acculturation in the US, but Pacific Islanders may be particularly vulnerable due to especially calorie-rich diets and less restrictive body image perceptions.17
Emerging community-based interventions for addressing diabetes and obesity in American Samoa may provide models for culturally tailored, rigorously evaluated solutions in Pacific Islander communities.18,19
Fourth, relative to Asian Americans we found higher rates of chronic diseases such as diabetes and hypertension among Pacific Islander women but not men, suggesting that interventions need to be not only culturally appropriate, but also gender-specific. Previous work on gender-specific differences in hypertension among Samoan women showed the significant contribution that psychosocial stress associated with culturally prescribed gender roles has on increased blood pressure.20
Finally, Pacific Islanders’ self-reported access to primary care was similar to both whites and Asian Americans for the measures in our study.
This study had a number of strengths. To our knowledge, it is one of the largest studies to use disaggregated Asian American and Pacific Islander health data to evaluate risk factors, disease outcomes, and access to care. The BRFSS is one of the first large national health surveys to report health data from Asian Americans and Pacific Islanders in numbers sizable enough to permit comparisons with reasonable statistical power. Furthermore, the survey over-sampled enough members of both groups (particularly in Western states that contain nearly 80% of the Pacific Islander population) to facilitate sex-stratified analyses.
A number of limitations were also present in this analysis. First, the BRFSS survey utilizes self-reported data that are subject to recall and misclassification bias, and were not verified with clinical or administrative data. However, a growing body of literature suggests that self-reported risk factor, chronic disease, and health status variables are reasonably accurate relative to measured variables.21–23
Second, the survey’s telephone sampling methodology might under-represent those without regular access to telephones, with cell phones, or who speak a language other than English or Spanish, factors that are prevalent within both Asian American and Pacific Islander communities in the US. Third, because of the limited Pacific Islander sample, some of the subgroup sample sizes were relatively small, as indicated by wide confidence intervals for variables such as coronary heart disease and heavy alcohol intake.
This study demonstrates that Pacific Islanders suffer from increased rates of some important deleterious health risk factors and associated chronic diseases. Understanding the magnitude and determinants of these disparities can help inform targeted interventions to reduce these disparities.