10/10/2017 Research Team Little Evidence-Based Clinical Practice - - PDF document

10/10/2017 1

D E T E R M I N I N G T H E P R O G R E S S F O R H E A L T H E Q U I T Y

Little Evidence-Based Clinical Practice for Asian Am ericans, Native Hawaiians, and Pacific Islanders?

Winston Tseng, PhD, Diana Lau, PhD, RN, CNS, Katie Lau, Justine Wong, RN, MSN, Kelsey Chun, Dustin Bainto, and Andrew Choothakan, MPH

Research Team Objectives

 Examine the data gap and what progress has been

made in clinical research among Asian Americans and Pacific Islanders (AAs and PIs)

 Conduct a systematic literature review using

PubMed focused on the state of clinical research for 10 major health conditions of concern among AAs and PIs

Historical Background

Model Minority Myth: Report of the Secretary’s Task Force

• n Black and Minority Health (Heckler Report 1985)

Out of the Shadows: AAs and PIs constitute some of the fastest growing racial groups in the US and can no longer be ignored or left behind. OMB Directive-15 (1997) and ACA Section 4302 (2010) developed national standards for disaggregation of AAs and PIs. Shining the Light on AA and PI health: HHS Plan for AANHPI Health (2011) identified major data gaps and provides national guidelines for advancing AA and PI health.

10/10/2017 2

What is PubMed?

 A free search engine accessing primarily the MEDLINE

(est. 1971) and Index Medicus (back to 1951 & earlier) databases of references and abstracts on life sciences and biomedical topics.

 1809 – first PubMed records  24.6 million Pub records (Feb 2015)  ~500,000 new records added per year  National Library of Medicine (NLM) maintains the

database as part of the Entrez system.

Methods

 Systematic review of PubMed records spanning from

conception (1809) to December 31, 2012.

 Article abstractions examined the publication titles,

abstracts, and full manuscripts as is available on PubMed.

 Search strategy excluded non-human or non-U.S.

subjects.

Methods

• Define search criteria and search terms/ timeline
• Identify Medical Subject Headings (MeSH) terms
• Identify records through PubMed searches
• Screened abstracts/ full-text for assessing eligibility
• Finalized articles to be included in review

Methods – Health Search Terms

Major AA and PI health conditions identified:

1.

Cancer

2.

Heart Disease

3.

Stroke

4.

Diabetes

5.

Hypertension

6.

Hepatitis B

7.

HIV/ AIDS

8.

Tuberculosis

9.

Infant Mortality

• 10. Immunization

10/10/2017 3

Methods – Asian Search Terms

 Asian  Asian American  Afghan  Andaman Islander  Andhra Pradesh  Assamese  Balochistani  Bangladeshi  Bengali  Bhutanese  Borneo  Burmese  Cambodian  Cantonese  Chinese  East Indian  Eurasian  Filipino, Filipina  Formosan  Goanese  Gonsei  Guamanian  Gujarati  Hmong  Hong Kong

 Indian  Indochinese  Indonesian  Issei  Japanese

2010 Census-defined Asian racial/ ethnic groups:

 Javanese  Karnatakan  Kashmiri  Katu  Keralan  Khmer  Korean  Laotian  Macanese  Madhya Pradesh  Madras  Maharashtran  Malaysian  Maldivian  Manchurian  Mandarin  Meo  Miao  Mien  Mnong  Mongolian  Montagnard  Myanmar  Mysorean  Naga  Nepalese, Nepali  Nisei  Okinawan  Oriental  Orissan

2010 Census-defined Asian racial/ ethnic groups:

Methods – Asian Search Terms

 Pakistani  Pathan  Pradeshi  Punjabi  Rajasthani  Ryukyu Islander  Sansei  Shan  Sikkim  Sikkimese  Singaporean  Singhalese  South Asian  South East Asian  Sri Lankan  Sumatran  Taiwanese  Tamil  Thai  Tibetan  Uttar Pradesh  Veddah  Vietnamese  Yonsei

2010 Census-defined Asian racial/ ethnic groups:

Methods – Asian Search Terms Methods – PI Search Terms

 American

Samoan

 Carolinian  Chamorro  Chuukese  Cook Islander  Fikian  Guamanian  Hawaiian  Maorian  Marshallese  Melanesian  Micronesian  Nauru  New Caledonian  New Zealander  Niuean  Norfolk Islander  Northern

Mariana

 Islander  Oceanian  Pacific Islander  Palau

2010 Census-defined Pacific Islander racial/ ethnic groups:

10/10/2017 4

Methods – PI Search Terms

 Papua New

Guinean

 Papuan  Pohnpeian  Polynesian

 Saipan  Solomon

Islander

 Tahitian  Tarawa

Islander

 Tasmanian  Tinian

Islander

 Tokelauan  Tongan  Trukese  Vanuatu  Yapese 2010 Census-defined Pacific Islander racial/ ethnic groups:

Results - Trends

75 170 474 1556 8 27 146 574 200 400 600 800 1000 1200 1400 1600 1800 1971-1980 1981-1990 1991-2000 2001-2010 # of Publications Year Totals by Decade for 10 Health Conditions AA PI

Results – AA Totals

Health Conditions AA Cancer 1,335 Heart 552 Diabetes 426 Hepatitis B 264 AIDS/ HIV 255 Immunization 241 Hypertension 238 Stroke 177 Tuberculosis 125 Infant Mortality 74 Total Publications 2,8 67 % (n=2,951,0 70 ) 0 .0 97%

Results – PI Totals

Health Conditions PI Cancer 481 AIDS/ HIV 152 Diabetes 128 Immunization 92 Heart 78 Hepatitis B 77 Infant Mortality 64 Hypertension 52 Stroke 47 Tuberculosis 30 Total Publications 94 8 %( v) 0 .0 32%

10/10/2017 5

Discussion

 The AA and PI PubMed research database has made

substantial progress, particularly since 1990. Yet much work needs to be done to catch up.

 The health conditions with most publications among

AAs include cancer and heart disease. For PIs, cancer and HIV/ AIDS have the most publications.

 Documenting the evidence-based clinical research

for the AAs and PIs in support of leading federal initiatives

Overall Recommendations

 Need to build research/ data capacity and pipeline to

better monitor and identify AA and PI health disparities

 Public-private partnerships are critical to developing

innovative and culturally relevant strategies to collect data in AA and PI communities

 Further disaggregation of data by AA and PI ethnic

groups to document these disparities measures is needed and can support the Healthy People 2020 disparities initiative and implementation of the data collection goals from the HHS Plan for AANHPI Health and ACA Section 4302

Data Recommendations

 2011: HHS Data Standards for AAs and PIs (Native Hawaiian, Guamanian or

Chamorro, Samoan, Other Pacific Islander)

 2011: AB 1088 (Eng) CA guidelines for AAs and PIs (Fijian,

Guamanian/ Chamorro, Native Hawaiian, Samoan, Tongan) (Dept Industrial Relations, Dept of Fair Employment & Housing)

 2016: AB 1726 (Bonta) new CA guidelines for AAs and PIs (Fijian,

Guamanian/ Chamorro, Native Hawaiian, Samoan, and Tongan) (Dept of Public Health)

 Support state and local surveys, healthcare providers, and administered health

programs to implement AB 1088 / AB 1726 standards for AAs and PIs

 Explore Partnerships with local health departments, BARHII, CA DPH and

CHIS on AA and PI data activities

Data Recommendations

 Regional sampling and oversampling from community clusters

with a high concentration of PIs to obtain robust data and keep survey costs down

 Instead of adjusting for race, stratify and report by race groups

for monitoring population health

 Indicate when no PI or AA data can be reported, rather than

aggregating Asian/ Pacific Islander data

 Disaggregate by PI ethnic groups and AA ethnic groups following

federal and state data standards whenever possible

 Pool data across years of data to ensure adequate PI or AA

sample for reporting

10/10/2017 6

Data Recommendations

 2011: HHS Data Standards for AAs and PIs (Native Hawaiian, Guamanian or

Chamorro, Samoan, Other Pacific Islander)

 2011: AB 1088 (Eng) CA guidelines for AAs and PIs (Fijian,

Guamanian/ Chamorro, Native Hawaiian, Samoan, Tongan) (Dept Industrial Relations, Dept of Fair Employment & Housing)

 2016: AB 1726 (Bonta) new CA guidelines for AAs and PIs (Fijian,

Guamanian/ Chamorro, Native Hawaiian, Samoan, and Tongan) (Dept of Public Health)

 Support state and local surveys, healthcare providers, and administered health

programs to implement AB 1088 / AB 1726 standards for AAs and PIs

 Explore Partnerships with local health departments, BARHII, CA DPH and

CHIS on AA and PI data activities

Data Recommendations

 Build a PI data infrastructure (PI liaison, cultural humility training,

PI field interviewers)

 Engage communities in the design, planning, implementation, and

dissemination of data on race, ethnicity, and language to ensure community participation and relevance

 Coordinate with faith-based organizations and community leaders

to increase buy-in regarding community outreach efforts

 Linguistically appropriate survey administration (translating and/ or

interpreting surveys for individuals with LEP, survey materials are culturally relevant)

Thank you!

For m ore inform ation: Winston Tseng winston@berkeley.edu Diana Lau lau2.ucsf@gm ail.com