Disaggregating Asian Race Reveals COVID-19 Disparities Among Asian American Patients at New York City’s Public Hospital System

Objectives: Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. Methods: We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City’s public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. Results: Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). Conclusions: Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.

Shining a light on food insecurity in Aotearoa New Zealand: Modification of a food security scale for use with individuals who have extreme food security needs

INTRODUCTION: Food insecurity in Aotearoa New Zealand is a growing concern but quantitative evidence focused on those in most need of support is scarce in the Aotearoa New Zealand context. This limits policy and practice decisions.METHODS: We modified Parnell and Gray’s (2014) Aotearoa New Zealand based food security scale to better capture the severity of food insecurity for individuals living in poverty and used a questionnaire to collect data from a sample of individuals seeking food assistance from foodbanks in Tāmaki Makaurau (Auckland). We used confirmatory factor analysis to assess the psychometric validity of the modified scale. We also tested group differences in food insecurity by gender and ethnicity using analysis of variance and investigated correlations between age, household size and food insecurity.FINDINGS: We found a six-item version of Parnell and Gray’s (2014) scale to be psychometrically robust for use with the study population. The sample participants reported concerning and chronic levels of food insecurity. We did not find any group differences.CONCLUSIONS: At the severe end of the food insecurity continuum, gender and ethnic subgroups appear to suffer at similar levels; however, this does not suggest that different approaches are not required to best meet the needs of different demographic subgroups. Further research is needed to ascertain how similar levels of food insecurity may produce differential effects on wellbeing outcomes for different groups. We recommend more widespread and regular use of the modified scale to assess the experience and impact of food insecurity for individuals living in poverty because it provides a more fine-grained understanding of the severity of food insecurity challenges experienced by individuals seeking food assistance. Fit for purpose measures enable accurate assessments that can better inform policymaking and practice decisions to reduce inequality and promote economic justice.

Are Americans less likely to reply to emails from Black people relative to White people?

In this article, we present the results from a large-scale field experiment designed to measure racial discrimination among the American public. We conducted an audit study on the general public—sending correspondence to 250,000 citizens randomly drawn from public voter registration lists. Our within-subjects experimental design tested the public’s responsiveness to electronically delivered requests to volunteer their time to help with completing a simple task—taking a survey. We randomized whether the request came from either an ostensibly Black or an ostensibly White sender. We provide evidence that in electronic interactions, on average, the public is less likely to respond to emails from people they believe to be Black (rather than White). Our results give us a snapshot of a subtle form of racial bias that is systemic in the United States. What we term everyday or “paper cut” discrimination is exhibited by all racial/ethnic subgroups—outside of Black people themselves—and is present in all geographic regions in the United States. We benchmark paper cut discrimination among the public to estimates of discrimination among various groups of social elites. We show that discrimination among the public occurs more frequently than discrimination observed among elected officials and discrimination in higher education and the medical sector but simultaneously, less frequently than discrimination in housing and employment contexts. Our results provide a window into the discrimination that Black people in the United States face in day-to-day interactions with their fellow citizens.

Motives for Studying and Student Wellbeing: Validation of the Motivational Mindset Model

Research on the joint effect of multiple motives for studying was recently given a push in a new direction with the introduction of the motivational mindset model (MMM). This model contributes to a better understanding of study success and student wellbeing in higher education. The aim of the present study is to validate the newly developed model and the associated mindset classification tool (MCT). To this end, 662 first-year university students were classified in one of the four types of motivational mindset using the classification tool and three exploratory validation procedures were conducted through sense of purpose, study engagement, and students’ background characteristics in terms of gender and ethnicity. Both purpose and study engagement are central dimensions of student wellbeing and predictors of study success. The results show that (1) sense of purpose and study engagement differ across the four types of mindset, (2) students in the low-impact mindset show the least optimal pattern of study engagement and sense of purpose, (3) sense of purpose and study engagement are positively related and this relationship is consistent across mindsets, and (4) overall differences in purpose and study engagement between gender and ethnic subgroups stem from one specific type of motivational mindset. The results provide support for the validity of the MMM and the usefulness of the MCT. The implications of the findings are discussed as well as promising avenues for future research.

Exploring the Subjective Caregiving Experience Among Chinese, Korean, and Southeast Asian Communities

Although the Asian American community is one of the fastest growing racial groups in the US, members of this group continue to be underserved and understudied, especially when it comes to the needs of family caregivers. Therefore, through a national initiative to understand the lived experiences of diverse family and friend caregivers, survey data was collected from a variety of Asian American ethnic subgroups including Chinese (n=148), Korean (n=131), and Southeast Asian (i.e., Vietnamese, Hmong, Cambodian, Laotian; n=161). Surveys were distributed in-person and online, and also offered in the translated native languages of the abovementioned groups. Caregivers had to be 18 years and older and providing care to a person aged 55 and older who needed assistance because of ongoing health problems or disabilities. For the overall sample of Asian American caregivers (n=440), participants were on average 51.68 years of age (SD=15.98), identified as female (n=336), were not born in the US (n=348), lived with the care receiver (n=247), and reported less than $10,000 in income per year (n=199). As guided by the Stress Process Model and through a series of ANOVA tests, when compared on all major outcomes, Southeast Asian caregivers significantly reported: 1) more difficulty with care related tasks (e.g., financial/legal decisions), 2) a stronger cultural commitment to caregiving, 3) higher work strain, and 4) more depressive symptomology. Discussion will focus on opportunities for professionals to meet the needs of Asian American caregivers through the use of available trainings and programs aimed to support diverse caregivers.

Shifts in Racial Self-Identification for the Greatest Generation: Evidence from Social Security Administrative Data

Researchers generally recognize that racial identification may shift over the life course. However, there is less consensus about the prevalence of these shifts. Previous estimates suggest as many as 6% of Americans shift their racial identity. Using administrative data on Social Security applications from 1984 to 2007, we quantify the magnitude and direction of shifts in racial and ethnic self-identification among Black, White, Asian, American Indian, and Hispanic members of the “Greatest Generation,” those born between 1901 and 1927 (N = 410,388). Approximately 9,274 (2.3%) persons in this dataset changed their racial or Hispanic identity, with distinct patterns of change for racial-ethnic subgroups. Overall, the most common shift was from a non-White identity to a non-Hispanic White identity. We then link to the 1940 Census to investigate whether social status in youth and young adulthood predicts a shift in identity in later life, and we find a positive and significant association between socioeconomic status in early life and a shift from non-White to non-Hispanic White identity. These systematic patterns would be unlikely if these shifts were due entirely to measurement error. We conclude the prevalence of racial fluidity is itself contingent, varying across time and cohort with response to racial climate, events in greater society, and social position.

Pharmacoethnicity of FOLFIRINOX versus gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer: a systematic review and meta-analysis

Treatment outcomes between FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and GNP (gemcitabine with albumin-bound paclitaxel) as first-line chemotherapy regimens for metastatic pancreatic cancer (PC) were assessed according to ethnic groups categorized as Western or Asian subgroups. PubMed, EMBASE, and Cochrane library were searched. Thirteen studies were eligible in this meta-analysis. Overall survival was not significantly different between FOLFIRINOX and GNP (HR 1.00, 95% CI 0.83–1.20, P = 0.990). However, the Western subgroup showed a higher survival benefit for FOLFIRINOX over GNP (HR 0.84, 95% CI 0.74–0.95, P = 0.006) whereas the Asian subgroup showed the survival benefit for GNP over FOLFIRINOX (HR 1.29, 95% CI 1.03–1.60, P = 0.030). Progression free survival was not significantly different between the two regimens in the Western subgroup (HR 1.01, 95% CI 0.84–1.20, P = 0.950) and the Asian subgroup (HR 1.13, 95% CI 0.97–1.33, P = 0.110). Occurrence of febrile neutropenia was significantly higher in FOLFIRINOX at both ethnic subgroups; however, that of peripheral neuropathy was significantly higher only in GNP of the Asian subgroup. Therefore, pharmacoethnicity might be a factor worth considering when deciding on a frontline chemotherapeutic regimen although the overall survival was not significantly different between FOLFIRINOX and GNP for metastatic PCs.

Asian American ethnic subgroup disparities in time to surgical treatment for breast cancer in the California Cancer Registry.

101 Background: Health risks and outcomes among Asian American patients are not adequately understood when Asians are treated as a homogenous ethnic group. This work is the first to explore trends in time to surgical treatment for breast cancer amongst Asian American ethnic subgroups. Methods: We used data from the population-based California Cancer Registry to identify a cohort of females diagnosed with invasive breast cancer between 2012-2017 in California. Time to surgical treatment was defined as the time elapsed between definitive diagnosis of breast cancer and receipt of surgery. Covariates included individual patient sociodemographic, health history, and tumor characteristics. Multivariable logistic regression was used to determine the odds of receiving surgery within 30 and 90 days of breast cancer diagnosis and multivariable Cox proportional hazards regression was used to analyze the likelihood of shorter time to surgery. A Bonferroni corrected alpha level was used to account for multiple racial/ethnic group comparisons. Results: Of 106,441 breast cancer patients, 57% were non-Hispanic white (NHW), 21% were Hispanic, 14% were Asian (4% Filipino; 3% Chinese; 1% each of Asian Indian or Pakistani (AIP), Vietnamese, Japanese, and Korean; 3% other Asian), and 6% were non-Hispanic black (NHB). Compared to NHWs, Hispanics (OR = 0.86, 99.5% CI = 0.82-0.92) and NHBs (OR = 0.82, 99.5% CI = 0.76-0.90) were less likely to receive surgery within 30 days of breast cancer diagnosis, while Chinese (OR = 1.30, 99.5% CI = 1.17-1.45) and AIPs (OR = 1.24, 99.5% CI = 1.04-1.48) were more likely to receive surgery within 30 days. These trends persisted for Hispanic (OR = 0.87, 99.5% CI = 0.79-0.96), NHB (OR = 0.73, 99.5% CI = 0.63-0.85), and Chinese patients (OR = 1.33, 99.5% CI = 1.04-1.71) when analyzing the likelihood of receiving surgery within 90 days of diagnosis. Compared to NHWs, Hispanics (OR = 0.94, 99.5% CI = 0.92-0.97), NHBs (OR = 0.88, 99.5% CI = 0.85-0.91), and Vietnamese (OR = 0.90, 99.5% CI = 0.83-0.98) were less likely to experience shorter time to surgical treatment, while Chinese (OR = 1.15, 99.5% CI = 1.09-1.21) and AIPs (OR = 1.09, 99.5% CI = 1.01-1.18) were more likely to have shorter time to surgery. Conclusions: In this population-based study of the California Cancer Registry, trends in time to surgical treatment for breast cancer were not consistent for patients belonging to different Asian ethnic subgroups. While Chinese and AIP patients tended to receive surgery sooner than NHW patients, Vietnamese patients face a disparity in receiving timely surgical treatment relative to NHW patients. Further research is needed to fully understand and appropriately target disparities in breast cancer treatment for patients of different Asian American ethnic subgroups.