Search

Background: Little is known about the epidemiology of Parkinson's disease (PD) patients in Native Hawaiian Or Other Pacific Islander (NHPI) and Asian American (AA) subgroups. Objective: To determine if the prevalence of hospitalized PD patients is different across age groups and racial/ethnic subgroups in Hawaii. Methods: We conducted a retrospective analysis of Hawaii statewide registry (2016–2020) hospitalization data for patients who were 50 years or older. PD patients were identified using an ICD 10 code: Parkinson's Disease (G20) as their primary/secondary hospitalization discharge diagnosis code. Demographic and clinical characteristics among racial/ethnic subgroups (White, Japanese, Filipino, Chinese, NHPI, or Other) were compared. Results: Of 146,844 total hospitalized patients (n = 429,879 records), 1.6% (n = 2,401) had a PD diagnosis. The prevalence of hospitalized PD patients was 2.3% among Japanese and Chinese, followed by 1.7% for Whites, 1.2% for Filipinos and was lowest for NHPI with 0.9% (p < 0.001). As patient's age increased, the prevalence of hospitalized PD patients increased, with 80–84 years old for the highest age range (3.4%). The prevalence of hospitalized PD patients at 80–84 years old varied across the race/ethnic subgroups (Chinese 4.3%, Japanese 4.0%, Whites 3.7%, Filipinos 2.5%, NHPI 2.3%). Conclusions: The prevalence of hospitalized PD patients among all case hospitalizations were lower for NHPI and Filipino compared to that of Japanese, Chinese, and Whites. As patients' age increased, the prevalence of hospitalized patients with PD increased, but less so in NHPI and Filipino groups. Further research is warranted to understand the reason for these observed differences among racial/ethnic subgroups. [ABSTRACT FROM AUTHOR]

Objective: To investigate the frequency of emergency department (ED) usage primarily for oral/dental conditions in Hawaii and to examine social‐demographic factors associated with the identified ED visits. Methods: This was a cross‐sectional study of the 2021 Hawaii Statewide Hospital data. We identified records indicating ED usage and a primary diagnosis of non‐traumatic dental conditions (NTDC) and other oral dental conditions (OODC). Descriptive analyses of ED visits for NTDC and OODC were performed to identify vulnerable individuals based on age, sex, race/ethnicity, primary source of payment, county of residence, and total charges per hospital record. A multivariable negative binomial regression model included age, sex, and county of residence was used to obtain adjusted rate ratios (aRR) and 95% confidence intervals (CI) of ED visits for NTDC. Results: Among hospital records with diagnoses for oral or dental conditions (n = 12,336), 97% indicated ED, of which half had an NTDC diagnosis, and the remaining half had an OODC diagnosis. Distinct differences in the characteristics of ED visits were observed between NTDC and OODC. The median total charges per record indicating ED for NTDC and OODC were $1439 and $2439, respectively. A higher rate of ED visits for NTDC was found for those aged 21–44 (aRR [95%CI] = 3.02 [2.41, 3.80], reference: 0–9 years) and those living in a less populous county (Hawaii: 1.73 [1.43, 2.07]; Kauai: 1.78 [1.45, 2.19], reference: Honolulu). Conclusions: Continued effort to improve dental health is required to reduce ED visits for oral and dental conditions among Hawaii residents, especially for vulnerable individuals. [ABSTRACT FROM AUTHOR]

Background: This study examined racial/ethnic differences in health-related quality of life (HRQOL) among adults and identified variables associated with HRQOL by race/ethnicity.Methods: This study was conducted under a cross-sectional design. We used the 2011-2016 Hawaii Behavioral Risk Factor Surveillance System data. HRQOL were assessed by four measures: self-rated general health, physically unhealthy days, mentally unhealthy days, and days with activity limitation. Distress was defined as fair/poor for general health and 14 days or more for each of the other three HRQOL measures. We conducted multivariable logistic regressions with variables guided by Anderson's behavioral model on each distress measure by race/ethnicity.Results: Among Hawaii adults, 30.4% were White, 20.9% Japanese, 16.8% Filipino, 14.6% Native Hawaiian and Pacific Islander (NHPI), 5.9% Chinese, 5.2% Hispanics, and 6.2% Other. We found significant racial/ethnic differences in the HRQOL measures. Compared to Whites, Filipinos, Japanese, NHPIs, and Hispanics showed higher distress rates in general health, while Filipinos and Japanese showed lower distress rates in the other HRQOL measures. Although no variables were consistently associated with all four HRQOL measures across all racial/ethnic groups, history of diabetes were significantly associated with general health across all racial/ethnic groups and history of depression was associated with at least three of the HRQOL measure across all racial/ethnic groups.Conclusions: This study contributes to the literature on disparities in HRQOL and its association with other variables among diverse racial/ethnic subgroups. Knowing the common factors for HRQOL across different racial/ethnic groups and factors specific to different racial/ethnic groups will provide valuable information for identifying future public health priorities to improve quality of life and reduce health disparities. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and barriers to human papillomavirus (HPV) vaccine uptake among 11–18 year olds in the Hawai'i's four major ethnic groups–Native Hawaiians, Filipinos, Japanese, and Caucasians. Study design: A telephone survey assessed parents' knowledge of HPV and the HPV vaccine, status of their child's HPV vaccine uptake, variables operationalizing the Health Belief Model, and barriers and motivators to uptake. Results: Across the groups, 799 parents completed the survey. About 35% of daughters and 19% of sons had received all three shots. Although ethnic differences in vaccine uptake were seen in bivariate analysis (with significantly lower uptake in Filipino youth), in multivariable logistic regression analysis, only Caucasian parents were significantly less likely to start their sons on the HPV vaccine series compared with Japanese parents (reference group). Having heard about the vaccine, believing in its effectiveness, and older age of the child were also associated with vaccine uptake. Motivators for HPV vaccination were physician's recommendation and wanting to protect one's child. The primary barrier to uptake was lack of knowledge about the vaccine. Conclusions: Findings reinforce the fact that a physician's recommendation and receipt of information about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic differences have not been adequately addressed in the utilization of mental health services among Medicaid populations. Aim: This study aimed to examine racial/ethnic differences in the utilization of health services for mental disorders in a Medicaid adult population aged between 21 and 64 years. Methods: Racial/ethnic differences in inpatient, outpatient and emergency department services utilization were assessed using 2010 Hawaii Medicaid data. Zero-inflated negative binomial regressions were employed adjusting for age, sex and residential area. Results: Among 73,200 beneficiaries, 29.7% were Whites, 28.5% Asians, 34.7% Native Hawaiians and Pacific Islanders (NHPIs); 60.2% were younger (21–44 years) and 58.6% were females. The patterns of utilization of health services differed across race/ethnicity. Compared to Whites, Asians and NHPIs were less likely to use outpatient services and had lower rates of inpatient visits. NHPIs were also estimated to have lower rates of outpatient and emergency department visits. Conclusion: Variation in the utilization of health services emphasizes the importance of race/ethnicity in mental health management. Various factors, such as language barriers and cultural differences, should be considered in developing clinical interventions or integrative health programs that aim to reduce racial/ethnic disparities among people with mental disorders. [ABSTRACT FROM AUTHOR]

Objective: To examine racial disparities in health services utilization in Hawaii among Medicare fee-for-service beneficiaries aged 65 years and above. Method: All-cause utilization of inpatient, outpatient, emergency, home health agency, and skilled nursing facility admissions were investigated using 2012 Medicare data. For each type of service, multivariable logistic regression model was used to investigate racial disparities adjusting for sociodemographic factors and multiple chronic conditions. Results: Of the 84,212 beneficiaries, 27.8% were White, 27.4% were Asian, 27.3% were Pacific Islanders; 70.3% had two or more chronic conditions and 10.5% had six or more. Compared with Whites, all racial groups experienced underutilization across all types of services. As the number of chronic conditions increased, the utilization of inpatient, home health care, and skilled nursing facility dramatically increased. Discussion: Disparities persist among Asians and Pacific Islanders who encounter the problem of underutilization of various health services compared with Whites. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) screening prevalence remains low among Asians and Pacific Islanders. This study examined disparities and predictors of CRC screening compliance in adults age 50-75 years in Asians and Pacific Islanders in Hawai‘i. Hawai‘i Behavioral Risk Factor Surveillance System (BRFSS) data for 2011-2014 were analyzed. CRC screening status was dichotomized. Logistic regression was used to examine ethnic differences in and predictors of CRC screening status. Filipinos (OR 0.56), Chinese (OR 0.70), and Hawaiians (OR 0.75) were significantly less likely than whites to be CRC compliant. Higher education and income, employment, regular health provider, and routine checkups were important predictors of CRC compliance. Findings confirm lower CRC screening compliance in three of the four largest Asian and Pacific Islander groups in Hawai‘i and that CRC screening compliance is influenced by several factors. Culturally tailored education and navigation services may be effective in reducing these disparities. [ABSTRACT FROM AUTHOR]

We investigated racial/ethnic and county-level disparities in inpatient utilization for 15 clinical conditions among Hawaii's Medicaid population. The study was conducted using inpatient claims data from more than 200,000 Hawai'i Medicaid beneficiaries, reported in the year 2010. The analysis was performed by stratifying the Medicaid population into three age groups: children and adolescent group (1-20 years), adult group (21-64 years), and elderly group (65 years and above). Among the differences found, Asians had a low probability of inpatient admissions compared to Whites for many disease categories, while Native Hawaiian/Pacific Islanders had higher probabilities than Whites, across all age groups. Pediatric and adult groups from Hawai'i County (Big Island) had lower probabilities for inpatient admissions compared to Honolulu County (O'ahu) for most disease conditions, but higher probabilities were observed for several conditions in the elderly group. Notably, the elderly population residing on Kaua'i County (Kaua'i and Ni'ihau islands) had substantially increased odds of hospital admissions for several disease conditions, compared to Honolulu. [ABSTRACT FROM AUTHOR]

The human papillomavirus (HPV) vaccine has the potential to decrease the incidence of several cancers that affect women and men. Despite recommendations by the medical and public health community, and the incorporation of the vaccine into the adolescent immunization schedule, uptake of the vaccine remains well below target goals. To understand potential physician barriers to recommendation and provision of the vaccine, a cross-sectional survey was administered to Hawai'i pediatricians and family physicians from July 2012 to September 2012 on their attitudes, practices, and perceived barriers regarding HPV vaccination. Surveys were mailed to 465 members of the local pediatrics and family medicine professional chapters, and 87 responses were received for a response rate of 19%. After excluding 14 responses, 73 surveys were included in the analysis. Although almost all of the respondents reported stocking and administering the HPV vaccine in their offices, only 71% reported strongly recommending the HPV vaccine to girls 11-12 years, and only 57% strongly recommend the vaccine to boys 11-12 years old. Lack of insurance coverage and other financial considerations were barriers to provision of the vaccine by physicians. Physicians who felt it is necessary to discuss sexuality with patients prior to recommending the vaccine were significantly less likely to strongly recommend the vaccine to boys 11-12 years old. Public health efforts should focus on addressing the financial barriers and encouraging physicians to recommend the HPV vaccine according to the guidelines. [ABSTRACT FROM AUTHOR]

Data on dementia in Native Hawaiians and many Asian subgroups in the United States are limited. Inpatients with dementia have higher costs, longer stays, and higher mortality than those without dementia. This study compared rates of inpatients with a dementia diagnosis for disaggregated Asian and Pacific Islanders (Native Hawaiian, Chinese, Japanese, Filipino) with those of whites according to age (18-59, 60-69, 70-79, 80-89, ≤90) for all adults hospitalized in Hawai'i between December 2006 and December 2010; 13,465 inpatients with a dementia diagnosis were identified using International Classification of Diseases, Ninth Revision, codes. Rates were calculated using population size denominators derived from the U.S. Census. In all age categories, Native Hawaiians had the highest unadjusted rates of inpatients with dementia and were more likely to have a dementia diagnosis at discharge at younger ages than other racial and ethnic groups. In adjusted models (controlling for sex, residence location, and insurer), Native Hawaiian inpatients aged 18 to 59 ( aRR = 1.50, 95% CI = 0.84-2.69), 60 to 69 ( aRR = 2.53, 95% CI = 1.74-3.68), 70 to 79 ( aRR = 2.19, 95% CI = 1.78-2.69), and 80 to 89 ( aRR = 2.53, 95% CI = 1.24-1.71) were significantly more likely to have dementia than whites, as were Japanese aged 70 to 79 ( aRR = 1.30, 95% CI = 1.01-1.67), 80 to 89 ( aRR = 1.29, 95% CI = 1.05-1.57), and 90 and older ( aRR = 1.51, 95% CI = 1.24-1.85). Japanese aged 18 to 59 had were significantly less likely to have dementia than whites ( aRR = 0.40, 95% CI = 0.17-0.94). These patterns have important public health and clinical care implications for Native Hawaiians and older Japanese populations. Future studies should consider whether preventable medical risk, caregiving, socioeconomic conditions, genetic disposition, or a combination of these factors are responsible for these findings. [ABSTRACT FROM AUTHOR]

Hospitalizations of those living with HIV are expensive and often indicate failures in access to, or retention in, primary care. Higher rates of hospitalizations among individuals with HIV have been reported in some US ethnic minorities, yet little information is available for Native Hawaiians and Asian subgroups. All hospitalizations in Hawai'i of individuals aged >13 years from December 2006-December 2010 were considered. Hospitalizations of individuals with HIV were identified using ICD-9 diagnosis codes of 042 and V08; 613 hospitalizations with an HIV diagnostic code were found. Using Hawaii State Department of Health 2010 data, estimated rates of hospitalizations among HIV positive individuals by race/ethnicity among the 2,600 Hawai'i residents living with HIV were calculated along with estimated rate ratios (using Whites as the reference group). Multivariable adjusted estimated rate ratios (aRR) were calculated with negative binomial models, adjusting for age, sex, and payer type. Demographic and clinical differences among hospitalized patients with HIV were also compared by race/ethnicity. Native Hawaiians (aRR: 3.21; 95%CI: 2.11-4.88), Japanese (aRR: 2.27; 95%CI: 1.38-3.72), and Filipinos (aRR: 1.62; 95%CI: 1.01-2.59) living with HIV all had higher likelihood of a hospitalization compared to Whites, even when controlling for age, sex, and payer. Chinese did not vary significantly from Whites. Also of note, the average age of HIV positive individuals who were hospitalized varied significantly across groups (P-value < .001), with Native Hawaiians as the youngest (45 years), followed by Filipinos (47 years), Whites (49 years), Chinese (50 years) and Japanese (54 years). Disparities appear to exist in hospitalizations among HIV positive individuals for Native Hawaiians and Asian subgroups. Further research is warranted to investigate the reasons for these health disparities. [ABSTRACT FROM AUTHOR]

Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawaiʻi, ages 3–12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants' diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3–12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6–12 months. Approximately 10% of infants, ages 6–12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawaiʻi. [ABSTRACT FROM AUTHOR]

Differences among Native Hawaiians/Pacific Islanders (NHPI) and Asian American (AA) subgroups have not been adequately studied in Parkinson's disease (PD). To determine differences in demographics, comorbidities, and healthcare utilization among NHPI, AA subgroups, and White hospitalized PD patients. We conducted a retrospective cross-sectional analysis of Hawaiʻis statewide registry (2016–2020). Patients with PD were identified using ICD10 code G20 and categorized as White, Japanese, Filipino, Chinese, NHPI, or Other. Variables collected included: age, sex, residence (county), primary source of payment, discharge status, length of stay, in-hospital expiration, Charlson Comorbidity Index (CCI) and Deep Brain Stimulation (DBS) utilization. Bivariate analyses were performed: differences in age and CCI were further examined by multivariable linear regression and proportional odds models. Of 229,238 hospitalizations, 2428 had PD (Japanese: 31.3 %, White: 30.4 %, Filipino: 11.3 %, NHPI: 9.6 %, Chinese: 8.0 %). NHPI were younger compared to rest of the subgroups [estimate in years (95 % CI): Whites: 4.4 (3.0–5.8), Filipinos: 4.3 (2.7–5.9), Japanese: 7.7 (6.4–9.1), Chinese: 7.9 (6.1–9.7), p < 0.001)]. NHPI had a higher CCI compared to White, Japanese, and Chinese (p < 0.001). Among AA subgroups, Filipinos were younger and had a higher CCI compared to Japanese and Chinese (p < 0.001). There were no significant differences in DBS utilization among subgroups. NHPI and Filipinos with PD were hospitalized at a younger age and had a greater comorbidity burden compared to other AAs and Whites. Further research, ideally prospective studies, are needed to understand these racial disparities. • Among hospitalized PD patients in Hawaiʻi, (2016–2020), Native Hawaiians/Pacific Islanders (NHPI) were younger. • NHPI higher a higher Charlson Comorbidity Index (CCI) compared to Whites, Japanese and Chinese with PD. • Among Asian Americans (AA), Filipino PD patients were younger and had higher CCI compared to Japanese and Chinese. • There was no difference in Deep Brain Stimulation Surgery (DBS) utilization among Whites, AAs and NHPIs. • Further studies are needed to understand the clinical and socioeconomic factors that are driving the observed disparities. • Among hospitalized PD patients in Hawaii (2016–2020), Native Hawaiians/Pacific Islanders (NHPI) were younger. [ABSTRACT FROM AUTHOR]

Purpose/Background: The HPV vaccine provides immunity against nine HPV strains that cause cancer and genital warts. It is recommended for 11 to 12 year olds, and "catch-up" immunization is recommended for females 13 to 26 years old and males 13 to 21 years old. College students represent an important population for HPV vaccination due to their increased risk for HPV infection. Despite the benefits of the HPV vaccine, its coverage rates are low in Hawaii. Hawai'i is the home of two large universities on two islands that are representative of Hawai'i's populations, including Native Hawaiians, Filipinos, and Pacific Islanders. The purpose of this study was to assess the current HPV and HPV vaccine knowledge, barriers and beliefs among incoming Freshmen university students at University of Hawai'i at Mānoa and University of Hawai'i at Hilo. Materials & Methods: In 2016, 200 University of Hawai'i at Mānoa (UHM) and University of Hawai'i at Hilo (UHH) Freshmen students responded to a survey that assessed their knowledge and awareness of HPV, the HPV vaccine, their current vaccination status, and barriers and motivators to vaccination. Descriptive statistics were used to summarize each survey variable first for all students and then separately for each campus. Results: Overall 76% of Freshmen from both campuses heard of the HPV vaccine and 54% reported hearing it from their health care provider. Only 28% UHM and 23% UHH Freshmen students have received partial (1-2 shots) or completed doses of the HPV vaccine. For those who received the vaccine, 45% reported that they were told by their parent and 43% were told by their doctor. For the 147 students who did not receive the vaccine, 28% reported that they are still not sure to get it and 20% need more information. Their main reasons for not receiving the HPV vaccine were: their doctor did not mention the vaccine to him/her (44%), he/she never knew about the vaccine (18%), and they don't know enough about the vaccine (17%). Discussion/Conclusion: Although the HPV vaccine has been available for 13 years, young adults remain unvaccinated. Freshmen students reported that they are informed about the vaccine, but were not vaccinated because of the lack of parental and/or healthcare provider recommendation. With no active education campaigns in Hawaii promoting the HPV vaccine at college campuses, a first step to increasing vaccination rates is to develop a health education campaign to inform students of the HPV vaccine and its availability at campus clinics and neighboring pharmacies. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a viral infection that sexually active females and males may be exposed to in their lifetime. The HPV vaccine is highly recommended especially among children to protect them before their anticipated exposure to HPV, however, vaccination uptake in Hawai'i remains low. As of 2017, legislation allows pharmacists to vaccinate for adolescent vaccines with the potential to increase access and opportunities for patients to complete the HPV vaccine series. Physicians in Hawai'i were surveyed to examine physicians' awareness of this law, their perceptions of the role of pharmacists, and willingness to send adolescent patients to pharmacies; 137 responses were received and analyzed. Overall, 72% (n=99) of respondents were willing while 28% (n=38) were unwilling to send patients to pharmacies for vaccines. Physicians view pharmacists' role as helpful but have concerns regarding correct administration and tracking doses given. Results show potential for more physician-pharmacist collaborations through further education and trainings for pharmacists and health providers to increase physician referrals for adolescent vaccine services in pharmacies., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2024 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Background: Alzheimer disease (AD), the most common neurodegenerative disorder in the United States, disproportionately burdens minority populations., Objective: To explore barriers to AD clinical trial participation by Asian and Native Hawaiian patients diagnosed with AD or mild cognitive impairment., Method: We surveyed 187 patients with a Mini-Mental State Examination score ≥14 between January 2022 and June 2022. The score cutoff for clinical trial eligibility was set by the institution. Individuals also completed a 15-question telephone survey that assessed demographics, barriers to clinical trial participation, and clinical trial improvement methods., Results: Forty-nine patients responded, with a response rate of 26%. Asian and Native Hawaiian patients were less likely than White patients to participate in AD trials. The main barrier to participation was a lack of information about AD trials. Providing additional information regarding AD trials to patients and family members were listed as the top two reasons patients would consider participating in a clinical trial., Conclusion: Insufficient information about AD clinical trials is the primary barrier to participation among Asian and Native Hawaiian patients, followed by difficulty coordinating transportation and, in the case of Asians, the time required for clinical trials. Increased outreach, education, and assistance with logistics in these populations should be pursued to improve rates of participation in clinical trials., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Many health and health disparities studies require population prevalence information of various race groups, but the estimation of single-race population sizes using the US Census data has been challenging. For each Census race group, Census only provides the counts of those reported being single race ("race alone") and those reported of that specific race regardless of whether the individuals were multiracial or not ("race alone or in (any) combination"). The issue of how to classify Census multiracial individuals is especially important for the state of Hawai'i due to its large multiracial population. The current study developed the Stepwise Proportional Weighting Algorithm (SPWA) for single-race population estimation using US Census data for major race groups in the Census and their nested detailed races. Additionally, given that "partial Native Hawaiian" has often been treated as "Native Hawaiian" in health disparities studies in Hawai'i, the algorithm can also adjust for the unique partial Native Hawaiian race categorization. This paper describes the estimation process with the SPWA and demonstrates its ability to estimate single-races for the 5 most common race groups in Hawai'i. This new methodology addresses an important concern regarding how to classify multiracial individuals to strengthen health and health disparities research in Hawai'i., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Hawai'i is the most ethnically diverse state with the highest proportion of multiracial individuals in the United States. The Stepwise Proportional Weighting Algorithm (SPWA) was developed to bridge the categorization of multiracial Census data into single-race population estimates for common races in Hawai'i. However, these estimates have not been publicly available. A Shiny web application, the Hawai'i Single-Race Categorization Tool, was developed as a user friendly research tool to obtain the age and sex distributions of single-race estimates for common racial groups in Hawai'i. The Categorization Tool implements the SPWA and presents the results in tabular and graphic formats, stratified by sex and age. It also allows the categorization of partial Native Hawaiians as Native Hawaiians in the population estimation. Using this tool, the current paper reports population estimates and distributions for 31 common racial groups using Hawai'i Census 2010 data. Among the major Census races, Asian had the largest population (631 881; 46.5%) in Hawai'i, followed by White (431 635; 31.7%) and Native Hawaiian and Other Pacific Islander (227 588; 16.7%). Among Census detailed races within Asian, Filipino had the largest population estimate (244 730; 18.0%), followed by Japanese (227 165; 16.7%) and Chinese (103 600; 7.6%). Native Hawaiian accounted for 12.3% of the Hawai'i population (166 944). After recategorizing part-Native Hawaiians as Native Hawaiians, Native Hawaiian increased by 150.0%, with the greatest increase among the young. This publicly available tool would be valuable for race-related resource allocation, policy development, and health disparities research in Hawai'i., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Background: Chronic kidney disease (CKD) is linked to high morbidity and mortality and increased hospitalization burden. If appropriately managed in the outpatient setting, ambulatory care-sensitive conditions (ACSCs) do not lead to hospitalization. Hospitalizations due to ACSCs are considered as potentially preventable hospitalizations. Patients with recurrent hospitalizations are considered as super-utilizers of inpatient services. The aim of this study is to determine prevalence of potentially preventable hospitalizations and super-utilization of inpatient services among patients with CKD in Hawai'i., Methods: Hawai'i statewide inpatient data (2015-2017) were used to identify adult CKD patients with hospitalizations during a 12-month period from the first recorded date of CKD. The associations between the potentially preventable hospitalizations and super-utilization and other key patient demographic and clinical variables (sex, age, ethnicity, insurance type, Charlson comorbidity index (CCI), county of residence, and homelessness indicator) were analyzed using bivariate analysis. Multivariable logistic regression was utilized to assess the associations between the potentially preventable hospitalizations and patient variables., Results: Approximately 2% of patients reported potentially preventable hospitalizations, and a total of 12.3% patients reported super-utilization. Out of all CKD-specific ACSC hospitalizations, 74.2% were due to heart failure and 25.8% were due to hyperkalemia. Patients who reported super-utilization were more likely to report potentially preventable hospitalization (OR: 5.98, 95%CI: 4.50-7.93) than patients who did not report super-utilization., Conclusion: This study showed prevalence of potentially preventable hospitalizations and high inpatient utilization among CKD patients in Hawai'i. Heart failure and hyperkalemia were the two major causes of CKD-specific ACSC hospitalizations in this cohort. Effective strategies should be employed to improve the outpatient CKD management to reduce hospitalizations and in turn reduce cost., (© 2022. The Author(s).)

The purpose of this study was to characterize the frequencies and patterns of emergency room (ER) visits with a non-traumatic dental-related diagnosis among adults (≥21 years old) in Hawaii, United States. This descriptive cross-sectional study used state-level inpatient and outpatient data recorded in Hawaii from 2016 to 2020. We identified dental-related ER visits using the diagnosis codes for non-traumatic dental-related conditions and summarized the frequency, rates, and cumulative total charges of the ER visits. The results show that approximately 30 thousand ER visits between 2016 and 2020 had a dental-related diagnosis. Sixty-seven percent of them had it as a principal diagnosis, amounting to USD 38.7 million total charges over the five years. A high proportion of these visits was found among those aged 21−44 years old (62%), Medicaid beneficiaries (49%), and Native Hawaiians/Part Native Hawaiians (26%). Compared to the proportions of ER visits with a secondary diagnosis, these groups had a higher proportion of ER visits with a principal diagnosis (ps < 0.001). A higher visit rate was found for those aged 21−44 years old and from less-populated counties. These results suggest that oral health disparities in age, socioeconomic status, and race/ethnicity exist in Hawaii. Our findings could provide insight in developing a framework to reduce oral health disparities, particularly among Medicaid beneficiaries and Native Hawaiians. Dental coverage with effective education in multiple dimensions is necessary to reduce non-traumatic dental-related ER visits.

Background: Previous studies of racial differences in Alzheimer disease (AD) presentation have not included Native Hawaiians and Pacific Islanders (NHPI)., Objective: To explore the presentation of AD and mild cognitive impairment (MCI) in NHPI., Method: We conducted a retrospective review of patient records from Hawaii with a diagnosis of unspecified AD or MCI from September 2000 to September 2019. Variables of interest included age at diagnosis, gender, race, marital status, insurance, comorbidities, and scores on the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA)., Results: We reviewed the medical records of 598 patients, including 224 Asians, 202 Whites, 87 NHPI, and 85 Other. AD was more dominant than MCI across all of the groups, with the highest percentage in NHPI. Among the mean ages of diagnosis, NHPI were the youngest. Across all groups, a higher proportion of women than men had AD, with the highest female prevalence among NHPI. Hypertension, hyperlipidemia, and type II diabetes were highest among NHPI compared with the other groups. Of individuals with MMSE/MoCA scores, there were significant variations in scores by racial group. The mean MMSE/MoCA score was highest among Whites and lowest among NHPI., Conclusion: Compared with other racial groups, NHPI have a higher proportion of AD than MCI at diagnosis, are diagnosed at a younger age, have a higher female prevalence, have more comorbidities that may contribute to AD/MCI onset, and present with lower MMSE scores., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: To date, little is known about cardiovascular disease risks among older adults with non-valvular atrial fibrillation by their association with diabetes and osteoarthritis status, based on longitudinal data with substantial amounts of non-white individuals. The objective of this study was to examine the risks for three cardiovascular diseases: stroke, acute myocardial infarction (AMI), and heart failure (HF), by diabetes and osteoarthritis status among older adults with non-valvular atrial fibrillation in Hawaii., Methods: We conducted a retrospective observational cohort study for older adults (65 years and older) with non-valvular atrial fibrillation using the Hawaii Medicare data 2009-2017. Their risks for the three cardiovascular diseases by diabetes and osteoarthritis status (diabetes, osteoarthritis, diabetes and osteoarthritis, and without diabetes and osteoarthritis) were examined by multivariable Cox proportional hazard regression models., Results: The analysis included 19,588 beneficiaries followed up for a maximum of 3288 days (diabetes: n = 4659, osteoarthritis: n = 1978, diabetes and osteoarthritis: n = 1230, without diabetes and osteoarthritis: n = 11,721).  Among them, those diagnosed with the cardiovascular diseases were identified (stroke: diabetes n = 837, osteoarthritis n = 315, diabetes and osteoarthritis n = 184, without diabetes and osteoarthritis n = 1630)(AMI: diabetes n = 438, osteoarthritis n = 128, diabetes and osteoarthritis n = 118, without diabetes and osteoarthritis n = 603)(HF: diabetes n = 2254, osteoarthritis n = 764, diabetes and osteoarthritis n = 581, without diabetes and osteoarthritis n = 4272). After adjusting for age, sex, race/ethnicity, and other potential confounders, those with diabetes and osteoarthritis had higher risks for HF (hazard ratio: 1.21 95% confidence interval: 1.10-1.33) than those without diabetes and osteoarthritis. They also had higher risks than those with osteoarthritis for HF. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups., Conclusions: Variation in cardiovascular disease risks for older adults with non-valvular atrial fibrillation in Hawaii exists with diabetes and osteoarthritis status.

The objective of this study was to assess the impact of medical school, sex, career choice, and location of practice of one pediatric residency program on physician workforce. This is a retrospective study of all categorical pediatric graduates of a residency program located in Honolulu, Hawai'i from 1968 to 2015. Information on medical school training, sex, career choice (general pediatrics or specialty), and location of practice were studied by examining data into five 10-year graduation periods. The program graduated 319 residents over nearly a 50-year timespan. Of these, 181 (56.7%) residents remained in Hawai'i to practice (adjusted odds ratio [OR] = 7.46, 95% confidence interval [CI]: 3.61-15.43). There were 125 (39.1%) graduates who relocated to the continental US with the majority moving to the West (55.2%), while other graduates moved to the South, Midwest, and Northeast (25.6%, 13.6%, and 5.6%, respectively). The remaining 13 (4.1%) graduates moved internationally. Female residents steadily increased over time ( P < .001), with females significantly choosing general pediatrics (OR = 3.05, 95% CI: 1.91-4.89). In the time periods with the highest percentage of University of Hawai'i medical school graduates, there was an increased percentage of graduates staying in Hawai'i. This study examined the regional and national impact of a small residency program. The results indicated that trends in gender and the impact of medical school location were important in establishing a pediatrician workforce for local communities. Support of both medical school and residency education should be considered when assessing future workforce needs., (©Copyright 2020 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Food insecurity and other nutritional risks in infancy pose a lifelong risk to wellbeing; however, their effect on diet quality in Native Hawaiian, Pacific Islander, and Filipino (NHPIF) infants in Hawai'i is unknown. In this cross-sectional analysis, the association between various indicators of food security and NHPIF infant diet quality were investigated in 70 NHPIF infants aged 3-12 months residing on O'ahu, Hawai'i. The dietary assessments of the infants were collected using a mobile food record TM . Foods consumed across four days were categorized into seven food groups. Indicators for food security were examined through an adapted infant food security index and other indicators. Data were analyzed using chi-square tests, independent sample t-tests, multinomial logistic regression, and linear regression models. In models adjusting for age and sex, infants defined as food insecure by the adapted index were found to consume foods from more food groups and consume flesh foods on a greater proportion of days. Of the indicators examined, the adapted index was shown to be the best indicator for food group consumption. Further work is needed on a more representative sample of NHPIF infants to determine the impact that food security has on nutritional status and other indicators of health.

Prevention is the recommended strategy for addressing childhood obesity and may be particularly important for minority groups such as Native Hawaiians, Pacific Islanders, and Filipinos (NHPIF) who display poorer health outcomes than other race/ethnic groups. Complementary feeding is a critical milestone in the first 1,000 days of life and plays a critical role in growth and eating habit formation. This cross-sectional study recruited NHPIF infants between 3 - 12 months of age residing on O'ahu, Hawai'i to examine timing and types of complementary foods introduced first as well as the dietary diversity of those infants 6 - 12 months of age. Basic demographic information and early feeding practices were assessed via online questionnaire. Diet was evaluated using the image-based mobile food record completed over 4-days. Images were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) score. Data were analyzed using descriptive statistics and linear regressions. Seventy participants completed the study with a majority being between the ages of 6 - 12 months (n=56). About half of the participants were provided a complementary food prior to 6 months of age with the most common first complementary food being poi (steamed, mashed taro). Grains were the most commonly reported food group while the high protein food groups was the least commonly reported. Approximately 25% of infants 6 - 12 months of age met MDD all four days. Meeting MDD was significantly associated with age. Findings illuminate opportunities for improvement (eg, delayed introduction) and for promotion (eg, cultural foods) in NHPIF complementary feeding., Competing Interests: None of the authors identify any conflict of interest., (©Copyright 2020 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Background: Diabetes mellitus, ischemic heart disease, and chronic kidney disease are three major chronic conditions that develop with increasing risks among adults as they get older. The interconnectedness of these three chronic conditions is well known, while each condition acts as a prognostic risk factor for the other two. It is important to understand the progressive relationships of these three conditions over time in terms of transitioning between clinical states and the impact on patients' survival., Methods: We investigate the survival characteristics of a Medicare population aged 65 years and above in a multistate system that contained clinical states specified by death and diagnosis combinations of three chronic conditions. The study was conducted using Hawaii Medicare claims data from 2009 to 2013. To evaluate the progression of a subject with one of the newly diagnosed chronic conditions, we analyzed quantities such as state occupation probabilities in eight states and hazards of sixteen transition types. We quantified effects and significances of potential covariates such as age, gender, race/ethnicity, comorbidity burden and financial status on these temporal functions. Nonparametric method of estimating state occupation probabilities and pseudo-value based method for estimating covariate effects of a survival system were utilized., Results: We found a range of age, gender, race/ethnicity and financial status based interesting covariate influences on transitions and state occupation probabilities of the system., Conclusion: Survival characteristics of the disease system are influenced by subject-specific effects. Subgroup-specific interventions/screenings should be considered for the optimal prevention and care.

A retrospective chart review in the Endoscopy Department at Queen's Medical Center identified 358 Native Hawaiian patients who had completed a colonoscopy screening procedure between August 2011 and January 2013, through either the Direct Referral Colonoscopy program or its Traditional Referral program. The differences in the characteristics of Native Hawaiian patients were summarized and compared between the two referral programs to identify potential barriers for future interventions and increase colorectal cancer screening. The combined colonoscopy screening rate among Native Hawaiians was 13%. Younger patients and those with private insurance were found to be undergoing colonoscopy screening through the Direct Referral program. The findings of this study underscore the need to reduce disparities in colonoscopy screening among Native Hawaiians.

Many congestive heart failure (CHF) hospitalizations are considered potentially preventable with access to high-quality primary care. Some Asian American and Pacific Islander groups have poor access to health care compared to Whites, yet CHF preventable hospitalizations are understudied in these groups. Hawai'i hospitalizations from December 2006 to December 2010 for Chinese, Japanese, Native Hawaiian, Filipino, and Whites aged 18+ years were considered (N = 245,435). CHF preventable hospitalizations were compared in multivariable models by age group (<65 vs. 65+) and gender. Native Hawaiians and Filipinos with CHF preventable hospitalizations were significantly (p < 0.001) younger than other racial/ethnic groups. In adjusted models, Native Hawaiians and Filipinos of all age and gender combinations had significantly higher CHF hospitalization rates than Whites as did Chinese women 65+. High preventable CHF hospitalization rates are seen in some Asian and Pacific Islander groups, especially Native Hawaiians and Filipinos, who have these hospitalizations at younger ages than other studied groups.

Objective: To examine the impact of key laboratory and race/ethnicity data on the prediction of in-hospital mortality for congestive heart failure (CHF) and acute myocardial infarction (AMI)., Data Sources: Hawaii adult hospitalizations database between 2009 and 2011, linked to laboratory database., Study Design: Cross-sectional design was employed to develop risk-adjusted in-hospital mortality models among patients with CHF (n = 5,718) and AMI (n = 5,703)., Data Collection/extraction Methods: Results of 25 selected laboratory tests were requested from hospitals and laboratories across the state and mapped according to Logical Observation Identifiers Names and Codes standards. The laboratory data were linked to administrative data for each discharge of interest from an all-payer database, and a Master Patient Identifier was used to link patient-level encounter data across hospitals statewide., Principal Findings: Adding a simple three-level summary measure based on the number of abnormal laboratory data observed to hospital administrative claims data significantly improved the model prediction for inpatient mortality compared with a baseline risk model using administrative data that adjusted only for age, gender, and risk of mortality (determined using 3M's All Patient Refined Diagnosis Related Groups classification). The addition of race/ethnicity also improved the model., Conclusions: The results of this study support the incorporation of a simple summary measure of laboratory data and race/ethnicity information to improve predictions of in-hospital mortality from CHF and AMI. Laboratory data provide objective evidence of a patient's condition and therefore are accurate determinants of a patient's risk of mortality. Adding race/ethnicity information helps further explain the differences in in-hospital mortality., (© Health Research and Educational Trust.)

Elderly (65+) Native Hawaiian, Filipino, and Japanese men and Filipino women have a higher risk of diabetes-related potentially preventable hospitalizations than Whites even when demographic factors and the higher diabetes prevalence in these populations is considered. The study objective was to determine if similar disparities are seen among the non-elderly (< 65). We used discharge data for all non-maternity hospitalizations by working-age adults (18-64 years) in Hawai'i from December 2006 to December 2010. Annual diabetes-related preventable hospitalization rates (by population diabetes prevalence) were compared by race/ethnicity (Japanese, Chinese, Native Hawaiian, Filipino, and White) and gender. Adjusted rate ratios (aRR) were calculated relative to Whites using multivariable models controlling for insurer, comorbidity, residence location, and age. After adjusting for ethnic-specific prevalence of diabetes and demographic factors, preventable hospitalizations rates were significantly higher for Native Hawaiians males (aRR:1.48; 95%CI:1.08-2.05) compared to Whites, but significantly lower for Chinese men (aRR:0.43;95%CI:0.30-0.61) and women (aRR:0.18;95%CI: 0.08-0.37), Japanese men (aRR:0.33;95%CI: 0.25-0.44) and women (aRR:0.34; 95%CI:0.23-0.51), and Filipino men (aRR:0.35;95%CI:0.28-0.43) and women (aRR:0.47;95%CI: 0.36-0.62). Rates for Native Hawaiian females did not differ significantly from Whites. Disparities in diabetes-related preventable hospitalizations were seen for working-age (18-64) Native Hawaiian men even when their higher population-level diabetes prevalence was considered. Further research is needed to determine factors affecting these disparities and to develop targeted interventions to reduce them. Significantly lower preventable hospitalization rates were seen among Asian groups compared to Whites. A better understanding of these findings may provide guidance for improving rates among Asian elderly as well as other non-elderly groups with disparities.

Introduction: Approximately 25% of individuals aged 65 years or older in the United States have diabetes mellitus. Diabetes rates in this age group are higher for Asian American and Pacific Islanders (AA/PI) than for whites. We examined racial/ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH) among people aged 65 years or older for Japanese, Chinese, Filipinos, Native Hawaiians, and whites., Methods: Discharge data for hospitalizations in Hawai'i for people aged 65 years or older from December 2006 through December 2010 were compared. Annual rates of DRPH by patient were calculated for each racial/ethnic group by sex. Rate ratios (RRs) were calculated relative to whites. Multivariable models controlling for insurer, comorbidity, diabetes prevalence, age, and residence location provided final adjusted rates and RRs., Results: A total of 1,815 DRPH were seen from 1,515 unique individuals. Unadjusted RRs for DRPH by patient were greater than 1 in all AA/PI study groups compared with whites, but were highest among Native Hawaiians and Filipinos [corrected]. In fully adjusted models accounting for higher diabetes prevalence in AA/PI groups, Native Hawaiian (adjusted rate ratio [aRR] = 1.59), Filipino (aRR = 2.26), and Japanese (aRR = 1.86) men retained significantly higher rates of diabetes-related potentially preventable hospitalizations than whites, as did Filipino women (aRR = 1.61)., Conclusion: Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older have a higher risk than whites for DRPH. Health care providers and public health programs for elderly patients should consider effective programs to reduce potentially preventable hospitalizations among Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older.