Pacific Islanders

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David Simmons - One of the best experts on this subject based on the ideXlab platform.

  • personal barriers to diabetes care lessons from a multi ethnic community in new zealand
    Diabetic Medicine, 1998
    Co-Authors: T Weblemoe, J A Voyle, A Prichard, L Leakehe, David Simmons, B Gatland
    Abstract:

    The aim of this study was to identify and quantify barriers to diabetes care perceived by diabetic subjects from a multiethnic, urban community (mainly New Zealand Europeans, Maori, and Pacific Islanders). A qualitative survey including 57 diabetic subjects and health care providers from a diverse range of backgrounds was followed by a cross-sectional household survey. Barriers to care were quantified among 1862 (2.1 %) diabetic residents of a total surveyed population of 90 477. Thirty barriers to care categories were generated incorporating patient beliefs, internal and external physical barriers, educational, psycho-social and psychological barriers. In spite of major difference in culture, acculturation, and socio-economic status, the top 10 barriers were similar between the ethnic groups. The most important barriers were perceiving that the benefits of self-care were outweighed by the disadvantages (20 % Europeans, 20 % Maori, 29 % Pacific Islanders, 16 % others, p < 0.001), lack of community-based services (13 % Europeans, 27 % Maori, 25 % Pacific Islanders, 11 % others, p < 0.001) and the limited range of services available (15 % Europeans, 22 % Maori, 20 % Pacific Islanders, 14 % others, p < 0.05). It is postulated that definition of these barriers, with subsequent, systematic action to reduce their impact, in both patients and populations could result in an improvement in diabetes outcomes. © 1998 John Wiley & Sons, Ltd.

  • diabetic nephropathy in new zealand maori and Pacific islands people
    Nephrology, 1998
    Co-Authors: David Simmons
    Abstract:

    Summary: In 1983, a study at Middlemore Hospital demonstrated that a high proportion of Maori and Pacific Islands (Polynesian) diabetic inpatients had chronic renal failure when compared with Europeans (8%, 28%vs 1%, respectively). Since this time renal replacement therapy (RRT) has grown by 10% p.a., and this is mainly due to increasing numbers of Polynesians with non-insulin-dependent diabetes (NIDDM). Among 286 new patients requiring RRT in 1995, 9% Europeans, 67% Maori and 43% of Pacific Islanders had NIDDM. There are now quantitatively more Maori than Europeans receiving transplants for diabetic nephropathy. the reasons for the increasing importance of diabetic nephropathy among Polynesians rest with their excess of NIDDM. All age-adjusted prevalences of known diabetes are 1.9% (1.7–2.0%) among Europeans but 5.2% (4.9–5.5%) among Maori and 4.0 (3.8–4.2%) among Pacific Islanders and their greater risk of diabetic nephropathy once NIDDM has developed (cross-sectional results showed that 0.3% Europeans, 4.7% Maori and 3.3% Pacific Islanders with NIDDM have end-stage renal failure, 22% of whom were untreated). the characteristics of the diabetic nephropathy in NIDDM are also different. Proteinuria is more common among Polynesians (5.4% Europeans vs 30.2% Maori vs 13.0% Pacific Islanders). Differences in rates of proteinuria and microalbuminuria and degree of glomerular hyperfiltration are seen within 5 years of diagnosis. the cause(s) for differences in predisposition remain unclear, although they are partly due to differences in glycaemia and blood pressure control. Family studies and prospective studies are currently underway to help unravel the underlying mechanisms.

Gle M Chertow - One of the best experts on this subject based on the ideXlab platform.

  • relationship of body size and mortality among us asians and Pacific Islanders on dialysis
    Ethnicity & Disease, 2011
    Co-Authors: Yoshio N Hall, Gle M Chertow
    Abstract:

    OBJECTIVES The influence of body size on dialysis-related mortality among Asians and Pacific Islanders--heterogeneous ethnic groups with dissimilar body compositions--is poorly understood. Our study objective was to compare the relations of body size and mortality among patients with end-stage renal disease of different ethnicities. DESIGN, SETTING, AND PARTICIPANTS We examined data from a cohort of 21,492 adult Asians, Pacific Islanders and non-Hispanic Whites who initiated dialysis during 1995-2003 within California, Hawaii and the US Pacific Islands. MAIN OUTCOME MEASURE Time to death through September 22, 2008. RESULTS Among both men and women, Pacific Islanders were the heaviest and Whites the tallest of the ethnic groups examined. Annual mortality rates were highest among Whites (29.6%), intermediate among Pacific Islanders (18.8%) and lowest among Asians (17.3%). Larger body size was associated with lower mortality among Pacific Islanders, Whites and most Asians on dialysis after adjustment for patient-level sociodemographic and clinical factors, area-based socioeconomic status and geographic clustering. Filipinos were the exception to this rule and showed a trend towards higher mortality with increasing body size. These findings were consistent irrespective of how body size was measured. CONCLUSIONS Larger body size is associated with lower mortality among Pacific Islanders, Whites and most Asians on dialysis. Use of disaggregated ethnicity data may enhance our understanding of how ethnicity- or community-specific factors influence body size, body composition and dialysis-related outcomes in these diverse populations.

  • neighborhood poverty and kidney transplantation among us asians and Pacific Islanders with end stage renal disease
    American Journal of Transplantation, 2008
    Co-Authors: Yoshio N Hall, A M Ohare, Essie A Young, Edward J Oyko, Gle M Chertow
    Abstract:

    The degree to which low transplant rates among Asians and Pacific Islanders in the United States are confounded by poverty and reduced access to care is unknown. We examined the relationship between neighborhood poverty and kidney transplant rates among 22 152 patients initiating dialysis during 1995–2003 within 1800 ZIP codes in California, Hawaii and the US-Pacific Islands. Asians and whites on dialysis were distributed across the spectrum of poverty, while Pacific Islanders were clustered in the poorest areas. Overall, worsening neighborhood poverty was associated with lower relative rates of transplant (adjusted HR [95% CI] for areas with ≥20% vs. <5% residents living in poverty, 0.41 [0.32–0.53], p < 0.001). At every level of poverty, Asians and Pacific Islanders experienced lower transplant rates compared with whites. The degree of disparity increased with worsening neighborhood poverty (adjusted HR [95% CI] for Asians–Pacific Islanders vs. whites, 0.64 [0.51–0.80], p < 0.001 for areas with <5% and 0.30 [0.21–0.44], p < 0.001 for areas with ≥20% residents living in poverty; race–poverty level interaction, p = 0.039). High levels of neighborhood poverty are associated with lower transplant rates among Asians and Pacific Islanders compared with whites. Our findings call for studies to identify cultural and local barriers to transplant among Asians and Pacific Islanders, particularly those residing in resource-poor neighborhoods.

  • differential mortality and transplantation rates among asians and Pacific Islanders with esrd
    Journal of The American Society of Nephrology, 2005
    Co-Authors: Yoshio N Hall, J Sugihara, Gle M Chertow
    Abstract:

    Few studies in patients with ESRD have examined outcomes in Asian or Pacific Islander subgroups compared with white individuals. The objective of this study was to assess ethnic disparities in mortality and kidney transplantation among a multiethnic cohort of incident dialysis patients. A total of 24,963 patients who initiated dialysis within the TransPacific Renal Network (Network 17) between April 1, 1995, and September 30, 2001, were studied to ascertain death and kidney transplantation through September 30, 2002. Overall, 12,902 deaths and 2258 kidney transplantations were observed during 59,075 person-years of follow-up. Mortality on dialysis among Asians and Pacific Islanders (except Chamorros) was lower than that of white individuals after controlling for differences in sociodemographic characteristics, comorbid conditions, and other risk factors for death (adjusted hazard ratio [95% confidence interval] versus white individuals: Japanese 0.64 [0.57 to 0.72], Chinese 0.64 [0.52 to 0.78], Filipino 0.64 [0.57 to 0.72], Native Hawaiian 0.84 [0.72 to 0.96], Samoan 0.62 [0.48 to 0.82], and Chamorro 0.96 [0.84 to 1.20]). In contrast, Asians and Pacific Islanders were much less likely to undergo kidney transplantation (adjusted rate ratio [95% confidence interval] versus white individuals: Japanese 0.34 [0.24 to 0.46], Chinese 0.54 [0.30 to 0.88], Filipino 0.32 [0.26 to 0.47], Native Hawaiian 0.17 [0.10 to 0.30], Samoan 0.17 [0.07 to 0.38], and Chamorro 0.04 [0.01 to 0.14]). Despite wide variations in primary cause of ESRD, clinical characteristics, and body size at dialysis initiation, Asians and Pacific Islanders experience better survival but substantially lower transplantation rates compared with white individuals. Strategies that are aimed at improving access to transplantation in Asian and Pacific Islander communities may further enhance survival among Asians and Pacific Islanders with ESRD.

Steve Young - One of the best experts on this subject based on the ideXlab platform.

  • hepatitis b among Pacific Islanders in southern california how is health information associated with screening and vaccination
    Journal of Community Health, 2011
    Co-Authors: Lois M Takahashi, Anna J Kim, Lola Sablansantos, Lourdes Quitugua, Jay Aromi, Jonathan Tana Lepule, Tony Maguadog, Rose Perez, Louise Young, Steve Young
    Abstract:

    We measured Hepatitis B virus (HBV) transmission knowledge and self-reported screening/testing behavior among Pacific Islanders (Guamanians/Chamorros, Samoans, and Tongans) in Southern California. We also examined access and trust by Pacific Islanders of varying health information sources. We administered and analyzed survey data (N = 297), using a convenience sample in Los Angeles, Orange, and San Diego Counties in spring 2009. We found that while Pacific Islander respondents reported that they receive health information from physicians, and largely trust this source, information from and trust in physicians were not statistically significant in explaining whether respondents sought HBV screening or vaccination.

Andrew J Karte - One of the best experts on this subject based on the ideXlab platform.

  • elevated rates of diabetes in Pacific Islanders and asian subgroups the diabetes study of northern california distance
    Diabetes Care, 2013
    Co-Authors: Andrew J Karte, Dea Schillinge, Alyce S Adams, Howard H Moffe, Jennife Y Liu, Nancy E Adle, Alka M Kanaya
    Abstract:

    OBJECTIVE We estimated the prevalence and incidence of diabetes among specific subgroups of Asians and Pacific Islanders (APIs) in a multiethnic U.S. population with uniform access to care. RESEARCH DESIGN AND METHODS This prospective cohort analysis included 2,123,548 adult members of Kaiser Permanente Northern California, including 1,704,363 with known race/ethnicity (white, 56.9%; Latino, 14.9%; African American, 8.0%; Filipino, 4.9%; Chinese, 4.0%; multiracial, 2.8%; Japanese, 0.9%; Native American, 0.6%; Pacific Islander, 0.5%; South Asian, 0.4%; and Southeast Asian, Korean, and Vietnamese, 0.1% each). We calculated age-standardized (to the 2010 U.S. population) and sex-adjusted diabetes prevalence at baseline and incidence (during the 2010 calendar year). Poisson models were used to estimate relative risks. RESULTS There were 210,632 subjects with prevalent diabetes as of 1 January 2010 and 15,357 incident cases of diabetes identified during 2010. The crude diabetes prevalence was 9.9% and the incidence was 8.0 cases per 1,000 person-years and, after standardizing by age and sex to the 2010 U.S. Census, 8.9% and 7.7 cases per 1,000 person-years. There was considerable variation among the seven largest API subgroups. Pacific Islanders, South Asians, and Filipinos had the highest prevalence (18.3, 15.9, and 16.1%, respectively) and the highest incidence (19.9, 17.2, and 14.7 cases per 1,000 person-years, respectively) of diabetes among all racial/ethnic groups, including minorities traditionally considered high risk (e.g., African Americans, Latinos, and Native Americans). CONCLUSIONS High rates of diabetes among Pacific Islanders, South Asians, and Filipinos are obscured by much lower rates among the large population of Chinese and several smaller Asian subgroups.

  • pathophysiologic differences among asians native hawaiians and other Pacific Islanders and treatment implications
    Diabetes Care, 2012
    Co-Authors: William C Hsu, Edward J Oyko, Mele A Look, Andrew J Karte, Alka M Kanaya, Wilfred Y Fujimoto, Wahida Karmally, George L King, Gertraud Maskarinec, Ranjita Misra
    Abstract:

    Differences in pathophysiology may affect the diagnosis, prevention, and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). Equally important are differences in cultural beliefs, dietary habits, and behavioral patterns among AANHPIs that require culturally effective translation of interventions into the community. These issues were discussed by clinicians and investigators at a conference held in Honolulu, Hawaii, in September 2011 with the theme “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action” by a coalition of health care organizations, clinicians, and scientists with strong interests in the topic and in the health of AANHPI populations (1). The discourse begins with an evaluation of pathophysiologic differences, followed by a discussion of the standard diagnostic criteria and current treatment algorithms as well as dietary recommendations. The focus then shifts to various diabetes prevention studies specific to AANHPIs and their relevance to this growing ethnic minority group in America. This review concludes with two investigations that demonstrate culturally appropriate interventions and a brief description of the role played by the National Diabetes Education Program (NDEP). ### Pathophysiology—type 1 diabetes Diabetes has reached an epidemic level around the world, with most of the increase attributable to type 2 diabetes in developing Asian countries such as India and China (2). Type 1 diabetes is also increasing, although at a much less dramatic rate than type 2 diabetes and is now also increasingly associated with obesity and insulin resistance (3). The highest rates for type 1 diabetes are found in Northern European and Scandinavian countries and among the Caucasian population of the U.S. In contrast, type 1 diabetes is approximately 5 to 10 times lower in prevalence in those of Asian than those of European descent (4). In the U.S., the incidence of type 1 diabetes is lower by two- to fivefold in …

  • heterogeneity of diabetes outcomes among asians and Pacific Islanders in the u s the diabetes study of northern california distance
    Diabetes Care, 2011
    Co-Authors: Alka M Kanaya, Dea Schillinge, Alyce S Adams, Howard H Moffe, Nancy E Adle, Jennife E Liu, Ameena T Ahmed, Andrew J Karte
    Abstract:

    OBJECTIVE Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated. RESEARCH DESIGN AND METHODS We performed a prospective cohort study (1996–2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites ( n = 40,286), blacks ( n = 8,668), Latinos ( n = 7,763), Filipinos ( n = 3,572), Chinese ( n = 1,823), Japanese ( n = 951), Pacific Islanders ( n = 593), and South Asians ( n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA1c, hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted. RESULTS Pacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites. CONCLUSIONS Incidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research.

Alka M Kanaya - One of the best experts on this subject based on the ideXlab platform.

  • elevated rates of diabetes in Pacific Islanders and asian subgroups the diabetes study of northern california distance
    Diabetes Care, 2013
    Co-Authors: Andrew J Karte, Dea Schillinge, Alyce S Adams, Howard H Moffe, Jennife Y Liu, Nancy E Adle, Alka M Kanaya
    Abstract:

    OBJECTIVE We estimated the prevalence and incidence of diabetes among specific subgroups of Asians and Pacific Islanders (APIs) in a multiethnic U.S. population with uniform access to care. RESEARCH DESIGN AND METHODS This prospective cohort analysis included 2,123,548 adult members of Kaiser Permanente Northern California, including 1,704,363 with known race/ethnicity (white, 56.9%; Latino, 14.9%; African American, 8.0%; Filipino, 4.9%; Chinese, 4.0%; multiracial, 2.8%; Japanese, 0.9%; Native American, 0.6%; Pacific Islander, 0.5%; South Asian, 0.4%; and Southeast Asian, Korean, and Vietnamese, 0.1% each). We calculated age-standardized (to the 2010 U.S. population) and sex-adjusted diabetes prevalence at baseline and incidence (during the 2010 calendar year). Poisson models were used to estimate relative risks. RESULTS There were 210,632 subjects with prevalent diabetes as of 1 January 2010 and 15,357 incident cases of diabetes identified during 2010. The crude diabetes prevalence was 9.9% and the incidence was 8.0 cases per 1,000 person-years and, after standardizing by age and sex to the 2010 U.S. Census, 8.9% and 7.7 cases per 1,000 person-years. There was considerable variation among the seven largest API subgroups. Pacific Islanders, South Asians, and Filipinos had the highest prevalence (18.3, 15.9, and 16.1%, respectively) and the highest incidence (19.9, 17.2, and 14.7 cases per 1,000 person-years, respectively) of diabetes among all racial/ethnic groups, including minorities traditionally considered high risk (e.g., African Americans, Latinos, and Native Americans). CONCLUSIONS High rates of diabetes among Pacific Islanders, South Asians, and Filipinos are obscured by much lower rates among the large population of Chinese and several smaller Asian subgroups.

  • pathophysiologic differences among asians native hawaiians and other Pacific Islanders and treatment implications
    Diabetes Care, 2012
    Co-Authors: William C Hsu, Edward J Oyko, Mele A Look, Andrew J Karte, Alka M Kanaya, Wilfred Y Fujimoto, Wahida Karmally, George L King, Gertraud Maskarinec, Ranjita Misra
    Abstract:

    Differences in pathophysiology may affect the diagnosis, prevention, and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). Equally important are differences in cultural beliefs, dietary habits, and behavioral patterns among AANHPIs that require culturally effective translation of interventions into the community. These issues were discussed by clinicians and investigators at a conference held in Honolulu, Hawaii, in September 2011 with the theme “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action” by a coalition of health care organizations, clinicians, and scientists with strong interests in the topic and in the health of AANHPI populations (1). The discourse begins with an evaluation of pathophysiologic differences, followed by a discussion of the standard diagnostic criteria and current treatment algorithms as well as dietary recommendations. The focus then shifts to various diabetes prevention studies specific to AANHPIs and their relevance to this growing ethnic minority group in America. This review concludes with two investigations that demonstrate culturally appropriate interventions and a brief description of the role played by the National Diabetes Education Program (NDEP). ### Pathophysiology—type 1 diabetes Diabetes has reached an epidemic level around the world, with most of the increase attributable to type 2 diabetes in developing Asian countries such as India and China (2). Type 1 diabetes is also increasing, although at a much less dramatic rate than type 2 diabetes and is now also increasingly associated with obesity and insulin resistance (3). The highest rates for type 1 diabetes are found in Northern European and Scandinavian countries and among the Caucasian population of the U.S. In contrast, type 1 diabetes is approximately 5 to 10 times lower in prevalence in those of Asian than those of European descent (4). In the U.S., the incidence of type 1 diabetes is lower by two- to fivefold in …

  • heterogeneity of diabetes outcomes among asians and Pacific Islanders in the u s the diabetes study of northern california distance
    Diabetes Care, 2011
    Co-Authors: Alka M Kanaya, Dea Schillinge, Alyce S Adams, Howard H Moffe, Nancy E Adle, Jennife E Liu, Ameena T Ahmed, Andrew J Karte
    Abstract:

    OBJECTIVE Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated. RESEARCH DESIGN AND METHODS We performed a prospective cohort study (1996–2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites ( n = 40,286), blacks ( n = 8,668), Latinos ( n = 7,763), Filipinos ( n = 3,572), Chinese ( n = 1,823), Japanese ( n = 951), Pacific Islanders ( n = 593), and South Asians ( n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA1c, hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted. RESULTS Pacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites. CONCLUSIONS Incidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research.