Identifying Research Opportunities for Asian American, Native Hawaiian, and Pacific Islander Health

The National Institutes of Health’s (NIH) National Heart, Lung, and Blood Institute (NHLBI), in partnership with eight other NIH institutes, convened a workshop on Identifying Research Opportunities for Asian American, Native Hawaiian, and Pacific Islander (AsA and NHPI) Health. The workshop assembled national experts from multiple disciplines to review current research and identify knowledge gaps, potential barriers, and opportunities for prevention research to improve health equity for AsA and NHPI populations.

Background

In 2019, ASA and NHPI comprised 6% of the total U.S. population (23.2 million AsA and 1.5 million NHPI). Over the last two decades, Asian Americans have been the fastest growing subpopulation in the United States (95% increase), and the total AsA population is expected to surpass 46 million by 2060. AsA and NHPIs are highly diverse linguistically, culturally, and demographically. However, in most national surveys, reports, and studies, these groups are aggregated, masking health disparities in specific groups. And over the past 25 years, NIH has invested only 0.17% of its budget in AsA and NHPI health research.¹

Workshop Purpose and Objectives

The objectives of this workshop were to:

1. Review the current state of health data and research in AsA and NHPI populations for healthy aging and chronic disease prevention, including heart and lung diseases, cancer, stroke, diabetes, Alzheimer’s disease and related dementias, related risk factors, morbidity, and mortality.
2. Uncover gaps in research.
3. Highlight challenges and barriers hindering progress in prevention research.
4. Identify research opportunities that address key gaps.
5. Propose effective approaches to engage AsA and NHPI communities in research to enhance awareness, participation, and collaboration.

Summary of Discussions

The workshop covered five domain areas: social, cultural, psychological, and lifestyle determinants of health; metabolic disorders; cardiovascular and lung diseases; cognitive function and healthy aging; and cancer.

The recurring themes from discussions across domains were:

1. There is a lack of AsA and NHPI-focused data and research for many major health conditions.
2. Data are very limited on prevalence, incidence, natural history, risk factors, and outcomes for most of the domain areas, especially for specific population subgroups.
3. Most of the existing data on AsAs and NHPIs are not appropriately disaggregated.

There is an urgent need for research that focuses on specific AsA and NHPI subgroups to provide insight into the epidemiology and etiology of common or high-risk health conditions to inform prevention, treatment, and patient care to improve health equity in these populations.

Below is a short list of research opportunities and strategies to improve the quality and impact of health research among AsA and NHPI populations discussed at the workshop.

I. Build infrastructure for studies in AsA and NHPI population groups.

Develop a state-of-the-art research infrastructure to serve as the platform to coordinate, collaborate, and implement innovative research in AsA and NHPI populations. Partner with AsA and NHPI communities to enhance study participant engagement, recruitment and retention, study implementation, and outcome dissemination.

• Develop prospective cohort studies with novel approaches, deep phenotyping, repeated measurements, and follow-up. Include multi-generational cohorts, hybrid cohorts (traditional epidemiologic cohorts supplemented by data from electronic health records), and immigrant cohorts.
• Create biobanks to enable genomic and other ‘omic studies and advance biological discoveries unique to AsA and NHPI populations.
• Identify new ways to leverage and enhance existing data sources by greater inclusion and with systematic identification of AsA and NHPI subgroups.
• Establish centralized repositories of standard or novel surveys and instruments (in multiple languages), develop new population-specific tools for measuring diet, and validate mental health and cognitive measures in AsA and NHPI populations.
• Build statistical methods for estimating annual AsA and NHPI population sizes to generate annual rates for monitoring of trends and patterns to inform prevention, resource allocation, and patient care.
• Develop a community-engaged approach focusing on patient-centered outcomes, partnering with community organizations to build capacity for research.

II. Incorporate novel technologies in exposure assessment and clinical evaluation.

Leverage modern imaging techniques and digital technology for exposure and outcome assessment to advance health research and clinical care in AsA and NHPI populations.

• Leverage the most appropriate imaging technologies, such as dual energy X-ray absorptiometry, magnetic resonance imaging, or computerized tomography scans, to quantify body composition more accurately, as AsA are more prone to abdominal obesity and cardiometabolic disorders despite having a lower prevalence of obesity.
• Deploy wearable and mobile health technology to capture objective and continuous data for more accurate and reliable measurement of exposures.
• Use an exposome approach incorporating early life and cumulative environmental exposures.
• Incorporate a populomics approach using multi-level data and multi-disciplinary methods.
• Compare and contrast distinct AsA and NHPI subgroups based on differences in risk exposure, genotype, phenotype, and outcomes for several cardiometabolic disorders.

III. Investigate how sociocultural determinants influence health, prevention, and outcomes.

Develop studies to better understand the impact of socioeconomic status, language use, culture and acculturation, and social networks on health disparities in AsA and NHPI groups.

• Investigate the intersection of ethnicity, culture, socioeconomic position, gender roles, and socioecological determinants on health, morbidity, health outcomes, and mortality.
• Study the effect of changes in lifestyle with acculturation in immigrant populations and the effects on health outcomes.

In summary, the workshop identified gaps, barriers, and research opportunities in these diverse populations. It highlighted common themes across different disease domains, and emphasized the importance of working together and with community partners to advance science and health equity for AsA and NHPI populations.

Publication Plans

The meeting organizers and participants will develop a workshop report for submission for publication in a peer-reviewed journal. The report will describe in more depth the discussions and research opportunities, including those under each of the five domain areas.

¹ Trends in Clinical Research Including Asian American, Native Hawaiian, and Pacific Islander Participants Funded by the US National Institutes of Health, 1992 to 2018: JAMA Network Open; 2019 Jul 3;2(7):e197432. doi: 10.1001/jamanetworkopen.2019.7432. (PubMed)