In the U.S., there is a perception is that Americans of Asian background are a “model minority” with superior income, education, and health—a myth refuted in recent work by LDI fellows Lan Ðoàn and Lola Fayanju.
In fact, one of the biggest misconceptions is the aggregation of diverse groups of people into a single category of “Asian American.” Two recent studies highlight the problem.
In Journals of Gerontology, Ðoàn and colleagues investigate cardiovascular disease in Asian Americans and Native Hawaiians and Pacific Islanders (NH/PIs), in aggregate and by ethnic subgroups. The researchers analyzed data from the 2011-2015 Medicare Health Outcomes Study, which included nearly 640,000 Medicare Advantage recipients and about 27,000 who self-identified as Asian American, Native Hawaiian, or Pacific Islander. The data allowed the researchers to analyze cardiovascular risk factors (such as diabetes or smoking) and outcomes (such as heart attack or stroke) in eight Asian American and two NH/PI subgroups.
The researchers found that breast cancer characteristics (such as tumor subtypes) and outcomes vary significantly among Asian women. For example, in aggregate, “Asian” women had the highest 10-year overall survival rates of all racial and ethnic groups. But Southeast Asian women had the worst overall survival of any Asian group, and had no better outcomes than white women. The authors recommend that researchers disaggregate data by country or region of origin to identify subgroups that are at risk for worse outcomes than aggregated data may suggest.
Among factors contributing to observed subgroup differences, Ðoàn and coauthors cite histories of colonization and structural racism, poor health care access, and overrepresentation in hazardous environments, for example, as health workers during the COVID-19 pandemic. Unlike many Asian Americans with an immigrant or refugee background, Native Hawaiians are an Indigenous people. Many Pacific Islanders enter the U.S. with nonimmigrant status because of political relationships between the U.S. and their country of origin. This status can affect access to U.S. health care.