Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021

Abstract

Objectives: Minimal research has assessed COVID-19’s unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population—an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. Methods: NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ 2 tests, independent and paired t tests, and linear and logistic regression analyses. Results: During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19–related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). Conclusions: Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.

COVID-19 Hospitalization in Hawaiʻi and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination

“…[22][23][24] In contrast, Native Hawaiian patients fared better in our analyses, with lower rates of in-hospital mortality, particularly during the Delta and Omicron period. While these data are similar to those collected by the HDOH, they contrast substantially with data on Native Hawaiian individuals and Pacific Islander individuals living in states other than Hawai'i 25,26. Given that Native Hawaiian individuals have a number of social and health disparities associated with increased risk for poor outcomes during COVID-19, possible explanations for this counterintuitive outcome include specific efforts targeting vaccination to Native Hawaiian individuals (with results not captured in this dataset), delayed first cases of COVID-19 (as indicated by HDOH data) thereby allowing provision of newly approved COVID-19 therapies, and an overall benefit of having health insurance within this cohort.…”

“…While these data are similar to those collected by the HDOH, they contrast substantially with data on Native Hawaiian individuals and Pacific Islander individuals living in states other than Hawaiʻi. 25 , 26 Given that Native Hawaiian individuals have a number of social and health disparities associated with increased risk for poor outcomes during COVID-19, possible explanations for this counterintuitive outcome include specific efforts targeting vaccination to Native Hawaiian individuals (with results not captured in this dataset), delayed first cases of COVID-19 (as indicated by HDOH data) thereby allowing provision of newly approved COVID-19 therapies, and an overall benefit of having health insurance within this cohort. 22 , 26 Finally, our observation that Japanese patients had better outcomes in the pre-Delta period but worse outcomes during the Delta and Omicron period merits further investigation, particularly given that Japanese patients (like Native Hawaiian patients) were less likely to be diagnosed with COVID-19 early in the pandemic.…”

Social Determinants of COVID-19 Vaccination Rates: A Time-Constrained Multiple Mediation Analysis

“…Studies in the U.S. have found that certain groups, including those with lower levels of education, ethnic minorities, those living in remote areas, and those who are socially disadvantaged, have lower rates of vaccination, even when they have higher rates of death and transmission of disease [3,4]. Some research also found that racial/ethnic minorities and people with disability experienced lower vaccination rates than whites or non-disabled populations [5][6][7][8]. Other research investigated the associations between distinctive characteristics of neighborhood environments such as the density of vaccination sites [9], housing conditions [10], other built environments, and the incidence of COVID-19 at a state or community level in the U.S. [11].…”