Younger and Sicker: Comparing Micronesians to Other Ethnicities in Hawaii

Hagiwara, Megan; Miyamura, Jill; Yamada, Seiji; Sentell, Tetine

doi:10.2105/ajph.2015.302921

Cited by 17 publications

(22 citation statements)

References 22 publications

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“…While Native Hawaiians are hospitalized younger than Whites, they also have more comborbidities (Sentell et al, 2013; Sentell et al, 2015). Similar patterns of higher comborbidities and younger ages are seen for other Pacific Islanders (Hagiwara et al, 2016). While Hawai‘i has excellent population-level insurance coverage, Native Hawaiians and other Pacific Islanders, due to lower economic status, have higher rates of Medicaid than Whites (Sentell et al, 2013; Sentell et al, 2015).…”

Section: Hypothesessupporting

confidence: 75%

“…The health status and life expectancy of the White population in Hawai‘i tends to fall below that of the Chinese and Japanese, but above that of Native Hawaiians (Park et al, 2009). Other Pacific Islanders (e.g., Samoan, Micronesian, Tongan) are diverse and understudied, but evidence suggests that most, if not all, of these populations in Hawai‘i have poorer health and socioeconomic status compared with other racial/ethnic groups (Hagiwara, Miyamura, Yamata, & Sentell, 2016; Yuen, 2013).…”

Section: Hypothesesmentioning

confidence: 99%

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Thirty-Day Inpatient Readmissions for Asian American and Pacific Islander Subgroups Compared With Whites

et al. 2016

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Asian and Pacific Islander (API) 30-day potentially preventable readmissions (PPRs) are understudied. Hawaii Health Information Corporation data from 2007-2012 statewide adult hospitalizations ( N = 495,910) were used to compare API subgroup and White PPRs. Eight percent of hospitalizations were PPRs. Seventy-two percent of other Pacific Islanders, 60% of Native Hawaiians, and 52% of Whites with a PPR were 18 to 64 years, compared with 22% of Chinese and 21% of Japanese. In multivariable models including payer, hospital, discharge year, residence location, and comorbidity, PPR disparities existed for some API subpopulations 65+ years, including Native Hawaiian men (odds ratio [OR] = 1.14; 95% confidence interval [CI] = 1.04-1.24), Filipino men (OR = 1.19; 95% CI = 1.04-1.38), and other Pacific Islander men (OR = 1.30; 95% CI = 1.19-1.43) and women (OR = 1.23; 95% CI = 1.02-1.51) compared with Whites, while many API groups 18 to 64 years had significantly lower PPR odds. Distinct PPR characteristics across API subpopulations and age groups can inform policy and practice. Further research should determine why elderly API have higher PPR rates, while nonelderly rates are lower.

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Section: Hypothesessupporting

confidence: 75%

Section: Hypothesesmentioning

confidence: 99%

Thirty-Day Inpatient Readmissions for Asian American and Pacific Islander Subgroups Compared With Whites

et al. 2016

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“…This is true especially among foreign-born Micronesians, who make up 42% of the study participants and are particularly underserved and understudied. 11,12 Though HBsAg prevalence was not statistically higher among Micronesians, they accounted for the majority of persons who were HBsAg seropositive. The results showing a 5.6% CHB infection prevalence among foreign-born APIs is consistent with previous research and confirms that foreign-born APIs are disproportionately affected by CHB infection, 15-19 especially in Hawai‘i, as the state has the densest, most diverse population of APIs among US states.…”

Section: Discussionmentioning

confidence: 93%

“…For the purpose of this article, "Micronesia" is limited to the 3 Micronesian nations under the Compact of Free Association, which include the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. 11,12 HBV testing via blood draw was conducted for detection of hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc; Elecsys electrochemiluminescence immunoassays; Roche Diagnostics, Indianapolis, IN). CHB infection was defined as demonstrating seropositivity for HBsAg.…”

Section: Exposure and Outcome Variablesmentioning

confidence: 99%

Hepatitis B Prevalence and Risk Factors in a Foreign-Born Asian and Pacific Islander Population at a Community Health Center in Hawai‘i

Ferrer

Katz

Hurwitz

et al. 2018

Asia Pac J Public Health

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Hawai'i has one of the highest rates of liver cancer in the United States. This is in large part due to undiagnosed chronic hepatitis B (CHB) infection among foreign-born Asian and Pacific Islanders (APIs). In order to estimate the prevalence of CHB infection among foreign-born APIs in Hawai'i, the Hawai'i State Department of Health conducted a cross-sectional study from August 2013 through August 2015 of patients of a federally qualified health center serving the largest population of medically underserved APIs in the state. Among 1261 patients surveyed, the prevalence of CHB infection (based on HBsAg seropositivity) was 5.6% (71/1259). No significant differences were detected by place of birth, age, or gender; however, the adjusted prevalence ratio of CHB infection was 6.0 times higher among persons reporting household contact with hepatitis B virus compared with those without such contact. Our findings underscore the need for targeted screening of at-risk individuals and their household contacts.

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“…Micronesians have particularly high rates of hypertension, diabetes, and renal disease compared to other Asian and Caucasian ethnic groups, and a disproportionate burden of kidney failure requiring hemodialysis [ 8 , 9 ]. The ED in our hospital sees a relatively high number of HD patients presenting with infectious symptoms.…”

Section: Introductionmentioning

confidence: 99%

Rate of bacteremia in the hemodialysis patient presenting to the emergency department with fever: a retrospective chart review

Villalon¹,

Farzan²,

Freeman³

2018

Int J Emerg Med

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BackgroundInfectious disease is the second most common cause of death in patients receiving hemodialysis (HD). When presenting to the emergency department (ED) with fever, it remains a diagnostic challenge to distinguish patients with potentially life-threatening bacterial infections from those with less significant causes of fever. The primary goal of this study was to determine the rate of bacteremia in HD patients presenting to the ED with fever. The secondary goal of this study was to identify any independent risk factors associated with bacteremia in the febrile HD patient.MethodsThis is a retrospective medical record review of all HD patients who presented to the ED with either subjective fever as primary complaint or with a documented triage temperature of 38 °C or higher during the 3-year period between September 1, 2014, and September 1, 2017. Patient visits were included in the study if blood cultures were ordered in the ED. Data related to demographic information, clinical parameters, diagnostic test results in the ER, final diagnosis, and results of microbiology cultures were collected from each patient encounter. Univariate analysis was performed to identify risk factors associated with bacteremia.ResultsWe identified 353 patient visits from 138 unique patients that met inclusion criteria. Fifty-eight percent of these were women, and the average age was 54.6 years. The rate of bacteremia was 31.7%, and the main microorganisms isolated in blood culture were non-MRSA Staphylococcus aureus (40.7%), MRSA (13.3%), Pseudomonas aeruginosa (11.5%), and Enterobacter spp. (11.5%). Independent prognostic factors associated with bacteremia were use of dialysis catheter, prior history of bacteremia, and > 5% neutrophilic band cells (OR 6.55 [95% CI 3.96–10.8; p < 0.0001]; OR 8.87 [95% CI 5.32–14.8; p < 0.0001]; OR 3.32 [95% CI 1.90–5.80; p < 0.0001] respectively).ConclusionHD patients presenting to the ED with fever have high rates of bacteremia, with a significantly higher rate in patients using dialysis catheters or those with a history of bacteremia. Other clinical data available in the ED is minimally useful in predicting bacteremia.

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Younger and Sicker: Comparing Micronesians to Other Ethnicities in Hawaii

Abstract: Micronesians were hospitalized significantly younger and often sicker than were comparison populations. Our results will be useful to researchers, state governments, and hospitals, providers, and health systems for this vulnerable group.

Cited by 17 publications

References 22 publications

Thirty-Day Inpatient Readmissions for Asian American and Pacific Islander Subgroups Compared With Whites

Thirty-Day Inpatient Readmissions for Asian American and Pacific Islander Subgroups Compared With Whites

Hepatitis B Prevalence and Risk Factors in a Foreign-Born Asian and Pacific Islander Population at a Community Health Center in Hawai‘i

Rate of bacteremia in the hemodialysis patient presenting to the emergency department with fever: a retrospective chart review

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