Asian and Pacific Islander diabetes data need segregating

By Sally Robertson, B.Sc.Oct 17 2012

Surveillance statistics that aggregate Asians and Pacific Islanders (APIs) are misleading in terms of establishing who would benefit most from increased diabetes prevention interventions, report US researchers.

The very high diabetes risk among Pacific Islanders, South Asians, and Filipinos is obscured by the much lower risk among Chinese and Japanese, shows analysis of a large, multiethnic cohort of patients.

"These findings represent a departure from the conventional wisdom regarding diabetes burden among APIs as being uniformly lower than African Americans and Latinos but higher than that of Whites," say Andrew Karter (Kaiser Permanente Northern California [KPNC], Oakland) and team.

In a study of 2,123,548 KNPC members, the team estimated the prevalence and incidence of diabetes overall and by race/ethnicity as of 1 January 2010 (baseline) until the end of the calendar year.

As reported in Diabetes Care, 210,632 individuals had diabetes at baseline, giving an 8.9% prevalence after age- and gender-standardization to the US population.

Each ethnic minority group had significantly higher diabetes prevalence than Whites, with the highest prevalence observed among Pacific Islanders, at 18.3%, followed by Filipinos at 16.1%, South Asians at 15.9%, Latinos at 14.0%, African Americans at 13.7%, and Native Americans at 13.4%.

Among Southeast Asians, Japanese, Vietnamese, Koreans, and Chinese, diabetes prevalence was 10.5%, 10.3%, 9.9%, 9.9%, and 8.2%, respectively.

Of the 1,912,916 individuals without prevalent diabetes at baseline, 15,357 incident diabetes cases were identified during 2010.

Patterns for age- and gender-standardized diabetes incidence were found to be similar to those observed for prevalence. Pacific Islanders had the highest incidence rate, at 19.9 cases per 1000 person-years. This was followed by incidence rates per 1000 person-years of 17.2, 14.7, 12.0, 11.2, 11.2, 7.5 and 6.5 among South Asians, Filipinos, Native Americans, Latinos, African Americans, Japanese, and Chinese, respectively.

"Pacific Islanders had more than three times the incidence of diabetes relative to Whites, compared with an approximately 75% higher diabetes incidence among African American and Latinos relative to Whites," note Karter and colleagues.

Surveillance statistics aggregating all APIs obscure the very high diabetes risk among Pacific Islanders, South Asians, and Filipinos, who would benefit from increased diabetes prevention efforts.

"In our efforts to meet our national objective of eliminating health disparities, we must continue to monitor diabetes prevalence and incidence among the API subgroups, as well as across races/ethnicities in general," concludes the team.

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