Aggregated Asian American Health Statistics Mask Important Disparities

Sophia Hua, PhD, MPH

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Current data show Asian Americans have the lowest prevalence of obesity among U.S. racial and ethnic groups. At a relatively low 12%, this number is less than half that of those who identify as White (29%) and Black (40%). However, health data for Asian Americans are misleading; among that Asian American demographic, there are multiple ethnic groups, some with higher prevalence of chronic disease and obesity. Viewing Asian Americans as one monolithic group masks disparities within subgroups that would benefit from more targeted intervention, highlighting the importance of disaggregating Asian American data, especially when making policies.

Asian Americans include those who are ethnically Chinese, Vietnamese, Filipino, Japanese, Korean, and Indian, to name a few. A recent study by Shah and colleagues (2022) showed that the prevalence of obesity among these groups range from 6% (Vietnamese) to 17% (Filipino). But these numbers do not actually represent the percentage of people who are at an elevated risk for heart disease and diabetes because they use the standard BMI threshold of 30 kg/m2 to define obesity rather than the modified threshold of 27.5 kg/m2 for many Asian populations that the WHO has recommended. The modified threshold better reflects disease risk among a population that carries fat differently than non-Hispanic White populations. Using this modified cutoff, 29% of Filipinos and 27% of Japanese are obese, comparable to non-Hispanic Whites. When we view Asian Americans as one, or when we use inaccurate systems for classification, we mistakenly believe that resources and interventions to prevent excess weight gain do not need to target this population.

Given the disparities in the prevalence of obesity among Asian American subgroups, it should come as no surprise that disparities also exist for diet-related chronic diseases. Shah and colleagues (2022) additionally showed that the prevalence of Asian Americans with diabetes, history of cardiovascular disease, and hypertension are 8%, 4%, and 21%, respectively. However, the prevalence of diabetes is 14% among Filipino, heart disease is 7% among Japanese, and hypertension is 39% among Japanese—almost double the overall statistic for each condition, and comparable to those who identify as non-Hispanic Black. There is clearly heterogeneity among Asian subgroups, and resource allocation should reflect these disparities.

In recognition of the importance of collecting data on this fast-growing racial group, the National Health and Nutrition Examination Surveys (NHANES) started oversampling Asians in 2011 so that we could obtain reliable public health estimates from the survey. While this is a critical start, it is not enough, especially when researchers cannot easily access subgroup information for research. Health disparities among Asian Americans need to be properly addressed; to do so requires a bigger push toward data disaggregation and access to such data.

About The Author:

​Dr. Sophia Hua is a postdoctoral research fellow in the Department of Nutrition at the Harvard School of Public Health. Her research focuses on behavioral interventions to prevent diet-related chronic diseases and evaluations of nutrition policies. In her spare time, she enjoys reading and baking.