Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study.

Despite improvements in colorectal cancer (CRC) screening in New York City (NYC) since the early 2000s, the degree to which disparities persist for specific Asian American subgroups has yet to be fully elucidated. The purpose of this study is to examine disparities in rates of timely colonoscopy screening among five racial/ethnic groups in NYC. We performed a retrospective cross-sectional analysis of combined 2014-2018 NYC Community Health Survey data. Prevalence estimates of timely colonoscopy screening (within the past 10 years) among individuals ≥ 50 years of age were calculated and presented overall (n = 24,288) and by socio-demographic variables. Racial/ethnic categories included White, Black, Hispanic, East Asian, and South Asian. Multivariable models examined socio-demographic and racial/ethnic predictors of timely colonoscopy screening. A trend analysis examined colonoscopy screening by race/ethnicity and year from 2012 to 2018 (n = 33,130). Age-adjusted prevalence of timely colonoscopy screening was lowest among Asian Americans (South Asian 61.1% and East Asian 65.9%) compared to Hispanics (71.3%), Blacks (70.2%), and Whites (68.6%). Adjustment by socio-demographics, including insurance status, further explained disparities for South Asians (adjusted risk ratio [RR] = 0.84, 95% CI = 0.73-0.97) compared to Hispanics; additionally, Whites (adjusted RR=0.88, 95% CI = 0.84-0.92) were less likely to have received a timely colonoscopy compared to Hispanics. Age, health insurance, poverty group, and education were significant predictors in adjusted regression. Results indicate that South Asians have not equally benefited from campaigns to increase colonoscopy screening in NYC. Our findings support the development of targeted, and linguistically and culturally adapted campaigns that facilitate access to health systems and leverage existing community assets and social support systems among South Asian populations.

Development and Assessment of a Helicobacter pylori Medication Adherence and Stomach Cancer Prevention Curriculum for a Chinese American Immigrant Population.

Chinese American immigrants are at increased risk for Helicobacter pylori infection and stomach cancer. Despite their increased risk, very few prevention strategies exist which target this vulnerable population. The purpose of this article is to present the stakeholder engaged development, review, assessment, refinement, and finalization of a H. pylori treatment adherence and stomach cancer prevention curriculum specifically designed to engage vulnerable, limited English proficient Chinese Americans in New York City.

Factors Associated with Health Insurance Status in an Asian American Population in New York City: Analysis of a Community-Based Survey.

BACKGROUND: Immigrants comprise approximately 13% of the US population and 33% lack health coverage. Asian Americans are the fastest growing immigrant group; many lack a usual source of care. This study examines factors associated with health insurance among Asian American immigrants living in New York City. METHODS: Community needs assessments were conducted among Asian American subgroups in New York City from 2013 to 2015; analysis was completed in 2017 and 2018. Descriptive statistics examined factors associated with health insurance status while stratifying by Asian ethnic subgroup; multivariable logistic regression models further assessed these associations (p < 0.05 significance level). RESULTS: Approximately 19% of the study population (n = 1399) was uninsured. Logistic regression models adjusted for all factors. Among East Asians, insurance status was associated with female sex (OR = 2.8, p = 0.005), excellent/very good health status (OR = 3.5, p = 0.014), and seeing a private doctor when sick or injured (OR = 3.2, p = 0.033). Among South Asians, insurance status was associated with high school/some college and college education (OR = 2.6 and 2.9, respectively, p = 0.039 and p = 0.021), having a routine health check in the past year (OR = 6.4, p < 0.001), no diabetes diagnosis (OR = 2.7, p = 0.030), and a tuberculosis diagnosis (OR = 4.7, p = 0.019). Among Southeast Asians, insurance status was associated with less than high school education (p < 0.05), living in the USA > 20 years (OR = 3.7, p = 0.009), having a routine health check in the past year (OR = 5.6, p = 0.025), and seeing a private doctor when sick or injured (OR = 2.6, p = 0.018). CONCLUSIONS: Health insurance status was associated with differing factors among each subgroup. Findings may inform strategies to address challenges and barriers of healthcare access to immigrants, making healthcare more accessible to this underserved population.

Racial and Ethnic Difference in Falls Among Older Adults: Results from the California Health Interview Survey.

BACKGROUND: Research suggests that fall risk among older adults varies by racial/ethnic groups; however, few studies have examined fall risk among Hispanics and Asian American older adults. METHODS: Using 2011-2012 California Health Interview Survey data, this study examines falling ≥2 times in the past year by racial/ethnic groups (Asian Americans, Hispanics, and Blacks) aged ≥65, adjusting for socio-demographic characteristics, body mass index, co-morbidities, and functional limitations. A secondary analysis examines differences in fall risk by English language proficiency and race/ethnicity among Asian Americans and Hispanics. RESULTS: Asian Americans were significantly less likely to fall compared to non-Hispanic whites, individuals with ≥2 chronic diseases were significantly more likely to fall than individuals with <2 chronic diseases, and many functional limitations were significantly associated with fall risk, when adjusting for all factors. African Americans and Hispanics did not differ significantly from non-Hispanic whites. Analysis adjusting for race/ethnicity and English language proficiency found that limited English proficient Asian Americans were significantly less likely to fall compared to non-Hispanic whites, individuals with ≥2 chronic diseases were significantly more likely to fall than individuals with <2 chronic diseases, and all functional limitations were significantly associated with fall risk, when adjusting for all factors. No differences were found when examining by racial/ethnic and English proficient/limited English proficient groups. CONCLUSION: Further research is needed to explore factors associated with fall risks across racial/ethnic groups. Culturally relevant and targeted interventions are needed to prevent falls and subsequent injuries in the increasingly diverse aging population in the USA.

Physical activity, fruit and vegetable intake, and health-related quality of life among older Chinese, Hispanics, and Blacks in New York City.

OBJECTIVES: We explored the relationship between health-related quality of life (HRQOL) and adequate physical activity (PA) and fruit and vegetable (F&V) intake among racial/ethnic minority groups aged 60 years or older living in New York City (NYC). METHODS: Survey data from 2009 to 2012 targeted minority groups in NYC ethnic enclaves; we analyzed 3594 individuals (Blacks, Hispanics, and Chinese) aged 60 years or older. Descriptive statistics were run; unadjusted and adjusted logistic regression evaluated the relationship of HRQOL with PA and F&V intake. RESULTS: Hispanics were most likely to engage in sufficient PA and eat recommended F&Vs and had significantly worse HRQOL. After multivariable adjustment, significant associations were found between PA and self-reported health, activity limitation and physical health days for all groups, and PA and mental health days for Hispanics. Significant associations were found between F&V intake and physical health days for Hispanics and F&V intake and self-reported health for Chinese. CONCLUSIONS: Findings indicated variations between HRQOL and PA by racial/ethnic subgroup. Despite being highly insured, recommendations for PA and F&V intake were not met. There is a need to promote healthy living behaviors among aging NYC racial/ethnic populations.

Is pregnancy after breast cancer safe?

The impact of treatment on subsequent fertility and the safety of childbearing are major complicating factors for young women diagnosed with breast cancer. As national data indicate women are postponing first pregnancy to older ages; therefore, many young patients are seeking clinical guidance regarding the safety of conception and treatment options that may not prevent subsequent pregnancy. Newly developed chemotherapy protocols of brief duration have improved life expectancy enabling some women to consider childbearing. This study was conducted to compare prognosis among breast cancer patients with and without a subsequent pregnancy. Medical record review of female members of a Northern California prepaid health care plan enabled the identification of 107 women with one or more subsequent pregnancies and 344 cases without a pregnancy, who were diagnosed between 1968 and 1995. Sets were matched on age, year and stage at diagnosis, months of survival and recurrence status at conception. Among the matched sets, neither risk of recurrence nor death differed significantly by subsequent pregnancy history during an average 12 years of follow-up (adjusted hazard ratio [HR] recurrence: 1.2 [0.8, 2.0]; adjusted HR death: 1.0 [0.6, 1.9]). Women interested in preserving their fertility and considering pregnancy are a self-selected population; therefore, to reduce potential bias, cases were matched on recurrence status at time of conception. Although the number of cases was limited, subgroup analyzes indicated a small, nonsignificant adverse effect among women who conceived within 12 months of diagnosis. This analysis of carefully matched cases provides reassurance that long-term prognosis was not adversely affected by subsequent pregnancy.