Cancer Prevention in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America.
Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America.
PLoS One. 2023 Aug 25;18(8):e0290794. doi: 10.1371/journal.pone.0290794. eCollection 2023.
The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes.
We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates.
Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey.
Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.
哮喘和慢性阻塞性肺疾病（COPD）在夏威夷原住民中的发病率较高，但这种差异的基础尚不清楚。我们分析了包括夏威夷原住民、太平洋岛民和菲律宾人在内的两个样本中哮喘和 COPD 的数据，以确定种族与呼吸疾病结果的关系。
我们分析了 2016 年和 2018 年行为风险因素监测调查（BRFSS）的数据，这是一项针对夏威夷州 18 岁及以上参与者的电话调查。标准变量是由医疗保健专业人员诊断的哮喘或 COPD。结构方程模型测试了五个假设的风险因素（吸烟、电子烟使用、二手烟暴露、肥胖和经济压力）如何在疾病发生的可能性方面对种族差异进行中介。年龄、性别和教育程度作为协变量。
2016 年数据的结构模型显示，夏威夷原住民的种族与五种风险因素的水平较高有关，每种风险因素与呼吸疾病的可能性较高有关。间接效应在几乎所有情况下均具有统计学意义，并且观察到对哮喘和 COPD 的直接效应。在太平洋岛民和菲律宾人中也注意到了通过类似途径的中介效应。这些发现与 2018 年调查的数据一致。
夏威夷原住民和太平洋岛民的种族与五种风险因素的暴露程度较高有关，这部分解释了呼吸疾病结果的种族差异。研究结果支持了该人群健康差异的社会生态模型。讨论了这些发现对预防干预措施的影响。
