Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis.
Department of Economics, University of California, Davis.
JAMA Netw Open. 2024 Oct 1;7(10):e2440071. doi: 10.1001/jamanetworkopen.2024.40071.
Asian American individuals comprise over 40 ethnoracial groups but are regularly aggregated into 1 category within health workforce analysis, thus obscuring substantial inequities in representation.
To describe trends in Asian American diversity across the 4 most populous US health professions (physicians, registered nurses, nursing assistants, and home health aides) and to characterize subgroup representation within professions.
DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional study from American Community Survey (ACS) population estimates of people reporting health profession occupations from 2007 to 2022. The ACS samples US residents every day, with approximately 3.5 million surveyed each year. Based on their sampling methods, the ACS then produces estimates of the entire US population for 1-year, 3-year, and 5-year periods. Data were analyzed from April to August 2024.
For each year and subgroup, the proportions of the US population, the profession, and Asian American individuals within the profession were calculated. The representation quotient (RQ) of each subgroup was then calculated, defined as the proportion of the subgroup within the profession of interest divided by the proportion of the subgroup within the US population. Trends were examined over the 15-year period.
Over the 15-year period, Indian Americans composed the largest percentage of Asian American physicians (mean [SD], 40.6% [1.6%]), followed by Chinese Americans (mean [SD], 18.9% [1.4%]). Pakistani and Indian Americans had the highest relative representation (mean [SD] RQ, 8.9 [0.9] and 7.8 [0.9], respectively). Conversely, Cambodian and Hmong Americans remained largely underrepresented (mean [SD] RQ, 0.2 [0.2] for both). Filipinx Americans accounted for more than half of Asian American registered nurses and nursing assistants, with high relative representation (mean [SD] RQ, 5.6 (0.3) and 2.9 [0.4], respectively). Bangladeshi and Chinese American relative representation were high among home health aides (mean [SD] RQ, 4.1 [1.5] and 2.7 [0.5], respectively). Asian American individuals accounted for an estimated 22% of physicians (approximately 260 693 respondents), 10% of registered nurses (approximately 420 418 respondents), 4.8% of nursing assistants (approximately 93 913 respondents), and 8.3% of home health aides (approximately 60 968 respondents) in 2022.
By examining disaggregated data, this study found persistent inequities among Asian American subgroups in the health workforce. Reducing Asian American populations to a single racialized group erases subgroup differences rooted in histories of racism, colonialism, and xenophobia; enables false narratives of Asian American overrepresentation and success; and hampers progress in advancing health justice.
亚裔美国人由 40 多个民族种族群体组成，但在卫生劳动力分析中通常被归为 1 个类别，从而掩盖了代表权方面的实质性不平等。
描述美国四个最常见的卫生专业（医生、注册护士、护理助理和家庭保健助手）中亚裔美国人多样性的趋势，并描述专业内的亚群代表性。
设计、设置和参与者：这是一项从美国社区调查（ACS）人群估计中获取的 2007 年至 2022 年期间报告从事卫生专业职业的人群的连续横断面研究。ACS 每天对美国居民进行抽样调查，每年约有 350 万人接受调查。根据他们的抽样方法，ACS 随后为 1 年、3 年和 5 年的整个美国人口产生估计数。数据分析于 2024 年 4 月至 8 月进行。
对于每年和每个亚组，计算了美国人口、该职业以及该职业中亚裔美国人的比例。然后计算了每个亚组的代表系数（RQ），定义为该亚组在相关专业中的比例除以该亚组在美国人口中的比例。在 15 年期间检查了趋势。
在这 15 年期间，印度裔美国人构成了美国医生中最大的亚裔美国人比例（平均[标准差]，40.6%[1.6%]），其次是华裔美国人（平均[标准差]，18.9%[1.4%]）。巴基斯坦裔和印度裔美国人的相对代表性最高（平均[标准差] RQ，分别为 8.9[0.9]和 7.8[0.9]）。相比之下，柬埔寨裔和苗族裔美国人的代表性仍然很低（平均[标准差] RQ，均为 0.2[0.2]）。菲律宾裔美国人占亚裔注册护士和护理助理的一半以上，具有较高的相对代表性（平均[标准差] RQ，分别为 5.6（0.3）和 2.9（0.4））。孟加拉裔和华裔美国人在家庭保健助理中的相对代表性较高（平均[标准差] RQ，分别为 4.1[1.5]和 2.7[0.5]）。2022 年，亚裔美国人估计占医生的 22%（约 260693 名受访者）、注册护士的 10%（约 420418 名受访者）、护理助理的 4.8%（约 93913 名受访者）和家庭保健助理的 8.3%（约 60968 名受访者）。
通过检查细分数据，本研究发现，在卫生劳动力中，亚裔美国人亚群之间存在持续的不平等现象。将亚裔美国人归为单一的种族群体，消除了基于种族主义、殖民主义和仇外心理历史的群体差异；支持亚裔美国人代表性和成功的虚假叙述；并阻碍了在推进健康正义方面的进展。
