vol-10-aug-2017

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Volume 10 - August 2017

Understanding the Health Needs of Diverse Groups of Asian and Native Hawaiian or Other Pacific Islander Medicare Beneficiaries

Key Findings:
  • Among Medicare beneficiaries, the rate of positive depression screen was more than two times greater for both Other Asians (25.2%) compared to Japanese (9.6%) and for Samoans (42.3%) compared to Native Hawaiians (19.6%).
  • Nearly half of NHOPI (49.4%) and 33.7% of Asian beneficiaries reported having fair or poor health. Significant differences were observed across NHOPI groups ranging from 36.9% for Native Hawaiians to 55.7% for Other Pacific Islanders. Also, significant differences were observed across Asian groups, ranging from 24.5% for Japanese to 43.9% for Vietnamese beneficiaries.
  • The rate of poor sleep quality was two-fold higher for Other Asians (26%) than Filipinos (13.2%) and nearly two-fold higher for Other Pacific Islanders (33.6%) than Native Hawaiians (16.3%).
  • Among Medicare beneficiaries, the prevalence of obesity was four times greater for NHOPI (41.2%) than among Asians (10%). Among NHOPI beneficiaries, more than 7 out of 10 Samoans were classified as obese.

Data Source: The 2013-2015 Medicare Health Outcomes Survey (HOS) Baseline Cohorts 16, 17, and 18

Introduction

Asians and Native Hawaiians or Other Pacific Islanders (NHOPI) are two distinct and growing populations in the United States. Among those aged 65 and over in 2050, 7.1 percent of the population are projected to be Asian and 0.3 percent are projected to be NHOPI.1 Given the rich diversity of these groups and their expected growth, it will become important to understand the health needs of these aging populations.

Identifying appropriate targets to improve health care quality and reduce health disparities requires sufficient data to permit analyses of detailed racial groups. In 2011, the U.S. Department of Health and Human Services (HHS) adopted data collection standards that included additional granularity for Asian and NHOPI racial groups on population surveys. These standards strengthen federal data collections by providing guidance on collecting additional demographic data to improve our understanding of healthcare disparities. To understand the health needs of diverse Asian and NHOPI groups it will become increasingly important to have nationally representative data sources that provide granular data for each of these distinct groups.

Since 2013, the Centers for Medicare & Medicaid Services (CMS) Medicare Health Outcomes Survey (HOS) has been collecting data on the health status of detailed Asian and NHOPI groups who are enrolled in Medicare Advantage and Medicare Advantage Prescription Drug Plans. This brief presents findings from the 2013-2015 HOS Baseline Cohorts 16, 17, and 18 for Asian and NHOPI beneficiaries. The HOS is a longitudinal survey that measures Medicare Advantage Organization (MAO) plans’ success in maintaining or improving beneficiaries’ physical and mental health.2 The three cross-sectional cohorts included Medicare beneficiaries enrolled in MAOs who are age 65 and over, as well as disabled beneficiaries under 65 years old. Asian beneficiaries (n= 23,721) included Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, and Multi-Asian. NHOPI beneficiaries (n= 2,849) included Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander, and Multi-Pacific Islander. Health status results presented in this brief include self-rated general health status, days with activity limitations, rates of depression, prevalence of obesity, and two measures of sleep health. Additional research findings on diverse Asian and NHOPI beneficiaries can be found in the companion national report available on the CMS Office of Minority Health website (PDF).

References

  1. U.S. Census Bureau. An Aging Nation: The Older Population in the United States. 2014. Available from: https://www.census.gov/prod/2014pubs/p25-1140.pdf.
  2. Haffer, S.C. and S.E Bowen, Measuring and Improving Health Outcomes in Medicare: The Medicare HOS Program. Health Care Financing Review, Summer 2004. 25(4): p. 1-3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194894/.
  3. Office of Disease Prevention and Health Promotion. U.S. Department of Health and Human Services. Health-Related Quality of Life and Well-Being. Available from: https://www.healthypeople.gov/2020/about/foundation-health-measures/Health-Related-Quality-of-Life-and-Well-Being.
  4. Ware, J.E., M. Kosinski, and S.D. Keller, SF-36 Physical and Mental Health Summary Scales: A User’s Manual. 1994, Boston: The Health Institute.
  5. Bailis, D.S., A. Segall, and J.G. Chipperfield, Two views of self-rated general health status. Social Science & Medicine, 2003. 56: p. 203-217.
  6. Anderson, R.J., K.E. Freedland, R.E. Clouse, and P.J. Lustman, The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care, 2001. 24: p. 1069-1078.
  7. Hitchcock, P.H., J.W. Williams, J. Unutzer, J. Worchel, S. Lee, J. Cornell, W. Katon, L.H. Harpole, and E. Hunkeler, Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being. Annals of Family Medicine, 2004. 2(6): p. 555-562.
  8. Division of Nutrition, Physical Activity, and Obesity. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Overweight and Obesity. 2017; Available from: www.cdc.gov/nccdphp/dnpa/obesity/index.htm.
  9. Division of Population Health. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Health-Related Quality of Life (HRQOL) Concepts. 2016; Available from: www.cdc.gov/hrqol/concept.htm.
  10. Division of Nutrition, Physical Activity, and Obesity. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. About Adult BMI. 2015; Available from: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html.
  11. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research. 2002. 53(3): p. 737-740.
  12. Centers for Medicare & Medicaid Services. Privacy Information for Researchers. 2015; Available from: /Research-Statistics-Data-and-Systems/Computer-Data-and- Systems/Privacy/Researchers.html.


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