Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples

• Published in: PloS one 2023-08, Vol.18 (8), p.e0290794
• Main Authors: Wills, Thomas A, Kaholokula, Joseph Keawe'aimoku, Pokhrel, Pallav, Pagano, Ian
• Format: Article
• Language: English
• Subjects: Adults; Air pollution; Analysis; Asian Americans; Asthma; Asthma - epidemiology; Asthma - ethnology; Asthma - etiology; Biology and Life Sciences; Chronic obstructive pulmonary disease; Cigarette smoking; Cigarettes; Cigars; Cultural differences; Demographic aspects; Diagnosis; Ecological effects; Ecological models; Electronic cigarettes; Electronic Nicotine Delivery Systems; Emergency medical care; Ethnic factors; Ethnic groups; Ethnicity; Hawaii - epidemiology; Health aspects; Health maintenance organizations; Health risks; HMOs; Humans; Lung diseases; Lung diseases, Obstructive; Mediation; Medical personnel; Medicine and Health Sciences; Minority & ethnic groups; Modelling; Multivariate statistical analysis; Native Hawaiian or Other Pacific Islander; Pacific Island People; Pacific Islander people; Passive smoking; People and Places; Population; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - ethnology; Pulmonary Disease, Chronic Obstructive - etiology; Respiration Disorders - epidemiology; Respiration Disorders - ethnology; Respiration Disorders - etiology; Respiratory diseases; Respiratory tract diseases; Respiratory Tract Diseases - epidemiology; Respiratory Tract Diseases - ethnology; Respiratory Tract Diseases - etiology; Response rates; Risk Factors; Risk taking; Smoking; Social Sciences; Statistical analysis; Surveys; Tobacco smoke; Vaping
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0290794

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.