Introduction

Asian Americans are the third largest and fastest growing minority group in the United States. In 1985, Asian Americans totaled an estimated 5.1 million and accounted for 2.1% of the U.S. population. From 1980-1985 the Asian American population increased 48.5% compared to an increase of 3.3% for the overall population. ×Ö´®9

Asian Americans display a wide spectrum of linguistic, cultural and racial diversity. The 1980 census enumeration listed 20 categories for Asian Americans and Pacific Islanders. Differences in country of origin, immigration status (refugee vs. citizen), nativity (native-born vs. foreign-born) and level of acculturation may make Asians as different from one another as they are from whites, Blacks, Hispanics and Native Americans. Asian Americans as a whole are better educated and better paid than the general U.S. population, although among some groups (e.g., recent refugees from S.E. Asia) the reverse is true. A bipolar socioeconomic pattern exists among Asian Americans with the more acculturated individuals enjoying a higher socioeconomic standing than more recent, less acculturated persons.

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The health status of Asian Americans as a group is remarkably good. Asian Americans enjoy longer life expectancies than whites and lower death rates from all causes including heart disease and cancer. In addition deaths from unintentional injury, homicide and suicide are lower among Asian Americans than other groups including whites. Certain Asian Americans groups suffer high rates of illness from specific causes (e.g., stomach cancer among Japanese and suicide among elderly Chinese women). More detailed epidemiologic research is needed to further define the health status and needs of this diverse and fast growing group.

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Since national morbidity and mortality figures are generally lacking for Asian Americans, the data that follow are gathered from existing regional sources and are appropriately identified as such.

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Demographic Data

With an estimated population of 5.1 million in 1985, Asian Americans accounted for 2.1% of the entire U.S. population. Asian Americans are the third largest minority in the U.S., after Blacks and Hispanics. ×Ö´®4

Asian Americans are the fastest growing population in the United States with an increase in population of 141% from 1970 to 1980 compared to an increase of 17% for Blacks, 39% for Hispanics and 12% for the overall population. ×Ö´®2

In 1980-1984, 48% of the legal immigrants coming into the United States were from Asia compared to 35% from Latin America and 12% from Europe. ×Ö´®5

As of April 30, 1986, 790,000 refugees from Southeast Asia had resettled in the U.S.

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In 1980, the percent of Asian Americans who were born abroad included 90.5% of Vietnamese, 81.8% of Koreans, 70.4% of Asian Indians, 66.3% of Filipinos, 63.3% of Chinese and 28.4% of Japanese. For comparison, in 1980 28.6% of Hispanics were foreign-born and 62% of the total U.S. Population.

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In 1980, nearly half of all Asian Americans lived in California (36.0%) and Hawaii (13.1%).

5 of the 6 major Asian American groups are most concentrated in California: Filipinos (45.8%), Chinese (40.1%), Japanese (37.5%), Vietnamese (34.8%) and Korean (28.7%). A higher percentage of Asian Indians (17.5%) live in New York than in any other State.

92% of Asian Americans lived in metropolitan areas in 1980 compared to 75% of the general U.S. population. ×Ö´®7

Education and Employment ×Ö´®1

More than one-half of adult Asian Indians and over one-third of Chinese and Filipinos living in the U.S. have graduated from college. In 1980 35% of the 6 main Asian American groups (Chinese, Filipinos, Japanese, Korean, Asian Indian, and Vietnamese) had graduated from college compared to 17% of white adults. ×Ö´®8

The median family income level for Asian/Pacific Americans in 1980 was $22,713. This income level is higher than that of any other group including nonminorities, although the figure may be inflated since a relatively large number of household members contribute to the household income. ×Ö´®6

Health Care Utilization ×Ö´®2

In 1979 the overall poverty rate for Asian/Pacific Americans was 13.1%, ranging from 7% among the Japanese to over 35% among the Vietnamese. In addition to the Vietnamese and other refugee groups, the Chinese and Korean Americans have a prevalence of poverty above the national average.

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Foreign-born Asians are both more likely to be service workers and more likely to be professionals than native-born Asians. ×Ö´®3

The unemployment rate for the Asian/Pacific Americans population is about 4.7%, nearly 2 percentage points lower than the nonminority rate.

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In 1980, all Asian American groups had unemployment rates lower than the rate of 5.8% for whites except for the Vietnamese whose rate of 8.2% was lower than the rate of 11.8% for Blacks. ×Ö´®2

In 1980, the percentage of foreign-born employed Asian Americans holding professional, managerial or executive positions was 47% for Asian Indians, 30% for Chinese, 28% for Japanese, and 26% for Filipinos compared to 24% for whites. ×Ö´®9

The highest percentage of foreign-born Asian American workers who are in service jobs is 22% for Chinese workers who are in service jobs as compared to 23% for Black workers.

In 1979, Asian/Pacific Americans averaged 1.55 visits to physicians compared to 2.70 visits by whites. Among those under 15 years there was little difference between Asian/Pacific Americans and whites; however, among those 65 and over, whites visited physicians more than 2 times as frequently as did Asian/Pacific Americans.

In 1979, Asian Pacific Americans were more likely to visit pediatricians and obstetricians (19.3% and 13.5% of all physician visits) than were whites (10.3% and 9.0%, respectively). Whites were more likely to visit surgeons (22.4% of physician visits and psychiatrists (3.2%) than were Asian/Pacific Americans (15.5% and 0.6%, respectively).

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Asian Pacific Americans in 1979 had a higher percentage of physician visits for diseases of the skin, the respiratory system, the digestive system and for examinations without sickness. Whites had relatively more visits for neoplasms, metabolic/endocrine diseases, mental disorders, diseases of the circulatory system, musculoskeletal system and for accidents. ×Ö´®2

Morbidity

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General Health Status

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Southeast Asian refugees do not necessarily enjoy the good health status of other Asian Americans. A 1982 study of refugees found that 61% had intestinal parasites, 55% had a positive tuberculin test, 37% were anemic, 14% had hepatitis B antigen and 12% had an abnormal VDRL test. ×Ö´®6

Data on heart disease morbidity among Asian Americans are too sparse to allow estimates of incidence or prevalence.

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A comparison of stroke prevalence rates among Japanese living in different areas revealed that Japanese in Japan had an age-adjusted stroke prevalence of 35.4 (per 1,000 population) as compared to 10.7 for Japanese in Hawaii and 10.4 for Japanese in California.

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The average annual incidence of stroke was higher among Japanese in Japan (7.4 cases per 1,000 population) than Japanese in Hawaii (2.7 cases per 1,000) in the same study.

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Cancer

The incidence of stomach cancer is 2.5 times higher for Japanese males and 3.8 times higher for females than for nonminority males and females. ×Ö´®2

Diabetes

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The prevalence of childhood-onset diabetes among Japanese has been reported to be about 1-13 per 100,000 compared to a rate of about 1 per 600 in the United States.

The age- and sex-adjusted prevalence rate of diabetes among Japanese Americans 15 and older in Hawaii and Los Angeles was 13.9% compared to a rate of 6.5% of Japanese living in Japan. ×Ö´®7

The prevalence of asymptomatic hyperglycemia plus diabetes among Japanese American adult males is between 10%-14%. The overall prevalence of diabetes (diagnosed and undiagnosed) in the U.S. is about 5.5% and the prevalence of impaired glucose tolerance is 4.6%-11.2%.

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Reproductive Health

Among Asians in 1983, the percent of births to teenage mothers was 6% of Filipino births, 3% of Japanese births and 1% of Chinese births. The corresponding figure for Blacks was 25% and for whites was 12%.

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The percent of mothers who began prenatal care in the first trimester of pregnancy in 1983 was 77% of Filipino mothers, 80% of Chinese mothers and 87% of Japanese mothers compared to 80% of white mothers and 62% of Black mothers.

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The percent of infants born at low birthweight (less than 2500 grams) in 1983 was about the same for Japanese (6.0%) and white (5.7%) infants but was lower for Chinese infants (5.0%) and higher for Filipino infants (7.4%).

Mental Health

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The lifetime prevalence of mental disorders among Chinese Americans in New York City was studied in a pilot project using the Diagnostic Interview Schedule (DIS) to diagnose major illnesses described by the Diagnostic Statistical Manual-III (DSM-III). Preliminary results revealed a lifetime prevalence among those 25-44 years old of 13.6% for somatization disorder, of 1.5% for panic disorder, and of 18.2% for major depressive disorder. ×Ö´®6

The National Institute of Mental Health's Epidemiologic Catchment Area program studied the lifetime prevalence of mental disorders in several populations using the DIS/DSM-III. Results from three areas revealed a lifetime prevalence among those 25-44 years old of 0.1%-0.3% for somatization disorder, of 2.1%-2.4% for panic disorder and of 7.5%-10.4% for major depressive disorder.

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Mortality ×Ö´®9

Overall Mortality and Life Expectancy

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In 1960, Japanese Americans had a longer life expectancy (77.4 years) than did whites (71.2 years). Similar figures were obtained in a 1960 California study of life expectancy: Japanese (77.9 years), Chinese (72.9 years), whites (71.3 years). ×Ö´®9

A 1980 study in Hawaii showed life expectancies of 80.2 years for Chinese, 79.7 years for Japanese, 78.8 years for Filipinos and 76.4 years for whites.

Cardiovascular Disease ×Ö´®6

The age-adjusted cerebrovascular disease mortality rate in 1979-81 for Japanese American men (86.7 deaths per 100,000 population) was higher than the rate for the general U.S. population (63.1) and the rate for whites (75.4) or Hispanics (63.1).

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Diabetes

Diabetes was listed more frequently as the underlying cause of death among Japanese Americans (9.9% of deaths) than among whites (5.9% of deaths) living in Hawaii during 1970-77.

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Japanese American diabetics have a higher prevalence of ischemic heart disease compared to Japanese diabetics living in Japan who exhibit more renal disease. ×Ö´®7

Homicide, Suicide and Unintentional Death

Among males under 45 years of age during 1979-1981, the average annual age-adjusted death rate for homicide was lower for Asian/Pacific Americans (8.0 homicide deaths per 100,000 population), than for whites (10.9), Blacks (73.4) or Native Americans (24.6).

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Among females under 45 years of age during 1979-1981, the average annual age-adjusted death rate for homicide was 3.3 (homicide deaths per 100,000 population) for Asian/Pacific Islanders compared to 3.2 for whites, 14.4 for Blacks and 8.4 for Native Americans. ×Ö´®8

Infant Mortality ×Ö´®7

The 1982 infant mortality rate was lower among Japanese Americans (4.6 deaths per 1,000 live births), Filipinos (5.8), and Chinese (6.1) than among whites (10.1) or the total population (11.5). Infant mortality rates among Asians may be understated due to classification problems. One study found Japanese infant mortality rates 22% higher after adjustment for classification errors.

The death rate from sudden infant death syndrome (SIDS) is lower among Asians (0.5 deaths per 1,000 live births) than in the overall population (1.5-2.0).

Risk Factor Prevalence

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The California Hypertension Survey reported that among men ages 18-49 years the prevalence of hypertension (BP higher than 140/90 mm Hg) was greater in Japanese Americans (19.2%) than in whites (15.0%); however, among men ages 50 and over, the prevalence of hypertension was lower in Japanese Americans (29.1%) than in whites (38.5%).

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The California study showed that the prevalence of hypertension among Japanese American women was much lower than for white women at all ages (0.4% vs. 4.8% for those ages 18-49 years, and 13.9% vs. 36.4% for those over 50 years of age).

Among Japanese men ages 45-68 years, cigarette smoking was more common among those living in Japan (75.6%) than those living in Hawaii (44.2%); however, smoking a pack or more per day was more common among those in Hawaii (16.6%) than among those in Japan (11.6%).

In a comparison of smoking among 45-64 year-old men in Framingham and Japanese men in Honolulu, 44.1% of the Japanese men in Honolulu were smokers compared to 57% of the Framingham men.

According to a 1977 National Health Interview Survey (NHIS) of Asian/Pacific Americans 20 years and over, 60.6% had never smoked, 28.7% were present smokers and 10.6% were former smokers.

The same NHIS data indicate that 31.6% of Asian/Pacific Americans never used alcohol, 51.6% occasionally did, 8.6% used alcohol once or twice a week and 8.2% used alcohol three or more times a week.

The 1977 NHIS data showed that 12.7% of Asian Americans 20 years and over were obese (defined as a body mass index of weight/height-2 of 27 or greater for males and 25 or greater for females). In 1976-80 approximately 30% of whites ages 35-74 years were over-weight using a similar definition. In the same age range, the figures were 35% for Black males and 55% for Black females.

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Mean serum cholesterol levels for Japanese men ages 50-54 were 182.5 mg% for those living in Japan compared to 219.4 mg% for those living in Hawaii and 228.2 mg% for those living in California. ×Ö´®8

The mean serum cholesterol level of a cohort of Japanese men in Honolulu (218.55 mg%) was 15% lower than the level among similar men in the Framingham study (233.96 mg%). ×Ö´®9

Significant Trends ×Ö´®4

Demographic Trends ×Ö´®9

The Asian population in America grew from 1.4 million in 1970 to 3.5 million in 1980 (1.5% of U.S. population) to an estimated 5.1 million (2.1% of U.S. population) in 1985.

The Asian American population increased 141% from 1970 to 1980 compared to an increase of 11.5% for the entire U.S. population. From 1980 to 1985 the Asian American population increased 48.5% compared to an increase of 3.3% for the overall population.

The average annual growth rate for the Asian American population decreased from 8.8% per year during the 1970s to 7% from 1980-85. Since 1980 the general U.S. population has increased 1.1% per year. ×Ö´®8

Between 1931 and 1960 Asians accounted for 5% of legal immigrants to the U.S. By 1970-79 Asians accounted for 34% of legal immigrants and by 1980-84 the figure had increased to 48%. ×Ö´®5

Barring major changes in U.S. immigration policy, Asian Americans could number almost 10 million by 2000.

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