CORVALLIS, Ore. - Clinical research funding continues to lag for the U.S. population of Asian Americans, Native Hawaiians and Pacific Islanders, even though the nation's largest biomedical funding agency has pledged to prioritize research on diverse populations, a new study from Oregon State University shows.
"We looked at how this commitment has translated to funding and we found that things really haven't changed," said Lan Doan, a doctoral candidate in public health at OSU.
"Population projections indicate we are going to be a very diverse America," she said. "But if we don't recognize the diversity with the Asian American, Native Hawaiian and Pacific Islander populations, we're not going to have a good picture of the health outcomes for these groups."
The findings were published recently by JAMA Network Open, the open-access arm of the Journal of the American Medical Association. Co-authors include Yumie Takata, Kari-Lyn Sakuma and Veronica Irvin, all assistant professors in OSU's College of Public Health and Human Sciences.
The National Institutes of Health is the largest biomedical research funder in the United States and the agency has established that projects focused on diverse populations should be a priority, Doan said. Her work was designed to explore how this commitment has impacted research on Asian American, Native Hawaiian and Pacific Islander populations.
Asian American, Native Hawaiian and Pacific Islander populations are the fastest-growing racial/ethnic group in the United States and represent more than 50 countries or cultures of origin. But Asians have often been viewed as a model minority - a stereotype indicating they don't face societal barriers, including health disparities, compared to other minority groups because they are highly educated and wealthy. Native Hawaiian and Pacific Islander populations are either combined with Asian Americans or excluded from studies altogether, despite the fact that they are distinct racial/ethnic groups.
Lumping these diverse populations together can hide real differences when it comes to health issues, Doan said. When all Asian Americans, Native Hawaiians and Pacific Islanders are lumped together, adult rates of liver cancer are double those of non-Hispanic white adults. But when the data is further broken down, incidence of liver cancer is seven times higher for Laotian men and nine times higher for Laotian women.
Even things like smoking rates can vary widely across groups within the larger population. Social differences, such as how and why a population first moved to the U.S. in large numbers, also can influence health, the researchers said.
That's why funding for projects that break down racial and ethnic data beyond the broad categories is so important, the researchers said. Funding for projects that look more deeply at issues facing specific Asian American, Native Hawaiian or Pacific Islander populations is also key.
Doan reviewed 529 clinical research projects funded by the NIH between 1992 and 2018, focusing on those that included Asian American, Native Hawaiian and Pacific Islander participants. She found that those studies made up only 0.17% of the NIH budget. Prior to 2000, those projects made up 0.12% of the NIH budget, and after 2000, 0.18%.
The findings indicate that change is needed on multiple levels, Doan said. More studies that focus on specific populations and more studies that include more specific data about the Asian American, Native Hawaiian and Pacific Islander populations are needed.
"There are ethnic and cultural groups that need more tailored health interventions," Doan said. "Public health is not one size fits all."
Also needed is better access to existing data collected by researchers but not included in studies because the numbers are small and hard to draw conclusions from, said Irvin. Researchers also could do more to recruit Asian American, Native Hawaiian and Pacific Islander participants, she said.
"We need to raise awareness among researchers and funders that Asian American, Native Hawaiian and Pacific Islander health is important and there are health concerns that can be addressed," Irvin said.