For effective population health management, providers should be wary of putting distinct ethnic and cultural groups under a single label.
- Population health management involved viewing larger groups of patients as a whole, but widening the lens too much can prevent providers from understanding key genetic, cultural, and language differences in ethnic and racial groups that are often lumped together. While the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is generally considered to be one large cohort, Dr. Scarlett Lin Gomez, PhD, argues that cancers and disease risks among these patients must be treated with a greater degree of sensitivity and understanding.
“AANHPI communities are flourishing across the country,” said Gomez, who is a research scientist at the Cancer Prevention Institute of California (CPIC). “The designation represents more than thirty countries and one hundred languages, with different genetic predispositions, needs, and understanding of the healthcare system. “Not only do they bear unique burdens of incidence and outcomes for certain cancer types, members of the AANHPI population have substantial variability in cancer incidence and survival patterns across their ethnic groups. We have a tremendous opportunity to draw insights into the causes of cancer and prognosis/survivorship by leveraging the heterogeneity within these populations.”
AANHPI residents of the United States have increased by 46% between 2000 and 2010, and are slated more than double in the next fifty years. As part of a special investigation into the needs of AANHPI populations, the latest issue of Cancer Epidemiology Biomarkers and Prevention (CEBP) has dedicated a section to studies detailing population health management techniques that are most effective for certain ethnic or racial sub-categories. Many groups show an increase in cancer screening rates when they can work with physicians who speak their own language, for example, and same-gender relationships between patients and providers may be more important for some cultures than others.
Other studies suggest significant variations in the incidence of breast cancer according to ethic group, and that Asian Americans, who have a high prevalence of hepatitis B infection, vary in their response to the virus, which is a major cause of liver cancer. Lung cancer incidence and responses to treatment may also vary between ethnic populations due to variations in the way sub-populations metabolize and excrete carcinogens, as well as cultural differences that increase smoking rates.
The same principles hold true of other ethnic and cultural groups that are usually lumped together on basic demographic forms, such as Hispanic/Latino groups or patients of African and Caribbean descent. Personalized medicine relies on a deeper understanding of individual responses to treatments and the likelihood of acquiring diseases, which largely comes down to a patient’s unique DNA. In her article for CEBP, Gomez suggests a greater focus on federally funded research for AANHPI patients as well as a greater overall effort to include these patients in clinical trials.
“Through investing in cancer research, we have a unique opportunity to accelerate the availability of cancer knowledge that is useful and impactful for the many distinct Asian American, native Hawaiian and Pacific Islander population groups that reside throughout the country,” Gomez said.