“Health Inequities of Asian-American, Native Hawaiian, and Pacific Islander Family Caregivers: Disaggregate vs. Aggregate Data & Findings”

The estimated number of Asian Americans (AA), Native Hawaiians (NH), and Pacific Islanders (PI) in the United States is 23.0 million (7.5%); AA (7.0%) and NH and PI (0.5%), respectively (U.S. Census Bureau, 2016a). AA are persons with ancestry from Asian countries and islands in the Pacific Rim Basin, and the largest AA populations are Chinese (4.8 million), Asian Indian (4.1 million), Filipino (3.9 million), Vietnamese (2.0 million), Korean (1.8 million), and Japanese (1.4 million) (U.S. Bureau of Census, 2016b). NH and PI are referred to as a person having origins in any of the original peoples of Hawai‘i, Guam, Samoa, or other Pacific Islands (Hixson, Hepler, & Kim, 2012). NH and PIs include Native Hawaiians, Guamanians, Micronesians, Polynesians, and Samoans. The uninsured, lowest education, English as a second language, and foreign-born Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) sub-groups in one or more of these categories should be recognized. These AANHPI include Pakistani, Cambodian, Bangladeshi, Micronesian, Samoan, Hmong, Taiwanese, Laotian, Indonesian, and Thai. Disaggregating AA, NH, and PI sub-groups is critical to avoid overlooking inequities and health disparity issues, which otherwise would be overlooked by analyzing and reporting aggregate data (National Council of Asian Pacific Islander Physicians, 2015). Approximately 43.5 million Americans provided unpaid care to an adult or child in the last 12 months (National Alliance for Caregiving & AARP Public Policy Institute, 2015a) with family caregivers contributing an estimated $522 billion of total expenditures for formal services provided by paid providers (Mehrotra, 2014). It is expected that between 2013 and 2030, there will be a 123% increase of older adults aged 65 years and older from racial/ethnic groups compared to only a 50% increase among the non-Hispanic, white group (U.S. Census Bureau, 2016c). In 2014, 42% of AA and PI were providing care for elders versus 22% of the general population (AARP Executive Summary Report, 2014). There is a limited number of U.S. studies on palliative and end-of-life care with AANHPI family caregivers and, in particular, NH and PI family caregiver studies are sparse. Empirical work done in nursing homes with AANHPI family caregivers has either been aggregated, reported in small percentages, or there is no reporting of race/ethnicity. There is also a paucity of AANHPI studies in the area of mental health, and few studies disaggregate into subgroups. Sentell et al. (2013) explicates the need to disaggregate AANHPI groups to provide granular insights into mental health needs, access, and utilization. There is limited research on AA, NH, and PI grandparents caring for their grandchildren in the United States. For example, NH and PIs grandparents caring and living with their grandchildren in comparison to other race/ethnic groups are the highest (9.9%); however, research is sparse among this group (U.S. Census Bureau, 2015d). Finally, Mayeno, Kaholokua, Liu, Asato, and Tseng (2011) resonate the need to disaggregate within both NH and PI and AA subgroups in efforts to understand and address health issues, needs, and increase the visibility for health inequities that impact these individual communities. They further report that there is a growing body of evidence that health inequities exist among AA, NH, and PI children and youth and reporting disaggregate data and findings are needed to further expose health inequities, which would otherwise be concealed and not reported. This special issue addresses the health inequities of AA, NH, and PI family caregivers by providing diverse and discrete elements of family caregiving based on six empirical studies on Asian,