Comparing Obesity-Related Health Disparities among Native Hawaiians/Pacific Islanders, Asians, and Whites in California: Reinforcing the Need for Data Disaggregation and Operationalization.

Since the 2000 Census, Asians and Pacific Islanders have been categorized as separate races. Government initiatives have called for greater study of Asian, Native Hawaiian, and other Pacific Islander (NHPI) health outcomes. NHPI often have worse health outcomes than Asians and Whites. Despite this, the lack of operationalization of racial definitions may affect the magnitude of health disparities. This analysis examined how utilizing different sociological race definitions could influence NHPI health outcomes when compared to Asians and Whites. Utilizing data from the 2009 California Health Interview Survey, NHPI had significantly higher age adjusted obesity prevalence than Whites under the UCLA Center for Health Policy Research (CHPR) (OR = 1.72, P = .03) and Self-Report (OR = 1.57, P = .01) definitions, but not the Census definition (OR = 1.42, P = .11). NHPI had significantly higher age adjusted obesity prevalence than Asians under all definitions (Census OR = 4.05, P < .01; CHPR OR = 4.81, P < .01; Self-Report OR = 4.46, P < .01). NHPI had significantly higher age adjusted diabetes/pre-diabetes prevalence than Whites across all definitions (Census OR = 3.27, P < .01, CHPR OR = 3.03, P < .01, Self-Report OR = 1.99, P = .01) but only the Census (OR = 2.12, P = .01) and CHPR (OR = 1.86, P = .04) when NHPI were compared to Asians. Overall, race definition changed the identification of health disparities. Future studies should operationalize racial definitions, as health disparities are masked post-hoc when utilizing different race definitions.