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Updated: May 19, 2021

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Large health studies sometimes paint a rosy picture of Asian Americans in comparison with other groups. But when researchers aren't using a broad brush, the portrait can be quite different.

When viewed not as a single entity of 20 million people but as people of Chinese, Filipino, Indian or other distinct backgrounds, significant differences – and health disparities – appear.

For example, a 2020 study in the American Journal of Public Health, based on California Health Interview Survey data, found Asians overall appeared healthier than non-Hispanic white people. But the aggregated data masked disparities: Filipino and Japanese adults reported high blood pressure more often than white and Asian people overall, and Japanese and Korean adults had higher rates of diabetes.

In a 2019 study of electronic health record data from Kaiser Permanente health plan members in Northern California, the frequency of cardiovascular risk factors such as obesity, smoking, diabetes and high blood pressure differed significantly among Asian ethnic groups. While that study showed 23.1% of all Asian adults had diabetes, the levels ranged from 15.6% for Chinese people to 31.9% for Filipinos.

"If we had only looked at the aggregate, we would have missed these differences," said the study's lead author, Nancy Gordon, of the Kaiser Permanente Division of Research in Oakland.

The problems that come from lumping data together are not unique to Asian Americans, said Stella Yi, an assistant professor in the department of population health at New York University's Grossman School of Medicine. But those problems do reflect historical and ongoing bias in how research is done.

"We're viewed as a niche community," she said. "We're viewed in a very particular or stereotypical light as being healthy, wealthy and wise. But we're not."

According to the Pew Research Center, most Americans of Asian descent trace their origins to 19 nations. As of 2019, most Asian Americans came from six groups – Chinese, Indian, Filipino, Vietnamese, Korean and Japanese.

A world of differences is reflected in those groups.

For example, Asian Americans are less likely than Americans overall to live in poverty, 10% versus 13%, according to the Pew Research Center. But taken individually, 12 of the 19 Asian ethnic groups the center analyzed had poverty rates as high as or higher than the U.S. average.

"That's the fundamental problem with the aggregation," Yi said. "You're lumping together sociopolitical context. You're lumping together language and linguistic ability," plus genetic differences and cultural attitudes toward food and lifestyle behaviors.