Time since immigration and health services utilization of Korean-American older adults living in Los Angeles County

The aim of this study was to characterize ambulatory healthcare utilization of older Korean Americans and its association with length of time since immigration. It was hypothesized that older Korean Americans who were recent immigrants would use outpatient physician visits less often than early immigrants. The data are from the 2000 Korean-American Health Survey, which assessed the health status and medical needs of Korean Americans living in Los Angeles County. The dependent variable was the number of visits to a physician for check-up or consultation. Multivariate regression modeling was used to assess the influence of length of time since immigration on the dependent variable controlling for predisposing, enabling, and need variables for a sample of 208 Koreans Americans aged 65 and older. Results indicated that high school education in Korea and health insurance status were significant predictors of number of visits to a physician during the previous year (P<.05). The main variable of interest, the number of years living in the United States, approached significance at P=.09. It was concluded that enabling variables such as education and health insurance significantly influenced use of healthcare services in the older Korean-American population. The lack of studies regarding older minority populations and their access to healthcare further highlight theneed not only to characterize the access of these often-vulnerable populations, but also to generate interest for further studies.     

Trends in the Health Status of Older Koreans

Several recent studies have suggested that mortality, disability, and self‐rated health in older Americans have improved in last decade, but data from rapidly aging Asians remain sparse, and it is unclear that improvement extends to various health outcomes among older Korean populations. Trends in mortality, morbidity, disability, health behavior, and self‐rated health in older Koreans were assessed. Data were obtained from the National Death Statistics (1983–2006) and three representative and repeated cross‐sectional nationwide surveys: the National Elderly Activity Status and Welfare Needs Survey, the National Long‐term Care Needs Survey, and the Korean National Health and Nutrition Examination Survey. All‐cause mortality and disability decreased rapidly among older Koreans over the survey years, although some dimensions of health, including mortality from cancer, ischemic heart disease, and diabetes mellitus, have continued to deteriorate during this same period. Data on self‐rated health have also confirmed this trend toward diminished health status. These results are not consistent with the theory of compression of morbidity. Given the complexity and controversies characterizing health changes in the older population, continuing examination of the latest information about various aspects of mortality, disability, morbidity, and health behavior is necessary for the development of future improvements in healthy life expectancies in older Koreans.     

Ethnic difference of Helicobacter pylori gastritis： Korean and Japanese gastritis is characterized by male- and antrum-predominant acute foveolitis in comparison with American gastritis

AIM: To investigate the clinicopathological factors underlying the ethnic differences of Helicobacter pylori gastritis and cancer. METHODS: We analyzed clinicopathological parameters of gastric biopsies having H pylori infection that were randomly selected from different ethnic populations including 147 Americans, 149 Japanese, and 181 Koreans. RESULTS: Males were predominant in Japanese and Korean populations (77.9 and 67.4% respectively) in comparison with Americans (48.3%) (P＜0.001). H pylori gastritis in Koreans and Japanese was characterized by the predominant antral involvement. In the antrum, neutrophilic infiltration into the proliferative zone of pit, i.e. acute foveolitis, was more frequent in Koreans (82%) than in Japanese (71%) (P＜0.05) and Americans (61%) (P＜0.001). Interstitial neutrophilic infiltration, intestinal metaplasia and atrophy were also frequent in Koreans and Japanese. In the body, the prevalence of acute foveolitis was not significantly different among the populations while chronic interstitial inflammation and lymphoid follicles were more pronounced in the body of Americans than in the body of others(P＜0.01). CONCLUSION: The male-, and antrum-predominant H pylori gastritis in Koreans and Japanese is compatible with the pattern of sex and topographical distribution of gastric cancer incidence. Our data suggest that persistent acute foveolitis at the proliferative zone is a crucial step in the gastric carcinogenesis.     

Health Perception and Depressive Symptoms Among Older Korean Americans

Given the increasing recognition of racial/ethnic health disparities, the present study focused on older Korean Americans. Using data from 230 older Korean Americans in Florida (M age = 69.8, SD = 7.05), we assessed (a) how background variables (demographic information and acculturation), health constraints (chronic conditions and functional disability), and psychosocial factors (sense of mastery and filial satisfaction) were associated with health perception and depressive symptoms; and (b) whether health perception mediated the connections between health constraints and depressive symptoms. We observed positive perceptions of health and emotional states among individuals with higher levels of acculturation, fewer chronic conditions, less disability, and a greater sense of mastery. We also found that persons who were more satisfied with their relationships with adult children and who had more positive health perception were less depressed. Additionally, the findings supported a mediation model of health perception in the linkages between physical and mental health. Findings and implications are discussed here in a cultural context.     

Attitudes of older Korean Americans toward mental health services

Given the increasing evidence that older ethnic minorities underuse mental health services, the present study assessed determinants of attitudes toward mental health services with a sample of older Korean Americans (N=472). Adapting Andersen's behavioral health model, predisposing factors (age, sex, marital status, education, length of residence in the United States), mental health needs (anxiety, suicidal ideation, depressive symptoms), and enabling factors (personal experiences and beliefs) were considered as potential predictors. Shorter residence in the United States and higher levels of depressive symptoms were associated with more-negative attitudes toward mental health services. Culture-influenced personal beliefs (knowledge about mental illness and stigmatism) were found to play a substantial role in shaping individuals' attitudes toward mental health services. Findings call attention to the need to investigate how culture influences the response to mental health needs and to develop community education and outreach programs to close the gaps between mental health needs and service utilization in older ethnic minority populations.     

Awareness and Completion of Advance Directives in Older Korean‐American Adults

There has been growing concern about racial and ethnic disparities in completion rates of advance directives (ADs) in community‐dwelling older populations. Although differences in AD completion rates between non‐Hispanic whites and African Americans have been reported, not much is known about the awareness and completion of ADs in other groups of ethnic minorities. Using a sample of community‐dwelling Korean‐American older adults (n = 675) as a target, factors associated with their awareness and completion of ADs were explored. Guided by Andersen's behavioral health model, predisposing (age, sex, marital status, education), need (chronic conditions, functional disability), and enabling (health insurance, acculturation) variables were included in the separate logistic regression models of AD awareness and AD completion. In both models, acculturation was found to be a significant predictor; those who were more acculturated were more likely to be aware of ADs and to have completed ADs. This study contributes to the knowledge about the role of acculturation in explaining AD awareness and completion in Korean‐American older adults and provides recommendations for possible AD educational interventions for this older adult minority population.     

Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from a Population-Based Survey in California

Background

Asian American immigrants have a lower level of health literacy than non-Latino whites, but their level of health literacy and its impact on health outcomes may differ among subgroups.

Objective

We investigated the level of health literacy across five subgroups of Asian American immigrants and explored the association between health literacy and self-rated health status and symptoms of depression.

Design

We utilized a cross-sectional survey research design and a population-based sampling strategy using the 2007 California Health Interview Survey (CHIS).

Participants

We sampled 30,615 non-Latino whites and 3,053 Asian American immigrants (1,058 Chinese, 598 Koreans, 534 Filipinos, 416 South Asians, and 447 Vietnamese).

Main Measures

We used two questions as proxy measures to assess the level of health literacy in non-Latino whites and in both aggregated and disaggregated Asian American immigrant groups. We then investigated the effect of health literacy on two main health outcomes: self-rated health status and depression symptoms.

Key Results

The level of health literacy varied across the five subgroups of Asian American immigrants. Chinese, Korean, and Vietnamese groups had the lowest levels of health literacy, while Filipinos showed the highest level. Health literacy was positively correlated with health status in Chinese and Korean immigrants, and negatively correlated with depression symptoms in Korean and South Asian immigrants.

Conclusion

We found heterogeneity in health literacy among Asian American immigrants and found that health literacy had varying associations with health outcomes. The aggregated Asian American immigrant group results may mask the true health disparities that each Asian American immigrant group faces. Koreans were the only group found to have a significant association between the proxy for health literacy and both health outcomes. Further research is needed to better understand the causes of heterogeneity and to investigate health literacy as a critical determinant of immigrant health.KEY WORDS: health literacy, health status, depression, Asian American immigrants, health disparity     

Health status of older Asian Americans in California

Given the paucity of research on differences between older adults representing the many Asian-American subcategories, the present study explored physical and mental health status in five subcategories of Asian Americans aged 60 and older: Chinese, Japanese, Korean, Vietnamese, and Filipino. Data were drawn from the 2007 California Health Interview Survey (CHIS). Background characteristics and physical and mental health conditions were compared, with results showing differences cross the five subcategories of older Asian Americans. Specific patterns were identified in chronic diseases, disease comorbidity, and disability rates. Vietnamese and Filipinos tended to have poorer physical health than Chinese, Japanese, and Koreans. The poorest self-rated health and the highest disability rate were found in the older Vietnamese. Filipinos also exhibited the greatest number of chronic diseases, including the highest rates of asthma, high blood pressure, and heart disease. Although Koreans had the fewest self-reported chronic diseases and the least evidence of disease comorbidity, they also had the highest psychological distress. The lowest psychological distress was found in older Japanese. Findings suggest that generalizing findings from one particular Asian category or from an aggregate Asian category may be problematic and may not reflect an accurate picture of the burden of health in specific Asian categories. Being aware of these differences in background and health characteristics may help providers to better serve older Asian clients.     

Correlates of Depression Among Chinese and Korean Immigrant Elders in the United States

This study examines the effects of life stresses, religiosity and family coping resources on depression in a regional probability sample of older Chinese (n?=?105) and older Korean (n?=?100) immigrants. A major focus is placed on assessing the ethnic differences found in the relationship between religiosity and depressive symptoms, as experienced by the two Asian ethnic groups. The data for this secondary analysis was derived from a landmark study, Asian American Elders in New York City Survey. Findings suggest that about 46 % of the Chinese sample and 24 % of the Korean sample were depressed, indicating higher depression rates than those found among older Americans of other ethnicities in the literature. Data also show that Korean immigrant elders reported higher levels of religiosity (attended religious services at least once a week and felt that religion was very important in their lives) than their Chinese counterparts. Multivariate analyses confirm ethnic differences in depressive symptoms. Other things being equal, factors of religiosity have an overall significant positive impact on depression among the Korean group, but appear to have no effect on the Chinese group. This data shows that the impact of religiosity on psychological well-being is crucial for mental health professionals in maintaining cultural competency when working with clients from different Asian immigrant subgroups.     

High rates of uninsured among HCV-positive individuals

BACKGROUND AND GOALS: There are no published data on the health insurance status of Hepatitis C virus (HCV)-positive individuals. To address this issue, we analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). STUDY: Individuals 18 years of age and older who participated in NHANES III were included in the study. We determined the rates of health insurance coverage according to HCV status. We also determined healthcare status and health service utilization according to health insurance status among HCV-positive persons. RESULTS: HCV-positive individuals were more likely to be uninsured compared with those who were HCV-negative (29.6% vs. 12.2%, P = 0.0002). Among those with health insurance, HCV-positive individuals were more likely to have government insurance compared with those who were HCV-negative (42.9% vs. 27.6%, P < 0.005). Among HCV-positive individuals, being uninsured was associated with younger age, being unmarried, living in the South, Mexican-American race/ethnicity, and not graduating from high school. Additionally, the uninsured were less likely than their insured counterparts to identify a healthcare facility for sick or routine care, and less likely to have regular contact with a healthcare professional. CONCLUSIONS: A high proportion of HCV-positive individuals are uninsured, and many HCV-positive individuals with health insurance have publicly funded insurance. This finding may have implications for access to health care and for liver-related disease outcomes in HCV-positive persons.     

Cultural and Gender Differences in Coping Strategies Between Caucasian American and Korean American Older People

Coping strategies have significant effects on older people’s health. This study examined whether gender and ethnic differences influence the coping strategies chosen by older adults when they encounter daily life stressors. Data were collected from 444 community-dwelling people over the age of 65, including 238 Caucasian Americans and 206 Korean Americans. Results showed significant differences between the two groups. Korean Americans had higher scores on problem and emotion-focused coping strategies as well as avoidant coping strategies than Caucasian Americans. Caucasian older women employed more active coping, planning, and positive reframing skills; relied more on religion; and sought emotional support more than Caucasian men. For Korean Americans, older women utilized religion and denial; whereas older men employed instrumental support and substance abuse. The results suggest that practitioners should develop ethnic, gender-specific programs to help older adults cope more effectively with their daily life stressors.     

Associations of Obesity With Lipoprotein Subfractions in Japanese American,African American,and Korean Men

BackgroundBoth indices of obesity and lipoprotein subfractions contribute to coronary heart disease risk. However, associations between indices of obesity and lipoprotein subfractions remain undetermined across different ethnic groups.ObjectiveThis study aims to examine the associations of indices of obesity in Japanese Americans, African Americans, and Koreans with lipoprotein subfractions.MethodsA population-based sample of 230 Japanese American, 91 African American, and 291 Korean men ages 40 to 49 was examined for indices of obesity—that is, visceral and subcutaneous adipose tissue (VAT and SAT, respectively); waist circumference; and body mass index—and for lipoprotein subfractions by nuclear magnetic resonance spectroscopy. Multiple regression analyses were performed in each of the 3 ethnic groups to examine the associations of each index of obesity with lipoprotein.ConclusionsVAT had significant positive associations with total and small low-density lipoprotein (LDL) and a significant negative association with large high-density lipoprotein (HDL) in all 3 ethnicities (p < 0.01). SAT, waist circumference, and body mass index had significant positive associations with total and small LDL in only Japanese Americans and Koreans, whereas these indices had significant inverse associations with large HDL in all ethnic groups (p < 0.01). Compared with SAT, VAT had larger R² values in the associations with total and small LDL and large HDL in all 3 ethnic groups. VAT is significantly associated with total and small LDL and large HDL in all 3 ethnic groups. The associations of SAT, waist circumference, and body mass index with lipoprotein subfractions are weaker than the associations of VAT in all 3 ethnic groups.     

Ethnic disparities in hospice use among Asian-American and Pacific Islander patients dying with cancer

Asian Americans and Pacific Islanders (AAPIs) are a rapidly growing population in the United States, yet little is known about hospice use and length of stay in hospice of older AAPIs dying with cancer. A retrospective study was conducted of the last year of life of AAPI and white Medicare beneficiaries registered in the Surveillance, Epidemiology, and End Results Program. White (n=175,467) and AAPI (n=8,614) patients aged 65 and older who were dying with lung, colorectal, breast, prostate, gastric, or liver cancer were studied. Cox proportional hazards models were used to examine hospice use and length of stay in hospice. All AAPI subgroups studied had lower rates of hospice use (Chinese (adjusted hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.55–0.69), Japanese (adjusted HR=0.67, 95% CI=0.60–0.73), Filipino (adjusted HR=0.61, 95% CI=0.54–0.70), Hawaiian/Pacific Islanders (adjusted HR=0.78, 95% CI=0.67–0.91), and other Asians (adjusted HR=0.70), 95% CI=0.55–0.90) than white patients, adjusting for patient demographic and clinical characteristics. Of those who enrolled in hospice (approximately 20% of the total sample), Japanese Americans had a shorter median length of stay (21 days), and Filipino Americans had a longer median length of stay (32 days) than white patients (26 days). Overall, approximately 20% of patients enrolled within 7 days of death, and only 6% had hospice stays that were longer than 2 months, with no significant differences across racial or ethnic groups. In conclusion, in every ethnic subgroup studied, AAPIs were less likely than whites to enroll in hospice. Further research is needed to understand these differences and eliminate potential barriers to hospice care.     

Perceptions of Aging in Two Cultures: Korean and American Views on Old Age

The current study investigated whether beliefs about aging vary by culture, age, and gender. The Lasher and Faulkender (Int. J. Aging Hum. Dev., 37:247–259, 1993) Anxiety about Aging scale was administered to 153 American and 167 South Korean men and women divided into three age groups: young (18–39), middle-aged (40–59), and older (60–91) adults. Significant cultural differences were found for the total anxiety scale and three of the four subscales. Compared to Americans, Koreans portrayed higher overall levels of anxiety about aging, and greater fear of old people, psychological concerns, and concerns over physical appearance. For Koreans, younger adults had greater fear of old people, whereas among Americans, older adults had greater fear of old people. In both cultures, the older adults had greater psychological concerns and fear of losses than did the younger groups, and American women showed more anxiety about aging and concerns over physical appearance than their male counterparts. Results are discussed in relation to aging in different cultural contexts.     

The Experience of Family Caregivers of Older Korean Americans With Dementia Symptoms

Despite the rapid growth of the older ethnic minority population, knowledge about dementia care for this population is limited. This study examined the experience of dementia caregiving among Korean Americans. We conducted four focus groups with 23 family caregivers of older Korean Americans with dementia symptoms and identified eight themes: (a) struggling and overwhelmed; (b) keeping the cultural roles and responsibility; (c) doing it by themselves; (d) family as a source of stress; (e) limited knowledge and misconceptions; (f) learning as they go; (g) undiagnosed dementia and misunderstandings about medical care; and (h) barriers to use of services and need for culturally responsive services. The findings underscore that Korean Americans need dementia caregiver programs that are linguistically and culturally responsive.     

Prevalence of and Risk Factors for Gastrointestinal Diseases in Korean Americans and Native Koreans Undergoing Screening Endoscopy

Background/Aims

In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors.

Methods

In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled.

Results

The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE.

Conclusions

Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.     

Poor health in the Korean older population: Age effect or adverse socioeconomic position

The objective of this study was to examine the impact of socioeconomic status and age on poor health among elderly people. Data were taken from the 2006 baseline survey of the Korean Longitudinal Study of Aging (KLoSA). We compared self-rated poor health, depressive symptoms, chronic disease, and disability in middle-aged (age 45-64), old (age 65-74), and very old (age 75-105) individuals. Logistic regression models were used to assess the effect of a poor social environment on health. Elderly Koreans generally had poor socioeconomic status and reported a high prevalence of poor health compared with middle-aged people. Respondents aged 65-74 years old and those aged 75+ were approximately three and four times more likely, respectively, to report self-rated poor health than middle-aged people. These differences were reduced by 41-71% after controlling for education, employment, and income. Elderly persons were also more likely to report depression, chronic disease, or disability, and the differences between age groups were reduced after adjustment for socioeconomic status, but to a lesser extent than was self-rated poor health. Our results indicate that a substantial portion of the gap in health status between middle-aged and older Koreans may be accounted for by the typically low socioeconomic status of elderly people. Income security and health-related interventions are required to improve the health of the elderly cohort who are confronted with the synergistic effects of aging and low socioeconomic status on health.     

Racial and Ethnic Differences in the Mental Health Needs and Access to Care of Older Adults in California

Little is known about the unmet mental health needs of minority older adults. Racial and ethnic differences in the prevalence rates of psychological distress and reported need and use of mental health services were examined in a population‐based sample of older adults using the 2005 California Health Interview Survey. The sample comprised 16,974 people aged 55 and older, with 13,974 non‐Hispanic whites, 719 African Americans, 1,215 Asians, and 1,066 Latinos. Respondents were compared in terms of prevalence of symptoms of mental distress and serious mental illness, reported need for help, and access to mental health services. African Americans, Asians, and Latinos were more likely to have mental distress than whites (21.2–24.2% vs 14.4%, P<.001) and a higher prevalence of serious mental illness (4.1–7.7% vs 2.5%, P<.001). After adjustment for age, sex, birthplace, marital status, education, limited English proficiency, chronic health conditions, and insurance status, older African‐American (adjusted odds ratio (aOR)=1.37, 95% confidence interval (CI)=1.04–1.81) and Asian (aOR=1.50, CI=1.13–2.00) adults still had greater odds of mental distress than whites. Furthermore, all three groups had worse access to mental health services than whites (African American aOR=0.64, 95% CI=0.43–0.96; Asian aOR=0.32, CI=0.16–0.63; Latino aOR=0.35, CI=0.17–0.70). Clinicians caring for older individuals should be aware of their high risk for mental health needs. Given that minorities' access to mental health services is worse than whites', even after adjusting for health insurance status, providing insurance alone will not eliminate this disparity. Innovative clinical and systemic strategies are needed to better identify individuals at risk and to provide needed services.     

Identifying older Chinese immigrants at high risk for osteoporosis

BACKGROUND: Data about whether Asian Americans are a high-risk or a low-risk group for osteoporosis are limited and inconsistent. Few previous studies have recognized that the heterogeneity of the Asian American population, with respect to both nativity (foreign- vs U.S.-born) and ethnicity, may be related to osteoporosis risk. OBJECTIVE: To assess whether older foreign-born Chinese Americans living in an urban ethnic enclave are at high risk of osteoporosis and to refer participants at high risk for follow-up care. DESIGN: Cross-sectional survey and osteoporosis screening, undertaken as a collaborative project by the Chinese American Service League and researchers at the University of Chicago. SETTING: Chicago's Chinatown. PARTICIPANTS: Four hundred sixty-nine immigrant Chinese American men and women aged 50 and older. MEASUREMENTS AND MAIN RESULTS: Chinese Americans in this urban setting are generally recent immigrants from south China with limited education and resources: mean age at immigration was 54, 56% had primary only or no education, and 57% reported "fair" or "poor" self-rated health. Eighteen percent are uninsured and 55% receive Medicaid. Bone mineral density (BMD) of the calcaneus was estimated using quantitative ultrasound. Immigrant Chinese women in the study had lower average BMD than reference data for white women or U.S.-born Asian Americans. BMD for immigrant Chinese men in the study was similar to white men at ages 50 to 69, and lower at older ages. Low body mass index, low educational attainment and older age at immigration were all associated with lower BMD. CONCLUSIONS: Foreign-born Chinese Americans may be a high-risk group for osteoporosis.     

Differences in the association between apolipoprotein E genotype and mortality across populations

BACKGROUND: The gene for apolipoprotein-E (APOE) has three common alleles (epsilon2, epsilon3, and epsilon4) that have been shown to be associated with differences in the risk of death in persons older than 60 years in European populations. However, previous research suggests that they may not be associated with mortality in African Americans, and the evidence in Asians is mixed. It is now possible to examine the effects of these genotypes on mortality in African American, Chinese, Japanese, and Korean populations. METHODS: The analysis is based on two types of published data: genotype by age and mortality by genotype. Demographic synthesis uses a multistate model to combine data from these case-control and cohort studies to provide maximum likelihood estimates of the relative risks of death. RESULTS: In general, the APOE epsilon2 allele is associated with 5%-10% lower mortality than the epsilon3/3 genotype. The epsilon4/4 allele is generally associated with a moderately high relative risk of death. The epsilon3/4 genotype is associated with 22% excess risk in Europeans and U.S. whites and with about 35% in Chinese. However, there is no evidence of excess risk with epsilon3/4 among African Americans and little excess risk among Japanese and Koreans. The relationship between genotype and mortality is consistent within these ethnic groups. For example, the estimates of R(3/4) for Japanese in Japan and Hawaii are both low, and the estimates for Chinese in Taiwan and Shanghai are relatively high. CONCLUSIONS:. The relationship between APOE genotype and mortality differs across population groups but shows little evidence of variation within groups.