Disaggregating Data to Measure Racial Disparities in COVID-19 Outcomes and Guide Community Response - Hawaii, March 1, 2020-February 28, 2021

Abstract

Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,^† which can affect health outcomes (4).^§ However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations^¶ (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.^†† In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams^§§ and tailored public health interventions and vaccination campaigns to more effectively address health disparities.

FIGURE

COVID-19 case rates, by race (alone or in combination with one or more other races)^,, — Hawaii, March 1, 2020–February 28, 2021 Abbreviations: CI = confidence interval; OMB = Office of Management and Budget. * Case rates were based on COVID-19 cases reported to the Hawaii State Department of Health during March 1, 2020–February 28, 2021 and were calculated as (cases/population) x 100,000. Population estimates were from the U.S. Census Bureau’s American Community Survey population estimates. Data analyzed included 21,005 (82%) of 25,480 patients for whom information on race was available. Bars represent 95% CIs for the rates. † Data from racial groups were examined without regard to ethnicity. Analyses were conducted with groups that were not mutually exclusive including persons of a race alone or in combination with one or more races; persons of more than one race were included in the total for each race reported. Asian, American Indian or Alaska Native, Black or African American, Native Hawaiian and Other Pacific Islander, and White represent the five minimum race categories required by the OMB. Samoan, Tongan, Other Polynesian, Guamanian or Chamorro, Marshallese, Other Micronesian, and Other Pacific Islander, not specified represent subcategories within the Pacific Islander category. § Square markers indicate Other race or OMB’s five minimum race categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White). ¶ Other race category includes persons with the “other” race category selected with no further specifications or with specified races that were not listed as a category (e.g., if a person had “Hispanic or Latino” indicated as their “race” or had written in a specific country).