Native Hawaiian and Pacific Islander Health Disparities in the United States (2022–2023 Aligned)

Overview

Native Hawaiian and Other Pacific Islander (NHPI) populations represent a small but highly distinct and diverse demographic group in the United States. According to U.S. Census baseline data, NHPI individuals account for approximately 0.3% of the U.S. population (about 874,000 people).

Modern public health surveillance continues to show that NHPI communities experience significant and persistent health disparities across chronic disease, infectious disease, maternal health, and behavioral risk factors. These inequities are documented in national surveillance systems including the Centers for Disease Control and Prevention.

Access to Healthcare and Insurance Coverage

Historically and in modern surveillance trends, NHPI populations face disproportionate barriers to healthcare access.

Baseline data from U.S. Census and public health analyses show:

• Approximately 21% of Asian American and Pacific Islander populations lack health insurance, compared to ~16% of the general U.S. population

These disparities are associated with:

• Higher rates of underinsurance
• Geographic isolation (particularly in Pacific Islander communities)
• Limited access to culturally competent care
• Economic and structural barriers to preventive services

Tuberculosis (TB) Burden

Asian American and Pacific Islander populations continue to experience the highest tuberculosis rates in the United States.

Historical surveillance (2001 baseline data):

• 33 per 100,000 among AAPI populations
• Compared to:14 per 100,000 (Black Americans)
  12 per 100,000 (Hispanic/Latino populations)
  11 per 100,000 (American Indian/Alaska Native populations)
  2 per 100,000 (White Americans)
  

While national TB rates have declined overall in 2022–2023 CDC reporting, AAPI populations remain disproportionately affected due to:

• Higher rates of latent TB infection in immigrant populations
• Screening and follow-up disparities
• Delayed diagnosis in underserved communities

Diabetes and Metabolic Disease (Native Hawaiians)

Native Hawaiian populations experience significantly elevated risk of diabetes.

Historical population-based data (1996–2000):

• Native Hawaiians were 2.5× more likely to be diagnosed with diabetes than non-Hispanic white residents of Hawaii of similar age

Current CDC-era trends continue to show elevated metabolic disease burden driven by:

• Dietary transitions
• Structural food access limitations
• Higher rates of obesity and metabolic syndrome

Infant Mortality Disparities

Infant health outcomes also show persistent inequities:

• Native Hawaiian infant mortality (2000 baseline): 9.1 per 1,000 live births
• Compared to white residents: 5.7 per 1,000 live births

This represents nearly a 60% higher infant mortality rate.

Contributing factors include:

• Prenatal care access gaps
• Maternal comorbidities
• Geographic barriers to obstetric services
• Socioeconomic inequities in early-life health support

Hepatitis B (HBV) and Liver Health

Hepatitis B remains a significant health concern in AAPI populations and is a major contributor to liver disease disparities.

• Acute HBV rate (2001 baseline):3.0 per 100,000 in AAPI populations
  1.3 per 100,000 in white populations
  

While 2022–2023 CDC data shows overall declines in acute infection rates, chronic hepatitis B burden remains disproportionately concentrated in AAPI communities due to:

• Higher prevalence of chronic infection in immigrant populations
• Underdiagnosis in asymptomatic individuals
• Limited access to long-term antiviral management

Asthma and Respiratory Health (Native Hawaiians)

Respiratory disease burden is significantly elevated in Native Hawaiian populations:

• Asthma prevalence (2000 Hawaii data):139.5 per 1,000 Native Hawaiians
  71.5 per 1,000 among other racial groups in Hawaii
  

This reflects nearly a 2× higher prevalence rate.

Contributing factors include:

• Environmental exposure differences
• Housing quality and ventilation disparities
• Healthcare access and chronic disease management gaps

Smoking and Behavioral Health Risk

Tobacco use remains a major preventable risk factor:

• Smoking prevalence (2000 Hawaii data):30.9% among Native Hawaiians
  19.7% overall Hawaii population rate
  

Current CDC-era surveillance trends continue to show higher smoking-related risk in Native Hawaiian communities, contributing to:

• Cardiovascular disease
• Cancer risk
• Respiratory illness burden

Key Health Equity Drivers

Across NHPI populations, health disparities are strongly influenced by structural and environmental factors, including:

• Geographic isolation (especially in Pacific Island communities)
• Healthcare access limitations and underinsurance
• Socioeconomic inequality
• Historical displacement and cultural disruption
• Food environment and chronic disease risk exposure

2022–2023 Public Health Context

While many of the baseline statistics in this analysis originate from earlier surveillance periods (1996–2001), modern CDC-era reporting confirms that disparities remain structurally persistent, particularly in:

• Chronic disease prevalence
• Infectious disease burden (TB and HBV)
• Maternal and infant health outcomes
• Preventable behavioral risk factors

These patterns continue to be tracked in national datasets through the Centers for Disease Control and Prevention.

National Institute on Minority Health and Health Disparities

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