摘要：Objectives. We compared the age at admission and the severity of illness of hospitalized Micronesians with 3 other racial/ethnic groups in Hawaii. Methods. With Hawaii Health Information Corporation inpatient data, we determined the age at admission and the severity of illness for 162 152 adult, non–pregnancy-related hospital discharges in Hawaii from 2010 to 2012. We performed multivariable linear regression analyses within major disease categories by racial/ethnic group. We created disease categories with all patient refined–diagnosis related groups. Results. Hospitalized Micronesians were significantly younger at admission than were comparison racial/ethnic groups across all patient refined–diagnosis related group categories. The severity of illness for Micronesians was significantly higher than was that of all comparison racial/ethnic groups for cardiac and infectious diseases, higher than was that of Whites and Japanese for cancer and endocrine hospitalizations, and higher than was that of Native Hawaiians for substance abuse hospitalizations. Conclusions. Micronesians were hospitalized significantly younger and often sicker than were comparison populations. Our results will be useful to researchers, state governments, and hospitals, providers, and health systems for this vulnerable group. Pacific Islanders, who are among the fastest growing racial/ethnic groups in the United States, often have many unmet health care needs. 1,2 Although often studied as a single, undifferentiated group because of sample size limitations, Pacific Islanders are highly heterogeneous, and it is important to consider Pacific Islander populations separately to understand their health needs and health care patterns. 3,4 Micronesians are a particularly understudied group of Pacific Islanders. Micronesia is a group of thousands of islands in the Pacific Ocean. Although people from this region have many distinct cultures and languages, in the United States they are often all labeled “Micronesian.” 5 The majority of Micronesians migrated to the United States following the signing of a series of treaties known as Compacts of Free Association (COFA) in the 1980s and 1990s between the United States and 3 Micronesian nations (the Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall Islands). Although these nations remain independent, the compacts gave the United States exclusive military authority over the region, along with the responsibility to develop their health, educational, and economic infrastructures with the ultimate goal of self-reliance. 6 Citizens of COFA nations are legally eligible to work and live in the United States without a visa, labor certification, or limits on length of stay. 7 COFA populations face significant social inequalities in the United States, including high poverty rates and language barriers. 8,9 Micronesia has experienced a variety of historical events that have contributed to poor health, including US nuclear testing in the region and the disruption of traditional economies, cultures, and diets. 6,10 Despite US responsibilities under the compacts, the Personal Responsibility and Work Opportunity Act of 1996 (Pub L 104–193, 110 Stat. 2105) deemed COFA migrants ineligible for most federal aid programs, including federal support for participation in Medicaid. In 2014, the Ninth Circuit Court ruled that states are not obligated to provide COFA migrants with Medicaid, reducing insurance coverage and health care access for an already vulnerable community. 11,12 This is an increasingly important health policy issue because Micronesians are among the fastest growing ethnic groups in the United States, 13 with large communities in Hawaii, Arkansas, and California. 14 Collecting population-based health information on COFA migrants in the United States is challenging. Most national and statewide surveys that use sampling strategies, such as random sampling and participant contact via landline telephones, are likely to undercount Micronesians. 15 Even census data cannot be relied on to enumerate Micronesians because they are typically aggregated into the category “other Pacific Islanders.” 16 Although data on Micronesian health are extremely limited, existing research indicates that Micronesians living both in their home nations and in the United States are highly affected by both chronic and infectious diseases. 8,15,17–21 A study using self-reported data from heads of households found that Micronesians living in Hawaii had a high burden of certain cancers, diabetes, heart disease, skin infections, and chronic infectious diseases. 15 A small study done in Hawaii concluded that Micronesians were at risk for certain sexually transmitted infections. 19 A study of 215 627 cancer cases collected by the Guam Cancer Registry from 1998 to 2008 found that Micronesians in Guam had the highest age-adjusted incidence rates for lung, bronchus, liver, and cervical cancer of all studied racial/ethnic groups. 20 Besides this handful of studies, little Micronesian health outcome–focused research exists. Yet because of their unique immigration status and high health burdens, the health of Micronesian populations in the United States is of high research and policy relevance. We addressed this gap in the literature by investigating a particularly expensive area of the US health care system: hospitalizations. We compared the severity of illness (SOI) and the age of hospitalized Micronesians with those of 3 other racial/ethnic groups in Hawaii. To the best of our knowledge, our study is the first population-level analysis of the health of hospitalized Micronesians. Racial/ethnic comparison groups were Native Hawaiians, Japanese, and Whites. These ethnicities are all large, stable populations in Hawaii. In 2012, the percentages of these populations in the state were estimated as 23.2% Native Hawaiian, 19.3% White, and 23.1% Japanese. 21 Whites are most often used as the reference group in national race-based health comparison research. Japanese are among the healthiest population groups in Hawaii. 22,23 Native Hawaiians are a larger and better studied Pacific Islander population group than are Micronesians. They are known to suffer from significant health inequities in Hawaii and to be hospitalized younger than most other racial/ethnic groups in Hawaii. 24,25 We hypothesized that SOI patterns and age for Micronesian hospitalizations would most closely follow those of Native Hawaiians, that is, they would be younger and sicker than would Whites and Japanese.
