Symbolic illustration of health disparities in diabetes prevention.

Diabetes Disparities: Why Prevention Isn't Equal for Everyone

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Elderly Native Hawaiians, Filipinos, and Japanese face higher risks of preventable diabetes hospitalizations compared to whites. Discover the hidden factors and what can be done."

Diabetes is a major health concern, especially for older adults. Approximately 25% of individuals aged 65 and older in the United States have diabetes mellitus. While this is a significant number on its own, the rates are even higher for certain racial and ethnic groups, particularly Asian Americans and Pacific Islanders (AA/PI).

Recent research has highlighted that Native Hawaiians, Filipinos, and Japanese elderly individuals face disproportionately high rates of diabetes and related complications. This leads to an important question: are these communities receiving the preventative care they need, and are there specific factors contributing to these disparities?

A groundbreaking study, conducted in Hawai'i between 2006 and 2010, delved into the racial and ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH). The study focused on elderly individuals (aged 65 and older) from Japanese, Chinese, Filipino, Native Hawaiian, and White backgrounds to uncover the root causes of these unequal outcomes and identify potential intervention points.

Unpacking the Disparities: Who's at Risk and Why?

Symbolic illustration of health disparities in diabetes prevention.

The Hawai'i-based study revealed some striking differences in DRPH rates among various ethnic groups. The initial data showed that all AA/PI groups had higher unadjusted rates of DRPH compared to Whites, with Native Hawaiians and Filipinos experiencing the highest rates. This raised concerns about access to care, cultural factors, and the effectiveness of current prevention programs.

However, the researchers didn't stop there. They recognized that simply comparing raw numbers wouldn't tell the whole story. Factors like age, insurance coverage, existing health conditions (comorbidity), and even where someone lives (urban vs. rural) can all play a role in hospitalization rates. Therefore, they used sophisticated statistical models to adjust for these variables and isolate the impact of race and ethnicity.

Native Hawaiian Men: Even after accounting for other factors, Native Hawaiian men had a significantly higher risk of DRPH compared to White men. The adjusted rate ratio (aRR) was 1.59, meaning they were 59% more likely to be hospitalized for preventable diabetes-related issues.
Filipino Men and Women: The disparity was even more pronounced for Filipinos. Filipino men had an aRR of 2.26, indicating a 126% higher risk of DRPH compared to White men. Similarly, Filipino women had an aRR of 1.61, a 61% increased risk compared to White women.
Japanese Men: Japanese men also faced a significantly elevated risk, with an aRR of 1.86, an 86% increased risk of DRPH compared to White men.

These findings paint a clear picture: even when considering other contributing factors, significant disparities in DRPH exist among elderly Native Hawaiians, Filipinos, and Japanese, particularly men. This begs the question: what are the underlying causes driving these inequalities, and what steps can be taken to address them?

Moving Towards Equity: What Can Be Done?

The study's conclusion is clear: Native Hawaiian, Filipino, and Japanese men, along with Filipino women, are at a higher risk for DRPH compared to their White counterparts. This highlights the urgent need for targeted interventions to address these disparities. Health care providers and public health programs must consider implementing culturally sensitive and effective programs to reduce potentially preventable hospitalizations within these communities.

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This article is based on research published under:

DOI-LINK: 10.5888/pcd10.120340, Alternate LINK

Title: Comparison Of Potentially Preventable Hospitalizations Related To Diabetes Among Native Hawaiian, Chinese, Filipino, And Japanese Elderly Compared With Whites, Hawai‘I, December 2006–December 2010

Subject: Public Health, Environmental and Occupational Health

Journal: Preventing Chronic Disease

Publisher: Centers for Disease Control and Prevention (CDC)

Authors: Tetine L. Sentell, Hyeong Jun Ahn, Deborah T. Juarez, Chien-Wen Tseng, John J. Chen, Florentina R. Salvail, Jill Miyamura, Marjorie L.M. Mau

Published: 2013-07-25

Everything You Need To Know

What are "Diabetes Disparities", and why are they important?

The term "Diabetes Disparities" refers to the unequal distribution of diabetes and related health outcomes across different racial and ethnic groups. The article specifically highlights how elderly Native Hawaiians, Filipinos, and Japanese individuals face a higher risk of diabetes-related hospitalizations compared to Whites. These disparities are significant because they point to inequalities in healthcare access, quality of care, and effectiveness of prevention programs. The implications are that these communities may be experiencing a disproportionate burden of illness and reduced quality of life due to factors such as cultural differences, socioeconomic status, and access to preventative care.

What are "Preventable Diabetes Hospitalizations", and what makes them significant in the context of the research?

The study examines "Preventable Diabetes Hospitalizations (DRPH)" which refers to hospitalizations related to diabetes that could potentially be avoided through preventative care, such as regular screenings, medication adherence, and lifestyle modifications. The research focuses on elderly individuals (65 and older) with Diabetes Mellitus, highlighting the specific challenges faced by Native Hawaiians, Filipinos, and Japanese populations. The importance lies in the fact that DRPH rates can serve as an indicator of the effectiveness of healthcare systems and preventative care programs. The implications of high DRPH rates for these groups are increased healthcare costs, a higher burden of illness, and potentially reduced life expectancy and quality of life.

What is an "Adjusted Rate Ratio" and how is it used in the study, and what are the implications?

The study uses the term "Adjusted Rate Ratio (aRR)" to quantify the increased risk of Preventable Diabetes Hospitalizations (DRPH) for specific ethnic groups, like Native Hawaiians, Filipinos, and Japanese individuals, compared to Whites, after controlling for other factors such as age, insurance coverage, and existing health conditions. The study found significantly higher aRR for these ethnic groups, indicating that these populations are at an elevated risk of preventable diabetes-related hospitalizations. The implications of these findings are that even when adjusting for other factors, disparities still exist, highlighting the complex interplay of race/ethnicity and health outcomes. This underscores the need for targeted interventions that account for specific cultural, social, and economic contexts.

Why did the study focus on Japanese, Chinese, Filipino, Native Hawaiian, and White individuals?

The study focuses on elderly individuals (aged 65 and older) from Japanese, Chinese, Filipino, Native Hawaiian, and White backgrounds to uncover the root causes of unequal outcomes and identify potential intervention points in relation to diabetes. These groups were chosen because they represent diverse racial and ethnic populations in Hawai'i, and the study aimed to identify disparities in Preventable Diabetes Hospitalizations (DRPH). The significance lies in the fact that these findings are key to understanding how different ethnic groups experience diabetes-related health outcomes. The implications of this study are the identification of specific communities who face higher risks and require focused intervention, leading to the development of culturally sensitive and effective programs.

Which populations are identified as being at higher risk and what are the implications?

The key populations at higher risk, as highlighted by the research, include elderly Native Hawaiians, Filipinos, and Japanese individuals, particularly men, and Filipino women. The research used Adjusted Rate Ratios (aRR) to highlight that these groups experience elevated risk of Preventable Diabetes Hospitalizations (DRPH) compared to Whites. The significance of these findings is that these disparities reflect a significant public health concern. The implications suggest that there's a need for targeted interventions, incorporating cultural sensitivity, and tailored programs within these communities to address factors that contribute to high DRPH rates, ultimately promoting improved health outcomes and reducing health disparities.