Rates of inpatient mental health hospitalizations for Asian American and Pacific Islander subgroups compared to Whites in Hawaii

Background: The study goal was to compare rates of inpatient mental health hospitalizations in 4 Asian American and Pacific Islander (AA/PI) subgroups and Whites for any mental health diagnosis and across 5 diagnostic groups (schizophrenia, depression, bipolar disorder, anxiety disorders, and other).

Methods: 2006-2010 Hawai'i Health Information Corporation data, which includes all-payer diagnostic-related groups and other discharge data on all hospitalizations in Hawaii, was used for those >=18 years. Annual rates were calculated using racial/ethnic population estimates from the Hawaii Behavioral Risk Factor Surveillance System. Negative binomial regression models adjusted for gender, age, payer, Oahu residence, and population size.

Results: In univariate analyses, Chinese had the lowest hospitalization rates for all diagnostic groups except schizophrenia, which was lowest among Japanese. Whites had the highest rates for all diagnostic groups except schizophrenia, which was highest in Native Hawaiians. Among AA/PI groups, Hawaiians had the highest mental health hospitalization rates in all diagnostic groups. In multivariate analyses, Chinese, Japanese, and Filipinos maintained significantly lower rates of hospitalization overall and for depression, bipolar disorder, and anxiety compared to Whites, but only Japanese had significantly lower rates for schizophrenia (p<0.001). Hawaiians differed significantly from Whites only for bipolar-related hospitalizations, where they had lower rates (p=0.014).

Conclusions: AA/PI subgroups generally had lower rates of mental health hospitalizations than Whites. However, significant differences were seen across AA/PI subgroups with Native Hawaiians having higher rates of mental health hospitalizations than other AA/PI subgroups. Studies of inpatient mental health services combining heterogeneous AA/PI groups likely miss important variation.