Elevated Rates of Diabetes in Pacific Islanders and Asian Subgroups

The Diabetes Study of Northern California (DISTANCE)

  1. Alka M. Kanaya, MD2
  1. 1Division of Research, Kaiser Permanente Northern California, Oakland, California
  2. 2Division of General Internal Medicine, University of California, San Francisco, California
  3. 3Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, California
  4. 4California Diabetes Program, California Department of Public Health, Sacramento, California
  5. 5Center for Health and Community, University of California, San Francisco, California
  1. Corresponding author: Andrew J. Karter, andy.j.karter{at}


OBJECTIVE We estimated the prevalence and incidence of diabetes among specific subgroups of Asians and Pacific Islanders (APIs) in a multiethnic U.S. population with uniform access to care.

RESEARCH DESIGN AND METHODS This prospective cohort analysis included 2,123,548 adult members of Kaiser Permanente Northern California, including 1,704,363 with known race/ethnicity (white, 56.9%; Latino, 14.9%; African American, 8.0%; Filipino, 4.9%; Chinese, 4.0%; multiracial, 2.8%; Japanese, 0.9%; Native American, 0.6%; Pacific Islander, 0.5%; South Asian, 0.4%; and Southeast Asian, Korean, and Vietnamese, 0.1% each). We calculated age-standardized (to the 2010 U.S. population) and sex-adjusted diabetes prevalence at baseline and incidence (during the 2010 calendar year). Poisson models were used to estimate relative risks (RRs).

RESULTS There were 210,632 subjects with prevalent diabetes as of 1 January 2010 and 15,357 incident cases of diabetes identified during 2010. The diabetes prevalence was 9.9%, and the incidence was 8.0 cases per 1,000 person-years after standardizing by age and sex to the 2010 U.S. Census. There was considerable variation among the seven largest API subgroups. Pacific Islanders, South Asians, and Filipinos had the highest prevalence (18.3, 15.9, and 16.1%, respectively) and the highest incidence (19.9, 17.2, and 14.7 cases per 1,000 person-years, respectively) of diabetes among all racial/ethnic groups, including minorities traditionally considered high risk (e.g., African Americans, Latinos, and Native Americans).

CONCLUSIONS High rates of diabetes among Pacific Islanders, South Asians, and Filipinos are obscured by much lower rates among the large population of Chinese and several smaller Asian subgroups.

  • Received April 16, 2012.
  • Accepted August 13, 2012.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.