O-02: Marked heterogeneity in type 2 diabetes prevalence across disaggregated Asian American and pacific islander adolescents and young adults in an integrated health system: the PAPAYA study
A Kubo, S Srinivasan, J Liu, J Acker, S Daredia, C Huang, S Negriff, A Kanaya, J Deardorff, A KarterAbstract
Introduction
Type 2 diabetes (T2D) in adolescents and young adults (AYA; 10–30 years) is increasing, yet risk within disaggregated Asian American (AsA) and Native Hawaiian and Pacific Islander (NHPI) subgroups is poorly characterized. Aggregating diverse AsA/NHPI populations can mask high-burden communities and hinder targeted prevention.
Objectives
To estimate age- and sex-standardized prevalence of clinically recognized T2D across disaggregated AsA and NHPI AYA subgroups in a large integrated health system.
Methods
Retrospective cohort study using electronic health record data from Kaiser Permanente Northern and Southern California (KPNC/KPSC) in the Predictors of Adverse Cardiometabolic Problems in Adolescents & Young Adults (PAPAYA) study. T2D was identified using validated EHR algorithms. Age- and sex-standardized prevalence as of 12/31/2024 was calculated by race/ethnicity and standardized to the 2020 U.S. Census population.
Results
As of 12/31/2024, 11,857 AYA had prevalent T2D. Marked heterogeneity was observed across disaggregated AsA/NHPI subgroups. Standardized prevalence per 1,000 was highest in NHPI (11.4; 95% CI 6.9–7.7) and Filipino AYA (11.3; 10.4–12.1), exceeding rates in Black (8.4; 8.0–8.9), Hispanic (8.2; 8.1–8.4), and Native American AYA (8.2; 6.1–10.3). Among other AsA subgroups, prevalence was lower: East Asian 4.3 (3.7–4.8), Other Southeast Asian 6.4 (5.4–7.4), and South Asian 5.7 (4.9–6.6).
Conclusions
Disaggregated estimates reveal substantial heterogeneity in AYA T2D burden, with NHPI and Filipino AYA experiencing the highest prevalence, surpassing traditionally high-risk groups. Disaggregation is essential for accurate surveillance and for informing screening and clinical risk assessment in AsA and NHPI youth and young adults. These findings support targeted outreach and consideration of subgroup-specific risk assessment in AYA.