New study of Asian, Native Hawaiian and Pacific Islander populations gets $38.7M grant

Fred Hutch scientists discuss a new study that will focus on health issues of Asian Americans, Native Hawaiians and other Pacific Islanders. — Dr. Garnet Anderson (left) and other Fred Hutch scientists met Wednesday to discuss a large new national collaboration that will focus exclusively on the health issues of Asian Americans, Native Hawaiians and other Pacific Islanders. Photo by Robert Hood / Fred Hutch News Service

How common are diseases like stroke and coronary artery disease in Asian American, Native Hawaiian and Pacific Islander subpopulations?

What’s the relationship between environmental, behavioral and/or genetic risk factors with diabetes, high cholesterol and other metabolic disorders? And how do various exposures impact health outcomes for these folks, including their sleep quality, their mental health and cognition?

Fred Hutchinson Cancer Center — and scientists across the country — have questions, many unanswered questions, regarding the health of Asian American, Native Hawaiian and Pacific Islander populations in the U.S.

That’s mainly because data on these people are scant, and that assessment comes from the folks who would know, the National Institutes of Health, or NIH. Data on these populations is so limited, the agency recently highlighted the urgent need to develop a scientific infrastructure to investigate the mechanisms of disease in people from these backgrounds.

Now, they’re putting significant funding to fill this need.

The National Heart, Lung and Blood Institute (NHLBI), along with four other NIH institutes, is building a new population study from the ground up. Fred Hutch has been awarded $38.7 million in a 7-year grant to coordinate this work.

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Launching a population study from scratch

The study will include five research institutions — University of Hawaii; Stanford University; University of Chicago; Fox Chase Cancer Center in Philadelphia and the New York University Langone Health Perlmutter Cancer Center — which will gather a pool of 10,000+ study participants (along with their health history and biodata), with Fred Hutch serving as the project’s coordinating center.

“There are a lot of gaps in our knowledge about the health of these populations and their risk factors for a variety of diseases,” said Garnet Anderson, PhD, director of Fred Hutch’s Public Health Sciences Division and holder of the Fred Hutch 40th Anniversary endowed chair. “With this grant, the National Institutes of Health is recognizing and responding to the lack of data on these populations.”

The new study will look at risk factors that drive cardiovascular disease, metabolic disorders, mental health issues and other conditions, collecting biospecimens like blood, urine and microbiome samples to answer these questions and create a biorepository for future studies.

They’ll also look at the social determinants of health — from socioeconomic status to food deserts to environmental racism — to see how these elements have impacted populations over the years. They’ll examine health influences across multiple levels — biological, lifestyle, behavioral, environmental, sociocultural — and will use a host of multidisciplinary methods to investigate the web of influences that impact the health of these populations, an approach known as a “populomics.”

timeline for new NIH study — The grant will extend over seven years, with the first two years focusing primarily on establishing the infrastructure. Courtesy of the NIH

Anderson, one of the principal investigators for the new coordinating center, will share leadership with James Floyd, MD, MS, University of Washington (UW) Associate Professor of Medicine and Epidemiology and Co-Director of the UW Cardiovascular Health Research Unit; Kwun Chuen (Gary) Chan, PhD, UW Professor of Biostatistics and Health Systems and Population Health and an associate director of the National Alzheimer’s Coordinating Center, and epidemiologist Robert Kaplan, PhD, the Dorothy and William Manealoff Foundation and Molly Rosen Chair in Social Medicine at the Albert Einstein College of Medicine in New York.

Kaplan, a frequent collaborator with investigators at Fred Hutch, provides expertise gained from his leadership of the Hispanic Community Health Study/Study of Latinos (HCHS-SOL), a similar study in the Hispanic/Latino population.

Anderson is principal investigator of the Women’s Health Initiative’s clinical coordinating center, also funded by the NHLBI, which has been housed at Fred Hutch for decades. The outstanding performance of the WHI-CCC served as the foundation for this new venture.

‘There are a lot of gaps in our knowledge about the health of these populations and their risk factors for a variety of diseases. With this grant, the NIH is recognizing and responding to the lack of data on these populations.’

— Dr. Garnet Anderson, director of Fred Hutch’s Public Health Sciences Division and one of the principal investigators on the grant

Filling the gaps in data

The project started when the NHLBI, along with eight other NIH institutes, convened a multidisciplinary workshop in March 2021 to review current research, knowledge gaps, barriers and approaches for disease prevention in the multiple Asian and native Pacific Islander populations living in the United States.

Their findings appeared a year later in a special report in Annals of Internal Medicine entitled “Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders.”

In it, the NIH owned that even though these groups comprise 7.7% of the U.S. population, it had put little funding toward researching their health risks.

More than 40 ethnic groups exist within the Asian, Native Hawaiian and other Pacific Islander populations, they wrote. It’s highly diverse “with respect to indigeneity, nativity or ancestry, culture, immigration patterns, acculturation, educational attainment, income, language, and English proficiency, all of which influence health, health care access, and outcomes.”

And health outcomes can vary widely from group to group. From the data that exists, we know that when compared to white Americans, there are:

Higher rates of Type 2 diabetes in Asian Americans, Native Hawaiian/Pacific Islanders and Chinese, Asian Indian, Filipino and Japanese people. But in Native Hawaiian and Pacific Islanders, diabetes is significantly more common and occurs 10 to 15 years earlier.
Higher rates of chronic kidney disease in people of Asian American, Filipino, Japanese and Native Hawaiian and Pacific Islander heritage
Higher rates of gastric cancer in Asian Americans and Japanese and Korean people

Along with data gaps, there’s also a ton of “aggregated data” — information that’s all been lumped together instead of divvied up into heritage groups. Unfortunately, aggregation masks the variation in risk factors, disease occurrence and trajectories, according to the experts.

‘An all-star team’

The new grant is meant to rectify these issues and more. It’s known as a U24, which Anderson said is a cooperative agreement among scientific institutions.

“It’s kind of an all-star team,” she said. “We’ll be working with five other sites selected by NIH as the leading experts in the field, as well as multiple NIH Institutes. The different NIH Institutes supporting this effort all recognize we don’t have much data on these populations.”

Funding for the large grant will come from NHBLI; the National Human Genome Research Institute; the National Institute of Mental Health; the National Institute on Minority Health and Health Disparities and the National Institute of Neurological Disorders and Stroke.

Principal investigators for the study include:

University of Hawaii: Marjorie Mau, MD, MS; Alika Maunakea, PhD, and Lani Park, PhD
Stanford: Ann Hsing, PhD, MPH; Clete Kushida, MD, PhD; Paul Wang, MD, and Joseph Wu, MD, PhD
University of Chicago: Brisa Aschebrook-Kilfoy, PhD, and Karen Kim, MD
Fox Chase Cancer Center: Carolyn Fang, PhD, and Grace Ma, PhD, of Temple University and Frank Hu, MD, PhD, of Harvard
New York University Perlmutter Cancer Center: Jiyoung Ahn, PhD, and Yu Chen, MPH, PhD

“It’s very much a team effort,” Anderson said. “I wanted to do this to promote more team science in PHS and to allow other people to grow into these experiences. Over time, I expect to phase out as others step in.”

Fred Hutch public health scientists (left to right) Drs. Trang VoPham, Jay Mendoza and Li Hsu will be part of the new study which will focus on building a large cohort of Asian Americans, Native Hawaiians and other Pacific Islanders in order to assess risks and identify interventions to improve their overall health.

Fred Hutch public health scientists (top to bottom) Drs. Trang VoPham, Jay Mendoza and Li Hsu will be part of the new study which will build a large cohort of Asian Americans, Native Hawaiians and other Pacific Islanders in order to assess risks and identify interventions to improve their overall health.

Fred Hutch file photos

Recruiting for current and future research

The data, however, will keep going strong.

“The goal is to recruit at least 10,000 people, which isn’t big enough to do genomics studies but it will be a contribution to consortiums like GECCO [a large collective colorectal study launched by Fred Hutch genomic epidemiologist Riki Peters, PhD] or TOPMed [the NHLBI’s Trans-Omics for Precision Medicine program],” Anderson said. “We’ll collect the data so they can be shared with other studies for larger scale analyses.”

Fred Hutch will manage and support the analysis of the collective data but will not recruit people in the Seattle region.

“We won’t be interacting directly with the participants,” she said. “Each field site will propose their own recruitment methods. They know their populations; they’re the experts in how to recruit them.”

Each site will select at least two populations and will recruit a representative sample of people ages 25 to 64. The grant gives the institutions two years to hit their initial recruitment milestones, Anderson said. If they make it, the grant continues.

Those first two years are crucial in more than one way, though.

“We have two years to figure out all the data we want to collect across everything — risk factors for disease, acculturation, discrimination, mental health and get in the field for the initial recruitment,” Anderson said. “We also have to figure out how to work together.”

Other public health researchers from Fred Hutch who are part of the coordinating center are already coming up with investigative questions.

Among them are biostatistician Li Hsu, PhD, who has proposed genetic association analyses, and epidemiologist Trang VoPham, PhD, MPH, who has proposed geospatial analyses for study participants who’ve immigrated to the U.S. from other countries as a way to identify risk factors associated with birth locations. Biostatistician Chongzhi Di, PhD, has proposed the inclusion of mobile device data in order to track physical activity and sleep. Jay Mendoza, MD, MPH, director of the Fred Hutch/UW/Seattle Children’s Cancer Consortium’s Office of Community Outreach and Education, will co-lead the Community Outreach and Engagement Committee (COE) for the grant, an area of emphasis in the NIH program announcement.

Additionally, nutritional epidemiologist Marian Neuhouser, PhD, and cancer prevention researcher Johanna Lampe, PhD, will be looking at dietary assessments.

“Diet is going to be very complex to address,” Anderson said. “We’ll also have to know how long they’ve acculturated their diet. The core study can’t cover all of this but there will be add-on studies — lots of opportunities for ancillary studies. We hope to collect microbiome samples and cardiovascular imaging studies. Most of the samples will be saved for future analysis.”

Additional expertise on mental health and acculturation will come from Isaac Rhew, PhD, MPH, Research Associate Professor of Psychiatry and Behavioral Sciences in the Department of Epidemiology in the UW School of Public Health, and Jenny Tsai, PhD, ARNP, Associate Professor and Director of the Graduate Certificate in Advance Practice Environmental and Occupational Health in the UW School of Nursing.

Team science excellence

Anderson said large research studies like are “engines for discovery in population sciences.”

“We collect the samples and annotate them with key data and eventually somebody comes up with a great idea and gets a grant to analyze them,” she said. “It happened with WHI. We have four million vials of blood, urine and DNA in our freezers. We didn’t know which women would get colorectal cancer when we collected their samples for WHI. But we followed the women for years and were able to use that data to support many studies that uncovered preventable risk factors for disease.”

She’s also thrilled to see this award come to fruition.

“It’s part of our strategic plan in PHS to launch these large initiatives,” she said. “Studies like WHI and EDRN [the Early Detection Research Network] are big science projects that generate resources and draw people in. They support a lot of novel research and new collaborations in the population sciences.”

And Fred Hutch is well positioned to contribute.

“We have particular strengths here,” she said. “Part of it is our strong biostatistics and epidemiological research. We have a long track record in that and know how to do it. It’s team science and we excel in that.”