Beyond the AAPI Umbrella: Implications of Racial Aggregation for Analyzing Spatial Access to Primary Care in Houston, Texas

Abstract

Native Hawaiian and Pacific Islanders (NH/PI) are frequently aggregated with Asian populations in data, limiting the ability to identify NH/PI-specific patterns in healthcare access. This study uses an enhanced two-step floating catchment area (E2SFCA) approach with multimodal travel-time modeling to characterize primary care accessibility among NH/PI-, Asian-, and White-concentrated community areas in Houston, Texas. Comparisons focused on the five tracts with the highest proportion of each group. Among the five tracts with the highest AAPI proportions, only 6 of 6,876 AAPI combined residents were NH/PI alone. By contrast, the five tracts with the highest NH/PI proportions contained 209 NH/PI alone residents, demonstrating that the aggregated AAPI concentrated and NH/PI concentrated areas are geographically distinct. When disaggregated, NH/PI concentrated tracts had the highest composite primary care accessibility (46.46 providers per 100,000 residents), despite higher poverty and lower median household income than Asian concentrated tracts. Disaggregated analysis was constrained by ACS data reliability, differential privacy, and the geographic dispersion of NH/PI residents. These findings suggest that geographic availability might not be the main barrier to primary care access for NH/PI communities in Houston, highlighting the need for improved NH/PI data collection and analysis to better characterize access and guide targeted interventions.