New report highlights health inequities in Hawaii COVID data

Despite making up just four percent of Hawaii’s population, Pacific Islanders accounted for 24% of the state’s diagnosed COVID-19 cases through the end of January. During that time, Pacific Islanders also had the highest age-adjusted mortality rate in the state at 319.6 deaths per 100,000 population. The next highest mortality rate was among Filipinos at 33.3 deaths per 100,000.

The Hawaii State Department of Health released these statistics as part of its “Addressing Health Equity in Diverse Populations” report on Tuesday.



The report identifies Native Hawaiians, Pacific Islanders and Filipino populations as being the most adversely impacted by the COVID-19 pandemic. Together, these three groups account for almost half of the state’s essential workforce, particularly in the tourism, hospitality, and retail industries, reads the report. They also play a large role in the health care workforce.

This, combined with the fact that they are more likely to live in multigenerational households and they face higher rates of chronic diseases, makes these groups particularly vulnerable to more severe cases of COVID-19. The report states:

“Access to health care services and COVID-19 treatment, if needed, is limited due to the socioeconomic circumstances of many Native Hawaiians, Pacific Islanders, and Filipinos. For example, a third (30%) of Native Hawaiians and Pacific Islanders are either uninsured or underinsured.”

Through Jan 31, 2021, Pacific Islanders and Filipinos accounted for 44% of all diagnosed COVID cases in Hawaii where race/ethnicity data is known. These two groups together make up just 20% of the state’s population. By comparison, white individuals make up 26% of the population, but 19% of cases.


Image: Hawaii State Dept. of Health


Of the 410 COVID deaths in Hawaii through the end of January, 96% of cases had known race/ethnicity data. During this time, Hawaii had the lowest COVID mortality rate in the country at 22 deaths per 100,000. However, at an estimated mortality rate of 319.6 per 100,000 for Pacific Islanders, the DOH estimates that this group has the highest mortality rate in the country. Even higher than places like New York City which experienced 286 deaths per 100,000 population.


Image: Hawaii State Dept. of Health


While the report evaluates data only through the end of January, the latest data from the DOH continues to reflect these trends. Currently, Pacific Islanders account for 22% of the state’s COVID cases, 30% of the hospitalizations, and 22% of the COVID-related deaths in Hawaii.

Further disaggregation of the Pacific Islander data finds that Samoan, Chuukese, and Marshallese populations have experienced the highest number of cases.

Data from the DOH also finds that Native Hawaiians and Pacific Islanders are receiving an inequitable number of COVID vaccinations. The state’s data dashboard, which combines the data for Native Hawaiians and Pacific Islanders, finds together they have received 13% of the state’s vaccine doses, despite accounting for a quarter of the state population. Asian groups (39% of the state population) have received 58% of the vaccinations, and white individuals have received 28% of vaccine doses administered.

The DOH’s equity report also includes a series of recommendations based on lessons learned from the state’s COVID response.

  1. “Advocate for more standardized, complete, and accurate data collection and analysis.
  2. Collaborate with community organizations to develop targeted, data-informed messaging.
  3. Conduct qualitative and quantitative studies to better understand the complexity of factors influencing the susceptibility to COVID-19 across the most impacted groups and communities.
  4. Include community stakeholders and use community-based research principles throughout the data analytic process.
  5. Support collaborative initiatives between health care professionals and community stakeholders for training and education on health equity issues and the importance of health equity data.
  6. Build and expand the representation of historically marginalized communities in government leadership positions, committees, workgroups, and task forces.”

The DOH says this will be the first of several reports that will dive into the details of Hawaii’s COVID case data to help inform researchers and policymakers.