The University of Chicago is among five clinical sites conducting a first-of-its-kind study aimed at uncovering risk factors and targeted interventions to better prevent disease in Asian Americans, Native Hawaiians and Pacific Islanders (AsA-NHPIs) — populations traditionally underrepresented in medical research.

The $4.35 million, seven-year Multi-ethnic Observational Study in American Asian and Pacific Islander Communities (MOSAAIC) will enroll roughly 10,000 people from areas with large Asian subgroup populations. Information on cardiovascular, lung and mental health, as well as social influences on health (such as access to safe housing, job opportunities, and clean air and water) will be collected.

“I think we’ll find these populations are more heterogeneous than we ever imagined,” said Brisa Aschebrook-Kilfoy, PhD, Associate Professor of Public Health Sciences and lead of the UChicago site for MOSAAIC. “We’re very excited because this is an opportunity to really understand health disparities and inform more targeted interventions, policies and resource allocation.”

MOSAAIC is the first study funded by the National Institutes of Health to focus on AsA-NHPIs, a demographic that comprises 20.6 million people in the United States (or 6.2% of the population) — yet typically has represented only about 2% of cohort participants in prior NIH studies.

Although they are made up of dozens of distinct ethnic subgroups, AsA-NHPIs are usually grouped under the broad category of ‘Asian’ in research involving cohorts. That approach overlooks key diversities in terms of those individuals’ disease risks, outcomes and exposures, Aschebrook-Kilfoy said.

“Asian populations are often considered to have disease risk aligned with the burden experienced by non-Hispanic whites,” said Aschebrook-Kilfoy. “A recent report from the American Heart Association showed that when the data is disaggregated, we find that atherosclerotic cardiovascular disease risk is highest among South Asian and Filipino adults but lowest among Chinese, Japanese and Korean adults.”

Expertise in population health research

UChicago was selected to participate in MOSAAIC in part for its expertise and infrastructure in large-scale population health research and underrepresented populations, as well as a long history of Asian engagement in health research.

The study, primarily funded by the National Heart, Lung and Blood Institute, capitalizes on UChicago’s experience visiting communities in mobile medical vans to enroll individuals in studies, collecting biological samples and conducting clinical phenotyping.

Researchers aim to recruit 2,000 participants in Chicago who have East Asian, South Asian or Southeast Asian ancestors, or who self-identify as Native Hawaiian and/or Pacific Islander.

To accomplish this, the UChicago team is collaborating with the Asian Health Coalition (AHC), a Chicago nonprofit founded by former Vice Provost for Research Karen Kim, MD, that supports culturally appropriate health initiatives to eliminate health disparities among AsA-NHPI, African and other underserved communities. The AHC, along with other partnering community-based organizations, will conduct outreach and help recruit participants.

Launched in August 2023, MOSAAIC is being conducted at four other clinical sites: New York University Langone Health/Perlmutter Cancer Center, the University of Hawaii at Mānoa, Stanford University and the Fox Chase Cancer Center in Philadelphia. The Fred Hutchinson Cancer Center in Seattle is the coordinating center and will manage the collected data.

Better understanding of health disparities

Researchers have begun a feasibility study on the language used in the questionnaires and how easy it is for patients to participate. A pilot study in October will involve 500 people (including 100 in Chicago); the full study launches next spring.

MOSAAIC participants will complete an extensive health survey and provide biological specimens such as blood, urine and saliva samples. They’ll also undergo a physical exam, electrocardiogram and a spirometry test that measures lung function; all of these data will be used to create a biorepository for future analyses.

“We’re hoping the longitudinal nature of this study will extend beyond seven years, as it has for other NHLBI-funded cohort research,” said Aschebrook-Kilfoy, who is also planning an ancillary study to investigate how air pollution and factors like occupation and geographic location drive differences in cardiovascular, metabolic and respiratory disease risk in AsA-NHPIs.

“We know Asian Americans have a higher exposure to air pollution, but we don’t really know how that varies across subpopulations,” Aschebrook-Kilfoy said. “We hope to build on the core MOSAAIC protocol and expand opportunities to look at health disparities in a more integrated and comprehensive way.”

Aschebrook-Kilfoy is a core faculty member of the Institute for Population and Precision Health (IPPH) and has been researching underrepresented populations for more than a decade. Along with IPPH leader Habibul Ahsan, MD, MMedSc, she leads precision medicine-oriented cohort studies for the NIH’s All of Us research program and the National Cancer Institute’s Connect for Cancer Prevention Study.