KaYing Yang, left, and Tiffany Yang, right, both say the lack of disaggregated health data has prevented the effort to shape policy. Credit: Ben Hovland | Sahan Journal

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Minnesota’s Hmong population is dying of COVID-19 at higher rates than any other Asian population in the state, according to a new report released earlier this month. 

The local Karen and Karenni population also died from COVID-19 at a disproportionate rate, according to the report. (The two groups are separate ethnicities from Myanmar.)

The report, released by the Coalition of Asian American Leaders (CAAL) and the Hmong Public Health Association, is the first known attempt to disaggregate state COVID-19 death data by race. Officials from the organizations behind the study say the numbers confirm what people in the local Hmong community knew all along. 

“This report is speaking to what they’re seeing in the community,” said Tiffany Yang, a member of the Hmong Public Health Association’s policy and advocacy team. “Having this data,” she added, “makes us feel heard.” 

The report comes after a year of frustration with the Minnesota Department of Health (MDH) and other local health organizations, some Hmong health experts said. 

“Every time we spoke with health systems leaders, they said they didn’t have the disaggregated data,” KaYing Yang, CAAL’s director of programs and partnership, said. 

MDH spokesperson Scott Smith, however, said that the department’s comprehensive and rigorous method of gathering COVID-19 death records makes a full-scale disaggregation of its own data impossible without more resources.

“We support the efforts of other researchers in the community and at the University of Minnesota to shed light on how COVID-19 is impacting different communities,” Smith said.

The CAAL report also found that nearly two-thirds of the Hmong, Karen, and Kareni deaths occured in St. Paul. In an interview with Sahan Journal, St. Paul Mayor Melvin Carter said these specific findings are “incredibly disturbing to us.”

“Our Asian American communities, particularly our Hmong and Karen communities, are stuck between, particularly, these really high, disproportionate rates of COVID infection, hospitalization, and death and, of course, the rise in Asian hate as well,” Carter said. 

Also alarming, the report found a 50 percent increase in the overall death rate for the Hmong community compared to 2019. More than 80 percent of this death rate rise stemmed from COVID-19. 

Minnesota Department of Health: ‘We do more than just look at the death certificate’

The organizations behind the report say its findings emphasize the need for more targeted public health outreach and resources dedicated to these specific communities. Officials with MDH, Ramsey County, and St. Paul city government all say they’re working on these goals. 

But the lack of data disaggregated data has prevented the effort to shape policy, KaYing Yang said. “We felt we were experiencing an inability to really advocate effectively for different communities within the Asian community,” she added. 

The CAAL report filled this void by enlisting the help of two University of Minnesota researchers. JP Leider, a senior lecturer at the University of Minnesota’s School of Public Health, pulled information for the report from publicly available death certificates at the Minnesota Office of Vital Records. 

“Death records have fields for many different races and ethnicities, including a number of east and South Asian options,” he wrote in an email to Sahan Journal. 

In total, Leider and Elizabeth Wrigley-Field, an assistant professor of sociology at the university, analyzed 223 death certificates of Asians in Minnesota who had died of COVID-19 between March and December of 2020. Of those deaths, they found that 110 came from the Hmong community. 

The death certificate records that Leider and Wrigley-Field analyzed are separate from the COVID-19 death statistics that MDH has been compiling and releasing to the public for the last year.

Since the pandemic began, MDH has continuously released its own COVID-19 race statistics in broader categories like “Asian.” As of April 21, MDH reports that 4 percent of the state’s more than 7,100 COVID-19 deaths occured in the Asian community. 

MDH’s data, Leider said, cannot be differentiated by specific ethnic groups.

In an email, spokesperson Smith told Sahan Journal that MDH’s process of collecting COVID-19 data is comprehensive and rigorous.

MDH researchers do “more than just look at the death certificate” when compiling COVID-19 death data, Smith said. They double check state records to make sure the person had a positive COVID-19 test and cross match the data with the death reports they get from health providers, long-term care facilities, hospitals, and other sources. 

Disaggregating this data, according to Smith, would require a “comprehensive process” and present “extensive challenges,” particularly in “data cleaning” and resolving issues with missing data.

“Right now, we currently do not have the staff capacity for such an effort,” Smith said.

‘If you’re not collecting it, how are you going to get the data out?’

The CAAL report issues a number of recommendations, chief among them for public agencies to ramp up data collection and prioritize disaggregating racial data to better understand how COVID-19 is affecting different communities.  

On the city level in St. Paul, Carter said disaggregating health data is something city leaders are looking into. Carter said his office has been having “ongoing conversations” with MDH about the importance of this process.. 

“We don’t always own the data to disaggregate at the local level, but to the extent that we do, it’s something that we’re exploring,” he said.

Ramsey County officials gave a similar explanation. Spokesperson Chris Burns said that Ramsey County Public Health has not independently confirmed the CAAL report numbers. But he added that they “have no reasons to question the methods or conclusions of the researchers.”

“We certainly are interested in working directly with the researchers to better understand the report methodology, data, and conclusions,” Burns wrote in an email. “We would want to take that step next if we were to consider policy changes based on this report.”

But the organizers behind the CAAL report say breaking out health data on Hmong, Karen, and other groups is essential. The problem also isn’t limited to COVID-19 death data.

KaYing Yang, for example, had to take pains to make sure her Hmong ethnicity was being properly recorded when she recently got a COVID-19 vaccine at a state-run vaccination site at the Minnesota State Fairgrounds. While registering for her vaccine over the phone, she told the person on the other end of the call to mark her as Hmong. The person had no trouble classifying KaYing as Asian, but reported that the registration system prevented her from recording anything more specific. 

“She said, ‘There’s no place for me to mark that,’” KaYing said. “I said, ‘Just figure out how to do it.’” 

KaYing added: “We want the vaccination data to be disaggregated, but if you’re not collecting it, how are you going to get that data out in the end?” 

What’s causing the high COVID-19 death rates in local Hmong, Karen, and Karenni populations?

Why are COVID-19 death rates higher in the Hmong, Karen, and Karenni communities? Looking for an answer to that question, researchers for the CAAL report made a “vulnerability analysis.”

One explanation: Data from the federal Centers for Disease and Control Prevention indicate that Hmong people have higher rates of diabetes and cancer compared to other Asian groups. When they contract COVID-19, some Hmong people may already have health vulnerabilities.

Another factor contributing to the high COVID-19 death rate in the Hmong population is the prevalence of multigenerational households. Quarantining sick family members to limit the spread of the virus is virtually impossible in this more crowded environment, said Tiffany Yang, a member of the Hmong Public Health Association’s policy and advocacy team.

“A lot of members of the Hmong and Karen communities also work in occupations where they are considered essential workers”—that is, trades like farming and machine operating, where employees can’t work from home—”which can increase their risk,” Tiffany Yang said.

Collecting data for specific ethnic groups would help many people in Minnesota, according to Tiffany Yang and KaYing Yang, director of programs and partnership at the Coalition of Asian American Leaders. The Black population, for instance, also lacks detailed medical data.

“If you look at other communities, they have a similar urgency, too,” KaYing Yang said.

Joey Peters

Joey Peters is a reporter for Sahan Journal. His work has appeared in Reuters, Public Radio International, Columbia Journalism Review, KFAI Radio, the Pioneer Press, City Pages, MinnPost and more. He previously...