Multi-ethnic Observational Study in American Asian and Pacific Islander Communities (MOSAAIC): Expanding Recruitment to Adults Aged 65 and Older

Project Summary Older adults of Asian American (AsA), Native Hawaiian, and Pacific Islander (NHPI) backgrounds represent one of the fastest growing demographics in the U.S. However, factors associated with healthy aging in these populations, including physical and cognitive function, as well as cardiometabolic diseases and other chronic conditions, remain poorly understood. This knowledge gap stems largely from their underrepresentation in biomedical research. To address this disparity and develop a more comprehensive understanding of health across the lifespan in AsA and NHPI populations, we propose expanding the Multiethnic Observational Study in American Asian and Pacific Islander Communities (MOSAAIC) cohort to include participants aged 65 and older. MOSAAIC is an NHLBI-funded newly established prospective cohort study, which will recruit 10,000 AsA-NHPI adults aged 18 to 64 from five U.S. Clinical/Community Field Centers (CCFCs) with the goal to study a wide range of health outcomes including cardiometabolic, pulmonary, and mental health conditions, and risk factors such as culture, indigeneity, diet, health behaviors, acculturation and social drivers of health (SDOH). MOSAAIC is currently in its pilot phase with a full-scale launch of participant recruitment planned for August 2025. This expansion is thus both timely and efficient. It will leverage MOSAAIC’s existing infrastructure for organization, data management, and biorepository capabilities, along with the scientific, statistical, and culture expertise of our exceptional team. Recruitment will draw upon our strong community partnerships and employ our culturally tailored data collection tools, which have been translated into five Asian- language versions and refined through extensive feasibility studies conducted earlier in 2024. The proposed expansion has three specific aims. Aim 1 is to expand the cohort by recruiting 1,500 participants aged 65 and older from East, Southeast, and South AsA, NH, and PI communities across the U.S. through five geographically diverse CCFCs. Aim 2 is to implement the MOSAAIC core protocol, which evaluates cardiometabolic and pulmonary outcomes, as well as SDOH and demographic, cultural, behavioral, and biological factors that may influence these outcomes. Aim 3 is to expand the assessment of aging-related health factors across multiple domains, including mobility, physical function, frailty, and cognitive health, focusing on cognitive decline and impairment and dementia. This proposed expansion will provide the resources to support comprehensive studies of aging and aging biology in AsA and NHPI populations, substantially increasing the scientific impact of the MOSAAIC cohort study. As part of the larger MOSAAIC cohort, it will also serve as a valuable resource and platform for future ancillary studies, using stored biospecimen and data to address emerging research questions beyond the scope of this application.