Familias in accion presentation

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Familias in accion presentation

  1. 1. Hypertension among Hispanics Carlos J. Crespo, DrPH, FACSM Portland State University School of Community Health
  2. 2. Hypertension among Hispanics Carlos J. Crespo, FACSM Portland State UniversityMajor Points:1.  Heterogeneity of Blood Pressure Control in Hispanic Population.2.  Lifestyle and Environmental determinants of high blood pressure control among Hispanics.3.  Recommendations to eliminate disparities and improve hypertension control rates.
  3. 3. Population Implementation: and Clinical How do you do it? Approaches Intervention Evaluation: to Health What works? Risk Factor Identification: What is the cause? Surveillance: What is the problem?Problem Response
  4. 4. Race/Ethnicity in the US, per OMB•  Ethnicity: –  Hispanics-can be of any race•  Race: –  Whites –  Blacks –  Asian/Pacific Islanders –  American Indians or Native Alaskans
  5. 5. Who are Hispanics•  Mexican Americans•  Puerto Ricans – mainland and island•  Cuban Americans•  Other Caribbean – e.g., Dominican Rep,•  Central Americans•  South Americans•  Spain
  6. 6. Percent Distribution of Hispanics Subgroups Central Otherand South 6% American 15%Cuban 4%PuertoRican 9% Mexican 66%
  7. 7. Distribution of Hispanic Subgroups, 2006 Type of origin Number PercentTotal 44,252,278 100.0 Mexican 28,339,354 64.0 Puerto Rican* 3,987,947 9.0 Cuban 1,520,276 3.4 Dominican 1,217,225 2.8 Central American 3,372,090 7.6 South American 2,421,297 5.5 Other Hispanic 3,394,089 7.7
  8. 8. Population growth of Hispanics in US120 102.6100 87.6 80 73 59.7 60 47.8 40 35.3 22.4 20 9.6 14.6 0 1970 1980 1990 2000 2010* 2020* 2030* 2040* 2050*
  9. 9. Hispanics as Percent of US Population30 24.425 22.3 20.120 17.8 15.515 12.5 910 6.4 4.7 5 0 1970 1980 1990 2000 2010* 2020* 2030* 2040* 2050*
  10. 10. Non-Hispanic Hispanic age White Male Female 85+ Male Female 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 15 10 5 0 5 10 15 15 10 5 0 5 10 15Source: Current Population Survey, March 2000, PGP-4
  11. 11. Top Five States by Hispanic Population Size: 2006 PopulationRank State Size 1 California 13,074,156 2 Texas 8,385,139 3 Florida 3,646,499 4 New York 3,139,456 5 Illinois 1,886,933
  12. 12. Top Five County by Hispanic Population, 2006Rank County Population Size 1 Los Angeles County, CA 4,706,994 2 Harris County, TX 1,484,311 3 Miami-Dade County, FL 1,471,709 4 Cook County, IL 1,200,957 5 Maricopa County, AZ 1,129,556
  13. 13. The Latino Paradox in Los Angeles •  Los Angeles is the healthiest its been since the late 1990s. The countys death rate dropped 22 percent from 1998 to 2007. •  Latinos had fewer deaths than blacks - despite comparable levels of income and access to health insurance. They also enjoyed lower mortality rates than non-Hispanic whites. •  Life expectancy among Latinos is 84.4 years - four years longer than the county average.Source: Glenn Braunstein, MD Cedars-Sinai Medical CenterAccessed at www.Huffingtonpost.com on , Oct 4, 2010
  14. 14. Leading Causes of Death among Hispanics, 2004 Perinatal Influenza Lower Respiratory Homicide Liver and Cirrhosis Diabetes mellitus Stroke Accidents Neoplasm Heart Disease0 5 10 15 20 25
  15. 15. Figure 1. Heart disease death rates, 1996-2000. Hispanic ages 35years and older by county.
  16. 16. Death Rate due to Heart Disease by Race/ Ethnicity, 2006 Deaths per 100,000 population: 320.6 250.0 212.5 175.2 170.2 160.9 136.3 118.9 113.2 87.3 White, Hispanic African Asian and American White, Hispanic African Asian and American Non- American Pacific Indian/ Non- American Pacific Indian/ Hispanic Islander Alaska Hispanic Islander Alaska Native Native Men WomenNOTES: Rates are age-adjusted.DATA: Centers for Disease Control and Prevention/National Center for Health Statistics, National Vital Statistics System.SOURCE: Health US, 2009 Table 32.
  17. 17. Disparities, Inequalities or Inequities•  Health Disparities= as differences in the occurrence, frequency, death, and burden of diseases and other unfavorable health conditions that exist among specific population groups, including racial and ethnic minority groups.
  18. 18. Determinants of Health Disparities •  Natural, biological variation; Inequalities •  Freely chosen health damaging behavior; •  Transient health advantage of one over another (first adopters of health promoting behavior);   Health damaging behavior where the degree of lifestyle choices is severely Inequities restricted;   Exposure to unhealthy, stressful living and working conditions;   Inadequate access to essential health and other basic services;   Natural selection (health related mobility) Sick people have less social advancement
  19. 19. CHD mortality among Hispanic subgroups in the US, 1994 All races Hispanics Mexican Americans Puerto Ricans Cuban Americans 200 150 100 50 0 Total Men WomenSource: CDC/NCHS, Healthy People 2000 Hispanic Progress Review, 1997 (all States except Oklahoma).
  20. 20. Stroke mortality among Hispanic subgroupsin the US, 1994 All races Hispanics Mexican Americans Puerto Ricans Cuban Americans 40 30 20 10 0 Total Men Women
  21. 21. Diabetes-related mortality among Hispanicsubgroups in the US, 1994 All races Hispanics Mexican Americans Puerto Ricans Cuban Americans 80 60 40 20 0 Total Men Women
  22. 22. Age adjusted (per 100,000 pop) hypertension-related mortalityand percent change among US adults aged 25+ yrs, 1995-2002 1995 2002 180 160 -3.7 +46.1 140 +30.7 +26.5 120 100 -5.2 80 60 40 20 0 Mexican- Mainland Cuban- Other White, non- American Puerto Rican American Hispanics HispanicSource: CDC, MMWR, 2006; 55(07):177-80
  23. 23. Hispanic, Race and Hypertension •  Dark-skinned Puerto Rican men: Higher prevalence of left ventricular hypertrophy & higher systolic blood pressure than their light skinned counterparts •  Wide Pulse Pressure as an independent risk factor for CVD mortality in Puerto Rican Men.Sorlie P, Garcia Palmieri MR, et al.,1988, Am Heart J, 116:777-83Garcia Palmieri MR, Crespo et al., 2005, Nutr Met CVD, 15: 71-8
  24. 24. Risk Factors for Coronary Heart Disease Modifiable Non-modifiable •  High Blood Pressure •  Age •  Dyslipidemia •  Family history •  Tobacco smoke •  Sex •  Physical Inactivity •  Diabetes •  Obesity and overweight •  GFR<60mL/min •  MicroalbuminuriaSource: JNC VII
  25. 25. Hypertension
  26. 26. Blood Pressure Classification, JNC VII Blood Pressure SBP, DBP, Classification mmHg mmHgNormal < 120 <80Pre-hypertension 120-139 80-89Stage 1 Hypertension 140-159 90-99Stage 2 Hypertension 160+ 100+
  27. 27. Definitions •  Hypertension >=140/90 or currently taking medication to lower high blood pressure •  Undiagnosed hypertension: A finding of HBP but never told by health care provider that blood pressure was high •  Treatment: Taking Rx to lower blood pressure •  Controlled: BP<=140/90 •  Treated-uncontrolled: Taking Rx but BP>=140/90 •  Resistant hypertension: failure to achieve goal BP after full doses of 3-drug regimen, including diuretic •  Pulse Pressure = SBP-DBPSource: JNC VII
  28. 28. Age-adjusted Prevalence of Hypertensionamong US Adults 20+ yrs, NHANES 1999-2000 Black, Not 45 Hispanic 40 Mexican White, Not 35 American Hispanic 30Age-adjusted percent 25 20 15 10 5 0 Total
  29. 29. Age Adjusted Prevalence of Hypertension in US, NHANES 1999-2006 Prevalence, % 50 42.5 40 30.5 29.1 30 26.1 20 10 0 Total Non-Hispanic Non-Hispanic Mexican White Black AmericanSource: NCHS Data Brief, No. 26, April, 2010
  30. 30. Age Adjusted Prevalence of Controlled Hypertension in US Adults 18+ yrs, NHANES, 1999-2000 60 White, Not 40 Black, Not Hispanic HispanicAge-adjusted percent Mexican American 20 Total 0
  31. 31. Age Adjusted Prevalence of Taking Action to HelpControl Hypertension in US Adults 18+ yrs, NHIS, 1998 Asian or Black, Not 100 Pacific Islander Hispanic White, Not Hispanic Hispanic 80 Age-adjusted percent 60 40 20 0 Total
  32. 32. Percent of Adults 18+ yrs who Know if Blood Pressure is High or Low, NHIS, 1998 100 80Age-adjusted percent 60 40 20 Total 0
  33. 33. Environmental Determinants of High Blood Pressure
  34. 34. Lifestyle Approaches to Control Blood Pressure Lifestyle Range Modification Recommendation mmHg Weight reduction BMI=18.5-24.9 5-10/10kg Physical Activity 30 min/d 4-9 DASH eating plan F/V/low fat dairy 8-14 Sodium reduction <=2.4 g Na 2-8 Moderate alcohol 1-2 d/day (F/M) 2-4Source: JNC VII
  35. 35. Inadequate Blood Pressure Control   Failure to prescribe lifestyle modification   Inadequate antihypertensive drug doses   Inappropriate drug combinationSource: JNC VII
  36. 36. Triple Aims of Health Reform Improve Population HealthQuality Patient Care Contain Cost
  37. 37. Environmental Determinants of High Blood Pressure Lifestyle Impact on Modification Determinants Hispanics Weight reduction Positive energy balance ✔ Physical Activity Built environment ✔ DASH eating plan Access to quality foods ✔ Sodium reduction Market forces ✔ Moderate alcohol Market forces ✔Source: JNC VII
  38. 38. Health=the science of humanadaptation The Economist, 2004
  39. 39. Our Evolution...America, as a whole, has successfully achieved a high level of productivity, producing abundant food, effective medical treatment, and labor saving technology...
  40. 40. Our Problem...Yet, this success has produced unintended consequences that make it difficult for many individuals to maintain a healthy lifestyle
  41. 41. Leading Health Indicators for US•  Physical Activity •  Mental health•  Overweight/Obesity •  Injury and violence•  Tobacco use •  Environmental quality•  Substance abuse •  Immunization•  Responsible sexual •  Access to health care behaviorSource: Healthy People 2010 (467 objectives in 28 focus areas)
  42. 42. Our advancing environment 14
  43. 43. Leading Health Indicators for US•  Physical Activity •  Mental health•  Overweight/Obesity •  Injury and violence•  Tobacco use •  Environmental quality•  Substance abuse •  Immunization•  Responsible sexual •  Access to health care behavior Source: Healthy People 2010 (467 objectives in 28 focus areas)
  44. 44. Body Fat ↓ Activity of daily Mass ↓ Work-related living physical activity High Fat,energy dense ↑ Sedendary foods behavior EIn EOut Palatable, Large low-cost, Portioneasily available Sizes foods
  45. 45. Age-specific prevalence of obesityamong boys in the US, 1999-2000 Whites Blacks Mexican Americans 30 25 20 15 10 5 0 2-5 yrs 6-11 yrs 12-19 yrsSource: Ogden et al., JAMA, 288;1728-32. NHANES, 1999-2000
  46. 46. Age-specific prevalence of obesityamong girls in the US, 1999-2000 Whites Blacks Mexican Americans 30 25 20 15 10 5 0 2-5 yrs 6-11 yrs 12-19 yrsSource: Ogden et al., JAMA, 288;1732 NHANES 1999-2000,
  47. 47. Percent of 17-20 year old not eligible for military services due to excess body weight Non-Hispanic White Mexican American 60 50 Men Women 40 30 20 10 0 Army Navy Air Marines Army Navy Air Marines Force ForceSource: Nolte, Franckowiak, Crespo et al., Am J Med. 2002;114:486-90
  48. 48. Spending in fast-food restaurants per person $0 $100 $200 $300 $400 $500 $600 US Japan Britain Italy 1995 1999Germany France Spain
  49. 49. Change Isn’t Easy
  50. 50. Exposure Racismto toxins, segregation Intrauterineallergens,& effectsinfections Childhood poverty Cognitive Marriage stimulation Family functionCommunity Access todecline cognitive and health care emotional Peer development Access to effects social stress behavior networks Educational employment achievement • Adult Health poverty
  51. 51. Trends in Consumption of Five or More Servings ofVegetable and Fruit among US Adults 18+ yr 1994-2007 35 30 24.2 24.4 24.1 24.4 23.6 24.3 24.7 25 Prevalence (%) 20 15 10 5 0 1994 1996 1998 2000 2003 2005 2007 YearSource: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape (2000, 2003,2005, 2007), NCCDPHP, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2004, 2006, 2008.
  52. 52. Surgeon General’s Report on Physical Activity and Heath, 1996•  Major findings: –  People who are usually inactive can improve their health by becoming moderately active on a regular basis –  Physical activity need not be strenuous to achieve health benefits –  Greater health benefits can be achieved by increasing amount (duration, intensity or frequency) of physical activity
  53. 53. Physical Activity is today’s best buy in public health •  Reduces risk of dying prematurely •  Reduces risk of dying from heart disease (and stroke) •  Reduces risk of developing diabetes •  Reduces the risk of developing and lowering high blood pressure •  Reduces risk of developing certain cancers (colon, breast) •  Reduces feeling of depression and anxiety •  Helps control weight •  Helps build and maintain healthy bones, muscles and joints •  Help older adults become stronger and better able to move about without falling •  Promotes psychological well-being

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