Aetna Presentation Latino Health Overview

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    Aetna Presentation Latino Health Overview - Presentation Transcript

    1. Latinos in the U.S. and Northeast Florida: A Health Overview Dr. Judith C. Rodriguez, RD, University of North Florida Mr. Daniel Santibanez, MPH Candidate, University of North Florida Mr. Radley Remo, (Duval County Health Department) - Health Data Feb. 25, 2005 This is part 1 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.
    2. National, state, and local health data Action Models and Initiatives Discussion
    3. National Health Data
      • Why?
      • Health status affects quality of life
      • Poor health is costly for the individual
      • Poor health status is costly for the nation
    4. Hispanics/Latinos…and Health
      • Many disease risk factors can be decreased
      • Need culturally appropriate information and approaches
    5. Leading Causes of Death – Overall, U.S., 2002
      • heart disease: 696,947
      • cancer: 557,271
      • stroke: 162,672
      • chronic lower respiratory disease: 124,816
      • accidents: 106,742
      • diabetes: 73,249
      • pneumonia/flu: 65,681
      • Alzheimer’s disease: 58,866
      • kidney disease: 40,974
      • suicide: 33,865
    6. Hispanic Health Issues
      • Heart disease
      • Diabetes
      • Overweight and obesity
      • Cancer
      • Environmental health
      • Other health issues
    7. Leading Causes of Death for Hispanics, Duval County 2001-03
      • Heart Disease (n= 71)
      • Cancer (n=57)
      • Injuries (Accidents) (n=27)
      Source: FDOH, Office of Vital Statistics, 2001-2003 (R.Remo DCHD)
    8. Selected Death Rates by Race/Ethnicity, Duval County Source: FDOH, Office of Vital Statistics, 2001-2003 Source Hispanic Population Estimates: Claritas 2003 Source Duval County Population Estimates: Demographic Estimating Conference Database, 4/2004 (R.Remo DCHD)
    9. Health Issues - Cardiovascular Disease
      • For Hispanics, too, heart disease the primary cause of mortality/death
      • Heart disease and stroke mortality average about 30% or more each year
    10. Health Issues - Cardiovascular Disease
      • Percent of total deaths
        • 28% of male deaths
        • 34% of female deaths
      • For MA:
      • about 29% for men
      • about 27% of women
      • American Heart Association (2004) Heart Facts 2004: Latino/ Hispanic Americans & AHA 2001 Heart & Stroke Statistics; AHA Hispanics and CVD
    11. Health Issues - Cardiovascular Disease
      • Death Rates for CVD
      • 1980 1990 1995-97
      • All ages, age adjusted 40.8 27.7 26.3
      • Males, age adj 44.9 30.2 28.4
      • White males, age adj 41.9 27.7 26.1
      • Black males, age adj 77.5 56.1 50.5
      • Hispanic males, age adj ---- 22.7 22.4
    12. Health Issues - Cardiovascular Disease
      • Serum Cholesterol
      • 1988-94 1988-94
      • Both sexes 203 203
      • Males 202 Females 204
      • White male 202 White f 205
      • Black male 199 Black f 203
      • Mexican male 204 Mex f 203
    13.  
    14. Health Issues - Hypertension
      • 1976-80 1988-94
      • Both sexes, age adj 39.0 23.1
      • Males, age adj 44.0 25.3
      • White male, age adj 43.5 24.3
      • Black male, age adj 48.7 34.9
      • Mexican male, age adj 25.0 25.2
    15. Healthy People 2010 Goals
      • 12-Heart Disease and Stroke
        • 12-1 Reduce coronary heart disease deaths
        • Baseline- 208 deaths per 100,000
        • Hispanics-145 deaths per 100,000
      • 12-11 Increase the proportion of adults with high blood pressure who are taking action to help control their blood pressure
        • Baseline- 82% of adults aged 18+
        • Hispanics- 74% of adults aged 18+
      • 12-15 Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years
        • Baseline- 67% of adults aged 18+
        • Hispanics- 59% of adults aged 18+
        • Healthy People 2010; www.health.gov/healthlypeople/
    16. Discussion
      • What are your experiences related to Hispanics and CVD in the NE Florida area?
    17. Health Issues - Diabetes
      • About one third of total diabetes among Hispanic Americans is undiagnosed (NHANES III; www.niddk.nih.gov)
    18. Health Issues - Diabetes
    19. Health Issues - Diabetes Based on 1997 American Diabetes Association criteria % of population 20% 12% 10% 12%
    20. Healthy People 2010 Goals
      • 5-2 Prevent Diabetes
        • Baseline- 3.5 new cases of diabetes per 1,000
        • Hispanics- 5.7 new cases of diabetes per 1,000
      • 5-5 Reduce the diabetes death rate
        • Baseline- 75 deaths per 100,000
        • Hispanics-86 deaths per 100,000
        • Healthy People 2010; www.health.gov/healthlypeople/
    21. Discussion
      • What are your experiences related to Hispanics and diabetes in the NE Florida area?
    22. Health Issues - Overweight and Obesity
      • Healthy wt Overwt Obesity Overwt*
      • Both sexes 41.7 54.6 22.6 65.2
      • Males 39.1 59.4 19.9 68.8
      • White Male 38.0 60.5 20.3 69.5
      • Black Male 40.2 57.0 20.9 62.0
      • Mexican Male 31.6 67.0 23.1 74.1
    23. Health Issues - Overweight and Obesity
      • Healthy wt Overwt Obesity Overwt*
      • Both sexes 41.7 54.6 22.6 65.2
      • Females 39.1 59.4 19.9 68.8
      • White Female 38.0 60.5 20.3 57.0
      • Black Female 40.2 57.0 20.9 77.5
      • Mex. Female 31.6 67.0 23.1 71.4
    24. Health Issues - Overweight and Obesity
      • Latinos: higher prevalence than the general population
      • Obesity is prevalent among Hispanics, especially women (Dairy Council Digest, Jan/Feb 2001; www.nationaldairycouncil.org )
    25. Health Issues - Overweight and Obesity
      • Among U.S. Groups: Hispanics had the most growth in prevalence of obesity
      • Hispanic ethnicity
      • 11.6% to 20.8% 1991-1999
    26. Health Issues - Overweight and Obesity
      • Mexican-American children ages 6-11 were more likely to be overweight (22 percent) than non-Hispanic black children (20 percent) and non-Hispanic white children (14 percent).
      • http://www.cdc.gov/nchs/pressroom/04facts/obesity.htm
    27.  
    28. Health Issues - Overweight and Obesity
      • Overweight Children*
      • 1988-1994 1999-2002
      • Both sexes 11.3 15.8
      • Males 11.6 16.9
      • Mex. Males 17.5 26.5
      • Female 11.0 14.7
      • Mex. Females 15.3 17.1
    29. Discussion
      • What are your experiences related to Hispanics and overweight or obesity in the NE Florida area?
    30. Health Issues - Physical Activity 50% 57% 65% 58% 25% 36% (Mex. American) % of Population
    31. Health Issues - Cancer
      • Cancer incidence rates, age adjusted, per 100,000, all sites
      • All persons 457.1
      • White male 542.2
      • Black male 642.9
      • Hispanic male 399.5
      • White female 418.2
      • Black female 378.4
      • Hispanic female 294.3
    32. Health Issues - Environmental health http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm
    33. Discussion
      • The Hispanic population is scattered throughout the area with little or no data collected beyond some basis census and health information, and even those figures are incomplete, controversial, or questionable.
      • What measures should be taken to better assess the situation? Whose responsibility should it become (i.e., Health Dept. or City)?
      • What can your agency or program do?
    34. Other health issues
      • Mental Health
      • HIV/AIDS
      • Osteoporosis
      • Lactose intolerance
      • Food safety
      • Health care access
    35. Mental Health
      • Substance abuse
      • Acculturation and self identity
      • Coping strategies
    36. Other health issues - HIV/AIDS
      • HIV/AIDS per 100,000 pop.
      • Group, all ages/ adjusted Death rates Cases
      • White male 4.3 13.6
      • Black male 33.3 109.2
      • Hispanic male 9.1 37.2
      • White female 0.9 2.2
      • Black female 13.4 49.0
      • Hispanic female 2.6 11.3
    37. Where? There are 9 characters in this picture
    38. Health Issues - Osteoporosis
      • Minority women are at a higher risk of developing osteoporosis than previously believed
    39. Health Issues - Osteoporosis
      • 55.5% of Hispanic, postmenopausal, women have low bone mineral densities and in 4.3% of these women, osteoporosis was identified (Diary council Digest, Jan/Feb 2001; www.nationaldiarycouncil.org )
    40. Health Issues - Lactose Intolerance
      • Lactose maldigestion occurs in about 53% Mexican Americans (Dairy Council Digest, Jan/Feb 2001; www.nationaldairycouncil.org )
      • Prevalence among minority groups is not clear
    41. Health Issues - Food Safety
      • Listeriosis occurs at higher prevalence rate among Latinos than in overall population
      • Hispanic infants had a 12 times greater incidence
      • Hispanic women age 30 to 34 had a 13 times greater incidence
      • http://www.fsis.usda.gov/OA/educator/educator7-2.pdf
    42. Health Issues - Maternal and Child Care
      • 6-Maternal, Infant, and Child Health
      • 16-6 Increase the proportion of pregnant women who receive early and adequate prenatal care
      • Baseline-
        • a. Care beginning in the first trimester; 83% of live birth
        • b. Early and adequate prenatal care; 74% of live births
      • Hispanics-
        • a. 74% of live births
        • b. 66% of live births
      • Healthy People 2010; www.health.gov/healthlypeople/
    43. Health Issues - Maternal and Child Care
      • 6-Maternal, Infant, and Child Health
      • 16-10 Reduce low birth weight and very low birth weight
      • Baseline-
        • a. Low birth weight; 7.6%
        • b. Very low birth weight; 1.4%
      • Hispanics-
        • a. Low birth weight; 6.4%
        • b. Very low birth weight; 1.1%
    44. Health Issues - Maternal and Child Care
      • Prenatal care for live births
      • Group % of live births
      • All 83.7
      • Hispanic/Latino 76.7
      • Mexican 75.7
      • Puerto Rican 79.9
      • Cuban 92.0
      • Central and South American 78.7
      • Other/Unknown 76.7
    45. Health Issues - Maternal and Child Care
      • Infant, neonatal, and postneonatal mortality rates
      • Group % of live births
      • All 7.0
      • Hispanic/Latino 5.6
      • Mexican 5.4
      • Puerto Rican 8.2
      • Cuban 3.7
      • Central and South American 5.1
      • Other/Unknown 7.1
    46. Other health issues - Infant Mortality, Florida: 1997-2001 Note: Five year average number of deaths and death rates per 1,000 live births. Infant deaths by Hispanic mother of origin, rate per 1,000 live births. Source: Florida Department of Health, Office of Vital Statistics, 1997-2001 and Florida Department of Health, Office of Planning, Evaluation and Data Analysis and Health Planning Council of N.E. Fla., Health Plan 2003-2006 12.8 2,916 5.6 4,119 4.7 1,033 7.2 7,133 Rate Num. Rate Num. Rate Num. Rate Num. Black White Hispanic All Races
    47. Other health issues - Infant Mortality Region IV, 1997-2001 Note: Five year average number of deaths and death rates per 1,000 live births. Source: Florida Department of Health, Office of Vital Statistics, 1997-2001 and Florida Department of Health, Office of Planning, Evaluation and Data Analysis and Health Planning Council of N.E. Fla., Health Plan 2003-2006 12.4 42 5.6 106 5.8 14 Volusia 17.5 11 6.1 33 0.0 0 St.John’s 13.2 4 5.4 18 0.0 0 Nassau 7.4 2 6.4 10 0.0 0 Flagler 16.4 339 7.1 266 6.2 16 Duval 14.0 11 7.5 60 7.2 3 Clay 8.7 2 6.1 9 0.0 0 Baker Rate Num. Rate Num. Rate Num. Black White Hispanic Area
    48. Discussion
      • What do you think contributes to the differences in infant mortality among the different Hispanic groups?
    49. Other health issues - Health care access
      • 44.3 million persons lacked health insurance in 1998 (CDC)
      • This represents a continuing increase in the number of uninsured persons (CDC)
      • Latinos (35%) are more likely to report being without health insurance
      • Hispanic vs. Latino Survey by comScore Dec 2002
      • http://www.ahorre.com/archives/2004/09/hispanic_vs_lat_1.html
    50.  
    51. Other health issues - Duval County (Mr. Radley Remo, DCHD)
    52. Leading Causes of Hospitalization for Hispanics, Duval County 2003
      • Single, live born, w/o cesarean (n=274)
      • Single, live born cesarean (n=107)
      • Pneumonia (n=48)
    53. Leading Causes of Ambulatory Care for Hispanics, Duval County 2003
      • Benign neoplasm of the colon (n=71)
      • Colon screening (n=41)
      • Unspecified cataract (n=40)
    54. 2002 Florida Behavioral Risk Factor Surveillance System
      • Statewide Self-Reporting Survey
      • Used to monitor health behavior & health status
      • 18 years & older
    55. Behavioral Risk Factors for Hispanics
      • Risk Factors
        • Overweight & Obese
        • Physical Activity
        • Smoking
        • Health Care Coverage & Access
    56. Risk Factors by Race/Ethnicity, Florida 2002 Red indicates statistically significant 13.6 40.1 (-) No Health Care Coverage 23.9 21.1 Smoking (current) 22.5 39.2 (-) No Physical Activity 21.4 20.8 Obese % White, Non-Hispanic % Hispanic Risk Factor
    57. Behavioral Risk Factor for Hispanics
      • Disease Prevention
        • Annual Flu Shot
        • Mammograms & Pap Tests
        • Colorectal Cancer Screenings
          • Blood Stool Test
        • HIV/AIDS Tests
    58. Disease Prevention by Race/Ethnicity, Florida 2002 Red indicates statistically significant (R.Remo DCHD) 44.2 53.0 (+) Ever been tested for HIV 48.8 31.4 (-) Ever had Blood Stool Test 93.5 88.8 Ever had Pap Smear Test 29.9 14.2 (-) Received Flu Shot w/I 12mo. % White, Non-Hispanic % Hispanic Disease Prevention
    59. Behavioral Risk Factors for Hispanics
      • Chronic Conditions
        • High Blood Pressure
        • Cholesterol
        • Asthma
        • Diabetes
    60. Chronic Conditions by Race/Ethnicity, Florida 2002 Red indicates statistically significant (R.Remo DCHD) 8.0 8.2 Have Diabetes 11.1 11.4 Ever Had Asthma 37.7 30.5 Had High Cholesterol 28.7 20.2 (+) Had High Blood Pressure % White, Non-Hispanic % Hispanic Chronic Condition
    61. Discussion
      • With the lack of sufficient specific ethnic data available at the regional and local level, what changes seem appropriate?
      • Knowing the wide range of intragroup diversity, is it appropriate to consider and document acculturation and SES among Hispanics?
    62. Examples of Action Models and Initiatives - Research
      • Hispanic/Latino Genetics Community Consultation Network HLGCCN project is a combined effort of Redes En Acción (Networks in Action), which is a major Special Populations Network effort of the NCI, Baylor College of Medicine, the National Institute of General Medical Sciences (NIGMS), and the National Human Genome Research Institute (NHGRI).
      • http://newscenter.cancer.gov/newscenter/pressreleases/HLGCCN
    63. Examples of Action Models and Initiatives - Health Orgs
      • American Diabetes Association
      • Programa de Asistencia y Recursos para la Diabetes
      • Diabetes Forecast en Español
      • http://www.diabetes.org/espanol/iniciativas-latinas-dar.jsp
    64. Examples of Action Models and Initiatives - Cultural Orgs
      • National Council of La Raza
      • Latino Cancer Education Pilot Project (LCEPP)
      • Salud para su Corazón
      • Comunidad a Comunidad
      • De Casa a Casa: A Diabetes Educational Tool Kit Project
      • http://www.nclr.org/content/programs/detail/27610/
    65. National Council of La Raza
      • Latino Cancer Education Pilot Project (LCEPP)
      • Who? NCLR Institute for Hispanic Health National Cancer Institute (NCI), Office of Minority Health and NIH
      • Focus? Identify knowledge, attitudes, and beliefs and barriers to cervical screening, make recommendations for refinement of materials
      • http://www.nclr.org/content/programs/detail/27610/
    66. National Council of La Raza
      • Salud para su Corazón
      • Who? NCLR Institute for Hispanic Health National Heart, Lung and Blood Institute (NHLBI) of the NIH
      • Focus? Multilevel strategies outreach model which provides heart health education. Relies on promotores de salud (lay health educators) who disseminate educational and prevention awareness materials.
      • http://www.nclr.org/content/programs/detail/27610/
    67. National Council of La Raza
      • Comunidad a Comunidad
      • Who? NCLR Institute for Hispanic Health and Centers for Disease Control and Prevention
      • Focus? Sharing lessons learned and building capacities of parents of youth and community-based organizations (CBOs) to develop culturally competent HIV/AIDS prevention programs.
      • http://www.nclr.org/content/programs/detail/27610/
    68. Examples of Action Models and Initiatives - Industry
      • AARP En Español
      • http://www.aarp.org/espanol/salud/
      • Spanish language web pages with information
      • http://www.elcerdoesbueno.com/
    69. Examples of Action Models and Initiatives - Government
      • Healthfinder
      • http://www.healthfinder.gov/news/esdefault.asp
      • Centers for Disease Control
      • http://www.cdc.gov/spanish/
    70. Discussion
      • Do you know of any special programs, projects, or resources in NE Florida?
      • What are some specific actions we can take to promote health in the Hispanic community?
      • CDC Interactive Heart Disease Mortality Maps
        • http://www.cdc.gov/cvh/maps/statemaps.htm
      • CDC Interactive Cancer Mortality Maps
        • http://www3.cancer.gov/atlasplus/charts.html
      • Florida Department of Health
        • http://www.doh.state.fl.us/
      • Florida Health Charts and Interactive Maps
        • http://www.floridacharts.com/charts/chart.aspx
      • Duval County Health Department
        • http://www.dchd.net/index.htm
      • City of Jacksonville Community Maps
        • http://www.coj.net/default.htm
      Resources: Data Web Sites
      • Extension - Spanish language materials http://www.extensionenespanol.net/contact.cfm
      • National Alliance for Hispanic Health www.hispanichealth.org
      • National Council of La Raza Institute for Hispanic Health www.nclr.org/policy/health.html
      • National Dairy Council
      • http://www.nationaldairycouncil.org/
      • Office of Minority Health http://www.omhrc.gov/omhrc
      • USDA Food and Nutrition Information Center, Ethnic and Cultural www.nal.usda.gov/fnic/etext/000010.html
      Resources: Web Sites
      • For Health Professionals
      • Health Issues in the Latino Community . By M. Aguirre-Molina, C. Molina, R. E. Zambrana. 2001.
      • Latina Health in the United States . By M. Aguirre-Molina, C. Molina. 2003.
      • Hispanic foodways, nutrition, and health . By Diva Sanjur. 1995.
      • The Health of Latino Communities in the South: Challenges and Opportunities.  Available at:
      • http://www.nclr.org/content/publications/detail/26898/
      Resources: Books
    71. Thank you! Any questions? This seminar is part 1 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Dept. For more information or register for the seminars, please call 620-1289 .
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