M A U R I C E D U G G I N S , M D

C L I N I C A L A S S I S T A N T P R O F E S S O R , K U S M - W

V I A C H R I S T I F A M I L Y M E D I C I N E R E S I D E N C Y P R O G R A M

AFRICAN AMERICAN HEALTH RISKS: What You Need to Know

US Mortality 2006

1. Heart Diseases 631,636 26.0

2. Cancer 559,888 23.1

3. Strokes 137,119 5.7

4. Chronic Lower Respiratory Diseases 124,583 5.1

5. Accidents (unintentional injuries) 121,599 5.0

6. Diabetes 72,449 3.0

7. Alzheimer Disease 72,432 3.0

8. Influenza & Pneumonia 56,326 2.3

9. Kidney Diseases 45,344 1.9

10. Septicemia 34,234 1.4

Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

Rank Cause of Death No. of deaths % of all deaths

10 Leading Causes of Death Among African-Americans

1. Heart Diseases

2. Cancer

3. Stroke

4. Accidents

5. Diabetes

6. Homicide

7. Kidney Diseases

8.Lower Respiratory Diseases

9. HIV/AIDS

10. Septicemia

African-Americans: Caucasians:

1. Heart Diseases2. Cancer3. Stroke4. Accidents5. Diabetes6. Homicide7. Kidney Disease8. Respiratory9. HIV/AIDS10. Septicemia

1. Heart Diseases2. Cancer3. Stroke4. Respiratory5. Accidents6. Alzheimer 7. Diabetes8. Influenza/Pneumonia9. Kidney Disease10. Suicide

HEALTH RISKS

#1 Heart Diseases

This includes diseases of the heart and diseases of the blood vessels

Heart AttacksConstriction or obstruction in the vessels that supply the heart

Peripheral Arterial Disease(PAD)Constriction or obstruction in vessels taking blood to extremities

Congenital Heart DiseaseHeart Diseases one is born with

Arrhythmias Abnormal rhythms or heart beats

#1 Heart Diseases

CARDIOMYOPATHYDecreased heart function due to diseases of the heart muscle

Hypertension (High Blood Pressure)The pressure in the blood vessels is above normal

#1 Heart Diseases

Hypertension (High Blood Pressure) affects African Americans at a much higher percentage rate than any other race.

Normal Blood Pressure: 120/80

Source: NCHS.

United States: 2010). Source: NHLBI.

177.1

73.7 76.6

39.2

0

40

80

120

160

200

Coronary HeartDisease

Stroke HypertensiveDisease

Heart Failure

Bil

lio

ns

of

Do

llar

sEstimated direct and indirect costs (in billions of dollars) of major heart diseases and stroke

. (ARIC Surveillance:1987-2004). Source: NHLBI.

02468

10121416

35-44 45-54 55-64 65-74

Per 1

,000

Per

sons

White Men Black Men White Women Black Women

Annual rate of first heart attack by age, sex and race

#1 Heart Diseases

RISK FACTORS:FAMILY HISTORY

Heart problem in a close family member : Parents, Siblings, etc.

OBESITYBody Mass Index >30 or Waist to Hip Ratio >1 for men Waist to Hip Ratio >.85 for women

INACTIVITYLess than 120-150 minutes of exercise weekly

#1 Heart Diseases

RISK FACTORS (continued) :DIABETES

Elevated blood sugar

HYPERTENSIONHigh Blood Pressure

DYSLIPIDEMIAHigh CHOLESTEROL, High TRIGYLCERIDES, High LDL or Low HDL

Source: D’Agostino et al., Circulation. 2008;117:743-753.

A B C DAge 50-54 50-54 50-54 50-54HDL Cholesterol, mg/dL 45-49 45-49 35-34 35-34Total Cholesterol (mg/dL) 160-199 200-239 200-239 200-239Systolic BP mm/Hg, no treat. 120-129 130-139 130-139 130-139 Smoker No No No YesDiabetes No No Yes Yesmm Hg = millimeters of mercury. mg/dL = milligrams per deciliter of blood

7.911.2

21.6

4.57.3

30+

15.9

24.8

0

5

10

15

20

25

30

35

A B C D

Estim

ated

10-

Year

Rat

e%

MenWomen

#1 Heart Diseases

#1 Heart Diseases

RESPONSE:

D.I.E.T.

Determine the changes needed

Increase Physical Activity

Educate self on your diagnosis and know your family history

Treatment: Start and don’t stop without your doctor’s permission.

Life Expectancy 2006

What do you think is the life expectancy for white men compared to black

men?

Life Expectancy 2006

White men - 76 years

Black men - 70 years

#2 CANCER

Leading Causes of Cancer Deaths:

o Lung Cancer

o Colorectal Cancer

o Prostate Cancer (men)

o Breast Cancer (women)

Estimated US Cancer Deaths 2009

ONS=Other nervous system.Source: American Cancer Society, 2009.

Men292,540

Women269,800

26% Lung & bronchus

15% Breast

9% Colon & rectum

6% Pancreas

5% Ovary

4% Non-Hodgkinlymphoma

3% Leukemia

3% Uterine corpus

2% Liver & intrahepaticbile duct

2% Brain/ONS

25% All other sites

Lung & bronchus 30%

Prostate 9%

Colon & rectum 9%

Pancreas 6%

Leukemia 4%

Liver & intrahepatic 4%bile duct

Esophagus 4%

Urinary bladder 3%

Non-Hodgkin 3%

Kidney & renal pelvis 3%

All other sites 25%

Cancer Incidence Rates* by Race and Ethnicity, 2001-2005

*Age-adjusted to the 2000 US standard population.†Person of Hispanic origin may be of any race.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2008.

551.4

354.0 336.6

423.6 398.9

287.8 296.4 317.8

651.5

419.4

0

100

200

300

400

500

600

700

800

White African American Asian/Pacific Islander American Indian/Alaska Native

Hispanic†

Men Women

Rate Per 100,000

Cancer Death Rates* by Race and Ethnicity, US, 2001-2005

230.7

138.8

190.0159.2

186.7

95.6

142.0

105.2

313.0

159.0

0

50

100

150

200

250

300

350

400

White AfricanAmerican

Asian/PacificIslander

AmericanIndian/ Alaskan

Native

Hispanic†

Men Women

*Per 100,000, age-adjusted to the 2000 US standard population.† Persons of Hispanic origin may be of any race.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2008.

Cancer Sites in Women for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005

All sites 186.7 159.2 1.2Stomach 5.5 2.5 2.2Myeloma 6.0 2.8 2.1Uterine cervix 4.7 2.3 2.0Esophagus 2.8 1.6 1.8Uterine corpus 7.1 3.9 1.8Colon and rectum 22.4 15.3 1.5Pancreas 12.4 9.0 1.4Breast 33.5 24.4 1.4

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

Site BLACK White Ratio of African American/White

Cancer Sites in Men for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005

All sites 313.0 230.7 1.4

Prostate 59.4 24.6 2.4Larynx 4.8 2.1 2.3Stomach 11.5 5.0 2.3Myeloma 8.3 4.3 1.9Oral cavity and pharynx 6.7 3.8 1.8Colon and rectum 31.8 22.1 1.4Lung and bronchus 93.1 71.3 1.3Pancreas 15.4 12.1 1.3

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2008.

Site Black WhiteRatio of African American/White

#2 CANCER

Progress: Cancer death rates have declined

The cancer death rate for African American men is 45% higher than that of white men

The cancer death rate for African American women is 22% higher than that of white women.

#2 CANCER

RISK Factors:Family History

BRAC 1and 2 genes

Excessive Sun ExposureYes, African Americans can get sunburns and skin cancer

ObesityPancreatic

Breast

Smoking

#2 CANCER

RESPONSE Screening

Stay Fit/ Lose Weight

Avoid Fatalism (Whatever will be will be.)

Healthy Diet

Screening Guidelines for the Early Detection of Breast Cancer

Yearly mammograms are recommended starting at age 40.

A clinical breast exam(CBE):every 3 years for women in their 20s and 30s. Annually for women aged 40 and older

Women should know how their breasts normally feel and report any breast changes promptly to their health care providers.

__________* Beginning at age 40 years, annual CBE should be performed prior to mammography

American Cancer Society

Screening Guidelines for the Early Detection of Cervical Cancer

Screening (PAP): Three (3) years after a Female begins having vaginal intercourse, but no later than 21 years of age.Screening should be done every year with regular Pap tests or every two years using liquid-based tests. –ASK your doctor.At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years with cervical cytology alone, or every 3 years with a human papillomavirus DNA test plus cervical cytology.Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.

American Cancer Society

Screening Guidelines for the Early Detection of Prostate Cancer

Beginning at age 50, health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men and offer the PSA blood test and the digital rectal examination.*

The AUA Foundation believes that the decision to screen is one that a man should make with his doctor following a careful discussion of the benefits and risks of screening. In men who wish to be screened, the AUA recommends getting a baseline PSA, along with a physical exam of the prostate known as a digital rectal exam (DRE) at age 40.

.

American Cancer Society and American Urological Association

Screening Guidelines for the Early Detection of Colorectal Cancer and Adenomas

Beginning at age 50, Men and Women should follow one of the following examination schedules:A flexible sigmoidoscopy (FSIG) every five yearsA colonoscopy every ten(10) yearsA double-contrast barium enema every five(5) yearsA Computerized Tomographic (CT) colonography every five yearsA guaiac-based fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) every yearA stool DNA test (interval uncertain)

Tests that detect adenomatous polyps and cancerTests that primarily detect cancer

People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule

American Cancer Society

Life Expectancy 2006

What do you think is the life expectancy for white

women compared to black women?

Life Expectancy 2006

White women - 81 years

Black women - 76.9 years

#3 STROKE

What is a stroke?Interruption of blood flow to any area of the BRAIN

Hemorrhagic• Rupture of blood vessel in the Brain

Ischemic• Blockage of the blood flow by clot

SIGNSSudden numbness or weakness of the face, arm, or leg.Sudden confusion or trouble speaking or understanding others.Sudden trouble seeing in one or both eyes.Sudden dizziness, trouble walking, loss of balance, or coordination.Sudden severe headache with no known cause.

#3 STROKE

RISKS:HIGH BLOOD PRESSURE

DIABETES

OBESITY

HEART DISEASES

ALCOHOL

HIGH CHOLESTEROL

SICKLE CELL ANEMIA

FAMILY HISTORY

(NHANES: 2003-2006). Source: NCHS and NHLBI.

0.3 1.0

7.4

0.62.7

7.5

12.615.4

02468

1012141618

20-39 40-59 60-79 80+

Per

cent

of P

opul

atio

n

Men Women

Prevalence of STROKE by Age and Sex

#3 STROKE

RESPONSE:QUIT SMOKING

INCREASE PHYSICAL ACTIVITY

KNOW YOUR RISK FACTORS

#4&6 ACCIDENTS & HOMICIDES

ACCIDENTALFalls

Motor Vehicle

Poisonings

Firearms

Child/Domestic/Elderly Abuse

HOMICIDESNUMBER ONE REASON FOR DEATH AMONG YOUNG MALES

#4&6 ACCIDENTS & HOMICIDES

RISKSPOVERTY

LOW EDUCATION LEVEL

VIOLENT ENVIRONMENT

RESPONSEPREVENTION

EDUCATION

IMPROVING ECONOMIC DISPOSITION

ANGER MANAGEMENT

#5 DIABETES

DEFINITION:

HIGH BLOOD SUGAR

NORMAL LEVELS: 80 TO 100

TYPES:

TYPE #1 -10%

THE BODY IS NOT PRODUCING INSULIN

TYPE#2 – 90%

THE BODY PRODUCES THE INSULIN BUT IT NOT GETTING INTO THE CELLS WHERE IT IS NEEDED

#5 Diabetes

DIAGNOSIS:

Fasting Blood Sugar 126 or greater

Random Blood Sugar 200 or greater.

A1C of 6.5 percent or greater

#5 DIABETES

Source: NCHS and NHLBI. NH – non-Hispanic.

6.4 6.4

12.8 13.011.8

13.1

0

2

4

6

8

10

12

14

Men Women

Per

cent

of P

opul

atio

n

NH Whites NH Blacks Mexican Americans

Prevalence of physician-diagnosed diabetes in Adults age 20 and older by race/ethnicity and sex (NHANES: 2003-2006).

#5 DIABETES

RISKS FACTORS:

OBESITY

INACTIVITY

FAMILY HISTORY

DIABETES IN PREGNANCY

#5 DIABETES

RESPONSE:LIFE LONG ACTIVITY

KEEP WEIGHT UNDER CONTROL

REDUCE REFINED SUGAR INTAKECOMPLEX CORBOHYDRATES

FIBER

STICK WITH TREATMENT AND MONITOR BLOOD SUGARS REGULARLY

#7 KIDNEY DISEASES

Nephritis

Nephrotic syndrome

Nephrosis

#7 KIDNEY DISEASES

RISKSHIGH BLOOD PRESSURE

DIABETES

ANEMIA

RESPONSECONTROL BLOOD PRESSURE

AVOID OR CONTROL DIABETES

DONATE BLOOD

# 8 RESPIRATORY

This refers to conditions affecting the Lung

COPD-Chronic Obstructive Lung DiseaseEmphysema

The soft tissue s of the lungs are damaged

Chronic Bronchitis/AsthmaThe tubes of the lungs are inflamed or constricted

# 8 RESPIRATORY

RISK Factors:Smoking

Second-hand Smoke

Asthma

Recurrent Lung Infections

Exposure to Toxins

# 8 RESPIRATORY

RESPONSE:Don’t start smoking

Quit smoking

Help your partner or other household members quit smoking

Avoid toxins:Wear Masks, Use filters –whenever possible.

Get regular AEROBIC Exercise (Physical Activity)

#9 HIV/AIDS

HIVINFECTION with HUMAN IMMUNODEFICIENCY VIRUS that leads to development of ACQUIRED IMMUNODEFICIENCY DISEASE SYNDROME (AIDS).

In 2006 there were an estimated 1.1 million people living with HIV infection, of which almost half (46%) were African American

Blacks accounted for 51% of the new HIV/AIDS diagnoses in 34 states when we add in the CHILDREN affected

#9 HIV/AIDS

African Americans with AIDS often don’t live as long as people of other races and ethnic groups with AIDS

AIDS is now the leading cause of death for African American women ages 25-34.

Twenty-five percent of HIV/AIDS patients are women, but African American women are over 21 times more likely to die from HIV/AIDS than Caucasian women.

#9 HIV/AIDS

GIRLS 13-19

In 2001 they represented 72% of the new HIV diagnoses among females in this age group

#9 HIV/AIDS

RISKSUNPROTECTED INTERCOURSE

POVERTY

DRUG USEALCOHOL, MARIJUANA, COCAINE, METH., …ETC

MISEDUCATION

STEREOTYPES

One can tell what an HIV infected person looks likes

MYTHS

If you are not “doing it” there is something wrong with you.

#9 HIV/AIDS

THEBODY.COM

#9 THE MANY FACES OF HIV/AIDS

Aavip.org

#9 HIV/AIDS

RESPONSE: ABCsA: ABSTINENCE until ready for a committed relationship

B: BE FAITHFUL to one partner

C: use a CONDOM

D: Don’t do DRUGS

E: Educate YOURSELF/OTHERS about HIV/AIDS EPIDEMIC

#10 SEPTICEMIA

When there is an infection in any part of the body and it also present in the blood stream- it’s called septicemia

#10 SEPTICEMIA

Septicemia: Infection in the blood Signs

Fever, high heart rate, feeling of weakness, low blood pressures, chills

RISKSMost people are unaware of ongoing infection

Kidney, bladder, and lungs are common sources

RESPONSEGet treated for infections right away.If on treatment and not getting better, Alert your DoctorHospitalization