Aetna Presentation Latino Health Overview

Latinos in the U.S. and Northeast Florida: A Health Overview

Dr. Judith C. Rodriguez, RD, University of North FloridaMr. Daniel Santibanez, MPH Candidate, University of North FloridaMr. 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.

National, state, and local health data

Action Models and InitiativesDiscussion

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

04/09/23 4

Hispanics/Latinos…and Health

• Many disease risk factors can be decreased

• Need culturally appropriate information and approaches

04/09/23 http://www.cdc.gov/nchs/faststats/deaths.htm

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

Hispanic Health Issues

• Heart disease

• Diabetes

• Overweight and obesity

• Cancer

• Environmental health

• Other health issues

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)

Selected Death Rates by Race/Ethnicity, Duval County

0

20

40

60

80

100

120

140

160

180

Heart Disease Cancer Injury

Hispanic

White, Non-Hispanic

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)

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


• Percent of total deaths28% of male deaths34% of female deaths

• For MA: about 29% for men about 27% of womenAmerican Heart Association (2004) Heart Facts 2004: Latino/ Hispanic Americans & AHA

2001 Heart & Stroke Statistics; AHA Hispanics and CVD


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


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

Health Issues - Hypertension

1976-80 1988-94

• Both sexes, age adj 39.0 23.1

• Males, age adj 44.025.3

• White male, age adj 43.5 24.3

• Black male, age adj 48.7 34.9

• Mexican male, age adj 25.025.2

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/

http://www.nationaldiarycouncil.org/

Discussion

• What are your experiences related to Hispanics and CVD in the NE Florida area?

Health Issues - Diabetes

• About one third of total diabetes among Hispanic Americans is undiagnosed (NHANES III; www.niddk.nih.gov)

04/09/23 Flegal KM, et al. Diabetes Care 18

Health Issues - DiabetesPrevalence of diagnosed and undiagnosed diabetes in Mexican Americans,

U.S., 1988-94

Note: fasting plasma glucose of 126 mg/dL or greater.

04/09/23 Harris et al, Diabetes Care, 1998; Health Issues in the Latino Community, 2001.

19

Health Issues - Diabetes

0%

5%

10%

15%

20%

25%

Diabetes Impaired FastingGlucose

MexicanAmericans

All Races

Based on 1997 American Diabetes Association criteria

% o

f p

op

ula

tion

20%

12%

10%

12%

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/

http://www.health.gov/healthlypeople/

Discussion

•What are your experiences related to Hispanics and diabetes in the NE Florida area?

Health, US 2004 Table 69

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


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 Female38.0 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

04/09/23 Healthy People 2010 24


• Latinos: higher prevalence than the general population

• Obesity is prevalent among Hispanics, especially women (Dairy Council Digest, Jan/Feb 2001; www.nationaldairycouncil.org)

http://www.nationaldairycouncil.org/

Mokdad, AH et al JAMA, Oct/99 v282 i16 p1519


Among U.S. Groups: Hispanics had the most growth

in prevalence of obesity

Hispanic ethnicity

11.6% to 20.8% 1991-1999


• 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



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. Females15.3 17.1

Discussion

•What are your experiences related to Hispanics and overweight or obesity in the NE Florida area?

04/09/23 AHA 2001 Heart & Stroke Statistics; AHA Hispanics and CVD

30

Health Issues - Physical Activity

0%

10%

20%

30%

40%

50%

60%

70%

No LeisurePhysical Activity

Overweight Obese

Hispanic Males Hispanic Females

White Males White Females

50%57%65%

58%

25%36%

(Mex. American)

% o

f P

op

ula

tion

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 male399.5

White female418.2

Black female378.4

Hispanic female294.3

Health Issues - Environmental health

http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm

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?

Other health issues• Mental Health

• HIV/AIDS

• Osteoporosis

• Lactose intolerance

• Food safety

• Health care access

Mental Health

• Substance abuse

• Acculturation and self identity

• Coping strategies


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

Where?

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04/09/23 Faulkner K. Am Soc Bone & Min Rsch. 1998. 23(5 Supp):S474 (NORA)

38

Health Issues - Osteoporosis

• Minority women are at a higher risk of developing osteoporosis than previously believed

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)

http://www.nclr.org/policy/health.html

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

http://www.nationaldairycouncil.org/

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

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/

http://www.nationaldiarycouncil.org/


• 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%

Health US 2004, Table 6


Prenatal care for live births

Group % of live birthsAll 83.7Hispanic/Latino 76.7Mexican 75.7Puerto Rican 79.9Cuban 92.0Central and South American 78.7Other/Unknown 76.7

Health US 2004, Table 6


Infant, neonatal, and postneonatal mortality rates

Group % of live birthsAll 7.0Hispanic/Latino 5.6Mexican 5.4Puerto Rican 8.2Cuban 3.7Central and South American 5.1Other/Unknown 7.1

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

All Races Hispanic White Black

Num. Rate Num. Rate Num. Rate Num. Rate

7,133 7.2 1,033 4.7 4,119 5.6 2,916 12.8

Other health issues - Infant Mortality Region IV, 1997-2001

12.4425.61065.814Volusia

17.5116.1330.00St.John’s

13.245.4180.00Nassau

7.426.4100.00Flagler

16.43397.12666.216Duval

14.0117.5607.23Clay

8.726.190.00Baker

RateNum.RateNum.RateNum.

BlackWhite HispanicArea

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

Discussion

•What do you think contributes to the differences in infant mortality among the different Hispanic groups?

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

Other health issues - Duval County

(Mr. Radley Remo, DCHD)

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)

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)

2002 Florida Behavioral Risk Factor Surveillance System

• Statewide Self-Reporting Survey

• Used to monitor health behavior & health status

• 18 years & older

Behavioral Risk Factors for Hispanics

• Risk Factors

– Overweight & Obese

– Physical Activity

– Smoking

– Health Care Coverage & Access

Risk Factors by Race/Ethnicity, Florida 2002

13.640.1 (-)No Health Care Coverage

23.921.1Smoking (current)

22.539.2 (-)No Physical Activity

21.420.8Obese

% White, Non-Hispanic

% HispanicRisk Factor

Red indicates statistically significant

Behavioral Risk Factor for Hispanics

• Disease Prevention– Annual Flu Shot

– Mammograms & Pap Tests

– Colorectal Cancer Screenings• Blood Stool Test

– HIV/AIDS Tests

Disease Prevention by Race/Ethnicity, Florida 2002

44.253.0 (+)Ever been tested for HIV

48.831.4 (-)Ever had Blood Stool Test

93.588.8Ever had Pap Smear Test

29.914.2 (-)Received Flu Shot w/I 12mo.

% White, Non-Hispanic% HispanicDisease Prevention

Red indicates statistically significant (R.Remo DCHD)

Behavioral Risk Factors for Hispanics

• Chronic Conditions

– High Blood Pressure

– Cholesterol

– Asthma

– Diabetes

Chronic Conditions by Race/Ethnicity, Florida 2002

8.08.2Have Diabetes

11.111.4Ever Had Asthma

37.730.5Had High Cholesterol

28.720.2 (+)Had High Blood Pressure

% White, Non-Hispanic

% HispanicChronic Condition

Red indicates statistically significant (R.Remo DCHD)

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?

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

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

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/

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/


• Salud para su Corazón Who? NCLR Institute for Hispanic Health National Heart,

Lung and Blood Institute (NHLBI) of the NIHFocus? Multilevel strategies outreach model which provides

heart health education. Relies on promotores de salud (lay health educators) who disseminate educational and prevention awareness materials.



• Comunidad a ComunidadWho? 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.


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/

Examples of Action Models and Initiatives - Government

• Healthfinder

http://www.healthfinder.gov/news/esdefault.asp

• Centers for Disease Control

http://www.cdc.gov/spanish/

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 Councilhttp://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

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.

Health & Medicine

Aetna Presentation Latino Health Overview