Filipino American Cardiovascular Health Presented to NYU PostGraduate

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Filipino American Cardiovascular Health Presented to: NYU Post-Graduate Medical School UP Medical Alumni Society

Filipino American Cardiovascular Health Presented to: NYU Post-Graduate Medical School UP Medical Alumni Society in America Presented by: Luceli C. Cuasay, Dr. PH, MPH Summit, July 8 -9, 2011 1

Largest Asian American Ethnic Groups Census 2000 and Census 2010 Race Alone 2

Largest Asian American Ethnic Groups Census 2000 and Census 2010 Race Alone 2

Filipino Population in U. S. Texas 2000 a 2006 b 2009 b Change 2000

Filipino Population in U. S. Texas 2000 a 2006 b 2009 b Change 2000 -2009 2, 364, 815 2, 915, 745 3, 177, 947 813, 132 34. 4% 75, 226 116, 773 128, 870 53, 644 71. 3% Rapidly increasing Filipino population has significant implications. a U. S. Census 2000 b American Community Survey Estimates Data for Filipino alone or in any race combination (97. 6% one race) 3

Educational Attainment by Race/Ethnicity ACS 2006 1 or more race(s) 4

Educational Attainment by Race/Ethnicity ACS 2006 1 or more race(s) 4

Median Household Income by Race/Ethnicity ACS 2006 1 or more race(s) 5

Median Household Income by Race/Ethnicity ACS 2006 1 or more race(s) 5

Filipino Occupation and Industry Census 2000 ACS 2009 Texas U. S. Management, professional or

Filipino Occupation and Industry Census 2000 ACS 2009 Texas U. S. Management, professional or related occupations 50% 38% 56% 41% Educational, health and social services industries 42% 29% 45% 33% Filipinos have favorable socioeconomic profile. Ages 16 and over 6

Unemployment Rate by Race/Ethnicity ACS 2006 1 or more race(s) 7

Unemployment Rate by Race/Ethnicity ACS 2006 1 or more race(s) 7

Poverty Rate by Race/Ethnicity ACS 2006 1 or more race(s) 8

Poverty Rate by Race/Ethnicity ACS 2006 1 or more race(s) 8

Filipino Population in U. S. n 47. 1% Male n 52. 9% Female n

Filipino Population in U. S. n 47. 1% Male n 52. 9% Female n 12. 4% Age 18 -24 n 12. 5% Age 65+ n 62. 9% Married n 64. 1% Family size 4+ n 68. 5% Foreign-born n 72. 9% ≥ 10 yrs in U. S. NHIS, 2004 -2006 9

FA Health Care Access & Utilization n 87. 4% has usual place for health

FA Health Care Access & Utilization n 87. 4% has usual place for health care n 12. 2% has no usual place n Type of place for health care • • 82. 3% 14. 3% 1. 8% 1. 1% Doctor’s office Clinic or health center Hospital ER or outpatient dept. Not one place most often n 3. 4% delayed medical care due to cost n 2. 2% did not receive medical care due to cost NHIS, 2004 -2006 10

FA Health Issues n n At high risk for hypertension, coronary artery disease, diabetes,

FA Health Issues n n At high risk for hypertension, coronary artery disease, diabetes, other metabolic disorders Leading causes of death: • • • n n n Heart disease Cancer Stroke 2 nd highest rate of hypertension of all APIs Highest TB cases among Asian immigrants; 2 nd of all immigrant groups High prevalence of HIV 11

FA Health Status/Behaviors n 33. 0% Overweight n 14. 1% Obese n 37. 0%

FA Health Status/Behaviors n 33. 0% Overweight n 14. 1% Obese n 37. 0% Inactive n 34. 7% Engaged in some activity n 9. 8% n 50. 7% Current drinker (8. 7% mod/heavy) n 16. 6% Former smoker n 13. 9% Current smoker NHIS, 2004 -2006 Former drinker 12

Smoking in Asian Subgroups NHIS 2004 -2006 13

Smoking in Asian Subgroups NHIS 2004 -2006 13

Smoking and Alcohol Consumption n n FA has 2 nd highest rate of former

Smoking and Alcohol Consumption n n FA has 2 nd highest rate of former and current smokers (31%), next to Koreans (35%) FA has 2 nd highest rate of former and current alcohol drinkers (61%), next to Japanese (68%) NHIS, 2004 -2006 14

FA: Obesity, CVD & Diabetes n n Most likely to be obese as compared

FA: Obesity, CVD & Diabetes n n Most likely to be obese as compared to other Asian groups Obesity prevalence (14%) - more than twice as likely to be obese as Asian Indian (6%), Vietnamese (5%), or Chinese (4%) Most likely to have ever been told they had hypertension (27%) Most likely to have ever been told they had diabetes (9%) or heart disease (7%), next to Asian Indians. NHIS, 2004 -2006 15

FA: CVD & Diabetes n Diabetes and CHD in Filipino-American women (Langenberg) • Significant

FA: CVD & Diabetes n Diabetes and CHD in Filipino-American women (Langenberg) • Significant predictors of high prevalence (31. 4%) of CHD n n socioeconomic disadvantage family history of diabetes larger waist San Diego Filipino Women’s Health Study (Araneta) • CVD prevalence = 20. 7%; 85. 5% newly diagnosed • Filipinas with CVD vs. without CVD n n n more antihypertensive medication use more family history of MI higher proinsulin levels lower adiponectin levels higher prevalence of metabolic syndrome and microalbuminuria 16

Type 2 Diabetes among Filipino Americans in Houston MSA STUDY OBJECTIVES n n To

Type 2 Diabetes among Filipino Americans in Houston MSA STUDY OBJECTIVES n n To determine the prevalence of previously diagnosed type 2 diabetes To determine the major risk factors Cuasay LC, et al, 2001 17

RESEARCH DESIGN & METHODS Cross-sectional survey FA in Houston MSA, September 1998 - March

RESEARCH DESIGN & METHODS Cross-sectional survey FA in Houston MSA, September 1998 - March 2000 Sample Population 831 survey respondents: • Of Filipino origin or ancestry • Ages 20 -74 years • Residents of Harris, Brazoria, Fort Bend, Liberty, Montgomery, Waller, and Galveston counties Survey Questionnaire • English • Tagalog 18

Table 1. Demographic characteristics of Filipino-Americans, ages 20 -74 years. Houston MSA. 19

Table 1. Demographic characteristics of Filipino-Americans, ages 20 -74 years. Houston MSA. 19

Table 2. Medical history of Filipino-Americans, ages 20 -74 years. Houston MSA. 20

Table 2. Medical history of Filipino-Americans, ages 20 -74 years. Houston MSA. 20

Table 3. Dietary practices of Filipino-Americans, ages 20 -74 years. Houston MSA. 21

Table 3. Dietary practices of Filipino-Americans, ages 20 -74 years. Houston MSA. 21

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Overall prevalence: 16. 1 (95 CI: 13. 5 -18. 7) 24

Overall prevalence: 16. 1 (95 CI: 13. 5 -18. 7) 24

STUDY RESULTS § Age- and sex-adjusted prevalence of previously diagnosed type 2 diabetes: 16.

STUDY RESULTS § Age- and sex-adjusted prevalence of previously diagnosed type 2 diabetes: 16. 1% § Major risk factors identified were: • older age [OR=5. 6 - 34. 2] [ • male sex [OR=1. 8] • family history [OR=4. 7] • obesity [OR=3. 6] • gestational diabetes [OR=21. 7] • low income in women [OR=5. 3] • region of birth [OR 3. 2] Cuasay LC, et al, 2001 25

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STUDY CONCLUSIONS n n n High prevalence of type 2 diabetes was observed; supports

STUDY CONCLUSIONS n n n High prevalence of type 2 diabetes was observed; supports earlier studies that FA are at higher risk. Both FA and US population surveys revealed: older age, obesity, and family history of diabetes to be associated with type 2 diabetes. FA diabetic population was less obese, yet, had a high frequency of hypertension. Survey data suggest an inverse association between acculturation and type 2 diabetes. Effect of acculturation on diabetes risk stresses importance of prevention and control strategies. Cuasay LC, et al, 2001 29

STUDY CONCLUSIONS n n n FA diabetic population had higher % of persons with

STUDY CONCLUSIONS n n n FA diabetic population had higher % of persons with parental history of diabetes, medical history of hypertension, and history of smoking − compared with U. S. diabetic population. “Westernization”, accompanied by decreased physical activity and changes in dietary pattern towards a less healthy diet − likely to increase risk for obesity and type 2 diabetes. Rapidly growing FA population, with high diabetes prevalence, will require increased diabetes-related health care and preventive services. Cuasay LC, et al, 2001 30

Filipino Americans An Invisible Minority n Large population, with very limited data on health

Filipino Americans An Invisible Minority n Large population, with very limited data on health needs n Major health issues persist in spite of: • having a favorable socioeconomic status, • large percentage employed in health care industry, • being English proficient — characteristics associated with improved health access and health status. 31

Filipino Health Needs Assessment (Fil. HNA) n n n Collect information on health status,

Filipino Health Needs Assessment (Fil. HNA) n n n Collect information on health status, health behaviors and beliefs, health care access, and utilization of Filipinos (≥ 18 years) residing in Brazoria, Fort Bend, Galveston, and Harris counties. Major emphasis on cancer, diabetes, circulatory and respiratory conditions, and mental health issues. Improve understanding of health and cancer concerns, so that educational programs and interventions can be developed to help meet the Filipino community’s needs. 32

Fil. HNA Project n n Qualitative study: study Conduct focus group interviews of key

Fil. HNA Project n n Qualitative study: study Conduct focus group interviews of key community groups (ages 18‑ 55 and >55 years). • physicians • nurses • allied health professionals • non-professionals Quantitative study: study Conduct health needs assessment survey of representative sample of Filipinos in four target counties. 33

References 1. 2. 3. 4. 5. 6. 7. Cuasay LC, et al. Prevalence and

References 1. 2. 3. 4. 5. 6. 7. Cuasay LC, et al. Prevalence and determinants of Type 2 diabetes among Filipino-Americans in the Houston, Texas Metropolitan Statistical Area. Diabetes Care 2001: 24: 2054 -2058. Barnes PM, Adams PF, Powell-Griner E. Health Characteristics of the Asian adult population: United States, 2004 -2006. Adv Data 2008; 394: 1 -22. Klatsky AL, Tekawa I, Armstrong MA. Cardiovascular risk factors among Asian Americans. Public Health Rep 1996; 111(Suppl 2): 62 -4. Ryan C, Shaw R, et al. Coronary heart disease in Filipino and Filipino American patients: prevalence of risk factors and outcomes of treatment. J Invasive Cardiol. 2000; 12(3): 134 -139. Stavig G, Igra A, Leonard A. Hypertension and related health issues among Asians and Pacific Islanders in California. Public Health Reports. 1988; 103, 28 -37. Langenberg C, Rosario M, et al. Diabetes and Coronary Heart Disease in Filipino-American Women: Role of growth and life course socioeconomic factors. Diabetes Care 2007; 30; 535 -541. Araneta MR, Wingard DL, Barrett-Connor E. Type 2 diabetes and metabolic syndrome in Filipina-American women: A high risk non-obese population. Diabetes Care 2002; 25(3): 494 -499. 34

QUESTIONS? Luceli C. Cuasay, Dr. PH, MPH lucelicuasay@westat. com 5615 Kirby Drive, Suite 710

QUESTIONS? Luceli C. Cuasay, Dr. PH, MPH [email protected] com 5615 Kirby Drive, Suite 710 Houston, TX 77005 35

Survey Questionnaire • English, English adapted from National Health and Nutrition Examination Survey (NHANES),

Survey Questionnaire • English, English adapted from National Health and Nutrition Examination Survey (NHANES), Hispanic Health and Nutrition Examination Survey (HHANES) & National Health Interview Survey (NHIS) questionnaires • Tagalog, Tagalog produced by back-and-forth translation 36

RISK FACTORS – DEFINITIONS Age Sex Family history of diabetes: diabetes Having a parent

RISK FACTORS – DEFINITIONS Age Sex Family history of diabetes: diabetes Having a parent or a sibling who had been diagnosed with diabetes. History of gestational diabetes: diabetes A “yes” response to the question, “Have you ever been told by a physician that you had diabetes when you were pregnant? ” Overall obesity: Self-reported body mass index (BMI) > 30 kg/m 2. Physical activity: activity Person engaged in any exercise, sports, or physically active hobbies for at least 20 minutes: physically active, 4 times a week; moderately active, 1 -3 times a week; and sedentary, < 1 time a week or no activity. 37

RISK FACTORS – DEFINITIONS Educational attainment and household income: Surrogate items for socioeconomic status

RISK FACTORS – DEFINITIONS Educational attainment and household income: Surrogate items for socioeconomic status Respondent’s birthplace (Philippines): n Manila, the country’s capital n One of 3 major regions: • Luzon (north) • Visayas (central) • Mindanao (south) 38

RISK FACTORS – DEFINITIONS Acculturation level: level A six-item acculturation score equal to the

RISK FACTORS – DEFINITIONS Acculturation level: level A six-item acculturation score equal to the arithmetic mean of the codes of six data items. • 1 st four items represented language ability and preference in speaking, reading, and writing • 5 th item generation • 6 th item food preference 1=strongest Filipino orientation 5=strongest American orientation 3=equally Filipino and American orientation Based on scores, respondents were classified into 3 acculturation levels: high, middle, and low 39