How To Get A Better Health Care Package For A Black Person

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Incidence of Type 2 Diabetes in Hispanics as Compared

to the General Population in Massachusetts

By Isabelle Pierre Krystal Amaral,

and Ardrianna Howard,

2014 SEP Participants 1

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TYPE 2 DIABETES MELLITUS

Definition:

● A metabolic disease in which the body’s inability to properly use insulin causes elevated levels of glucose in the blood

● Contrary to type 1 diabetes mellitus where the body is unable to produce insulin

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WHAT IS A HEALTH DISPARITY?

The NIH defines a health disparity as:

“The differences in the incidence, prevalence, mortality, and burden of disease and other adverse health

conditions that exist among specific population groups compared to a larger group.”

Health disparities limit continued improvement in overall quality of care and population health and result in unnecessary costs.

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Hispanic Population in Massachusetts

The Massachusetts population is 8%

Hispanic

CDC National Center for Health, 2013

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Black 6.21%

American Indian 0.20%

White 80.38%

Asian

5.01% Hispanic 8.21%

Black American Indian White Asian Hispanic

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Hispanic vs. General Population

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1.6 times more likely to have diabetes than Non-Hispanic Whites

1.5 times more likely to die from diabetes compared to Non-Hispanic Whites

0 2 4 6 8 10 12 14 16

1990 1992 1994 1996 1998 2000 2002 2004 2006

Prevalence (%)

Year

Prevalence of Diabetes: 1990-2007

Hispanic White Black

Source data: Massachusetts BRFSS

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Leading Causes

Diabetes is the 4th leading cause of death in Hispanics

● Genetics

● Inequalities in Income and Education

● Lifestyle Patterns

● Access and Quality of Healthcare

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Genetics

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• Mutations of one gene increase the risks for developing Type 2 diabetes

• SLC16A11 variation accounts for about 20 percent of Hispanics' increased risk of Type 2 diabetes

Strong link to family history and lineage

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Lifestyle Patterns

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2011 BRFSS

Routine Doctor Visits

o Hispanic adults less likely to have visited doctor in the last year (78.6% versus 85.7%) than Non-Hispanic

White adults

o Less likely to have early detection Diet and Nutrition

o Higher prevalence of poor diet Obesity and Overweight

o Hispanic adults are 50% more likely to be obese than Non-Hispanic Whites.

o 2010 MA Department of Public Health

Family History

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49% of Hispanic students spend three or more hours watching TV

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daily compared to 46% of Black students and 27% of Non-Hispanic White students

2007 MA Youth Risk Behavior Survey

Physical Activity

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Percentage

Year

Physical Activity in the Past Month

Hispanic Black White

Source data: Massachusetts BRFSS

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Inequalities in Income and Education

● 43% of Hispanics in Massachusetts do not complete high school compared to 13%

of Non- Hispanic Whites

● 44% Hispanics reported receiving diabetes education compared to 59% of Whites

● Individuals with less income and less education have higher rates of diabetes .

Source: US Census Bureau, American Community Survey 3- Year Estimates, 2005-2007

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7%

22%

15%

29%

20%

10%

0%

5%

10%

15%

20%

25%

30%

35%

White Black Asian Hispanic AI/AN Massachusetts

Percentage Below Poverty (%)

Race

Individuals in Massachusetts Under 100% Poverty

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Access and Quality of Healthcare

2011 MA FRBSS

Uninsured Hispanic adults dropped from 19% to 11% following health care reform

Three times as many uninsured Hispanic adult residents compared to Non- Hispanic Whites.

20% of Hispanic adults without a personal health care provider

2010 MA Department of Public Health

0%

11

10%

20%

30%

40%

50%

60%

70%

2001 2002 2003 2004 2005 2006 2007 2008

Percent

Year

Adults Without Personal Health Care Provider

Hispanic Massachusetts White

Source: MDPH BRFSS 2001-2008

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Current News: Project REACH

Project is based in the Greater Lawrence Family Health Center Goals:

Work to raise awareness of diabetes and its complications in the Hispanic population of Massachusetts.

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Racial and Ethnic Approaches to Community Health

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The Lawrence Latino Diabetes Prevention Project (LLDPP)

Collaboration with UMass Lowell and UMass Medical School Goals:

Inexpensive, culturally sensitive intervention program to

improve the incidence of diabetes in the Latino population of Lawrence.

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The Lawrence Latino Diabetes Prevention Project (LLDPP)

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0 10 20 30 40 50 60 70 80

Percentage (%)

Diabetes Care for Latino Residents Treated at the Greater Lawrence Family Health Center

2001 2007

Source: REACH Latino Health Project

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Narrowing The Gap

Preventative Care

Recognizing the symptoms

Self- Management

Less-costly alternative

Nutrition Education

Better dietary choices

Active Living

Increased insulin sensitivity

Decrease total calories to lose weight

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Culturally tailored interventions

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Conclusion

• Incidence of Type 2 Diabetes is higher in Hispanics than in the general population

• Socioeconomic factors contribute to disparity

• Awareness campaigns such as Project REACH help raise awareness and lower the prevalence of diabetes within high risk communities

“together we can put an end to diabetes” 16

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Questions?

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References

1. Ockene I. S., Tellez T. L., Rosal, M. C. ,Reed, G. W., Mordes J., Merriam, P. A., Olendzki,B. C., Handelman, G., Nicolosi, R., and Ma, Y. 2012. Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence Latino Diabetes Prevention Project. American Journal of Public Health

2. Rosal M. C., Ockene I. S., Restrepo A. , White M. J., Borg A., Olendzki B., Scavron J., Candib L., Welch G., and Reed G. 2011.

Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos. Diabetes Care 34:838-844

3. Welch G., Allen N. A, Zagarins S. E., Stamp K. D, Bursell S-E. and Kedziora R. J. 2011. Comprehensive Diabetes Management Program for Poorly Controlled Hispanic Type 2 Patients at a Community Health Center. The Diabetes Educator

35(7):680-688

4. Bhargava A., Wartak S. A, Friderici J and Rothberg M.B. 2014. The Impact of Hispanic Ethnicity on Knowledge and Behavior Among Patients With Diabetes. The Diabetes Educator 40(3):336-343

5. Welch G, Schwartz C, Santiago-Kelly P. 2001. Diabetes- related Emotional Distress of Hispanic and Non- Hispanic Type Two Diabetes Patients. Ethnicity & Disease. 17:541-547

6. Massachusetts Department of Public Health. Health of Massachusetts. Boston, MA; April 2010.

7. Connor, A., Baumgartner, R., Baumgartner K., et al. 2012. Associations between TCF7L2 polymorphisms and risk of breast cancer among Hispanic and non-Hispanic White women: the Breast Cancer Health Disparities Study. Breast Cancer Res

Treat 136(2):593-602

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