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Que Sera? Sera? Elizabeth Lee-Rey, MD Luz Towns-Miranda, PhD Hispanic Center of Excellence Albert Einstein College of Medicine Que Sera? Sera? OBJECTIVES To obtain an overview of demographic representation of Latinos nationally and locally in NYC and the Bronx. To gain knowledge regarding key health issues facing Latinos/as. Que Sera? Sera? OBJECTIVES To increase awareness regarding significant parameters that impact the health care of Latinos. To gain greater understanding of the differences that distinguish the predominant Latino groups in the Bronx. Name all 11 countries in South America. Peru Brazil Ecuador Uruguay Bolivia Paraguay Chile Argentina Colombia Venezuela the Guyana Name all 8 countries in Central America. Panama Costa Rica Guatemala Nicaragua Salvador Honduras Belize What are the 3 countries of Hispanic origin found in the Caribbean? Cuba Dominican Republic Puerto Rico What are some of the barriers to health care for Hispanics? Poverty Less education Unemployment rates Poor access to adequate health care Discrimination Socioeconomic status Lack of health insurance $100 Tortillas are a staple food of which ethnic group? a) Puerto Ricans b) Mexicans c) Salvadorians d) Dominicans $200 The largest ethnic parade held in NYC is celebrated by which Latino group? a) Mexicans b) Dominicans c) Cubans d) Puerto Ricans $300 Mangu is a breakfast food for which Latino group? a) Mexicans b) Cubans c) Puerto Ricans d) Dominicans $500 Which group is less likely to have a regular physician? a) Asian Seniors b) Hispanic Male Adolescents c) African American Newborns d) Middle-age Women Minority Boys Are Less Likely to Have a Regular Physician 30 Percent of boys with no regular MD 25 20 Total White Black Hispanic 15 10 5 0 The Commonwealth Fund Survey of the Health of Adolescent Girls, 1997 Louis Harris and Associates, Inc $1000 Who was the first female Puerto Rican Congresswoman? a) Iris Chacon b) Nydia Velazquez c) Marife Hernandez d) Celia Cruz Who was the first NYC Dominican Councilman? a) Guillermo Linares b) Victor Marisete c) Adriano Espaillat d) Tito Puente $2000 What percentage of Latino babies are born into poverty? a) 50% b) 66% c) 75% d) 40% What percentage of Latino Babies are born into poverty? Percent of NYC Women Below the Poverty Line 70 58 60 PR Almost 2/3 of all DR 50 40 59 ¾ of Latino babies are born into poverty Total 35 40 Latino children live below the poverty line 73% of Hispanic children are living in “distressed neighborhoods.” Mex 30 20 10 0 Source:NYC Depart of Planning-1990 Census Presented by NYC Mayor's Off of Health Service SSSSS $4,000 Hispanic women make up what percentage of the total NYC female population? a) 29% b) 33% c) 45% d) 50% Hispanic women make up what percentage of the total NYC female population? Median Age of Women in NYC 41 39 37 35 33 31 29 27 25 40 35.2 White Black Hispanic Total 31.8 29.6 Source:NYC Depart of Planning Presentation by NYC Major’s Off of Health Service Latinas represent 29% of the total female population in NYC Latinas comprise approx. 51% of the Hispanic pop in NYC Their median age is lower than for all other racial and ethnic groups $6000 Latinas nationally are how likely to have diabetes as compared to the general population a) As likely b) Less likely c) Twice as likely d) Three times as likely Latinas and Diabetes While NYC statistics are not available be ethnicity, data from neighborhoods where Hispanics comprise more than 60% of the population indicate that the incidence of DM hospitalizations far exceeds the average. Latinas nationally are twice as likely as the general population to have diabetes. The average incidence of DM hospitalizations in NYC is 7.4 per 1000. In Bushwich, where the Hispanic population is 67%, the rate is 20.8 per 1000. Presentation by the NYC Mayor’s Office of Health Services $8,000 Latina’s biggest cancer risk is a) Colon b) Lung c) Breast d) Cervical Cancer Facts Latinas are somewhat under-represented in the total cancer statistics. This may due to the relatively younger age of Latinas Latina’s biggest cancer risk is Breast Cancer. As a whole, the rate of Latina deaths due to Breast Ca is 1.7 per 100,000. This compares to less than .5 for all other forms of cancer to the reproductive health organs. Presented by the NYC Mayor’s Office of Health Services $16,000 The leading cause of death for Hispanic females from birth to 49 is a) Cancer b) Heart Disease c) AIDS d) Diabetes The leading cause of death for Hispanic Males age 1 to 59 is a) Homicide b) Heart Disease c) AIDS d) Cancer The Leading Cause of Death for Hispanics in NYC In NYC, according to 1995 data, AIDS was the leading cause of death for Hispanic males from ages 1 yr old to 59 yrs old. It was the leading cause of death for Hispanic females from birth to 49 yrs old. Source: The seventh Annual Hispanic Federation Annual Survey Hispanic New Yorkers on Nueva York Report 4:Latinos and HIV/AIDS $32,000 Who are the Uninsured? a) Live in families with incomes higher than the federal poverty level. b) Poor, unemployed and belong to a racial ethnic group. c) Seniors over the age of 65. d) Children. Who Are The Uninsured? Many Americans stereotype the uninsured as poor, unemployed, and minorities. While these groups run a greater risk, they do not represent the majority of Americans without health coverage. Who Are The Uninsured? In fact, most of the 44 million uninsured Americans: live in families with incomes higher than federal poverty level. Are from working families with at least one full time worker. Are adults under the age of 65. Work in medium size/large businesses with more than 25 employees. Are not from America’s racial and ethnic minority groups. $64,000 What is the distribution of the Hispanic nonelderly uninsured when compared by race and ethnicity? a) 50% b) 25% c) 5% d) 17% The Nonelderly Uninsured, by Race/Ethnicity, 1998 5% 17% 1% 25% 52% 44 MILLION Source:Urban Institute,1999 Data:Current Population Survey, March 1999 Black Native American Hispanic White Asian/S.Pac.Islander $125,000 Which group is at most risk of being uninsured? a) White (non-Hispanic) b) Black c) Native American d) Hispanic Uninsured Adults by Race and Hispanic Origin, 1996 Am er ica n an ic As ia n H isp Bl ac k W hi te 50 40 30 20 10 0 To ta l Percent of Adults-18-64 ys Which group is at most risk of being uninsured? SOURCE: Hall, Collins, and Glied, 1999 The Commonwealth Fund Collins, Hall, and Neuhaus, U.S. Minority Health: A Chart Book, 1999 White Black Hispanic Asian American Total $250,000 Which Hispanic group report the worst health status and the highest incidence of acute medical conditions? a) Colombians b) Ecuadorians c) Puerto Ricans d) Mexicans Which Hispanic group report the worst health status and the highest incidence of acute medical conditions ? Total Latinos Poverty Status By Proportion Of Subgroup Population Mexican Percent 30 22.8 25 20 24.1 25.8 Puerto Rican 23.6 17.3 Cuban 16.7 15 7.7 10 Central/South American Other Latino 5 0 Source:Therrien & Ramirez 2000 The Hispanic population in the US:3/2000 US Bureau of Census for Labor Statistics 3/99 Non-Latino $500,000 When was the category Hispanics first included in national data systems such as US census and birth/death certificates? a) 5 years ago b) In the last 2 decades c) Never an issue d) 100 years ago What is the projected growth of the Hispanic population of the US population within the next 50 years? a) Nearly 25% b) Half c) No growth anticipated d) Not significant Projected Resident Population by Race and Ethnicity of US 2001- 2050 1990 2000 2005 2010 2030 2050 11.8 12.2 12.3 12.6 13.1 13.6 AFRICAN AMERICAN 9 HISPANIC 11.4 13.3 13.8 18.9 24.5 White 52.8 % 0 60.5 71.8 69.3 68 25 Source: Day,J.C. 1996 Population projection for the US by age,sex,race,and Hispanic origin:1995-2050 Source Data for 2005:Population projections program, US census 75.6 80 $1,000,000 Which group has had the most emerging presence in US population? a) Central and South America b) Puerto Rican c) Mexican d) Cuban Characteristics of the Hispanic Population in the US,2000 National Origin Percent of all Hispanic Percent Arriving US 1990Present Distribution of Citizenship US Born Naturalized Noncitizen All Hispanics 100.0% 19.3% 60.8% 9.8% 29.4% Mexican 66.4 18.8 62.0 7.5 30.5 Central/ South American 14.6 31.3 32.3 19.1 48.6 8.9 9.6 100.0 NA NA 4.0 18.5 36.5 34.4 29.1 Puerto Rican Cuban Source:Project HOPE Center for Health Affairs-Dec 2000 Current Population Survey Emerging Latino Populations The Latino population is by all accounts growing dramatically and in the year 2000 became the country’s largest “minority” group. Immigration from the Caribbean and South America is making significant contributions to the growth of the Latino population. Relatively new Latino subgroups- Salvadorians, Dominicans, and Mexicans. Between 1980-2000 the size of the Central and South American pop doubled from 7% to 14.5%. Latinos In The United States Other Hispanics 6% Cuban 4% Puerto Rican 9% Central and South America 15% Mexican 66% Source:Therrien, M.,& Ramirez,RR 2000. The Hispanic Population in the US: March 2000 National Origin of Latinos in New York City: Est 2000 Census 16% 3% 39% 4% 9% 29% SOURCE: NYC Depart of Planning Presented by the NYC Mayor’s Office of Health Service Puerto Rico Dominican Republic Mexico Colombia Ecuador Other Vignette You are seeing for the first time a 56 yo Latina woman who comes in because she is “ feeling that her blood pressure is high”. She has a past medical history significant for Diabetes, Hypertension, Hyperlipidemia, and a family history of Breast Cancer. She volunteers to you that she had been listening to a doctor over the Spanish radio who was talking about herbal teas and concoctions (“preparaciones”) for her blood pressure which might be helpful to her symptoms. She is considering ordering a sampler package. She also wants her cholesterol checked because she also feels it is high. Vignette Her 19 yo daughter who comes to the appointment her, reports that she is concerned about a breast lump that her mother found on herself about 3 months ago but had not sought medical attention for it. Patient had last mammogram 3 years ago. Results were not known. PHYSICAL EXAM FINDINGS History offered by patient and daughter. Exam revealed an Overweight, Hispanic woman who appeared much older than her stated age. VSS- T98.7 BP 170/100, repeat 168/ 90 HR 70 HEENT- Fundi cotton wool spots noted and changes consistent with HTN retinopathy PERRLA- fair dentition with upper dentures Neck- Supple, No neck masses, No bruits noted Lungs- Mild upper airway rhonchi, no rales or wheezes noted. Adequate inspiratory effort noted Cor- Distant heart sounds, mild 2/6 systolic ejection murmur at apex. PHYSICAL EXAM FINDINGS Breast Firm, discrete, irregular 2x4 cm, nontender mass palpated in LUQ Left breast. Left Axillary node palpated-mildly tender Abd Obese, nontender with no HSM or masses noted No abd bruits noted Ext Limited ROM with crepitus of knees noted when getting on and off exam table, 1+ edema with varicosities bilaterally. Without skin breakdown or fissue Of evidence of infection. UE arthritic changes noted bilaterally Neuro Cranial nerves intact. Monofilament testing revealed sensory deficits bilaterally Vignette Medications: Atenolol 50 mg po qd HCTZ 25 mg po qd Zocor 100mg po qd Metformin 500mg po qd ASA 81mg po qd Premarin 4months/d/c’ed Una de gato Shark cartilage Hoja de Tilo Hoja de naranja Agria Flores de Coco Indio Anis de Estrella Allergies- NONE Tobacco 30 yr/pack Quit 10 years ago Vignette Questions: What are are some challenges presented to the physician in this encounter? Given what what you have just learned about Latino health: What are some possible health needs to be addressed with this patient? What are some factors that can facilitate or hinder the doctor-patient relationship to be considered? What issues seem important to this patient? Outcome Patient went for mammogram, which indeed revealed breast mass as palpated by patient and confirmed by MD. Subsequently, needed special views, ultrasound of the area and an excisional biopsy was ordered. Pathology revealed a fibroadenoma. No evidence of malignancy. Annual mammograms with monthly SBE were recommended. Pt with positive family history will require surveillance. Diabetes and Arthritis no active issues. Remain stable and are monitored on following visits. Outcome After several visits patient revealed that she had believed that a mass found in her breast meant cancer and that meant death. It was in” la manos de dios” and so had not needed attention. Patient had met with the local cuidrandero and had been going for banos. Patient starts to come to her visits unaccompanied by daughter. Daughter schedules appointment with provider. “To Feel Heard and Understood is Perhaps the Most Precious Gift of Life” Arthur Frank, Just Listening,1988 Thank You Which Latino group has the highest rate of poverty? a) Salvadorians b) Mexicans c) Ecuadorians d) Puerto Ricans National Origin of Latinos in NYC Other 16% Ecuador 3% Mexico 9% Colombia 4% P.R. 39% Source: NYC Department of Planning, D.R. 29% Ecuador Mexico Colombia D.R. P.R. Other Who was the first Puerto Rican Congressman? a) Ramon Velez b) Bobby Garcia c) Herman Badillo d) Luis Munoz Marin Thanks to: Technical Support Carol Whitaker Maria Pasa Wilma Burgos Taneka Banks