Transcript Que Sera? - Albert Einstein College of Medicine

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