awareness, treatment and control of hypertension among filipino americans mariano rey, m.d....
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Awareness, Treatment and Control of Hypertension among Filipino Americans
Mariano Rey, M.D.Principal Investigator
July 8-9, 20110Gaylord National Hotel and Convention Center, Maryland
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Overview of Project AsPIRE(Asian American Partnership in Research and Empowerment)
Background on Project AsPIRE: Development Process Descriptive Study Experimental Study Future Directions
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CSAAH was founded in 2003 and funded by NIH/NIMHD as a Center of Excellence dedicated to the research and reduction of health disparities affecting Asian Americans through research, training, and partnership.
Project EXPORT P60 Center
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Mission
Kalusugan Coalition is a multidisciplinary collaboration dedicated to creating a unified voice to improve the health of the Filipino community in the NY/NJ area through network development, educational activities, research, community action, and advocacy.
Lead Community Partner:
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Project AsPIRE: Overall Goal
To improve the health care access and CVD health status in the NYC Filipino American community through interventions by community health workers
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The Big Picture
3 year planning grant
5 year implementation grant
3 year dissemination grant
Potential funding for 11 years
Funding by NIH/NIMHD for health disparities intervention research
7th year
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Community-Based Participatory Research (CBPR)
“A collaborative approach to research
that equitably involves all partners in
the research process and recognizes
the unique strengths that each brings”.
--W.K. Kellogg Foundation (2001)
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Descriptive Study
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What the literature shows: Filipinos and Hypertension
Heart disease accounted for 33% of all deaths for Filipino Americans compared to 19% for Vietnamese, 24% for Koreans, 28% for Japanese, and 29% for Chinese.
Ryan et al., 2000
The 2004-2006 National Health Interview Survey showed Filipino American adults as having the highest HTN prevalence among Asian Americans at 27%. NHANES
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What the literature shows: Filipinos and Diabetes
Filipinos had a higher incidence of diabetes (34.7% vs. 24.1%) than whites. Ryan et al., 2000
Filipinos (n=294) had higher prevalence of type 2 diabetes and metabolic syndrome compared to White women (n=379) [Filipina women (36.4%), Caucasian women (8.7%)]. Araneta et al., 2002
Diabetes is more common among Filipino (n = 268) than in Whites (n=3164) and other Asian Pacific Islander subgroups (n = 801) [Filipinos (21.2%), Whites (8.1 %), All Asians combined (12.9%)]. Javier et al., 2007; Gomez et al, 2004.
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Who are we targeting:Filipino Population in NYC & NJ
5,246
5,446
33,225
7,918
10,223
NJ - largest population by county
Morris County - 3,459Essex County - 8,406Union County - 6,313Middlesex - 13,507Bergen County - 15,403Hudson County - 30,066
Total Filipino Population
New York State: 120,940New Jersey State: 121,197
Total NYS & NJS: 242,137
Note: Alone or in Combination Source: U.S. Census Community Health Survey, 2008
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Experimental Study
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AsPIRE Screening Data
Sample size: n=1634
Gender: 68% female, 32% male
Geography: NYC (59%), NJ (41%)
Place of birth: 98% born outside of the U.S.
Insurance status: 50% uninsured
Self-perceived health status:
Poor (2%)
Fair (21%)
Good (49%)
Very good (21%)
Excellent (7%)
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Hypertension Awareness, Treatment, and Control (AsPIRE Sample)
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Predicting Awareness of Hypertension a, b
Final Model
OR 95% C.I. p-value
Age Range (25-55) 56-65 2.4 1.7 – 3.5 <0.001 66-85 3.7 2.4 – 5.7 <0.001
Self-Reported Health (Excellent/Very good) Good 1.7 1.1 - 2.4 <0.01 Fair/Poor 2.2 1.4 - 3.4 <0.01
High cholesterol diagnosis (No/Don’t know) Yes 2.1 1.5 - 2.9 <0.001
Family History of Hypertension (No/Don’t know) Yes 2.9 2.1 - 4.1 <0.001
a Adjusted for genderb Categories in parentheses are reference groups
Predictors of HTN Awareness
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Predicting hypertension treatment a, b
Final ModelOR 95% C.I. p-value
Age Range (25-55) 56-65 3.0 1.6 - 5.5 <0.001 66-85 9.7 3.3 - 28.6 <0.001 Insurance (Uninsured) Insured 2.4 1.3 - 4.5 <0.01 Years in the U.S. (≤ 5 years) 6-15 years 1.3 0.7 - 2.5 0.37 > 15 years 2.6 1.1 - 5.7 <0.05 Smoking (Yes) No 3.2 1.3 - 7.9 <0.05 Diabetes diagnosis (No/Don’t know) Yes 3.23 1.2 - 9.2 <0.05
a Adjusted for genderb Categories in parentheses are reference groups
Predictors of HTN Treatment
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Predicting controlled hypertension a, b
Final Model
OR 95% C.I. p-value
Age Range (25-55)
56-65 0.4 0.2 - 0.7 <0.01
66-85 0.6 0.3 - 0.9 <0.05
Insurance (Uninsured)
Insured 2.1 1.3 - 3.4 <0.01
Diabetes diagnosis (No/Don’t know)
Yes 0.4 0.2 – 0.6 <0.01
a Adjusted for genderb Categories in parentheses are reference groups
Predictors of HTN Control
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Type of Medication, Single Antihypertensive Drug Therapy
27.5%
13.5%
27.7%
27.8%
3.9%
N=317
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Future Directions
States and certain localities should develop surveillance capacity that would include direct assessment of “awareness, detection, treatment, and control of obesity, HTN, dyslipidemia, and diabetes.”Angell SY et al., 2008
Community organizing strategies increase the feasibility of reaching a large community-based population.
Coalition building and engagement of multiple sectors (faith-based and community-based organizations, businesses, and health professional associations), optimize recruitment efforts and provide mechanisms to refer participants to necessary healthcare resources, especially to manage and control their HTN.
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Future Directions
Findings from CBPR efforts such as this study can provide valuable information to policy makers and health departments as to how to address the burden of HTN in similar populations.
Community-based screenings provide an effective means of increasing HTN awareness.
Behavioral interventions are also critical to improving HTN control.
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This presentation was made possible by Grant Number R24 MD001786 from NIMHD and its
contents are solely the responsibility of the authors and do not necessarily represent the
official views of the NIMHD.
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Acknowledgements
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Mariano J. Rey, MD
Director, Institute of Community Health and Research
(212) 263-0985
Rhodora Ursua, MPH
Project Director, Project AsPIRE
(212) 263-3776
For more information: