Que Sera? Sera?

Elizabeth Lee-Rey, MD

Luz Towns-Miranda, PhDHispanic 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.

PeruEcuadorBoliviaChileColombiaVenezuela the Guyana

Brazil Uruguay Paraguay Argentina

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

0

5

10

15

20

25

30

TotalWhiteBlackHispanic

The Commonwealth Fund Survey of the Health of Adolescent Girls, 1997 Louis Harris and Associates, Inc

Percent of boys with no regular MD

$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?

35

58 59

40

0

10

20

30

40

50

60

70

Percent of NYC Women Below the Poverty Line

Total

PR

DR

Mex

SSSSS

Source:NYC Depart of Planning-1990 CensusPresented by NYC Mayor's Off of Health Service

¾ of Latino babies are born into poverty

Almost 2/3 of all Latino children live below the poverty line

73% of Hispanic children are living in “distressed neighborhoods.”

$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?

40

31.829.6

35.2

252729313335373941

Median Age of Women in NYC

WhiteBlackHispanicTotal

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 groupsSource:NYC Depart of Planning

Presentation by NYC Major’s Off of Health Service

$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

44 MILLION

17%

1%

25%52%

5%

BlackNative AmericanHispanicWhiteAsian/S.Pac.Islander

Source:Urban Institute,1999 Data:Current Population Survey, March 1999

$125,000

Which group is at most risk of being uninsured?

a) White (non-Hispanic)

b) Black

c) Native American

d) Hispanic

Which group is at most risk of being uninsured?

Uninsured Adults by Race and Hispanic Origin, 1996

01020304050

Total

White

Black

Hispan

ic

Asian A

mer

ican

Per

cent

of

Ad

ults

-18-

64 y

s

WhiteBlackHispanicAsian AmericanTotal

SOURCE: Hall, Collins, and Glied, 1999

The Commonwealth Fund

Collins, Hall, and Neuhaus, U.S. Minority Health: A Chart Book, 1999

$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 ?

22.8 24.125.8

17.3 16.7

23.6

7.7

0

5

10

15

20

25

30

Poverty Status By Proportion Of Subgroup Population

Total Latinos

Mexican

Puerto Rican

Cuban

Central/SouthAmericanOther Latino

Non-Latino

Percent

Source:Therrien & Ramirez 2000 The Hispanic population in the US:3/2000 US Bureau of Census for Labor Statistics 3/99

$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

52.8

24.5

13.6

60.5

18.9

13.1

68

13.8

12.6

69.3

13.3

12.3

71.8

11.4

12.2

75.6

9

11.8

White

1990

2000

2005

2010

2030

2050

AFRICAN AMERICAN

HISPANIC

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

% 0 25 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,2000National Origin Percent of

all Hispanic

Percent Arriving US 1990-Present

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

Puerto Rican8.9 9.6 100.0 NA NA

Cuban 4.0 18.5 36.5 34.4 29.1

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 Hispanics6%

Cuban4%

Puerto Rican9%

Central and South America

15%

Mexican66%

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

3%

4%

9%

29%

39%

16%

Puerto RicoDominican RepublicMexicoColombiaEcuadorOther

SOURCE: NYC Depart of Planning

Presented by the NYC Mayor’s Office of Health Service

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 70HEENT- Fundi cotton wool spots noted and changes consistent with

HTN retinopathyPERRLA- fair dentition with upper denturesNeck- Supple, No neck masses, No bruits notedLungs- Mild upper airway rhonchi, no rales or wheezes noted.

Adequate inspiratory effort notedCor- 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 tenderAbd 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: Allergies- NONEAtenolol 50 mg po qd Tobacco 30 yr/packHCTZ 25 mg po qd Quit 10 years agoZocor 100mg po qd Metformin 500mg po qdASA 81mg po qd Premarin 4months/d/c’ed Una de gatoShark cartilageHoja de TiloHoja de naranja AgriaFlores de Coco IndioAnis de Estrella

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

Mexico9%

Colombia4%

D.R.29%P.R.

39%

Other16%

Ecuador3%

Ecuador

Mexico

Colombia

D.R.

P.R.

Other

Source: NYC Department of Planning,

Who was the first Puerto Rican Congressman?

a) Ramon Velez

b) Bobby Garcia

c) Herman Badillo

d) Luis Munoz Marin

Thanks to:

Technical SupportCarol WhitakerMaria PasaWilma BurgosTaneka Banks