Health Disparities and Disabilities among Hispanic Populations

1. Health Disparities and Disabilities among Hispanic Populations Lucy Wong-Hernandez, M.S. School of Allied Health Sciences East Carolina University & Monica Carrion-Jones, MD Physical Medicine and Rehabilitation Brody Medical School East Carolina University

2. Objectives • Identify the target population • Identify health disparities among this population • Causes of Health Disparities and Disabilities • How can we decrease the gap

3. Hispanic Population • This ethnic group includes any person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. • According to the population estimates of the U.S. Census Bureau review of 2006, there are approximately 42.6 million Hispanics in the U.S. (14% of total population).

4. Health Disparities • As define by the National Institute of Health (NIH) “…health disparities indicatesdifferences in the • incidence, • prevalence, • mortality, and • burden of diseases and other adverse health conditions that exist among specific population groups in the United States."

5. Where are the Hispanics?

6. Cancer Diabetes Heart Disease HIV/AIDS Immunization Infant Mortality Stroke Asthma Work-Related Injuries Areas of Health Disparities

7. Cancer • In 2003, Hispanic men were 19% less likely to have prostate cancer as non-Hispanic white men. • In 2003, Hispanic women were 39% less likely to have breast cancer as non-Hispanic white women. • Hispanic men and women have higher incidence and mortality rates for stomach and liver cancer. • In 2003, Hispanic women were 2.2 times as likely as non-Hispanic white women to be diagnosed with cervical cancer.

8. Diabetes • In 2003 Mexican American adults were 2 times more likely than non-Hispanic white adults to have been diagnosed with diabetes by a physician. • In 2002, Hispanics were 1.5 times as likely to start treatment for end-stage renal disease related to diabetes, as compared to non-Hispanic white men. • In 2003 Hispanics were 1.5 times as likely as non-Hispanic Whites to die from diabetes.

9. Heart Disease • In 2004, Hispanics were 10% less likely to have heart disease, as compared to non-Hispanic whites. • In 2003 Mexican American men were 30% less likely to die from heart disease, as compared to non-Hispanic white men. • Mexican American women were 1.2 times more likely than non-Hispanic white women to be obese.

10. HIV / AIDS • Hispanics accounted for 18% of HIV/AIDS cases in 2004. • Hispanic males had over 3 times the AIDS rate as non-Hispanic white males. • Hispanic females had over 5 times the AIDS rate as non-Hispanic white females. • Hispanic men were 2.7 times as likely to die from HIV/AIDS as non-Hispanic white men. • Hispanic women were 4.5 times as likely to die from HIV/AIDS as non-Hispanic white women.

11. Immunization • In 2004 Hispanic adults aged 65 and older were 20% less likely to have received the influenza (flu) shot in the past 12 months -- as compared to non-Hispanic whites of the same age group. • In 2004, Hispanic adults aged 65 and older were 40% less likely to have ever received the pneumonia shot, -- as compared to non-Hispanic white adults of the same age group. • Although Hispanic children 19 to 35 months old had comparable rates of immunization for hepatitis, influenza, MMR, and polio -- they were slightly less likely to be fully immunized, when compared to non-Hispanic white children.

12. Infant Mortality • In 2003, infant mortality rates for Hispanic subpopulations ranged from 4.6 per 1,000 live births to 8.2 per 1,000 live births, compared to the non-Hispanic white infant mortality rate of 5.7 per 1,000 live births. • In 2003, Puerto Ricans had 1.4 times the infant mortality rate of non-Hispanic whites. • Puerto Rican infants were 2.1 times as likely to die from causes related to low birth weight, as compared to non-Hispanic white infants. • Mexican American mothers were twice as likely as non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.

13. Asthma • During 1993-1995 in the northeast U.S., Hispanics/Latinos had an asthma death rate of 34 per million -- more than twice the rate for white Americans (15.1 per million).

14. Work-Related Injuries • Mexican foreign born workers accounted for more than two thirds (69 percent) of the 2,440 fatally injured, foreign born workers between 1995 and 2000. • Lower percentages of fatally injured workers came from Cuba (146 or 6 percent), El Salvador (131 or 5 percent), Guatemala (90 or 4 percent), and Dominican Republic (87 or 4 percent).

15. Stroke • In 2003, Hispanic men were 20% less likely to die from a stroke than non-Hispanic white men. • In 2003 Hispanic women were 30% less likely to die from a stroke than non-Hispanic white women.

16. Causes of Health Disparities • Socioeconomic factors • Lifestyle behaviors • Social and built environment • Access to preventive health-care services • Access to affordable health insurance

17. Socioeconomic factors • Education attainment • Employment • Poverty • Insurance coverage

18. NO Usual Place of Care(Preventive care in a clinic or health center VS. doctor’s office)

19. NO Health Insurance Coverage

20. Lifestyle behavior • Lack of physical activity • Alcohol intake • Smoking • Food intake (diet)

21. Social Environment • Educational and economic opportunities • Racial/ethnic discrimination • Neighborhood and work conditions • Lack fluency in English • Lack of familiarity with the U.S. health-care system

22. Access to preventive health-care services • Cancer screening • HIV screening • Vaccination • Pre-natal care

23. What is happening in NC?

24. Social and economical well-being

25. Maternal care

26. Adult Health

27. Communicable diseases

28. Adult Health

29. Violence and Injuries

30. Health Promotion

31. How do we eliminate the GAP? • Increment National Standards on Culturally and Linguistically Appropriate Services. • Community education that involves all members of the community • Knowing the problem and the causes (Research). • Promoting preventive health care that is also culturally sensitive.

32. DISABILITY AMONG HISPANICS ****

33. Disability Overview: • Disability Definition • Access & Challenges • Health & Disability Disparities Issues • Cultural Sensitivity & Competency • Recommendations for Research

34. DISABILITY • Disability definition: • The condition of having a disability or limitation. • The period or length of such a condition • A disadvantage or deficiency, especially a physical or mental impairment that interferes with or prevents normal achievement in a particular area or major life activities of the individual. • Law: A legal incapacity or disqualification.

35. In 2005, an estimated 20.6% civilians not living in an institution (or 53.9 million people) met the criteria for disability. Women and girls with disabilities are estimated to number 28.6 million, which is 21.3% of the female population. An estimated 25.3 million men and boys with disabilities make up 19.8% of the male population. One in five Americans has a diagnosed disability; more than half of those with disabilities are female.

36. Americans with and without disability by gender

37. Females report more limitations in old age, while males report more limitations in youth.

38. Disabilities in NC • Approximately: 1,139,375 adults 18 and over experience a disability. • Representing 18.3% of the population • Women: 19.4% or 648,215 • Men: 17.0% or 491,160

39. Rate by Age: Age 5 to 20 = 7.4 % Age 21 to 64 = 14.4% Age 65 and over = 43% Causes: Genetic Work related injuries Automobile and industrial accidents Environmental contamination Rate by Race & Ethnicity: Hispanics 13.8% Whites non-Hispanics 18.5% Blacks 19.1% Native Americans 23.5% Disabilities in NC

40. Demographic Trends • It is projected that by the year 2020, --- 30% of the new workers entering into the labor force will be people from diverse cultural and ethnic backgrounds --- also classified as people from minority backgrounds. • According to data from the Department of Labor: • There is a higher incidence of work disabilities among minorities: 13.7% --- of African Americans 8.2% --- of Hispanic Americans AS COMPARED TO: ONLY 7.9% --- of White Americans who acquired a work related disability.

41. What is Culture? • Culture is a collective reality of a group of people --- and it is from this collective reality --- that attitudes, behaviors, and values are formed and become reinforced among a group of people. • Culture is commonly held characteristics such as beliefs, values, customs and patterns of behaviors held by a group, which has been learned and reinforced through a socialization process.

42. Hispanic / Latino • The Hispanic American population: is the fastest growing and most diverse ethnic group in the U.S. • According to the latest US Census report of 2000 --- and its latest revision (2005) – the U.S Hispanic or Latino population is projected to grow from 31.7 million (12% of the population) in 1999 -- to 98.2 million (24% of the U.S. population) by 2050. • This indicates the Hispanic American population has grown over 7 times ---- and as fast as the rest of the nation --- between 1980 to 1990 and 1990 to 2005.

43. Hispanic • Hispanic is not a racial group – it is an ethnic group (including White Europeans, Blacks, Asians of various ethnic groups including indigenous and “mestizos”). • Hispanics are united by a common language – but not all Hispanics are fluent in the Spanish language. • 15.3 % --- have some type of disability (US). • They are mostly affected by what is labeled as “preventable causes of disability.”

44. Access to Health Care among Hispanic Women: U.S., 2000-2002* Among the nation’s 33.4 million Hispanic women: • 31% do not have health insurance coverage; • 20% do not have a usual clinic to go for medical care; and • 22% experienced unmet health care needs during the past year due to cost. *Centers for Disease Control and Prevention (CDC, 2005)

45. Lack of access to health care creates health disparities.

46. What is “Health Disparity?” A health disparity is a difference in health status that is persistent across subgroups of a population. Source: http://www.health.state.mn.us/

47. Consequences of Health Disparities • Absence of and poor health care contributes to chronic illnesses. • Chronic illnesses become permanent disabilities. • Disabilities may become complicated by secondary disabling conditions. • There is close correlation between disability and poverty. • 25% of the population diagnosed as disabled is living at poverty level or lower.

48. Barriers Affecting Hispanics with Disabilities

49. Health Disparities among Persons with Disabilities • Less health insurance coverage and use of the health care systems. • Higher rates of chronic illnesses and secondary conditions. • Lower rates of social participation. • Lower rates of recommended health behaviors (e.g. smoking cessation, diet, etc). • Less participation in health screening (women with disabilities).

50. Health & Disability Disparities • Over 53 million Americans have either a severe or a non severe disability • Disparities in rates of disability are pronounced for culturally diverse groups • Hispanic Americans with disabilities are second to African Americans with disabilities with a 20.0% • Self-reported health status is one of the lowest at: 30.4% for Good and 47.7% for Poor health.