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Incidence of Type 2 Diabetes in Hispanics as Compared to the General Population in Massachusetts
By Isabelle Pierre Krystal Amaral, and Ardrianna Howard, 2014 SEP Participants
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TYPE 2 DIABETES MELLITUS
Definition:
● A metabolic disease in which the body’s inability to properly use insulin causes elevated levels of glucose in the blood
● Contrary to type 1 diabetes mellitus where the body is unable to
produce insulin
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WHAT IS A HEALTH DISPARITY?
The NIH defines a health disparity as:
“The differences in the incidence, prevalence, mortality, and burden of disease and other adverse health
conditions that exist among specific population groups compared to a larger group.”
Health disparities limit continued improvement in overall quality of care and population health and result in unnecessary costs.
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Hispanic Population in Massachusetts
The Massachusetts population is 8%
Hispanic
CDC National Center for Health, 2013 4
Black 6.21%
American Indian 0.20%
White 80.38%
Asian 5.01% Hispanic
8.21%
Black American Indian White Asian Hispanic
Hispanic vs. General Population
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● 1.6 times more likely to have diabetes than Non-Hispanic Whites ● 1.5 times more likely to die from diabetes compared to Non-Hispanic Whites
0
2
4
6
8
10
12
14
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1990 1992 1994 1996 1998 2000 2002 2004 2006
Pre
vale
nce
(%
)
Year
Prevalence of Diabetes: 1990-2007
Hispanic
White
Black
Source data: Massachusetts BRFSS
Leading Causes Diabetes is the 4th leading cause of death in
Hispanics ● Genetics ● Inequalities in Income and Education ● Lifestyle Patterns ● Access and Quality of Healthcare
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Genetics
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• Mutations of one gene increase the
risks for developing Type 2 diabetes
• SLC16A11 variation accounts for about 20 percent of Hispanics' increased risk of Type 2 diabetes
Strong link to family history and lineage
Lifestyle Patterns
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2011 BRFSS Routine Doctor Visits
o Hispanic adults less likely to have visited doctor in the last year (78.6% versus 85.7%) than Non-Hispanic White adults
o Less likely to have early detection Diet and Nutrition
o Higher prevalence of poor diet Obesity and Overweight
o Hispanic adults are 50% more likely to be obese than Non-Hispanic Whites.
o 2010 MA Department of Public Health Family History
10 ● 49% of Hispanic students spend three or more hours watching TV
daily compared to 46% of Black students and 27% of Non-Hispanic White students
2007 MA Youth Risk Behavior Survey
Physical Activity
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Per
cen
tage
Year
Physical Activity in the Past Month
Hispanic
Black
White
Source data: Massachusetts BRFSS
Inequalities in Income and Education ● 43% of Hispanics in Massachusetts do not complete high school compared to 13%
of Non- Hispanic Whites ● 44% Hispanics reported receiving diabetes education compared to 59% of Whites ● Individuals with less income and less education have higher rates of diabetes
.
Source: US Census Bureau, American Community Survey 3- Year Estimates, 2005-2007
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7%
22%
15%
29%
20%
10%
0%
5%
10%
15%
20%
25%
30%
35%
White Black Asian Hispanic AI/AN Massachusetts
Perc
enta
ge B
elow
Pov
erty
(%)
Race
Individuals in Massachusetts Under 100% Poverty
Access and Quality of Healthcare
2011 MA FRBSS ● Uninsured Hispanic adults dropped from 19% to 11% following health
care reform ○Three times as many uninsured Hispanic adult residents compared to
Non- Hispanic Whites. ● 20% of Hispanic adults without a personal health care provider
● 2010 MA Department of Public Health
11 0%
10%
20%
30%
40%
50%
60%
70%
2001 2002 2003 2004 2005 2006 2007 2008
Per
cen
t
Year
Adults Without Personal Health Care Provider
Hispanic
Massachusetts
White
Source: MDPH BRFSS 2001-2008
Current News: Project REACH
Project is based in the Greater Lawrence Family Health Center
Goals:
Work to raise awareness of diabetes and its complications in the Hispanic population of Massachusetts.
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Racial and Ethnic Approaches to Community Health
The Lawrence Latino Diabetes Prevention Project (LLDPP)
Collaboration with UMass Lowell and UMass Medical School
Goals:
Inexpensive, culturally sensitive intervention program to improve the incidence of diabetes in the Latino population of Lawrence.
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The Lawrence Latino Diabetes Prevention Project (LLDPP)
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0
10
20
30
40
50
60
70
80
Per
cen
tage
(%
)
Diabetes Care for Latino Residents Treated at the Greater Lawrence Family Health Center
2001 2007
Source: REACH Latino Health Project
Narrowing The Gap
● Preventative Care ● Recognizing the symptoms
● Self- Management ● Less-costly alternative
● Nutrition Education ● Better dietary choices
● Active Living ● Increased insulin sensitivity ● Decrease total calories to
lose weight
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Culturally tailored interventions
Conclusion
• Incidence of Type 2 Diabetes is higher in Hispanics than in the general population
• Socioeconomic factors contribute to disparity • Awareness campaigns such as Project REACH help raise
awareness and lower the prevalence of diabetes within high risk communities
16 “together we can put an end to diabetes”
Questions?
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References 1. Ockene I. S., Tellez T. L., Rosal, M. C. ,Reed, G. W., Mordes J., Merriam, P. A., Olendzki,B. C., Handelman, G., Nicolosi, R., and
Ma, Y. 2012. Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence Latino Diabetes Prevention Project. American Journal of Public Health
2. Rosal M. C., Ockene I. S., Restrepo A. , White M. J., Borg A., Olendzki B., Scavron J., Candib L., Welch G., and Reed G. 2011.
Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos. Diabetes Care 34:838-844
3. Welch G., Allen N. A, Zagarins S. E., Stamp K. D, Bursell S-E. and Kedziora R. J. 2011. Comprehensive Diabetes Management
Program for Poorly Controlled Hispanic Type 2 Patients at a Community Health Center. The Diabetes Educator 35(7):680-688
4. Bhargava A., Wartak S. A, Friderici J and Rothberg M.B. 2014. The Impact of Hispanic Ethnicity on Knowledge and
Behavior Among Patients With Diabetes. The Diabetes Educator 40(3):336-343 5. Welch G, Schwartz C, Santiago-Kelly P. 2001. Diabetes- related Emotional Distress of Hispanic and Non- Hispanic Type
Two Diabetes Patients. Ethnicity & Disease. 17:541-547 6. Massachusetts Department of Public Health. Health of Massachusetts. Boston, MA; April 2010.
7. Connor, A., Baumgartner, R., Baumgartner K., et al. 2012. Associations between TCF7L2 polymorphisms and risk of breast cancer among Hispanic and non-Hispanic White women: the Breast Cancer Health Disparities Study. Breast Cancer Res Treat 136(2):593-602
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