awareness, treatment and control of hypertension among filipino americans mariano rey, m.d....

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

Overview of Project AsPIRE(Asian American Partnership in Research and Empowerment)

Background on Project AsPIRE: Development Process Descriptive Study Experimental Study Future Directions

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

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:

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

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

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)

Descriptive Study

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

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.

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

Experimental Study

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%)

Hypertension Awareness, Treatment, and Control (AsPIRE Sample)

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

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

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

Type of Medication, Single Antihypertensive Drug Therapy

27.5%

13.5%

27.7%

27.8%

3.9%

N=317

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.

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.

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.  

Acknowledgements

Mariano J. Rey, MD

Director, Institute of Community Health and Research

mariano.rey@nyumc.org

(212) 263-0985

Rhodora Ursua, MPH

Project Director, Project AsPIRE

rhodora.ursua@nyumc.org

(212) 263-3776

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