The leading causes of mortality in the United States are linked to social and behavioral factors (Mokdad, 2004). Obesity is a major risk factor for diabetes (Must, 1994) and other medical conditions such as hypertension and heart disease. The prevalence of abdominal obesity is 43% in white women and 55% in Latinas (Okosun, Prewitt, & Cooper, 1999). Abdominal obesity accounts for over 10% of the ethnic differences in risk of diabetes between Latina and white women (Okosun, 2000). Interventions to increase exercise and promote a healthy diet can decrease the incidence of diabetes in a high-risk group by as much 58% (Diabetes Prevention Program Research Group, 1999). However, individually-focused programs of behavior change are often ineffective.
Data from national surveys demonstrate a high and increasing prevalence of childhood and adolescent obesity. The IOM has highlighted the special needs of Latinos who are at great risk for becoming obese, including children (IOM, 2005). Obesity is highly prevalent in the AI/AN population as well, and presages other comorbidities (Will 1999). The potential long-term health effects of child and adolescent obesity are alarming. Obesity increases the risk of many conditions including hypertension, CVD, stroke, type 2 diabetes, and certain types of cancer.
Diabetes is among the top five leading causes of death for Latinos and Native Americans. Over 18.2 million Americans suffer from the disease, over a third of whom may remain undiagnosed. Rates for type 2 diabetes are two to five times greater for Latinos and American Indians than the general population, there is higher mortality from diabetes among Latinos, and Latinos have earlier onset and more severe forms of the disease (Perez-Stable et. al., 1989; Stern et al., 1990). The proportion of adults who receive the recommended services of HBA1c testing, retinal eye examination, and foot examination in past year was lower among minorities than among white-nonLatinos (AHRQ, 2006).
Cardiovascular Disease (CVD)
More than 70 million Americans (over one-fourth of the population) live with CVD, which is the leading cause of death in the United States (CDC, 2007). Over 927,000 Americans die of CVD each year. Biologic, environmental, and social factors all contribute to racial/ethnic cardiovascular disease disparities. Minorities are less likely to receive cardiac diagnostic and therapeutic studies than white non-Latinos. When multiple risk factors and/or comorbidities co-occur in the same individual they may significantly complicate management and outcomes.
Cancer is also a major contributor to population mortality in all populations, and aptly illustrate the importance of quality of care process including prevention, early detection, and regular timely treatment. For example, Latinos have the lowest percentage of adults age 50 and over who reported they had a fecal occult blood test within the past 2 years,ï¿½ by ethnicity, United States, 2003 (AHRQ, 2007). Latinos also have the lowest percentage of adults age 50 and over who reported they ever had a colonoscopy, sigmoidoscopy, or proctoscopy,ï¿½ by ethnicity, United States, 2003. (30% versus 46% for whites). The cervical cancer mortality rate for AI/A N women is twice that of all races in the United States (Giroux 2000). In one study that examined cancer-screening rates extracted from the 1995 diabetic audit for the 12 IHS areas, screening rates for women with diabetes when compared to those without diabetes in the 12 areas varied as follows: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69% (Giroux 2000).
|Support for this program was provided by a grant from the Robert Wood Johnson Foundation ® Princeton, New Jersey|