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

2

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.

3

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

16

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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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

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Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos. Diabetes Care 34:838-844

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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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