Awareness, Treatment and Control of Hypertension among Filipino Americans

1
Awareness, Treatment and Control of Hypertension
among Filipino Americans
Mariano Rey, M.D. Principal Investigator July
8-9, 20110 Gaylord National Hotel and Convention
Center, Maryland
2
Overview of Project AsPIRE(Asian American
Partnership in Research and Empowerment)

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

3
Project EXPORT P60 Center

• 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.

4
Lead Community Partner

• 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.

5
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

6
The Big Picture
Potential funding for 11 years
7th year

• 3 year planning grant

5 year implementation grant
3 year dissemination grant
Funding by NIH/NIMHD for health disparities
intervention research
7
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)

8
Descriptive Study
9
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

10
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 (n294) had higher prevalence of type 2
  diabetes and metabolic syndrome compared to White
  women (n379) Filipina women (36.4), Caucasian
  women (8.7).
• Araneta et al., 2002
• Diabetes is more common among Filipino (n 268)
  than in Whites (n3164) 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.

11
Who are we targetingFilipino Population in NYC
NJ
Total Filipino Population New York State
120,940 New Jersey State 121,197 Total NYS
NJS 242,137 Note Alone or in Combination
Source U.S. Census Community Health Survey, 2008
10,223
5,446
33,225
NJ - largest population by county Morris County
- 3,459 Essex County -
8,406 Union County - 6,313 Middlesex -
13,507 Bergen County -
15,403 Hudson County - 30,066
7,918
5,246
12

• Experimental Study

13
AsPIRE Screening Data
Sample size n1634 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)
14
Hypertension Awareness, Treatment, and Control
(AsPIRE Sample)
15
Predictors of HTN Awareness
Predicting Awareness of Hypertension a, b Predicting Awareness of Hypertension a, b Predicting Awareness of Hypertension a, b Predicting Awareness of Hypertension a, b
Final Model Final Model Final Model
OR 95 C.I. p-value
Age Range (25-55)
56-65 2.4 1.7 3.5 lt0.001
66-85 3.7 2.4 5.7 lt0.001
Self-Reported Health (Excellent/Very good)
Good 1.7 1.1 - 2.4 lt0.01
Fair/Poor 2.2 1.4 - 3.4 lt0.01
High cholesterol diagnosis (No/Dont know)
Yes 2.1 1.5 - 2.9 lt0.001
Family History of Hypertension (No/Dont know)
Yes 2.9 2.1 - 4.1 lt0.001
a Adjusted for gender b Categories in parentheses
are reference groups
16
Predictors of HTN Treatment
Predicting hypertension treatment a, b Predicting hypertension treatment a, b Predicting hypertension treatment a, b Predicting hypertension treatment a, b
Final Model Final Model Final Model
OR 95 C.I. p-value
Age Range (25-55)
56-65 3.0 1.6 - 5.5 lt0.001
66-85 9.7 3.3 - 28.6 lt0.001
Insurance (Uninsured)
Insured 2.4 1.3 - 4.5 lt0.01
Years in the U.S. ( 5 years)
6-15 years 1.3 0.7 - 2.5 0.37
gt 15 years 2.6 1.1 - 5.7 lt0.05
Smoking (Yes)
No 3.2 1.3 - 7.9 lt0.05
Diabetes diagnosis (No/Dont know)
Yes 3.23 1.2 - 9.2 lt0.05
a Adjusted for gender b Categories in
parentheses are reference groups
17
Predictors of HTN Control
Predicting controlled hypertension a, b Predicting controlled hypertension a, b    
Final Model Final Model Final Model
OR 95 C.I. p-value
Age Range (25-55)
56-65 0.4 0.2 - 0.7 lt0.01
66-85 0.6 0.3 - 0.9 lt0.05
Insurance (Uninsured)
Insured 2.1 1.3 - 3.4 lt0.01
Diabetes diagnosis (No/Dont know)
Yes 0.4 0.2 0.6 lt0.01
a Adjusted for gender b Categories in parentheses
are reference groups
18
(No Transcript)
19
Type of Medication, Single Antihypertensive Drug
Therapy
N317
27.5
13.5
27.7
27.8
3.9
20
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.

21
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.

22

• 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.  

23
Acknowledgements
Rhodora Ursua, Project Director David Aguilar,
Project Coordinator Henry Soliveres, CHW Romerico
Foz, CHW Leonie Gamboa, CHW Jay Duller, Research
Analyst Chau Trinh-Shevrin, Academic
Partner Nadia Islam, Academic Partner Darius
Tandon, Academic Partner Ed Fryer,
Biostatistician Thomas Miyoshi,
Biostatistician Laura Wyatt, Data
Manager Noilyn Abesamis-Mendoza, KC
Chair Ben Ileto, Community Advisor Josephine
Rago-Adia, Community Advisor Potri Ranka Manis,
Community Health Nurse Patricia Roy, Research
Assistant Mary Grace Centeno, Research
Assistant Denise Kim, Research Assistant Cinyuki
Chung, Research Assistant Rachel Slutsky,
Research Assistant
24
For more information
Rhodora Ursua, MPH Project Director, Project
AsPIRE rhodora.ursua_at_nyumc.org [phone]
Mariano J. Rey, MD Director, Institute of
Community Health and Research mariano.rey_at_nyumc.or
g [phone]