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Published on August 7, 2007

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South Asian Immigrant Cardiovascular Risk Assessment in Houston, Texas2005:  South Asian Immigrant Cardiovascular Risk Assessment in Houston, Texas 2005 Aijaz Ali Khowaja Dr.P.H. Dissertation Presentation Advisor & Committee Members :  Advisor andamp; Committee Members Dr. David Paul Smith Dr. Jacquelyn Slomka Dr. Asha S. Kapadia Cardiovascular diseases include diseases of heart, stroke, HBP, CHF, congenital heart defects, hardening of arteries, and other diseases of circulatory system:  Cardiovascular diseases include diseases of heart, stroke, HBP, CHF, congenital heart defects, hardening of arteries, and other diseases of circulatory system WHO estimated - 2001 16.6 million global deaths 7.2 million death from HD 5.5 million deaths from Stroke 600 million had HBP CVD contributed 1/3 of global deaths 78% in developing countries. Cardiovascular Diseases :  Cardiovascular Diseases has now become a disease of the poor in rich countries and of the rich in poor countries. Hoeymans N 1996 Purpose of Study :  Purpose of Study To assess the cardiovascular risk factors in the South Asian immigrant community residing in Southwest Houston, Texas. Hypothesis:  Hypothesis South Asian immigrants have a higher risk of developing cardiovascular diseases than native United States residents. South Asian Countries:  South Asian Countries Afghanistan Bangladesh Bhutan India Maldives Nepal Pakistan Sri Lanka History of South Asian Migration to United States :  History of South Asian Migration to United States 1820 Came 1901 4713 SA 1920 Clustered in Sacrament valley, CA 1950 Students - professionals 1965 Change in INS laws 1990 Naturalization 13% to 49% 2004 10.7 million Asian andamp; Pacific (4%) 2050 33.4 million Texas 563,000 Asians – 1/5 Houston HC 65,000 SA Problem Statement:  Problem Statement Heart Disease is the leading cause of death Stroke is the third leading cause of death 61 million Americans are living with CVD 12 million has Coronary Heart Disease 950,000 Americans die from HD andamp; Stroke 13140 (365/100000) deaths from CVD vs (350/100000) in Texas. 25% of all deaths in India – CVD 4-5 times higher than Europeans Risk Factors:  Risk Factors High blood pressure High blood cholesterol Diabetes Nutrition Physical inactivity Overweight andamp; Obesity Smoking Alcohol Other factors – congenital defects Age Gender Marital Status Socioeconomic status Geographic area Eastern andamp; Southern States Western andamp; Northern States Significance:  Significance 44 million Americans are uninsured 800,000 people in HC are uninsured Little know about SA health status No data on risk factors for CVD in SAs SA migrated had dietary andamp; cultural issues Access to healthcare services, Difficult (language, transport, culture, low education) Expensive (insurance cost, consultation, diagnosis andamp; imaging, hospitalization, andamp; pharmacy) Ibn Sina Foundation :  Ibn Sina Foundation Community Clinics Southwest Houston Clear Lake Provide low cost clinical, preventive, dental, specialty and laboratory services 73% SA; 12% Hispanics; 10% whites andamp; 5% African Americans Methodology:  Methodology Study Jan.1st, - March 31st, 2005 Ibn Sina Community Clinic, Houston SA visiting every Saturday for CV screening After CV screening andamp; blood testing Participants were requested; if they agree Consent signed Took Height, weight, andamp; blood pressure. Administered structured questionnaire Demographic, Lifestyle, Medical history andamp; Insurance status Procedure set in clinic Methodology:  Methodology Sample of Convenience Sample Size Inclusion criteria Exclusion criteria Data Collection Human Subjects 191 visited for CV screening 162 were South Asians All age groups and gender Must be South Asian Non South Asian andamp; willing Jan. 1st,-March 31st, 05 Approved Results:  Results Response Rate Country of Origin 78% 64% Pakistanis 31% Indians 5% Bangladeshis, Maldives, and Nepalese Result:  Result Race/Ethnicity Age Gender Marital Status 90% Muslims of Pakistan, India, andamp; Bangladesh 9% Hindus 1% Christians Mean age 48 years 56% Males 44% Females 87% married 7% single 5% widow 1% divorced Education Level :  Education Level Male Female High School and less 41% 75% HS andamp; Some College 22% 9% At least BS Degree andamp; above 37% 16% Immigration Status :  Immigration Status Male Female 0-25 years 39% 21% 26-44 years 41% 50% 45 + years 20% 29% Mean 33 years Employment Status :  Employment Status Male Female Full time 51% 9% Part time 10% 13% Self Employed 23% 4% Homemaker 3% 57% Others 13% 17% Insurance Coverage:  Insurance Coverage 89% had no health insurance (Ibn Sina patients only) Female 93% Men 86% 10% had insurance through Aetna and Unicare 1% had Medicare and Medicaid Physical Activity :  Physical Activity Male Female Yes 54% 61% No 46% 39% Prevalence of Physical inactivity in Americans Age 20 and Older by Race/ethnicity and Sex:  Prevalence of Physical inactivity in Americans Age 20 and Older by Race/ethnicity and Sex   White Black Mexican Asian/Pac. S. Asian Male 32.5% 44.1% 48.9% 30.9% 46.5% Female 36.2% 55.2% 57.4% 45.5% 39.3% Prevalence of Tobacco Smoked by American Adults age 20 and above by Race/Ethnicity and Sex:  Prevalence of Tobacco Smoked by American Adults age 20 and above by Race/Ethnicity and Sex White Black Mexican Asian/Pac. S. Asian Male 25.8% 26.1% 24.1% 24.3% 26.8% Female 21.6% 20.8% 12.3% 7.1% 1.8% Drinking of Alcohol:  Drinking of Alcohol 100% of women do not drink 87% of men do not drink Those who drink 2-3 drinks per day 74% tried to stop drinking in last 12 months Dietary Pattern :  Dietary Pattern 94% of SA prefer traditional Asian Diet 6% of respondents consume Western, Chinese, andamp; other mix diet Income :  Income Male Female (thousand dollars) andlt;20 42% 84% 20-35 22% 10% 35-70 30% 4% 70+ 6% 2% Mean = $ 28,000 75% less than $36,000 Previous History of High Blood Pressure :  Previous History of High Blood Pressure 35% SA participants 37% women 34% men Mean is 3.5 years Previous History of Heart Disease:  Previous History of Heart Disease 24% SA respondents Women 30% Men 18% Mean is 4.3 years Family History of Heart Diseases:  Family History of Heart Diseases 48% of SA participants Women 46% Men 49% Taking Medicine for CVD Women 27% Men 23% Blood PressureSystolic Diastolic :  Blood Pressure Systolic Diastolic Prevalence of High Blood Pressure (>140/90) by Race/Ethnicity and Sex in Americans Age 20 and above:  Prevalence of High Blood Pressure (andgt;140/90) by Race/Ethnicity and Sex in Americans Age 20 and above National White Black Mexican S. Asian Male 26.4% 25.2% 36.7% 24.2% 38% Female 21.4% 20.5% 36.6% 22.4% 29% Height Weight :  Height Weight BMI of South Asians:  BMI of South Asians Mean height 5 feet 5 inches Mean weight 165 pounds (desirable 115-145) Mean BMI is 28 (desirable 19-24) Prevalence of Overweight and Obesity in American Adults (BMI 25 and above) by Race/Ethnicityand Sex:  Prevalence of Overweight and Obesity in American Adults (BMI 25 and above) by Race/Ethnicity and Sex White Black Mexican Asian/Pac. S. Asian Male 67% 61% 75% 37% 75% Female 57% 77% 72% 27% 84% Prevalence of Obesity in American Adults (BMI 30 and above) by Race/Ethnicity and Sex:  Prevalence of Obesity in American Adults (BMI 30 and above) by Race/Ethnicity and Sex White Black Mexican Asian/Pac. S. Asian Male 27% 28% 29% 7% 30% Female 30% 50% 40% 6% 46% Blood Glucose Levels> 110 mg/dl:  Blood Glucose Levels andgt; 110 mg/dl Male Female 20-39 years 21% 0% 40-59 years 33% 23% 60 + years 50% 17% Prevalence of Pre-Diabetes in American Adults(Fasting Blood Glucose 110 - <126mg/dl) by Race/Ethnicity and Sex :  Prevalence of Pre-Diabetes in American Adults (Fasting Blood Glucose 110 - andlt;126mg/dl) by Race/Ethnicity and Sex White Black Mexican S. Asian Male 9.4% 8% 12.1% 12.7% Female 4.8% 6.8% 6.7% 12.5% Prevalence of Uncontrollable Diabetes (Fasting Blood Glucose 126mg/dl or more) in American Adults by Race and Sex:  Prevalence of Uncontrollable Diabetes (Fasting Blood Glucose 126mg/dl or more) in American Adults by Race and Sex White Black Mexican S. Asian Male 3% 2.8% 5.8% 21.2% Female 2.1% 4.7% 3.9% 7.1% Cholesterol levels:  Cholesterol levels 62% of SA Women had high cholesterol levels 48% of SA men had high Cholesterol levels 83% of women age 60+ had high total cholesterol levels Prevalence of Total Cholesterol of 200 mg/dl or higher by Race/Ethnicity and Sex in Americans Age 20 and above:  Prevalence of Total Cholesterol of 200 mg/dl or higher by Race/Ethnicity and Sex in Americans Age 20 and above White Black Mexican S. Asian Male 52% 45% 53% 48% Female 49% 46% 48% 62% Overall 50% 45% 50% 54% LDL HDL(<130mg/dl) (>39 mg/dl):  LDL HDL (andlt;130mg/dl) (andgt;39 mg/dl) Triglycerides:  Triglycerides 42% of SA men 36% of SA women had high triglycerides level (andgt;150mg/dl) Mean is higher than normal Proportion of South Asian Population with Cardiovascular Risk Factors :  Proportion of South Asian Population with Cardiovascular Risk Factors   Male Female High Blood Pressure 0.38 0.29 Tobacco Smoking 0.27 0.02 Excessive Drinking of Alcohol 0.13 0 Nutrition and Diet 0.94 0.94 Previous history of high blood pressure 0.37 0.34 Previous history of heart disease 0.18 0.3 Family history of high blood pressure, heart disease, andamp; diabetes. 0.49 0.46 High blood cholesterol and other lipids 0.48 0.62 Physical inactivity 0.46 0.39 Overweight and obesity 0.75 0.84 Diabetes Mellitus 0.13 0.13 Total 4.58 4.32 Risk Factors:  Risk Factors Male Female 20-39 years 4.2 2.7 40-59 years 4.7 4.3 60 + years 4.5 5 Combine Risk Factors, Blood Pressure >140/90 mm Hg and Fasting Blood Glucose >110 mg/dl of the total South Asian Population :  Combine Risk Factors, Blood Pressure andgt;140/90 mm Hg and Fasting Blood Glucose andgt;110 mg/dl of the total South Asian Population Male 14.10% Female 9.10% Both 12% Combine Risk Factors, Blood Pressure >140/90 mmHg and BMI > 25 of the total South Asian Sample Population:  Combine Risk Factors, Blood Pressure andgt;140/90 mmHg and BMI andgt; 25 of the total South Asian Sample Population Male 30% Female 27% Both 21% Combine Risk Factors Blood Pressure >140/90 mm Hg and Cholesterol >200 mg/dl of the total South Asian Population:  Combine Risk Factors Blood Pressure andgt;140/90 mm Hg and Cholesterol andgt;200 mg/dl of the total South Asian Population Male 15.5% Female 23.6% Both 19% Limitations:  Limitations Time and Resources Study population was a convenient sample Study population was not a representative Most rates are prevalences No age standardization of population examined Recommendations :  Recommendations Prevent and Control High Blood Pressure Early detection and treatment, increase access to PHC, pharmacy, compliance, andamp; emergency care Prevent and Control Type 2 Diabetes Physical activity, healthy diet, health education and promotion, diabetic management, drug therapies Prevent and Control High Cholesterol level Screening and identification, Medical advice andamp; treatment Conclusion :  Conclusion SA are at greater risk of developing CVD High prevalence of HBP, Diabetes, Cholesterol, overweight and obesity, and less physical activity. Public Health Strategy Access to Primary Health Care Culturally competent Community Outreach Programs Health Education - change in lifestyle Prevention and Control of cardiovascular risk factors Thanks :  Thanks I gratefully acknowledge the constant support and guidance given to me by all the members of my dissertation committee. I am privileged to have had Dr. David P. Smith as my advisor and committee chairman, and Dr. Asha S. Kapadia and Dr. Jacquelyn Slomka as dissertation committee members, who always encouraged me and provided ongoing advice through the completion of this project. Thanks to Dr. Salma Khuwaja for her support and encouragement. Slide52:  Spend now on prevention or pay later for treatment Sandeep Gupta 1995

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