M A U R I C E D U G G I N S , M D
C L I N I C A L A S S I S T A N T P R O F E S S O R , K U S M - W
V I A C H R I S T I F A M I L Y M E D I C I N E R E S I D E N C Y P R O G R A M
AFRICAN AMERICAN HEALTH RISKS: What You Need to Know
US Mortality 2006
1. Heart Diseases 631,636 26.0
2. Cancer 559,888 23.1
3. Strokes 137,119 5.7
4. Chronic Lower Respiratory Diseases 124,583 5.1
5. Accidents (unintentional injuries) 121,599 5.0
6. Diabetes 72,449 3.0
7. Alzheimer Disease 72,432 3.0
8. Influenza & Pneumonia 56,326 2.3
9. Kidney Diseases 45,344 1.9
10. Septicemia 34,234 1.4
Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.
Rank Cause of Death No. of deaths % of all deaths
10 Leading Causes of Death Among African-Americans
1. Heart Diseases
2. Cancer
3. Stroke
4. Accidents
5. Diabetes
6. Homicide
7. Kidney Diseases
8.Lower Respiratory Diseases
9. HIV/AIDS
10. Septicemia
African-Americans: Caucasians:
1. Heart Diseases2. Cancer3. Stroke4. Accidents5. Diabetes6. Homicide7. Kidney Disease8. Respiratory9. HIV/AIDS10. Septicemia
1. Heart Diseases2. Cancer3. Stroke4. Respiratory5. Accidents6. Alzheimer 7. Diabetes8. Influenza/Pneumonia9. Kidney Disease10. Suicide
HEALTH RISKS
#1 Heart Diseases
This includes diseases of the heart and diseases of the blood vessels
Heart AttacksConstriction or obstruction in the vessels that supply the heart
Peripheral Arterial Disease(PAD)Constriction or obstruction in vessels taking blood to extremities
Congenital Heart DiseaseHeart Diseases one is born with
Arrhythmias Abnormal rhythms or heart beats
#1 Heart Diseases
CARDIOMYOPATHYDecreased heart function due to diseases of the heart muscle
Hypertension (High Blood Pressure)The pressure in the blood vessels is above normal
#1 Heart Diseases
Hypertension (High Blood Pressure) affects African Americans at a much higher percentage rate than any other race.
Normal Blood Pressure: 120/80
Source: NCHS.
United States: 2010). Source: NHLBI.
177.1
73.7 76.6
39.2
0
40
80
120
160
200
Coronary HeartDisease
Stroke HypertensiveDisease
Heart Failure
Bil
lio
ns
of
Do
llar
sEstimated direct and indirect costs (in billions of dollars) of major heart diseases and stroke
. (ARIC Surveillance:1987-2004). Source: NHLBI.
02468
10121416
35-44 45-54 55-64 65-74
Per 1
,000
Per
sons
White Men Black Men White Women Black Women
Annual rate of first heart attack by age, sex and race
#1 Heart Diseases
RISK FACTORS:FAMILY HISTORY
Heart problem in a close family member : Parents, Siblings, etc.
OBESITYBody Mass Index >30 or Waist to Hip Ratio >1 for men Waist to Hip Ratio >.85 for women
INACTIVITYLess than 120-150 minutes of exercise weekly
#1 Heart Diseases
RISK FACTORS (continued) :DIABETES
Elevated blood sugar
HYPERTENSIONHigh Blood Pressure
DYSLIPIDEMIAHigh CHOLESTEROL, High TRIGYLCERIDES, High LDL or Low HDL
Source: D’Agostino et al., Circulation. 2008;117:743-753.
A B C DAge 50-54 50-54 50-54 50-54HDL Cholesterol, mg/dL 45-49 45-49 35-34 35-34Total Cholesterol (mg/dL) 160-199 200-239 200-239 200-239Systolic BP mm/Hg, no treat. 120-129 130-139 130-139 130-139 Smoker No No No YesDiabetes No No Yes Yesmm Hg = millimeters of mercury. mg/dL = milligrams per deciliter of blood
7.911.2
21.6
4.57.3
30+
15.9
24.8
0
5
10
15
20
25
30
35
A B C D
Estim
ated
10-
Year
Rat
e%
MenWomen
#1 Heart Diseases
#1 Heart Diseases
RESPONSE:
D.I.E.T.
Determine the changes needed
Increase Physical Activity
Educate self on your diagnosis and know your family history
Treatment: Start and don’t stop without your doctor’s permission.
Life Expectancy 2006
What do you think is the life expectancy for white men compared to black
men?
Life Expectancy 2006
White men - 76 years
Black men - 70 years
#2 CANCER
Leading Causes of Cancer Deaths:
o Lung Cancer
o Colorectal Cancer
o Prostate Cancer (men)
o Breast Cancer (women)
Estimated US Cancer Deaths 2009
ONS=Other nervous system.Source: American Cancer Society, 2009.
Men292,540
Women269,800
26% Lung & bronchus
15% Breast
9% Colon & rectum
6% Pancreas
5% Ovary
4% Non-Hodgkinlymphoma
3% Leukemia
3% Uterine corpus
2% Liver & intrahepaticbile duct
2% Brain/ONS
25% All other sites
Lung & bronchus 30%
Prostate 9%
Colon & rectum 9%
Pancreas 6%
Leukemia 4%
Liver & intrahepatic 4%bile duct
Esophagus 4%
Urinary bladder 3%
Non-Hodgkin 3%
Kidney & renal pelvis 3%
All other sites 25%
Cancer Incidence Rates* by Race and Ethnicity, 2001-2005
*Age-adjusted to the 2000 US standard population.†Person of Hispanic origin may be of any race.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2008.
551.4
354.0 336.6
423.6 398.9
287.8 296.4 317.8
651.5
419.4
0
100
200
300
400
500
600
700
800
White African American Asian/Pacific Islander American Indian/Alaska Native
Hispanic†
Men Women
Rate Per 100,000
Cancer Death Rates* by Race and Ethnicity, US, 2001-2005
230.7
138.8
190.0159.2
186.7
95.6
142.0
105.2
313.0
159.0
0
50
100
150
200
250
300
350
400
White AfricanAmerican
Asian/PacificIslander
AmericanIndian/ Alaskan
Native
Hispanic†
Men Women
*Per 100,000, age-adjusted to the 2000 US standard population.† Persons of Hispanic origin may be of any race.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2008.
Cancer Sites in Women for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005
All sites 186.7 159.2 1.2Stomach 5.5 2.5 2.2Myeloma 6.0 2.8 2.1Uterine cervix 4.7 2.3 2.0Esophagus 2.8 1.6 1.8Uterine corpus 7.1 3.9 1.8Colon and rectum 22.4 15.3 1.5Pancreas 12.4 9.0 1.4Breast 33.5 24.4 1.4
*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.
Site BLACK White Ratio of African American/White
Cancer Sites in Men for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005
All sites 313.0 230.7 1.4
Prostate 59.4 24.6 2.4Larynx 4.8 2.1 2.3Stomach 11.5 5.0 2.3Myeloma 8.3 4.3 1.9Oral cavity and pharynx 6.7 3.8 1.8Colon and rectum 31.8 22.1 1.4Lung and bronchus 93.1 71.3 1.3Pancreas 15.4 12.1 1.3
*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2008.
Site Black WhiteRatio of African American/White
#2 CANCER
Progress: Cancer death rates have declined
The cancer death rate for African American men is 45% higher than that of white men
The cancer death rate for African American women is 22% higher than that of white women.
#2 CANCER
RISK Factors:Family History
BRAC 1and 2 genes
Excessive Sun ExposureYes, African Americans can get sunburns and skin cancer
ObesityPancreatic
Breast
Smoking
#2 CANCER
RESPONSE Screening
Stay Fit/ Lose Weight
Avoid Fatalism (Whatever will be will be.)
Healthy Diet
Screening Guidelines for the Early Detection of Breast Cancer
Yearly mammograms are recommended starting at age 40.
A clinical breast exam(CBE):every 3 years for women in their 20s and 30s. Annually for women aged 40 and older
Women should know how their breasts normally feel and report any breast changes promptly to their health care providers.
__________* Beginning at age 40 years, annual CBE should be performed prior to mammography
American Cancer Society
Screening Guidelines for the Early Detection of Cervical Cancer
Screening (PAP): Three (3) years after a Female begins having vaginal intercourse, but no later than 21 years of age.Screening should be done every year with regular Pap tests or every two years using liquid-based tests. –ASK your doctor.At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years with cervical cytology alone, or every 3 years with a human papillomavirus DNA test plus cervical cytology.Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.
American Cancer Society
Screening Guidelines for the Early Detection of Prostate Cancer
Beginning at age 50, health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men and offer the PSA blood test and the digital rectal examination.*
The AUA Foundation believes that the decision to screen is one that a man should make with his doctor following a careful discussion of the benefits and risks of screening. In men who wish to be screened, the AUA recommends getting a baseline PSA, along with a physical exam of the prostate known as a digital rectal exam (DRE) at age 40.
.
American Cancer Society and American Urological Association
Screening Guidelines for the Early Detection of Colorectal Cancer and Adenomas
Beginning at age 50, Men and Women should follow one of the following examination schedules:A flexible sigmoidoscopy (FSIG) every five yearsA colonoscopy every ten(10) yearsA double-contrast barium enema every five(5) yearsA Computerized Tomographic (CT) colonography every five yearsA guaiac-based fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) every yearA stool DNA test (interval uncertain)
Tests that detect adenomatous polyps and cancerTests that primarily detect cancer
People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule
American Cancer Society
Life Expectancy 2006
What do you think is the life expectancy for white
women compared to black women?
Life Expectancy 2006
White women - 81 years
Black women - 76.9 years
#3 STROKE
What is a stroke?Interruption of blood flow to any area of the BRAIN
Hemorrhagic• Rupture of blood vessel in the Brain
Ischemic• Blockage of the blood flow by clot
SIGNSSudden numbness or weakness of the face, arm, or leg.Sudden confusion or trouble speaking or understanding others.Sudden trouble seeing in one or both eyes.Sudden dizziness, trouble walking, loss of balance, or coordination.Sudden severe headache with no known cause.
#3 STROKE
RISKS:HIGH BLOOD PRESSURE
DIABETES
OBESITY
HEART DISEASES
ALCOHOL
HIGH CHOLESTEROL
SICKLE CELL ANEMIA
FAMILY HISTORY
(NHANES: 2003-2006). Source: NCHS and NHLBI.
0.3 1.0
7.4
0.62.7
7.5
12.615.4
02468
1012141618
20-39 40-59 60-79 80+
Per
cent
of P
opul
atio
n
Men Women
Prevalence of STROKE by Age and Sex
#3 STROKE
RESPONSE:QUIT SMOKING
INCREASE PHYSICAL ACTIVITY
KNOW YOUR RISK FACTORS
#4&6 ACCIDENTS & HOMICIDES
ACCIDENTALFalls
Motor Vehicle
Poisonings
Firearms
Child/Domestic/Elderly Abuse
HOMICIDESNUMBER ONE REASON FOR DEATH AMONG YOUNG MALES
#4&6 ACCIDENTS & HOMICIDES
RISKSPOVERTY
LOW EDUCATION LEVEL
VIOLENT ENVIRONMENT
RESPONSEPREVENTION
EDUCATION
IMPROVING ECONOMIC DISPOSITION
ANGER MANAGEMENT
#5 DIABETES
DEFINITION:
HIGH BLOOD SUGAR
NORMAL LEVELS: 80 TO 100
TYPES:
TYPE #1 -10%
THE BODY IS NOT PRODUCING INSULIN
TYPE#2 – 90%
THE BODY PRODUCES THE INSULIN BUT IT NOT GETTING INTO THE CELLS WHERE IT IS NEEDED
#5 Diabetes
DIAGNOSIS:
Fasting Blood Sugar 126 or greater
Random Blood Sugar 200 or greater.
A1C of 6.5 percent or greater
#5 DIABETES
Source: NCHS and NHLBI. NH – non-Hispanic.
6.4 6.4
12.8 13.011.8
13.1
0
2
4
6
8
10
12
14
Men Women
Per
cent
of P
opul
atio
n
NH Whites NH Blacks Mexican Americans
Prevalence of physician-diagnosed diabetes in Adults age 20 and older by race/ethnicity and sex (NHANES: 2003-2006).
#5 DIABETES
RISKS FACTORS:
OBESITY
INACTIVITY
FAMILY HISTORY
DIABETES IN PREGNANCY
#5 DIABETES
RESPONSE:LIFE LONG ACTIVITY
KEEP WEIGHT UNDER CONTROL
REDUCE REFINED SUGAR INTAKECOMPLEX CORBOHYDRATES
FIBER
STICK WITH TREATMENT AND MONITOR BLOOD SUGARS REGULARLY
#7 KIDNEY DISEASES
Nephritis
Nephrotic syndrome
Nephrosis
#7 KIDNEY DISEASES
RISKSHIGH BLOOD PRESSURE
DIABETES
ANEMIA
RESPONSECONTROL BLOOD PRESSURE
AVOID OR CONTROL DIABETES
DONATE BLOOD
# 8 RESPIRATORY
This refers to conditions affecting the Lung
COPD-Chronic Obstructive Lung DiseaseEmphysema
The soft tissue s of the lungs are damaged
Chronic Bronchitis/AsthmaThe tubes of the lungs are inflamed or constricted
# 8 RESPIRATORY
RISK Factors:Smoking
Second-hand Smoke
Asthma
Recurrent Lung Infections
Exposure to Toxins
# 8 RESPIRATORY
RESPONSE:Don’t start smoking
Quit smoking
Help your partner or other household members quit smoking
Avoid toxins:Wear Masks, Use filters –whenever possible.
Get regular AEROBIC Exercise (Physical Activity)
#9 HIV/AIDS
HIVINFECTION with HUMAN IMMUNODEFICIENCY VIRUS that leads to development of ACQUIRED IMMUNODEFICIENCY DISEASE SYNDROME (AIDS).
In 2006 there were an estimated 1.1 million people living with HIV infection, of which almost half (46%) were African American
Blacks accounted for 51% of the new HIV/AIDS diagnoses in 34 states when we add in the CHILDREN affected
#9 HIV/AIDS
African Americans with AIDS often don’t live as long as people of other races and ethnic groups with AIDS
AIDS is now the leading cause of death for African American women ages 25-34.
Twenty-five percent of HIV/AIDS patients are women, but African American women are over 21 times more likely to die from HIV/AIDS than Caucasian women.
#9 HIV/AIDS
GIRLS 13-19
In 2001 they represented 72% of the new HIV diagnoses among females in this age group
#9 HIV/AIDS
RISKSUNPROTECTED INTERCOURSE
POVERTY
DRUG USEALCOHOL, MARIJUANA, COCAINE, METH., …ETC
MISEDUCATION
STEREOTYPES
One can tell what an HIV infected person looks likes
MYTHS
If you are not “doing it” there is something wrong with you.
#9 HIV/AIDS
THEBODY.COM
#9 THE MANY FACES OF HIV/AIDS
Aavip.org
#9 HIV/AIDS
RESPONSE: ABCsA: ABSTINENCE until ready for a committed relationship
B: BE FAITHFUL to one partner
C: use a CONDOM
D: Don’t do DRUGS
E: Educate YOURSELF/OTHERS about HIV/AIDS EPIDEMIC
#10 SEPTICEMIA
When there is an infection in any part of the body and it also present in the blood stream- it’s called septicemia
#10 SEPTICEMIA
Septicemia: Infection in the blood Signs
Fever, high heart rate, feeling of weakness, low blood pressures, chills
RISKSMost people are unaware of ongoing infection
Kidney, bladder, and lungs are common sources
RESPONSEGet treated for infections right away.If on treatment and not getting better, Alert your DoctorHospitalization
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