National Landmark Reports Highlighting Cancer Disparities Problem

Transcription

1 National Landmark Reports Highlighting Cancer Disparities Problem Pre

2 5 Leading Causes of Death, U.S., 2003, Female All races Cardiovascular Cancer Cerebrovascular Chronic lower respiratory Alzheimer s White Cardiovascular Cancer Cerebrovascular Chronic lower respiratory Alzheimer s Black Cardiovascular Cancer Cerebrovascular Diabetes Nephritis American Indian Cardiovascular Cancer Accidents Diabetes Cerebrovascular Asian or Pacific Islander Cancer Heart Cerebrovascular Accidents Diabetes Hispanic Cardiovascular Cancer Cerebrovascular Diabetes Accidents White, non- Hispanic Black, non- Hispanic Cardiovascular Cardiovascular Cancer Cancer Cerebrovascular Cerebrovascular Chronic lower respiratory Diabetes Alzheimer s Nephritis Heron, M. P., & Smith, B. L. (2007). Deaths: Leading causes for 2003 (No. DHHS Kagawa-Singer Publication - Women (PHS) and 1120): National Center for Health Statistics.

3 Disease always occurs within a context of human circumstances, including economic status, social position, culture and environment.

4 Ecological Model of Health * Modified from McElroy and Townsend, 1996.

5 Culture Environment Economy Technology Religion/World View Language Social Structure Beliefs and Values

6

7 Poverty and gender should NOT be an offense which is punishable by death. Harold Freeman, M.D., 2006

8 California Demographics 2000 >36 million 30% 1% 49% 12% 8% Whites (excluding Hispanics) Asian or Pacific Islander American Indian, Eskimo, or Aleut Blacks Latino

9 Three Major Questions What populations have poor survival? What are the causes of disparities in survival? How can we eliminate disparities?

10 Three Major Answers Biases in our society due to: Racism Sexism Ageism

11

12 California Hispanic Age 35+ Heart Disease Rate CDC 6/9/ 05 www\\\apps.ncd.cdc.gov

13

14

15

16

17 Kian and Remee Horder

18 California Age 35+ Heart Disease Rates by Ethnicity v. U.S. CDC 6/9/ 05 www\\\apps.ncd.cdc.gov Race/Ethnicity Population Heart Disease - Rate Total Pop 12,576, AI/AN 105, AAPI 1,899, Blacks 1,023, Hispanics 3,450, WHITES 9,

19 Age-Adjusted Death Rates for Diseases of the Heart* Among Women, by Race/Ethnicity, Average annual deaths per 100,000 women, age adjusted to 1940 U.S. standard population, International Classification of Diseases, 9th Rev., codes , 402, and Source: Journal of Women s Health and Gender-Based Medicine, Vol. 10, No. 8, pp

20 Major Causes of Death in the U.S. Women have higher rates than Men for CVD and Diabetes *All data are age adjusted to 2000 total U.S. population. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270:

21 Underlying Causes of Most Chronic Diseases 35% -65% Lifestyle choices *All data are age adjusted to 2000 total U.S. population. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; Kagawa-Singer 270: Women and

22 Smoking Rates Among Ethnic Populations and Gender Native American (40.8%). Caucasian American (23.1%). African American (20.8%). Among Youth Males: 19.1% Females 20.7% Hispanic American (12.3%). Asian/Pacific Islanders (7.1%). 7/nhsda983.htm#E10E29

23 Cancer Incidence Trends California, Rate per 100, Asian/Pacific Islander Hispanic Black Non-Hispanic White S. Minority Kwong, Health Nov 2008

24 Female Breast Cancer Trends California, Rate per 100,000 Chinese Filipino Japanese Korean South Asian Vietnamese S. Kwong,

25

26

27 Ethnic Minorities in the U.S. Behavior is influenced by: Cultural Beliefs Minority Status

28

29 Relationship with Husbands of Chinese-, Japanese- & European-American Breast Cancer Survivors Theme 2: Nature of marital relationship A. Mutual emotional give and take B. Harmony and Intimacy C. Communication D. Role expectations Same for the 3 groups Harmony rather than intimacy predominates Non-Verbal Inshin denshin in Japanese and Zhih Yi in Chinese Wife s role clearly differentiated as emotional nurturer and husband as source of security Intimacy predominates v. harmony Direct and verbal communication is valued Ability to be dependent on husband Kagawa-Singer and Wellisch, 2002 Psycho-Oncology

30 Relationship with Husbands of Chinese-, Japanese- & European-American Breast Cancer Survivors Theme 3: Sources of dissonance: Meeting needs A. Empathy Expectations of wives not met by husbands B. Recognition of individuality C. Perceived types of support from H D. Sources of support for W Invalidation of individuality cut a little slack but abandoned to own resources No time out from ongoing stress in relationship Pragmatic problem-solving assistance and tangible aid driving, housecleaning, also reassurance and calm Friends/coworkers (3) Daughters/ Family (husband) (6) Husbands (15) Kagawa-Singer and Wellisch, 2002 Psycho-Oncology

31 Comparison of Physician Discussion, Decision-making and Disclosure at End of Life after adjustment * Odds Ratio (95% Confidence interval) Japanesespeaking Japanese Americans Englishspeaking Japanese Americans Japanese living in Japan Discuss end-of-life with a physician 0.73 (0.41, 1.31) 1.10 (0.62, 1.94) 1.0 Group decision-making model 1.11 (0.70, 1.74) 0.63 (0.41, 0.97) 1.0 Terminal prognosis disclosure to the patient using words 8.79 (5.42, 14.3) 2.80 (1.79, 4.37) 1.0 Terminal prognosis disclosure to the family using words 2.01 (1.05, 3.88) 1.03 (0.58, 1.83) 1.0 Matsumura, et al. 2000

32 PATH For Women Survivors and THRIVERS!!

33 Leading Causes of Death for Asian Males and Females, California, Male Cancer Heart Disease Cerebrovascular Disease Chronic Lower Respiratory Disease Accidents Female Cancer Heart Disease Cerebrovascular Disease Influenza & Pneumonia Diabetes

34 Five Most Frequently Diagnosed Cancers Among Asian/Pacific Islanders, Rank Male Prostate Lung & Bronchus Colon & Rectum Liver Female Breast Colon & Rectum Lung & Bronchus Uterus 5 Stomach Thyroid

35 Top 5 Cancer Sites Ethnicity API API Asian Ind Asian Ind Chinese Chinese Filipino Filipino Gender Male Female Male Female Male Female Male Female 1 Lung* Lung* Lung* Breast Lung* Lung* Lung* Lung 2 Colorectum Breast Prostate Lung* Liver* Colorectum Prostate Breast 3 Liver* Colorectum Pancreas Colorectum Colorectum Breast Colorectum Colorectum 4 Prostate Pancreas Leukemia Ovary Stomach Stomach Liver* Pancreas 5 Stomach Stomach Liver* Pancreas Prostate Liver* Non-Hodgkin Ovary Ethnicity Japanese Japanese Korean Korean Vietnamese Vietnamese Gender Male Female Male Female Male Female 1 Lung* Lung* Lung* Lung* Lung* Lung* 2 Colorectum Breast Stomach Stomach Liver* Liver* 3 Stomach Colorectum Liver* Liver* Stomach Colorectum 4 Prostate Pancreas Colorectum Colorectum Colorectum Breast 5 Pancreas Stomach Pancreas Pancreas Leukemia Stomach Ethnicity Nat. Hawai Nat. Hawai Samoan Samoan White White Gender Male Female Male Female Male Female Lung* Colorectum Prostate Lung* Breast Pancreas Lung* Stomach Colorectum Lung* Breast Stomach Lung* Prostate Colorectum Lung* Breast Colorectum Chu, Stomach Pancreas Colorectum Stomach Liver* Prostate Ovary Endomet. Pancreas Non-Hodgkin Ovary Pancreas

36 Age-Adjusted Death Rates Due to All Causes, California White Black Native American Mexican Puerto Rican Cuban Other Hispanic Chinese Japanese Korean Vietnamese Cambodian Thai Laotian Filipino Asian Indian Other Asian Hawaiian Guamanian Samoan Other Islander

37 Five Cancers contributing to overall cancer incidence burden in males by race/ethnicity and geography Chinese Males Percent of All Cancers 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Colon (5) Esophagus (6) Liver (12) Stomach (20) Lung (26) Stomach (7) Colon (8) Nasopharynx (9) Liver (11) Lung (24) Rectum (5) Liver (8) Colon (10) Prostate (16) Lung (18) China Hong Kong/ Singapore Geographic Region US Chinese

38 1999 Poverty Status in Asian Americans 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 12.38% 17.69% 12.60% 9.75% 29.28% 13.50% 6.25% 37.78% 9.72% 14.77% 18.50% 16.46% 14.35% 16.05% US Total NHOPI Asian Alone Asian Indian Cambodian Chinese Filipino Hmong Japanese Korean Laotian Pakistani Thai Percentage Below Poverty Vietnamese Source: Census 2000 Population

39 Prostate Cancer Five-Year Average Annual Age-Adjusted Incidence Rates per 100,000, California, Rate per 100,000 S. Kwong, Chinese Filipino Japanese Korean South Kagawa-Singer Asian Vietnamese - Women and

40 Lung and Bronchus Cancer Five-Year Average Annual Age-Adjusted Mortality Rates per 100,000, California, Rate per 100,000 Male Female 55.3 S. Kwong, Chinese Filipino Japanese Korean South Kagawa-Singer Asian Vietnamese - Women and

41 20.0 Differences between and Cancer Mortality Rates White Total API Chinese Filipino Japanese Nat. Haw. AI/AN Hispanic Chu, K. 2004

42

43