Border Health Issues and its Implications for Hispanic Mathematicians

Transcription

1 Border Health Issues and its Implications for Hispanic Mathematicians Jorge Ibarra, MD, MPH Adjunct Faculty, Epidemiology Statistical Consulting Laboratory UTEP Friday, September 25, 2009

2 Border Health Issues and its Implications for Hispanic Mathematicians Objectives: To become familiar with selected Border Health Issues Learn from an example from San Elizario, TX Gain knowledge of epidemiology applications Learn about the profession of epidemiology and career opportunities in the Border US Mexico

3 The U.S. Mexico Border Region Issues The United States México Border region is defined as the area land being 100 kilometers (62.5 miles) north and south of the international boundary. It stretches approximately 2,000 miles from the southern tip of Texas to California, with an estimated population of 12 million inhabitants US MX Border Health Commission 2007

4 United States Mexico Border: 100 Km North and South

5 The U.S. Mexico Border Region: Issues Immigration increased from 30,000 in 1961 to around 400,000 in 2001 Estimates of Hispanics in US Border States: California 4,026,219 Texas 2,356,703 Arizona 618,105 New Mexico 111,049 PAHO/WHO Health in the Americas 2007

6 The U.S. Mexico Border Region: Issues Border Cities Population % Nogales 194,517 3 Reynosa 527,888 5 McAllen 678,652 6 El Paso 821,306 7 Tucson 925,000 8 Tijuana 1,410, Ciudad Juarez 1,383, San Diego 2,936, Largest population concentrations are in San Diego, C Juarez and Tijuana. The population is expected to reach 20 million by the year 2020 PAHO/WHO Health in the Americas 2007

7 The U.S. Mexico Border Region: Issues More than 300 million people cross the Border each year Almost 100 million cars and trucks cross 24 official ports of entry More than 3,000 maquiladoras are located along the Border PAHO/WHO Health in the Americas 2007

8 The U.S. Mexico Border Region: Issues Air Pollution Pollutants from: Motor vehicles, power plants, industrial facilities, agricultural operations, mining, unpaved roads, and open burning trash, including: Sulfur dioxide, suspended particulate matter (PM 10 and PM 2.5 microns), nitrogen dioxide, ozone, and carbon monoxide. CDC National Center of Environmental Hazards & Health Effects 2007

9 The U.S. Mexico Border Region: Issues The US Mexico Border is a medically underserved region 25% 30% uninsured rates, high rates of migration, inequitable health conditions, high rate of poverty (average income is $14,500), 25 year olds average 2 3 years less of school compared to other US regions US MX Border Health Commission 2007

10 The U.S. Mexico Border Region: Issues Mexico and the US trade about $700 million/day In 2000, US exports to MX > $110 billion, imports from MX > $130 billion Regardless of economic changes, the Border continues facing major problems associated with poverty. It demands increased and sustained governmental and private funding for health programs, infrastructure and education US MX Border Health Commission 2007

11 The U.S. Mexico Border Region: Issues Life expectancy, a measure that reflects public health and social justice successes, ranges from 72 years in Texas to 77 years in Arizona. PAHO/WHO Health in the Americas 2007

12 The U.S. Mexico Border Region: Issues By age 65, 24.4% women and 48.7% men will be diagnosed with diabetes in the US Border Prevalence (a measure of known events in a period) of diabetes in 2001, : MX Border 19.5 % US Border 16.1% PAHO/WHO Health in the Americas 2007

13 The U.S. Mexico Border Region: Issues Prevalence of Overweight (BMI kg/m 2 ) US Border 39.3% MX Border 41.2% Prevalence of Hypertension (SBP 140, DBP 90 mm/hg) US Border 23.5% MX Border 36.7% PAHO/WHO Health in the Americas 2007

14 The U.S. Mexico Border Region: San Elizario, TX San Elizario, TX is a medically underserved region The purpose of the study was to describe the health status and assess the prevalence of biological markers for cardiovascular risk factors and diabetes in 136 fasting residents Ibarra, Anders, Gibbs, Camilletti, and Bean. Poster. UTEP 2009

15 The U.S. Mexico Border Region: San Elizario, TX 79% were living in the Colonia more than 10 years, 75% were married, half the population achieved years of education, 79% reported working in the US with a median annual income of $14,400, 66% were living under current guidelines of poverty Ibarra, Anders, Gibbs, Camilletti, and Bean. Poster. UTEP 2009

16 The U.S. Mexico Border Region: San Elizario, TX About 64% of the population buy medications in El Paso, 77% declared having problems in obtaining health care, 70% spent more than 30 minutes travelling to their health care provider, almost 60% have no medical insurance, and almost 30% owed money to their medical provider. Ibarra, Anders, Gibbs, Camilletti, and Bean. Poster. UTEP 2009

17 The U.S. Mexico Border Region: San Elizario, TX Prevalence of the ratio: total cholesterol/high density lipoprotein (TC/HDL) a risk factor predictor of death from cardiovascular events was 52% Prevalence of diabetes was 28.1%. 27% men and 75% of women had a waist circumference above guidelines 48.4% had a BMI score greater than 30

18 The U.S. Mexico Border Region: San Elizario, TX With the exception of high blood pressure ( 140/90 mm/hg), individuals with obesity (BMI 30 Kg/m 2 ), high cholesterol ( 200 mg/dl), depression, and diabetes (glucose 110 mg/dl), were 46% to 5 times more likely to have access to health care, compared to individuals with no such medical diagnoses Ibarra, Anders, Gibbs, Camilletti, and Bean. Poster. UTEP 2009

19 The U.S. Mexico Border Region: What is There To address environmental issues in the Border: Border XXI Program Border 2012 Program Program focuses on cleaning the air, providing safe drinking water, reducing the risk of exposure to hazardous waste, and ensuring emergency preparedness CDC National Center of Environmental Hazards & Health Effects 2007

20 The U.S. Mexico Border Region: What is There To address environmental and health issues in the Border: Pan American Health Organization (WHO PAHO) US MX Border Health Association US MX Border Health Commission The University of Texas, University of Arizona, University of California San Diego, Texas Tech University Paso del Norte Health Foundation, Border Health Foundation, California Endowment, Amgen CDC National Center of Environmental Hazards & Health Effects 2007

21 Why Mathematicians? The association of numbers with the practice of medicine starts at the beginning of the 17 th Century with the measurement of body constants to a single individual (clinical statistics), numerical statements related to small groups of individuals (medical statistics), measurements relating to large groups or to a whole population, like the enumeration of similar cases in vital statistics, demography, and epidemiology

22 Why Mathematicians? PCA Louis ( ) introduced his mathematical method to clinical medicine, by recording patient characteristics, symptoms, treatments, and outcomes. He evaluated blood letting as a treatment for pneumonia, a standard practice for over 2,500 years, by comparing two groups of people, and concluded that it was useless as a treatment for pneumonia.

23 Why Mathematicians? With regard to his numerical method, PCA Louis stated that counting is not easy It is necessary to account for different circumstances of age, temperament, physical condition, natural history of the disease, and errors in giving therapy This method requires much more labor and time than the most distinguished members of the medical profession can dedicate to it

24 Why Mathematicians? PCA Louis techniques for success were: publishing, teaching, and convincing good students His followers included William Farr ( ) who introduced several key epidemiological concepts such as herd immunity, dose response, death rate, and cohort effect Farr noted the correlation between social economic class and disease

25 Why Mathematicians? PCA Louis students founded : The Society for Medical Observation in Paris The Statistical Society of London The Society for Medical Observation in Boston The American Statistical Society

26 Why Mathematicians? Another example was the development of the Case Control method from the investigation of the relationship of cigarette smoking and lung cancer in the mid 20 th Century by Sir Austin Bradford Hill and Sir Richard Doll.

27 The U.S. Mexico Border Region: Approaches Epidemiology and biostatistics provide the quantitative foundation for public health and clinical research by: Gathering and using data from populations, developing study designs for investigations, and obtaining unbiased evidence for testing hypothesis

28 The U.S. Mexico Border Region: Approaches Access to Health Care (ensuring access) Cancer mortality (breast cancer, cervical cancer) Diabetes (mortality rates, hospitalizations) Environmental health (sewage, pesticide poison) HIV/AIDS /Tuberculosis (incidence of HIV/AIDS/TB) Immunizations and Infectious Diseases (expansion) Injury Prevention (mortality from crashes) Maternal, Infant and Child Health (defects, teens) Mental Health (suicide mortality) Oral Health (access to health care) Respiratory diseases (hospitalizations due to asthma) CDC National Center of Environmental Hazards & Health Effects 2007

29 The U.S. Mexico Border Region: Approaches Recently, in response to the Institute of Medicine Report The Future of Public Health, the Public Health Faculty/Agency Forum drafted the Competences for Public Health including as core sciences, Epidemiology and Biostatistics

30 The U.S. Mexico Border Region: Approaches Examples of Skills are: Apply stratified and multivariate methods for data analysis to test hypotheses Calculate and interpret quantitative measures like the Odds Ratio, the Relative Risk, the Attributable Risk, etc., in a causal framework Synthesize data and literature in a balanced fashion Develop a simple budget Work in a multidisciplinary research team Produce manuscripts and get funding for research Respond to ethical issues of scientific research

31 The U.S. Mexico Border Region: Approaches Mentoring students to learn mathematical methods as applied to public health, in Community Colleges and Universities (2020 Health Objectives) Mathematical Modeling of Diseases and Events: Development of statistical methods for disease surveillance, methods for the early detection of disease outbreaks, development of cluster modeling methods, disease mapping methodology

32 The U.S. Mexico Border Region: Approaches Become a Hispanic Epidemiologist: 3% Hispanic 5% African American 15% Asian 77% Non Hispanic White OD Carter Pokras Annals of Epidemiology 09