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Lorig KR, Ritter PL, Jacquez A. Outcomes of Border Health Spanish/English Chronic Disease Self-management Programs. DIABETES EDUCATOR 2016; 31:401-9. [PMID: 15919640 DOI: 10.1177/0145721705276574] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to evaluate the community-based Chronic Disease Self-management Program (CDSMP) and the Spanish-language version (Tomando Control de Su Salud) programs as delivered in settings along the Texas/New Mexico/Mexico border. The programs had proven effective in randomized trials, and the authors wished to determine if they would be as effective when administered by others to different populations. Methods The El Paso Diabetes Association administered the CDSMP and Tomando to 445 persons with chronic illness (two thirds with diabetes) in Texas, New Mexico, and Mexico. Four-month and 1-year outcomes were compared to baseline using t tests of change scores. Regression models were used to test whether baseline demographics and self-efficacy were associated with positive outcomes of the programs. Results Participants showed improvements in health behaviors, health status, and self-efficacy at both 4 month and 1 year. Baseline self-efficacy and 4-month change in self-efficacy were significantly associated with improved 1- year outcomes. Conclusions The CDSMP and Tomando are effective when used in settings other than that of the original study for populations other than those for which they were initially developed.
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Affiliation(s)
- Kate R Lorig
- The Patient Education Research Center, Stanford University, Stanford, California (Ms Lorig, Mr Ritter)
| | - Philip L Ritter
- The Patient Education Research Center, Stanford University, Stanford, California (Ms Lorig, Mr Ritter)
| | - Anna Jacquez
- Formerly from the El Paso Diabetes Association, El Paso, Texas (Ms Jacquez)
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Ottenbacher AJ, Snih SA, Karmarkar A, Lee J, Samper-Ternent R, Kumar A, Bindawas S, Markides KS, Ottenbacher KJ. Routine physical activity and mortality in Mexican Americans aged 75 and older. J Am Geriatr Soc 2012; 60:1085-91. [PMID: 22647251 PMCID: PMC4138143 DOI: 10.1111/j.1532-5415.2012.03995.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the association between routine physical activity and risk of 3-year mortality in Mexican Americans aged 75 and older. DESIGN Longitudinal study involving a population-based survey. SETTING Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE) survey conducted in the southwestern United States (TX, CO, AZ, NM, CA). PARTICIPANTS Mexican-American men and women aged 75 and older (N = 948) participating in the H-EPESE. MEASUREMENTS Responses to the Physical Activity Scale for the Elderly (PASE) were assessed in 2005-06. Mortality was determined according to report of relatives at 3-year follow-up and from the National Death Index. Covariates included sociodemographic characteristics, financial strain, smoking status, body mass index, activities of daily living, depressive symptoms, cognitive function, and comorbid conditions. RESULTS The mean age of the sample was 82.2 ± 4.5. Cox proportional hazard regression estimated that the hazard ratios of death for persons in the low, moderate, and high quartiles of physical activity (PASE scale) ranged from 0.36 (95% confidence interval (CI) = 0.21-0.62) to 0.50 (95% CI = 0.31-0.82) compared to persons in the sedentary quartile after adjusting for covariates. CONCLUSION Routine physical activity involving household and leisure activities was associated with lower 3-year risk of mortality in a sample of older Mexican Americans living in the community.
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Affiliation(s)
- Allison J Ottenbacher
- Center for Healthcare Quality and Safety, University of Texas Health Science Center, Memorial Hermann, Houston, Texas, USA.
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Willey JZ, Rodriguez CJ, Moon YP, Paik MC, Di Tullio MR, Homma S, Sacco RL, Elkind MSV. Coronary death and myocardial infarction among Hispanics in the Northern Manhattan Study: exploring the Hispanic paradox. Ann Epidemiol 2012; 22:303-9. [PMID: 22424967 DOI: 10.1016/j.annepidem.2012.02.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Prior studies have reported that Hispanics have lower cardiovascular disease (CVD) mortality despite a higher burden of risk factors. We examined whether Hispanic ethnicity was associated with a lower risk of nonfatal myocardial infarction (MI) coronary death (CD) and vascular death. METHODS A total of 2671 participants in the Northern Manhattan Study without clinical CVD were prospectively evaluated. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of race-ethnicity with nonfatal MI, CD, and vascular death after adjusting for demographic and CVD risk factors. RESULTS Mean age was 68.8 (10.4) years; 52.8% were Hispanic (88% Caribbean-Hispanic). Hispanics were more likely to have hypertension (73.1% vs. 62.2%, p < .001) and diabetes (22.0% vs. 13.3%, p < .001), and less likely to perform any physical activity (50.1% vs. 69.2%, p < .001) compared to non-Hispanic whites (NHW). During a mean 10 years of follow-up there were 154 nonfatal MIs, 186 CD, and 386 vascular deaths. In fully adjusted models, Hispanics had a lower risk of CD (adjusted HR = 0.36, 95% CI: 0.21-0.60), and vascular death (adjusted HR = 0.62, 95% CI: 0.43-0.89), but not nonfatal MI (adjusted HR = 0.95, 95% CI: 0.56-1.60) when compared to NHW. CONCLUSIONS We found a "Hispanic paradox" for coronary and vascular deaths, but not nonfatal MI.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, New York, NY, USA.
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Samper-Ternent R, Kuo YF, Ray LA, Ottenbacher KJ, Markides KS, Al Snih S. Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. J Am Med Dir Assoc 2012; 13:254-9. [PMID: 21450197 PMCID: PMC3128678 DOI: 10.1016/j.jamda.2010.07.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 07/28/2010] [Accepted: 07/28/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND The oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old. OBJECTIVE To compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. METHODS This study included 568 community-dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly 2004-2005 and 933 non-Hispanic whites (NHW) of the same age from the Health and Retirement Study 2004. Measures included sociodemographic variables, self-reported medical conditions, activities of daily living (ADLs), and instrumental activities of daily living. Logistic regression analysis was used to examine 2-year mortality in both populations. RESULTS Heart attack was significantly more prevalent in oldest old NHW compared with MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared with their NHW counterparts. Compared with NHW men, MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared with NHW women. Significant differences in ADL disability were observed only between both groups of women, whereas significant differences in instrumental activities of daily living disability were observed only between men. MA men and women had higher prevalence of obesity compared with NHW. Predictors of 2-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was a mortality predictor only for NHW. Similarly, lung disease was a predictor only for MA. CONCLUSION Health-related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of the oldest old adults.
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Affiliation(s)
- Rafael Samper-Ternent
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, USA.
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Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care 2008; 31:408-14. [PMID: 18096810 DOI: 10.2337/dc07-1313] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine 1) whether participants in the Spanish Diabetes Self-Management Program (SDSMP), when compared at 6 months to randomized control subjects, would demonstrate improvements in health status, health behaviors, and self-efficacy; and 2) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement. RESEARCH DESIGN AND METHODS A total of 567 Spanish-speaking adults with type 2 diabetes were randomized to a usual-care control group or 6-week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated telephone messages or no reinforcement. A1C was measured at baseline and 6 and 18 months. All other data were collected by self-administered questionnaires. RESULTS At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C (-0.4%), health distress, symptoms of hypo- and hyperglycemia, and self-efficacy (P < 0.05). At 18 months all improvements persisted (P < 0.05). SDSMP participants also demonstrated improvements in self-rated health and communication with physicians, had fewer emergency room visits (-0.18 visits in 6 months, P < 0.05), and trended toward fewer visits to physicians. At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group. CONCLUSIONS The SDSMP demonstrated effectiveness in lowering A1C and improving health status. Reinforcement did not add to its effectiveness. Given the high needs of the Spanish-speaking population, the SDSMP deserves consideration for implementation.
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Affiliation(s)
- Kate Lorig
- Stanford University School of Medicine, 2000 Welch Rd., Ste. 204, Palo Alto, California 40304, USA
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McGhan R, Radcliff T, Fish R, Sutherland ER, Welsh C, Make B. Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 2007; 132:1748-55. [PMID: 17890477 DOI: 10.1378/chest.06-3018] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients who survive a severe exacerbation of COPD are at high risk of rehospitalization for COPD and death. The objective of this study was to determine predictors of these events in a large cohort of Veterans Affairs (VA) patients. METHODS We identified 51,353 patients who were discharged after an exacerbation of COPD in the VA health-care system from 1999 to 2003, and determined the rates of rehospitalization for COPD and death from all causes. Potential risk factors were assessed with univariate and multivariate survival analysis. RESULTS On average, the cohort was elderly (mean age, 69 years), predominately white (78% white, 13% black, 3% other, and 6% unknown), and male (97%), consistent with the underlying VA population. The risk of death was 21% at 1 year, and 55% at 5 years. Independent risk factors for death were age, male gender, prior hospitalizations, and comorbidities including weight loss and pulmonary hypertension; nonwhite race and other comorbidities (asthma, hypertension, and obesity) were associated with decreased mortality. The risk of rehospitalization for COPD was 25% at 1 year, and 44% at 5 years, and was increased by age, male gender, prior hospitalizations, and comorbidities including asthma and pulmonary hypertension. Hispanic ethnicity and other comorbidities (diabetes and hypertension) were associated with a decreased risk of rehospitalization. CONCLUSIONS Age, male gender, prior hospitalizations, and certain comorbid conditions were risk factors for death and rehospitalization in patients discharged after a severe COPD exacerbation. Nonwhite race and other comorbidities were associated with decreased risk.
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Affiliation(s)
- Ryan McGhan
- Denver Health and Hospital Authority, Denver, CO, USA.
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Kaushik VP, Al Snih S, Ray LA, Raji MA, Markides KS, Goodwin JS. Factors Associated with Seven-Year Incidence of Diabetes Complications among Older Mexican Americans. Gerontology 2007; 53:194-9. [PMID: 17337900 DOI: 10.1159/000100443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Accepted: 05/12/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes is common in elderly persons and is highly prevalent in Mexican Americans. Little is known about factors associated with the incidence of diabetes complications. OBJECTIVE To examine the social, demographic and health factors associated with a 7-year incidence of diabetes complications among older Mexican Americans with diabetes. METHODS A 7-year prospective cohort of 536 non-institutionalized Mexican Americans aged > or =65 years with diabetes residing in the Southwest of USA. Measures included socio-demographic factors, duration of diabetes, diabetes treatment, medical conditions and body mass index. Diabetes complications were assessed by self-reports of any kidney, eye and circulation problems or amputation due to diabetes over a 7-year period. RESULTS Subjects with disease duration of > or =10 years were found to have an increased incidence of kidney, eye and circulation problems or amputation over a 7-year period. Hazard ratio (HR) for circulation problems was significantly higher in foreign-born subjects with >15 years in the USA. Foreign-born subjects with <15 years in the USA and those with a frequent number of physician visits were at increased risk of kidney complications. Subjects with baseline eye complications had a higher HR for incidence of amputations in the next 7 years. Subjects with baseline circulation complications had a higher incidence of amputations, eye and kidney complications in the next 7 years. CONCLUSIONS Our data suggest that risks of diabetes complications are influenced by different factors. Prolonged diabetes duration, being foreign-born, living in the USA for a longer period, and frequent physician visits were factors associated with diabetes complications. Designing intervention strategies to reduce diabetes complication risks requires an understanding of the differences in demographic and health predictors of such risks.
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Affiliation(s)
- Vinod P Kaushik
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0460, USA
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Adams SG, Anzueto A, Pugh JA, Lee S, Hazuda HP. Mexican American elders have similar severities of COPD despite less tobacco exposure than European American elders. Respir Med 2006; 100:1966-72. [PMID: 16626949 DOI: 10.1016/j.rmed.2006.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 02/24/2006] [Accepted: 02/26/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hispanics are the fastest growing ethnicity of the US population and the largest subset includes those of Mexican origin. Hispanics, including Mexican Americans (MAs), consistently report less tobacco exposure than European Americans (EAs), but limited data are available regarding differences in the clinical characteristics, severity of airflow obstruction, and functional status between MAs and EAs with chronic obstructive pulmonary disease (COPD). METHODS Participants in a community-based study of aging and frailty among MAs and EAs, San Antonio Longitudinal Study of Aging, underwent spirometry. Participants with spirometry values consistent with COPD by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria are described here. RESULTS Thirty-four percent (248/721) of the participants who underwent spirometry had evidence of GOLD Stages 1-4 COPD. Significantly more MAs with COPD reported being never smokers compared to EAs with COPD. Among those with COPD who also smoked, MAs reported significantly less tobacco exposure than EAs (15.7 vs. 32.4 pack-years, respectively), but both groups had surprisingly similar severities of airflow obstruction. Additionally, MAs had worse functional status and perceived health than did EAs. CONCLUSIONS Despite significantly less exposure to tobacco smoke, MAs with COPD had a similar degree of obstruction to airflow compared with EAs with COPD. Healthcare providers should have a high index of suspicion for COPD in MAs who are exposed to even small amounts of cigarette smoke.
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Affiliation(s)
- Sandra G Adams
- Department of Medicine, The University of Texas Health Science Center at San Antonio, TX, USA.
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Wong MD, Tagawa T, Hsieh HJ, Shapiro MF, Boscardin WJ, Ettner SL. Differences in Cause-Specific Mortality Between Latino and White Adults. Med Care 2005; 43:1058-62. [PMID: 16166877 DOI: 10.1097/01.mlr.0000178196.14532.40] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding differences in cause-specific mortality between Latinos and whites is important for targeting future public health interventions and research aimed at eliminating health disparities. OBJECTIVES We sought to determine the contribution of specific causes of death to Latino-white differences in mortality. RESEARCH DESIGN Using nationally representative data, we estimated cause-specific mortality risks, which were then used in a simulation model to estimate mortality events for a cohort of persons starting at age 25 and followed until death or age 75. SUBJECTS Subjects were 507,820 Latino and white adults, age 25 or older, who participated in the 1986-1994 National Health Interview Surveys. MEASURES Outcomes were years of potential life lost before age 75 from specific causes of death and age-specific mortality rate ratios for Latinos compared with whites. RESULTS Latinos had higher mortality rates than whites before age 45 and similar mortality rates at older ages. Latino women lost 315 (95% confidence interval [CI], 229-2423) more years of potential life (per 1000 persons before the age of 75) than white women and Latino men lost 595 (95% CI, 513-1675) more years than white men. For both men and women, whites lost substantially more years of potential life than Latinos from lung cancer. Homicide, diabetes, HIV, and liver disease contributed most to the excess years of potential life lost among Latino men, and diabetes and HIV contributed most to the excess years of potential life lost among Latino women. CONCLUSIONS To eliminate health disparities between Latinos and whites, future health policy and public health efforts should target diabetes, homicide, HIV, and liver disease among Latinos and lung cancer among whites.
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Affiliation(s)
- Mitchell D Wong
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, California 90095-1736, USA.
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Angel JL, Angel RJ. Aging trends - Mexican Americans in the Southwestern USA. J Cross Cult Gerontol 2004; 13:281-90. [PMID: 14617909 DOI: 10.1023/a:1006505814367] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J L Angel
- The University of Texas, Austin, USA.
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Ruiz T, Chalita LVDAS, Barros MBDA. Estudo de sobrevivência de uma coorte de pessoas de 60 anos e mais no município de Botucatu (SP) - Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2003. [DOI: 10.1590/s1415-790x2003000300006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O aumento proporcional do número de idosos na população tem motivado estudos no sentido de melhorar a qualidade de vida desta faixa etária através de políticas sociais e, entre elas, o planejamento em saúde. Com o objetivo de conhecer riscos de mortalidade para a população de sessenta anos e mais, um estudo de sobrevida foi realizado rastreando, no ano de 1992, os idosos participantes de um inquérito de morbidade referida realizado na cidade de Botucatu em 1983/84. Foram localizados 89,6% destes idosos. Curvas de sobrevivência foram calculadas com o método de Kaplan-Meier e a análise de riscos, utilizando-se a Regressão Múltipla de Cox ajustando-se o modelo agregando as variáveis por blocos. Para o sexo masculino foram encontradas associadas, independentemente, ao aumento da mortalidade as seguintes categorias de variáveis: idade de 70 anos e mais: Hazard Ratio (HR)=2,4 (1,6 - 3,7); salário menor que um salário mínimo: HR=2,2 (1,3 - 3,8); ter "outras rendas": HR=2,2 (1,3 - 3,9); ser o chefe da família ou seu cônjuge: HR=2,3 (1,2 - 2,4); referência de doenças do aparelho circulatório: HR=1,6 (1,1 - 2,4); referência de diabetes mellitus: HR=3,0 (1,3 - 7,0). Para o sexo feminino, foram encontradas associadas a idade de 70 anos e mais: HR=4,6 (3,0 - 7,1); referência de diabetes mellitus: HR=3,0 (1,7-5,3) e ter "outras rendas": HR=2,0 (1,1 - 4,0).
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Otiniano ME, Ottenbacher KJ, Markides KS, Ray LA, Du XL. Self-reported heart attack in Mexican-American elders: examination of incidence, prevalence, and 7-year mortality. J Am Geriatr Soc 2003; 51:923-9. [PMID: 12834511 DOI: 10.1046/j.1365-2389.2003.51304.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the prevalence, incidence, and mortality of self-reported heart attack in older Mexican Americans and to identify significant factors associated with heart attack. DESIGN Cross-sectional and longitudinal study. SETTING Baseline and three follow-up interviews in five southwestern states (Arizona, California, Colorado, New Mexico, and Texas) of the Hispanic Established Population for the Epidemiological Study of the Elderly. PARTICIPANTS Three thousand fifty Mexican Americans aged 65 to 107 (mean age = 73). MEASUREMENTS Sociodemographic factors (age, sex, marital status, language of interview, health insurance coverage, living arrangements, and financial strain) and health factors (smoking, alcohol consumption, obesity, diabetes mellitus, hypertension, stroke, cancer, hip fracture, arthritis, depression, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and mortality) were determined at baseline (1993-94). New heart attacks were assessed at follow-ups in 1995-96, 1998-99, and 2000-01. Vital status was determined over the 7-year follow-up. RESULTS Prevalence of self-reported heart attack was 9.1% at baseline. Incidence of self-reported heart attack was 6.1%, 9.1%, and 7.9%, respectively, for the three subsequent follow-ups. Older age, male sex, diabetes mellitus, hypertension, and stroke were significantly associated with heart attack at baseline. Age was a significant predictor for new heart attack at each follow-up. Having ADL (odds ratio (OR) = 2.91, 95% confidence interval (CI) = 2.19-3.86) and IADL (OR = 2.25, CI = 1.72-2.94) disabilities was significantly associated with self-reported heart attack. Subjects with heart attack were significantly more likely to die at 7 years (hazard ratio = 1.57, 95% CI = 1.29-1.91). Of those with self-reported heart attack, 42.4% had died of heart attack as the underlying cause of death by 7-year follow-up. CONCLUSION In Mexican Americans, self-reported heart attack was associated with being older and male and having diabetes mellitus, hypertension, stroke, and ADL and IADL disabilities. Nearly half of subjects with heart attack had died of heart attack as underlying cause of death by 7-year follow-up. Prevention and control for this disease would be especially important in this population to avoid early mortality.
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Affiliation(s)
- Max E Otiniano
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA
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Shin C, In KH, Shim JJ, Yoo SH, Kang KH, Hong M, Choi K. Prevalence and correlates of airway obstruction in a community-based sample of adults. Chest 2003; 123:1924-31. [PMID: 12796169 DOI: 10.1378/chest.123.6.1924] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Virtually all the information available on the prevalence of obstructive airway disease is from Western countries. There are no data from Korea, and reports from other regions of Asia are poorly documented. OBJECTIVES To evaluate the prevalence and correlates of airway obstruction in a community-based setting in Korea. DESIGN A cross-sectional, population-based study. SETTING Ansan City, near Seoul, South Korea. PARTICIPANTS A sample of 1,160 community-dwelling men and women aged >or= 18 years (73.1% of the men and 4.1% of the women were either current or former smokers). MEASUREMENTS Subjects underwent physical examinations following a standardized protocol. Data on demographic and health-related factors also were collected. Pulmonary function testing was administered according to American Thoracic Society (ATS) recommendations. RESULTS The prevalence of airway obstruction was 10.3% (men, 17%; women, 5.6%) by ATS criteria. Ninety percent of the cases of airway obstruction were mild in degree. Twenty percent of male current smokers had airway obstruction. After adjusting for age, gender, and alcohol consumption, the odds of disease was 3.2 times greater in subjects who had smoked for >or= 20 pack-years vs never smokers (95% confidence interval [CI], 1.7 to 6.2). The adjusted odds of disease were 4.3-fold higher in subjects >or= 45 years of age vs those who were younger (95% CI, 2.6 to 7.0). CONCLUSIONS Since airway obstruction is strongly related to age and smoking, the prevalence of obstructive airway disease in countries like Korea, where the population is rapidly aging and cigarette smoking is on the rise among younger individuals (particularly among women), can be expected to increase. Further efforts to diagnose early obstructive airway disease and to prevent or delay its onset should be emphasized as a major public health concern.
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Affiliation(s)
- Chol Shin
- Medical Science Research Center, Ansan Hospital, Korea University Medical Center, Ansan, South Korea
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Xu KT, Rojas-Fernandez CH. Ancillary community pharmacy services provided to older people in a largely rural and ethnically diverse region: a survey of consumers in West Texas. J Rural Health 2003; 19:79-86. [PMID: 12585778 DOI: 10.1111/j.1748-0361.2003.tb00545.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the quality of pharmacy services provided to the rural elderly population. This exploratory study examines rural/urban and ethnic differences in perceived access to ancillary pharmacy services among elderly people. Two telephone surveys were conducted using directory listings in West Texas to generate a longitudinal sample. Persons aged 65 years and older who were not cognitively impaired were asked to complete the survey. The number of participants in both rounds of the survey was 3,689. Seven ancillary pharmacy services were examined: delivery of medications, medication counseling, written medication information, blood pressure monitoring, blood glucose monitoring, osteoporosis screening, and immunization. The sample was stratified by county of residence (urban, rural, or frontier) and racial/ethnic background. Chi-square tests were performed to detect rural/urban and racial/ethnic differences in access to the seven ancillary services. The association between proficiency in English and access to the services was also examined. Rural residents were more likely than urban residents to report that their pharmacies provide delivery of medications, medication counseling, and immunization services, but they were less likely than their urban counterparts to report that their pharmacies provide blood pressure monitoring. Access to ancillary pharmacy services was reported as poorer by older Hispanic people compared with non-Hispanics. Deficiency in English was significantly related to inequality in reported access to ancillary pharmacy services. It is essential to consider the special needs of rural and Hispanic elderly people to ensure equitable access to ancillary pharmacy services.
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Affiliation(s)
- K Tom Xu
- Department of Health Services Research and Management, Texas Tech University Health Sciences Center, 3601 4th Street, Room 1C165, Lubbock, TX 79430, USA.
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Otiniano ME, Du X, Ottenbacher K, Black SA, Markides KS. Lower extremity amputations in diabetic Mexican American elders: incidence, prevalence and correlates. J Diabetes Complications 2003; 17:59-65. [PMID: 12614970 DOI: 10.1016/s1056-8727(02)00175-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.
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Affiliation(s)
- Max E Otiniano
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Bastida E, Cuéllar I, Villas P. Prevalence of diabetes mellitus and related conditions in a south Texas Mexican American sample. J Community Health Nurs 2001; 18:75-84. [PMID: 11407181 DOI: 10.1207/s15327655jchn1802_01] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prevalence of self-reported diabetes mellitus in a Mexican American sample population living in Hidalgo County in south Texas was examined along with risk for related sequelae. Data from a stratified random sample of 849 Mexican American men and women ages 45 and older were examined. A subsample of 193 diabetics was compared to 656 nondiabetics with respect to hospitalization, reasons for hospitalization, and other related medical conditions. The prevalence of self-reported diabetes for both men and women was 25.9%. Hospitalization rates for diabetics over a 1-year period and a 5-year period were significantly higher than nondiabetics. Hypertension, cardiac problems, amputations, kidney or urinary problems, eye problems, and joint and bone problems were significantly more common in the diabetics sample than in the nondiabetic sample. The data indicate that diabetes in Mexican Americans may be undertreated in south Texas.
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Affiliation(s)
- E Bastida
- Center on Aging and Health, Department of Sociology, University of Texas-Pan American, 1201 W. University Drive, Edinburg, TX 78539, USA.
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Zargar AH, Wani AI, Masoodi SR, Laway BA, Bashir MI. Mortality in diabetes mellitus--data from a developing region of the world. Diabetes Res Clin Pract 1999; 43:67-74. [PMID: 10199590 DOI: 10.1016/s0168-8227(98)00112-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This retrospective study presents the mortality trends in diabetic patients in a developing region of the world. The data were collected by screening the hospital records of all diabetic patients who died over a period of a decade at Institute of Medical Sciences, a tertiary care medical centre in Kashmir Valley of India. Of 133,374 patients admitted to the centre from January 1987 to December 1996, 9627 died, of whom 269 (151 males and 118 females) were recorded to have diabetes mellitus. The mean+/-S.D. age at the time of death was 51.61+/-13.77 years for males and 51.50+/-15.50 years for females. The common causes contributing to death were infections (33.83%), chronic renal failure (30.85%), coronary artery disease (16.36%), cerebrovascular disease (13.75%), hypoglycaemia (7.81%), diabetic ketoacidosis (6.69%) and hyperosmolar coma (2.23%). In 7.43% patients the cause of death could not be ascertained. Death was attributed to single cause in 60.22%, to two causes in 26.39% and to three or more causes in 5.95%. Most (59.11%) of these diabetic patients died within a week of hospitalisation. We conclude that mortality trends in diabetes mellitus differ in developing regions as compared to developed regions reflecting poor healthcare in general and diabetic care in particular. Unlike in west, where the major killers in diabetic patients are coronary artery disease and cerebrovascular disease, infections and chronic renal failure continue to be leading causes of death in patients with diabetes mellitus in developing regions like ours.
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Affiliation(s)
- A H Zargar
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Espino DV, Lichtenstein MJ, Hazuda HP, Fabrizio D, Wood RC, Goodwin J, Stroup-Benham CA, Markides KS. Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly. J Am Geriatr Soc 1998; 46:1228-34. [PMID: 9777904 DOI: 10.1111/j.1532-5415.1998.tb04538.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence rates of prescription and over-the-counter (OTC) medication usage among community-dwelling older Mexican Americans. DESIGN Cross-sectional survey of a regional probability sample of older Mexican Americans. SETTING The 1992-1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS 2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates. OUTCOME MEASURES Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in-home review of medication containers. RESULTS Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self-perceived health and number of co-morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage. CONCLUSIONS These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.
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Affiliation(s)
- D V Espino
- Department of Family Practice, University of Texas Health Science Center at San Antonio, USA
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