3 environmental issues disproportionately affecting Hispanic patients

AMA Wire
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Special factors influencing the health of the Hispanic population stepped into the spotlight during a panel discussion last week.  Learn what health care researchers are discovering about environmental factors that impact the health of this underserved patient population.

Researchers and physicians at the event hosted by the AMA Minority Affairs Section and the National Hispanic Medical Association discussed how multiple factors—ranging from a lack of Hispanic physicians in medicine to lurking environmental contaminants—shape Hispanic health. Some of the top issues they discussed included:

The impact of environmental contaminants on Hispanic children

Often, when people think of the environment, they “think of whales and wilderness, trees and tigers, but actually, the environment is everywhere we are …. And a child’s environment [consists of] everything we come in touch with,” said Maryann Suero, PhD, an environmental health scientist for the Environmental Protection Agency (EPA).

Suero said the average adult interacts with nearly 60,000-80,000 chemicals each day. These chemicals have varying levels of toxicity, she said, and the harmful ones often find children indoors—at home or in childcare facilities—rather than outside.

For instance, lead disproportionately affects Hispanic children, and many are not being tested for it. “When we look at the blood-lead testing rate for Illinois, almost 29 percent of children were tested in Illinois, but only 5.7 percent of Hispanic kids are tested,” she said.

Suero said certain diseases—like lead poisoning and asthma—also are “environmentally attributable” and increase health costs. “If only 1 percent of health costs are attributable to environmental exposures, [that] accounts for nearly $2 billion,” she said.

To help address these issues, she suggests physicians offer lead tests at their practices or refer patients for testing, educate other health professionals on environmental health and familiarize themselves with the EPA’s resource page for health care professionals.

How particulate matter increases risk for cardiopulmonary disease

Despite decreased pollution levels due to the Clean Air Act, particulate matter still adversely impacts U.S. and global population health, said Gökhan M. Mutlu, MD, a professor for the section of pulmonary and critical care medicine at the University of Chicago Pritzker School of Medicine.

“Particulate matter in pollution is a global health problem,” Dr. Mutlu said, highlighting multiple studies on the health impact of particulate matter that have been released since the 1990s.

Particulate matter increases risks for lower lung function, respiratory disease and lung cancer. Particulate matter also “increases mortality rates due to increased thrombatic cardiovascular events,” Dr. Mutlu said.

For instance, a landmark study of six cities conducted by Harvard School of Public health found that people who lived in areas with a greater concentration of particulate matter were dying faster—almost two to three years earlier—than those who didn’t.

“If we summarize these large studies since the 1990s, particulate exposure has accounted for roughly 3.3 million premature deaths per year in the world,” Dr. Mutlu said. “This corresponds with about 40,000-60,000 premature deaths in the United States.”

Dr. Mutlu suggests physicians, especially those who practice pulmonary care, study the associated risks of particulate matter on their patients, paying close attention to those with asthma and other respiratory conditions. Understanding these risks can help physicians better equip patients with knowledge about the impact of particulate matter on their health.

Preventing human papillomavirus (HPV) infection among adolescents

HPV is a very common virus currently infecting nearly 80 million people—about one in four—in the United States. HPV is so common that almost everyone who becomes sexually active gets it at some point in their lives, according to the Centers for Disease Control and Prevention (CDC).

The virus is a precursor to cervical cancer, but “the good thing is that we have a vaccine that protects against [this] cancer. It’s the first cancer prevention vaccine,” said Maribel Chavez-Torres, a program director at the Chicago Department of Public Health.

However, despite some improvements, HPV vaccination rates still remained low in 2014 and continue to lag behind rates for the Tdap and quadrivalent meningococcal conjugate vaccines, she said.

Hispanic teens also lag behind in HPV vaccinations, which significantly increases their chances for cervical cancer in adulthood, she said. Currently, Hispanic women have the highest rates of cervical cancer in the United States. For every 100,000 women living in the United States, about 11 Hispanic women are diagnosed with cervical cancer, compared to only seven non-Hispanic women, according to the CDC.

This is why educating patients, especially those in communities of color, about the importance of the HPV vaccine is crucial, Chaves-Torres said. In fact, researchers at the Chicago Department of Public Health found that when a clinician recommends the vaccine, “parents are actually vaccinating their adolescents because they feel comfortable with the clinicians … the parent may have several questions, but the clinician can actually walk the parent through those questions, and the child gets vaccinated,” she said.

This finding underscores the importance of diversifying the physician workforce, so more Hispanic clinicians can collaborate with parents and teens who may prefer communicating with a Hispanic physician about the vaccine, Chaves-Torres said.

Her recommendation is a particularly salient one considering a recent study in JAMA, which found that non-white physicians cared for 53.5 percent of minority and 70.4 percent of non-English-speaking patients. 

Want more ways to promote diversity and minority health? 

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Dec 12, 2017
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