Transcript – CDC Telebriefing: New Vital Signs Report – Health risks differ among the Hispanic population in the U.S.

OPERATOR: Welcome and thank you for standing by. At this time all participants are in a listen only mode. During question and answer session you may press star 1. Today’s conference is being recorded.  At this time I am turning the call over to Belsie Gonzalez.

BELSIE GONZALEZ: Thank you. And thank you all for joining us today for the release of new CDC Vital Signs, this on leading causes of death and health risks among Hispanic population in the U.S. we are joined by the director for the Centers of Disease Control And Prevention Dr. Tom Frieden and Dr. Ken Dominguez, lead author of this Vital Signs report.  Dr. Frieden will provide some of his remarks in Spanish for the convenience of the Hispanic media who are listening as well. Please know to ask only one question and a follow up question, if you need to.

TOM FRIEDEN:  ¡Buenas tardes!  Good afternoon and thank you for joining. CDC works 24/7 to protect health, safety and security of American people. One of the ways we do this is by providing information that helps doctors help their patients make decisions about their health and their health risks. On the first Tuesday of each month we release a vital signs focusing on the latest data about one critical health issue facing our nation and even more importantly what can be done about it. An increasing proportion of our population is Hispanic, some 57 million people. Today’s vital signs is CDC’s first comprehensive national study on Hispanic’s leading causes of death, risk factors and access to health services in the U.S. it has important information for doctors and other health professionals as well as for the Hispanic community. The bottom line is that there are wide variations in disease and health risks depending on where someone was born, whether here or in their country of origin and that some areas of health are better among Hispanic population, some are worse, but all can be improved. Just as we can’t look at one individual to represent a whole population we can’t look at any racial or ethnic group as homogenous. We as doctors and other professionals look at differences among populations to get a better picture of health risks and barriers in order to provide the most appropriate care. Today’s report highlights recent data from the national census and several national health surveillance systems. In terms of Hispanic health there is good news and not so good news. There are substantial differences among Hispanics by origin and by gender.  Hispanics have lower death rates overall but are twice as likely to die of diabetes or liver disease as white Americans. While rates of heart disease and cancer are lower than in white Americans they still remain the leading causes of death and could be lower still if we do a better job reducing smoking and controlling high blood pressure compared to white Americans Hispanics are  24 percent more likely to have poorly controlled blood pressure. We can address these problems specifically with counseling on weight and diet and with steps like hepatitis b vaccination.  Chronic liver disease and cirrhosis is sixth leading causing death for Hispanics.  Half of these deaths among Hispanics are believed to be alcohol related. By reducing harmful drinking which is a major contributor we can reduce deaths from these diseases. We also need to reduce smoking among Hispanics. Smoking rates overall are lower for Hispanics than among whites but are higher among Puerto Rican males and Cuban males.  As doctors and other health professionals we need to ask Hispanic patients if they smoke and if they do encourage them to quit and help them quit. We also need to encourage physical activity.  Simply, 30 minutes of a brisk walk every day can make a huge difference not only on weight but also on blood pressure, cholesterol, mood and a variety of other risks and health aspects that can protect and improve health. U.S.-born Hispanics had much higher likelihood of being obese, having high blood pressure, smoking, having heart disease and having cancer than foreign born Hispanics. These risks were 30, 40, 72, 89 and 93 percent higher for these five conditions.  Hispanics face challenges in getting care needed to protect their health.  Many social factors affect how, how often and how well Hispanics get health care. Hispanics are twice as likely to live below the poverty line and almost three times more likely to be uninsured than whites. As doctors we can do a lot to help reduce barriers our Hispanic patients face such as speaking Spanish or getting translators when that is the preferred language, using community health workers also known as ‘promotores de salud’ to link patients to care and insuring that patients stay engaged in care. I’ll repeat a part in Spanish before turning it over to Dr.  Dominguez, the lead author of the study. 

[Esta edición de Signos Vitales es el primer estudio nacional del CDC acerca de las principales causas de muerte, los factores de riesgo de los hispanos en los Estados Unidos. Tiene información importante para doctores, otros profesionales de la salud, y para la comunidad hispana.]. En resumen, hay una gran variedad de enfermedades y riesgos de salud en los hispanos dependiendo de si nacieron en los Estados Unidos o en otro país.

Este informe tiene tres puntos muy importantes para la salud de los hispanos.

Primero, el tabaco es el enemigo número uno de la salud.  No es sólo que el tabaco le puede matarle, también causa mucho sufrimiento.  Para evitar dolor, deje de fumar.

Segundo, manténgase activo, por ejemplo, camine rápido unos treinta minutos al día.  O de tres caminatas de diez minutos cada día. Cualquier cosa que a usted le guste hacer y que va a continuar haciendo día a día, por meses y años.  Aun si no pierde peso, va a estar mucho más sano, y se va a sentir mucho mejor.

Tercero: Limite su consumo de alcohol. Aunque la población hispana en general bebe menos alcohol, hay demasiadas personas que beben demás.‎ Hombres, nunca tomen más de cuatro ‎bebidas en una ocasión, y mujeres, no más de tres.

And now I will turn this over to Dr. Ken Dominguez, the lead author of the study before we open it up for questions. 

KEN DOMINGUEZ: I am delighted to have the opportunity to talk with y’all about this vital signs report.  Using data from the national vital statistics system, the national health interview survey and the national health examination and nutrition survey we confirm that Hispanics have different degrees of illness or health risks than whites and there are differences among Hispanic subgroups. We look at Hispanics ages 18 to 64 years during 2009 to 2013. We found that Mexicans and Puerto Ricans are about twice as likely to die from diabetes as whites. Mexicans had an 80 percent higher death rate from chronic liver disease and cirrhosis than whites. Puerto Ricans had a 20 percent higher death rate from all causes of death combined than Mexicans and Cubans.  Smoking overall among Hispanics at 14 percent is less common than among whites at 24 percent. But smoking is high among Puerto Rican males at 26 percent and Cuban males at 22 percent. About 70 percent more Puerto Ricans smoke than Mexicans. 80 percent more heart disease compared to Hispanics overall. Colorectal cancer screening varies for Hispanics by origin ages 16 to 75 years. Hispanics are as likely as whites to have high blood pressure but less likely to have it under control. Hispanic women with high blood pressure are twice as likely as Hispanic men to get it under control. Some of the actions that Hispanics living in the U.S.can take to protect or improve their health include finding out if they are eligible for health insurance through the health insurance market place and sign up. The website is in English and Spanish. Learning about diabetes and how to prevent type II diabetes such as eating a healthy diet low in salt, low in total fat and cholesterol and rich in fresh fruits and vegetables. Making a strong effort to follow proven health tips recommended by doctors and health care providers such as quitting smoking and staying on medicine to control blood pressure and cholesterol, getting screening tests for cancer and other health risks when they are needed and following up on any abnormal results and as Dr. Frieden mentioned keeping healthy weight and taking at least one brisk walk three times a day five days a week. 

BELSIE GONZALEZ:  Thank you, Thank you Dr. Frieden and Dr. Dominguez We are ready for questions. 

OPERATOR: Thank you.  We are now ready to begin the question and answer session.  If you would like to ask a question please press star 1.  You will be prompted to record your name.  To withdraw your request you may press star 2.  Press star 1 to ask a question.  One moment please for our first question.  Our first question comes from Mike Stobbe with the Associated Press.  You may ask your question. 

MIKE STOBBE: Hello. Thank you for taking my question. The first one, Dr. Dominguez as you noted Puerto Ricans had 20 percent higher death rate from all causes than combined.  Puerto Ricans looked a little worst in several key measures. Can you speak to why that is or why that might be? My follow up question is how come y’all didn’t make a comparison to African-Americans? 

KEN DOMINGUEZ:  For the first part in terms of why that might be Puerto Ricans have higher all-cause mortality than for example Mexicans and Cubans, I think really the biggest reason that we can think of based on our report is the overall higher smoking rates. They have 66 percent higher smoking rates than those other two groups. We know that smoking overall causes 2 in every 10 deaths in the United States. It is a major risk factor for mortality here in the United States. We think that that is probably the biggest factor. Once again, since we didn’t look at that specifically all we can do is look at the literature that is published and try to answer that question and the second question, could you repeat the second question? 

MIKE STOBBE: Why not compared to —

KEN DOMINGUEZ: — due to the nature of this particular report we decided that we wanted to focus very brief report so we don’t have a lot of room in this report. So in order to provide a nice overview we decided to limit the comparison to the larger population which is Non-Hispanic whites. 

TOM FRIEDEN:  Just on the issue of risk factors among Puerto Rican population, as some may know there has been for many years a description of what is sometimes referred to as the Hispanic paradox that in general Hispanics despite having more risk factors and a lower socioeconomic status tend to live longer or as long as or longer than people with lower degrees of risk factors or higher socioeconomic status. Recent investigations by other groups that are corroborated by this analysis suggests that a lot of that, maybe even most of it, relates to lower smoking rates in Hispanics. Tobacco remains leading preventable death in the country.  Therefore it is particularly important that we ensure that smoking rates remain low in Hispanic groups in which they are low and are decreased in groups in which they are higher. 

BELSIE GONZALEZ: We are ready for the next question. 

OPERATOR: Thank you, and this question comes from Ramon Sahmkow with AFP.  You may ask your question. 

RAMON SAHMKOW:  Hi.  Hello? 

TOM FRIEDEN:  Go ahead. 

RAMON SAHMKOW: Hi. Thanks for taking the question. Yes, could you please elaborate more on why the health situation, health conditions for Hispanics is better in terms of the overall comparison with whites? How do you explain this? 

TOM FRIEDEN: Although the overall death rate is lower, there are certain individual factors that are higher. The lower overall death rate is likely closely related to the lower smoking rate in the Hispanic population. Tobacco use is the leading preventable cause of death in the country. The fact that people smoke less makes it more likely for them to live longer.  Nevertheless, heart disease and cancer remain the leading cause of death in the Hispanic population and more progress is possible. There are warning signs such as lower rates of control of high blood pressure in Hispanic population.  Furthermore, there are areas where the health status is worse than the white population in the U.S.in particular for chronic liver disease and for obesity and diabetes. Those problems are more severe in the Hispanic population and therefore this report allows health care providers, community organizations, individuals and families to address those disproportionate sources of ill health as well as preserving the low smoking rate which is allowing longer and healthier lives. 

TOM FRIEDEN: We are ready for the next question. 

OPERATOR: The next question from Dennis Thompson with HealthDay. You may ask your question. 

DENNIS THOMPSON: Hi.  I just wanted to see if you can go into why U.S.-borne Hispanics tend to have higher prevalence of health risks than foreign born Hispanics. Anything they are being exposed to here from birth? 

KEN DOMINGUEZ:  I think in terms of the question of why U.S-borne Hispanics have worse prevalences of a lot of these conditions I think it has a lot to do with the types of foods that are marketed towards folks.  For example, sugary drinks, fatty foods.  It gets a lot of play on TV.  I think that probably has a lot to do with it. The biggie sizes of various fast food outlets.  I think they are trying to work on that.  I think that is part of it. 

TOM FRIEDEN: One thing that is clear is that it is not genetics because people’s genes don’t change when they come to this country.  We find the longer people stay in this country the longer the factors in our environment that may promote obesity or increase smoking rates may influence their health. 

DENNIS THOMPSON:  Thank you. 

KEN DOMINGUEZ:  I have one other thing to add is that levels of acculturation and lower levels of education.  That is an example of how acculturation can increase smoking. 

BELSIE GONZALEZ: Next Question?

OPERATOR:  Next question from Alexandra Olgin from KJZZ. 

ALEXANDRA OLGIN:  Thank you very much.  I was wondering if there were any differences among Hispanics in the U.S. based on the region they live. 

KEN DOMINGUEZ: We didn’t look at regions of the country in this particular report.  We are unable to answer that question. 

OPERATOR: Thank you.  Next question from Patricia Guadalupe with NBCNEWS.COM. 

PATRICIA GUADALUPE: Thank you for taking my question. I had a question about the Puerto Rican population. Are you looking at Puerto Ricans in the U.S. or Puerto Ricans in Puerto Rico?  Did you mace distinction there?  Another real quick question, this is the first report that you are doing on this. How often do you envision doing another one like this again?  Thank you. 

KEN DOMINGUEZ: Well, I can answer the first one. That is, in terms of Puerto Ricans that were included in the study, basically it is Puerto Ricans living in the 50 states and D.C., not included — we were unable to include Puerto Ricans living in Puerto Rico as they are not part of the NHIS. 

PATRICIA GUADALUPE: Okay. 

TOM FRIEDEN:  And in terms of future reports we’ll take it from here.  We are just releasing this one today. I would like to clarify, also, for the previous question that there are CDC sources of information by state such as the behavioral risk factor surveillance system which can give data by state for Hispanics in the U.S. I also wanted to clarify something I said in my opening statement which was that Hispanics have 24 percent more poorly controlled high blood pressure. That was a complex way to say it, but fundamentally the rate of poor [Editor’s Note: added poor in language] blood pressure control is higher [Editor’s Note: lower changed to higher] among Hispanics. 24 percent relatively higher [Editor’s Note: lower changed to higher] than it is among Non-Hispanic whites. Next question.

OPERATOR: No further questions. 

TOM FRIEDEN:  So let me just close by thanking Dr. Dominguez and his team for an excellent report.  Thank you for joining us for this.  There are big differences among different groups of Hispanics by both country of origin and place of birth.  And that while the overall health status has some good news in terms of the overall death rate, lower smoking rate, there is still a real challenge in many preventable cancers and heart attacks, strokes that can be addressed by stopping smoking and improving control of blood pressure, obesity and diabetes is higher in Hispanics and therefore addressing weight, for example, by increasing physical activity and a much higher rate of liver disease which is related to both increased alcohol use as well as variety of other factors including obesity which increases the risk for liver disease.  So to address these specific factors doctors, community organizations, families and individuals have now more information that they can use to live longer and healthier lives.  Thank you for joining us. 

BELSIE GONZALEZ:  Thank you, Dr. Frieden and Dr. Dominguez for joining us today as well as reporters.  For follow up questions call the Press Office at 404-639-3286 or send an e-mail to media@cdc.gov.  Thank you for joining us.  This concludes our call. 

OPERATOR: Thank you. This does conclude today’s conference. We thank you for your participation. At this time you may disconnect your line.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES