Culture-Specific of Health Risk

Health Status: Morbidity and Mortality

Ranked Leading Causes of Death Among Filipino American Older Adults 65 years and older:

1. Cardiovascular Disease
2. Malignancy
3. Stroke
4. Chronic Lower Respiratory Disease (COPD) and Asthma
5. Diabetes Mellitus
6. Influenza and Pneumonia
7. Nephritis, Nephrotic Syndrome, and Nephrosis
8. Accidents (Unintentional Injuries)
9. Aortic aneurysm and Dissection 10. Hypertension and Hypertensive Renal Disease (Huo, 2009).

Cardiovascular Disease and Diabetes

A cross-sectional study of Filipino American women (N=389) in San Diego County between 1995 and 1999 showed that being socially disadvantaged during childhood, a family history of diabetes, and a larger waist circumference were significant predictors of diabetes occurrence, while factors limiting early growth of the legs may increase the risk of coronary heart disease (Langenberg, 2007).

A study of Filipino American patients (N=527) in Daly City, CA between 1992 and 1996 showed that this population has a higher incidence of hypertension and diabetes compared to its Caucasian counterparts (n=3,176). Being of Filipino American ethnicity was also found to be an independent predictor of death after a catheterization laboratory intervention, an emergency procedure, a depressed ejection fraction, a history of myocardial infarction and age greater than 65.

The need for any re-intervention was significantly higher among the Filipino American group compared to the Caucasian group (Ryan, 2000).

A cross-sectional survey conducted among Filipino Americans (N=831) in Houston, Texas between 1998 and 2000 showed a high prevalence of type 2 diabetes compared to the US non-Hispanic white population, especially among the elderly. The independent risk factors were a family history of diabetes, male sex, obesity, and Mindanao as region of birth (Cuasay, 2001).

A cross-sectional study from 1992 to 1999 in San Diego County between two groups of community dwelling women aged 50 – 69 showed that the Filipina American Group (N=294) had a higher prevalence of type 2 diabetes by oral glucose tolerance test criteria and more features of the metabolic syndrome as compared to their Caucasian counterparts (N=379) (Araneta, 2002).

Filipino Americans exhibit significantly higher levels of hypertension than other Asian Americans. These levels are similar to those of African Americans who live in the US (President’s Advisory Commission on Asian Americans and Pacific Islanders, 2003).

Chronic Kidney Disease

An epidemiologic study among Asian Americans in Hawaii between 2001 and 2003 showed that Filipino Americans were at increased risk for developing chronic kidney disease if they were age 65 or older, or had hypertension or diabetes mellitus (Mau, 2007).

Cancer

Filipino American women, including the elderly, have the highest incidence (127.6 per 100,000) and the highest mortality rate (17.5 per 100,000) for breast cancer compared with other Asian American ethnic groups. Established risk factors include obesity, acculturation and the adoption of westernized diet and behaviors. Filipino American men, including the elderly, have the highest incidence and death rate from prostate cancer among Asian American groups. They also have the third highest incidence and mortality rate from lung cancer among Asian American groups. Filipino Americans have among the lowest incidence and second lowest motality rate for colorectal cancer among Asian American groups.(California Cancer Registry, 2015).

Filipinos have the second poorest five-year survival rates for colon and rectal cancers of all US ethnic groups (Miller, 1996).

In regards to other cancer, the incidence of liver cancer in Filipino populations is higher than rates among Caucasians (Cooper, 1997). [MSG2] They also have shortest and worst survival rates for gastric cancer (instead of bladder cancer) compared to other Asian ethnic groups and their Caucasian counterparts (Kim, 2009). Finally, Filipino populations have the shortest median survival and worse survival for bladder cancer compared to other Asian ethnic groups (Hashibe, 2003).

Foreign-born Asians, including Filipinos, have an approximately 35% higher rate of non-small-cell lung cancer than US-born Asians. This fact may be due to the increased prevalence of smoking habits among Foreign-born Asian men compared to their US-born Asian men counterparts. For foreign-born Asian women, environmental tobacco or non-tobacco exposure puts them at a higher risk for non-small cell lung cancer. (Raz, 2008).

Dementia

Data regarding the prevalence of dementia among elderly Filipino Americans is limited, most probably because of minimal case findings.

Depression and Suicides

Separation from family, economic hardship and geographic isolation are common stressors among Filipino Americans with clinical depression (Tompar- Tiu & Sustento-Senneriches, 1995).

Many Asians, including Filipino Americans, either unconsciously or consciously conceal the experience and expression of their emotions, finding it more acceptable to express psychological distress through bodily symptoms (somatization) rather than by mental or emotional means (Chun, 1996).

Compared with other Asian minorities, Filipino Americans were found to have a lower incidence of suicide because of the influence of Catholicism and the availability of extended family and social support systems (Grudzen & Mc Bride, 2001).

A pilot study conducted at a senior community center in Queens, NY revealed that 15% of the senior Filipino population is moderately or severely depressed. A lower incidence of depressive symptoms was strongly correlated with a higher quality of life, and the level of depression as a powerful predictor of the degree of life satisfaction (Asian American Federation of New York, 2003).

Elder Abuse

Based on the reports of elder abuse filed with Adult Protective Services for several Northern California Counties, one of the most vulnerable groups is recent WWII Filipino veteran immigrants who relocated to the US in 1990 to become naturalized, but were not entitled to veterans’ benefits. In the San Francisco Bay Area, 12 elderly veterans who were living under severe oppressive conditions came to the attention of Adult Protective Services through an investigative report. Action from the Filipino Community contributed greatly to the correction of the problem (Chin, 1993a,b).

Admittedly, there is very little to non-existent research on this important issue. However, elder abuse is typically under reported and under treated and we suspect this to be the case for Filipino American older adults as well. Unfortunately, the patients and families involved in such cases are uninformed about available resources and believe that caring for the elder is their responsibility (Lewis, Sullivan & McBride, 2000). More research is certainly needed to gain a better understanding of this important issue.

Gout

Hyperuricemia and gout have been recognized among the Filipinos in Hawaii, Alaska, and mainland United States for almost two decades (Torralba & Bayani- Soison,1975). Due to the lack of adequate research, we are unable to comment on the broader clinical impact ( if any) of this problem.

Osteoporosis

Although Asian women including elderly Filipinos are considered at high risk for osteoporosis, health data remained scarce, especially in postmenopausal women. Lack of referent databases for Asian American women has also resulted in inconsistent data about their risk status and diagnostic criteria (Walker, 2006).

Infectious Disease: Tuberculosis and HIV

According to the Centers for Disease Control and Prevention, more than half of TB cases in the US in 2008 were found in foreign-born individuals, with immigrants from the Philippines ranked second behind those from Mexico (CDC, 2008a). Asian Americans and Pacific Islanders comprised 0.6% of the total US population living with HIV/AIDS in 2005(CDC, 2008b). Little is known about the number of elderly Filipino Americans living with HIV.