Each of us is a unique combination of our genes…inherited from our parents, their parents and down through the roots of our family tree. Our genes comprise a genetic profile that impacts which diseases we may be more susceptible to, what medications may be more or less effective in maintaining our optimal health, and more.
Patients’ genetic makeup can make a huge difference in how you may choose to treat or help avoid many health issues. So can patients’ cultural upbringing, living environment and finances. That’s why RxLive offers pharmacogenomic testing (PGx) as part of our services, and include questions about diet, regular exercise and other lifestyle factors in our medication-management patient consults.
However, as care providers, we must remember that many conditions have proven to be more prevalent and severe to people of certain heritages, which is why HHS’ Office of Minority Health (OMH) was formed, and why it marks April as National Minority Health Month.
2020’s Active & Healthy campaign
While there are a number of diseases — and reactions to medications — that are greatly impacted by our genetic makeup, all patients benefit from having an active lifestyle, especially during this time when we’re being encouraged to self-isolate to minimize the effects of the COVID-19 coronavirus across the population.
The month’s theme of “Active & Healthy” enables OMH and minority health advocates around the nation to advance health outcomes by highlighting the benefits of incorporating small amounts of moderate-to-vigorous physical activity into our schedules. These are highlighted in the second edition of Physical Activity Guidelines for Americans (free PDF download). Research shows significant health benefits of an active and healthy lifestyle that incorporates even small amounts of moderate-to-vigorous physical activity throughout the day.
The Physical Activity Guidelines provide excellent reminders of key guidelines by age group — from adults with chronic health conditions and/or disabilities, pre-school-age children, children and adolescents, adults, older adults, women during pregnancy and the post-partum period, and broad guidelines for safe physical activity. Along with an excellent summary recapping top recommendations, it goes into more detail for each area in a quick and simple-to-read format, parts of which you may want to share with your patients of all ethnic backgrounds.
These kinds of simple changes to a patient’s daily routine can transform lives and reduce the risk of chronic diseases and other conditions that often are more common or severe among racial and ethnic minority groups. See just a few of those conditions below.
Diseases common to certain populations
- Sickle cell disease — Most common among African-Americans, other racial and ethnic groups are also affected, including Latinos and people of Middle Eastern, Indian, Asian and Mediterranean backgrounds. Sub-Saharan Africa has the greatest burden of disease, with more than 300,000 babies born with the disease each year. However, it’s common enough in the U.S. that there are about 100,000 people currently living with sickle cell disease but uncommon enough that medical professionals rarely see sickle cell disease patients. Unfortunately, only about 1 in 4 patients with sickle cell disease receive the standard of care described in current guidelines, and many studies have shown that patients don’t receive treatment for their pain as soon as — or in appropriate doses as — other patients. So it’s important to keep sickle cell in mind because, based on your patient population, you may not be accustomed to watching for it.Here’s a brief from the Agency for Healthcare Research and Quality’s (AHRQ) new Healthcare Cost and Utilization Project that includes recent data, including historical trends and cost, on inpatient stays among patients with sickle cell disease, and a map from the National Institutes of Health (NIH) of privately and publicly funded clinical studies on sickle cell disease in the U.S.
- Heart disease and stroke — I talked about these major killers of Americans in two blogs on Life’s Simple 7 recommendations and recent cardiac advances) during February Heart Month that I encourage you to refer back to. This quick overview of black/African-Americans by OMH also provides great information and perspective. The American Heart Association has determined that more than half of all African-American adults suffer from some form of cardiovascular disease. According to the Centers for Disease Control and Prevention (CDC):
– African-Americans ages 35-64 years are 50% more likely to have high blood pressure than whites.
– African-American women have the highest rates of being overweight or obese compared to other groups in the U.S.
– In 2015, African-Americans were 20% less likely to engage in active physical activity as non-Hispanic whites.
- Diabetes — This is another all-too-prevalent disease that can be significantly improved by better diet, exercise, early detection and proper medication. The American Heart Association reports that Hispanic adult males and females are nearly twice as likely to have diabetes, though cholesterol levels are not that disparate than white non-Hispanic males and females. Americans with Hispanic heritage are also at increased risk of cardiovascular disease and obesity.
- Cancer — This major American killer can affect many minorities more severely…often because they lack good access to affordable healthcare in their area and thus don’t have it detected early. Lack of medication, diet and exercise counseling also impact their chances. The American Cancer Society reports that while Hispanics have comparably low rates for the most common cancers, they have disproportionately high rates for cancers associated with infectious agents (such as cancers of the liver, stomach and uterine cervix) and of gallbladder cancer. Some of it can be attributed to Hepatitis C or B significantly increasing the incidence of liver cancer or cirrhosis; primary prevention of infection is achievable through vaccinations available through public health services or their provider’s offices and outreach.Stomach cancer in Hispanic men is more than 60% higher than in non-Hispanic white men, and among women the rate in Hispanics is double. Importantly, Hispanics have a higher risk of early-onset stomach cancer than non-Hispanic white, non-Hispanic blacks, and Asians/Pacific Islanders.
Here again, early detection, counseling on smoking cessation and diet are key. Diet includes reducing consumption of alcohol, foods preserved with salt, and processed meat, along with reducing the prevalence of H. pylori through improved hygiene practices.
- Tuberculosis — I mention this during Minority Health Month to call out the health challenges that Native Americans and Alaska Natives often face. Remember that not all persons with one of these genetic backgrounds are treated by the Indian Health Service or live in the state of Alaska. Their tuberculosis rate in 2017 was almost 4 times higher than the U.S. white non-Hispanic population.
Some of the other leading diseases and causes of death for Native Americans and Alaska Natives are heart disease, cancer, diabetes and stroke. They also have a high prevalence and risk factors for mental health and suicide, unintentional injuries, obesity, substance use, sudden infant death syndrome (SIDS), teenage pregnancy, diabetes, liver disease and hepatitis. However small a percentage of today’s U.S. population that they may be, these native Americans are most worthy of our respect for their culture, heritage and their unique health challenges.
Reducing the risk early
There are many more reports and suggestions for reducing the impact of these and other diseases across minorities and the entire U.S. population (see below for a few more). For providers, it takes time which is often not possible in a short office visit that’s focused on an immediate health issue, and we hope these are helpful.
I hope these will help you keep the impact of your patient’s history — including heritage — in mind while you’re working to optimize the health of your patient population. We welcome the opportunity to supplement your efforts by allowing us to sit down with your patients for a private medication-management telehealth consultation that will go over their conditions, meds and lifestyle to help you help them. Call us at (866) 234-4974 to learn more and get started.
FastStats: Health of Black or African-American non-Hispanic U.S. Population (CDC)
Delivering Cultural Competent Health Care to Hispanics (HHS/OMH; PDF)
Hispanic Health: Vital Signs (CDC)
Asian American and Pacific Islander Health (HHS/OMH)
Profile: American Indian/Alaska Native (HHS/OMH)
Health Conditions and Behaviors of Native Hawaiian and Pacific Islander Persons in the U.S. (CDC; PDF)