Women’s Health Disparities Among Border Populations

1. Women’s Health Disparities Among Border Populations Francisco A. R. García, MD, MPH, FACOG Distinguished Outreach Professor Public Health Obstetrics & Gynecology Mexican-American Studies Pharmacy

2. US-Mexico Border • 2000 miles • 100 km strip on either side of international boundary • 4 US and 6 Mexican states • 44 US counties & 80 Mexican municipios • 12.2 M people border region • 800,000-1.1M legal border crossing every day

3. US-Mexico Border

4. US Border Communities • 7.2 M individuals (3.1M in 1970) • 44 US counties • 3 of 10 poorest counties • 2 of 10 fastest growing metro areas • 5 of 7 poorest metro areas • 25 tribal communities

5. Hispanics make up 15 percent of total US population (64% of Mexican descent). Foreign-born Mexicans are the largest immigrant group in the US. >11.5 million Mexican immigrants in the US (30.7%) of all US immigrants. Immigrants beginning to settle in non-traditional areas. Hispanic Immigrants in the US

6. Women in Border Communities • Mexican origin • 51% population • < 15y ( 23% v 19%) • > 45y (36% v 40%)

7. Women in Border Communities • 18% below FPL (9% US) • More likely to live in poverty compared to men (18 v 14%) • 27% uninsured (17%)* • 29% women v 33% men • 1 of 3 reside in HPSAs * National comparison www.borderhealth.org

8. Women in Border Communities;2009 BRFSS

11. Adults with Diabetes in Border Communities by Race/Ethnicity, 2007

12. Reproductive Health • 41% reproductive age • Fertility rate 2.5 (2.1*) • 123k births/year • Adolescent preg 5% (3.4) • Lower LBW and VLBW

13. Cancer Among Women in Border Communities

14. Age Adjusted Cervical Ca Mortality, 2003-2005

15. Invasive, age-specific cervical cancer incidence (per 100,000 women) Coughlin. Cancer 2008.

16. AZ Cervix Cancer Mortality 2001-2004 Courtesy of T Flood, AZ DHS

17. Hispanic Cervical Cancer Mortality 1990-2006 (SEER) Rate per 100,000 Hispanic Females Counties are not shown if < 5 cases

18. Cancer Screening in Border Communities:BRFSS1999-2000 Factors Positively Associated with Pap <3 years: Younger age, non-Hispanic ethnicity, lower parity, non-rural residence, physician visit past year & insurance. S. Coughlin. Fam Community Health 2003

19. Yuma Project • Cross-sectional population based study (n=504) • Post menopausal (>50) women in Yuma County • Mexican-born, US-born Hisp, White/Non-Hisp • Cancer screening & utilization • Garcia & Nuno

20. Behavioral Risk Factors

21. Adult Current Tobacco Use in Border Communities BRFSS US White Hisp(Exc) Hisp (Border) Ever Smoke 37% 42% 22% 18%

22. Adult Alcohol Consumption in Border Communities, 2007

23. Women in Border Communities;2009 BRFSS

25. Mortality Among Women in Border Communities, 2005

26. Leading Causes of Death in Border Communities, 2005

27. Positive Variance

28. Considerations for Future Research in Border “Disparities” • Disparities provide opportunities to improve biological/behavioral insight into health and disease • Focus on “positive outliers” & strengthening protective factors in communities • Access though the major contributor to disparities, will not solve the problem • Solutions to be sustainable and realistic must be “native” and arise organically from communities • Disease and health are not bounded by international borders

29. Reducing Women’s Health Disparities in Border Communities • Informed women • Access to health care • Aware providers • Good data • Enlightened policy makers

30. Francisco Garcia, MD, MPH 520 626 8539 fcisco@u.arizona.edu

31. Hispanics in the US