 Selected
Facts and Findings
“Genes, Culture, and Medicines: Bridging Gaps in Treatment for
Hispanic Americans”
Hispanics are now the largest minority population in the
U.S.
Currently 38.8 million Hispanics reside in the U.S. with another
3.8 million in Puerto Rico and represent 14% of the U.S. population.
The U.S. Hispanic population (42.6 million) is larger than the entire
population of Canada (31.9 million) and more than twice that of
Australia (19.5 million).
Hispanics have less access to medications.
Hispanics face significant disparities in access, quantity, and
quality of pharmaceutical care. For example, even after adjusting
for income, age, insurance coverage, and overall health status:
• Childhood Asthma — Upon discharge, Hispanic preschoolers
with asthma are 17 times less likely than their white counterparts
to be prescribed a nebulizer for home use.
• Heart Disease — On discharge from a hospital after
myocardial infarction, Mexican Americans are less likely to receive
medications than whites.
• HIV/AIDS — Hispanic HIV/AIDS patients are less likely
than whites to receive medications.
• Pain (fractures) — Of patients with long bone fractures,
Hispanics are twice as likely (55%) as whites (26%) to receive no
pain medication in the emergency room.
Even when Hispanics have access, they are less likely to
get newer state-of-the-art medications.
• Childhood Asthma — Hispanic children with similar
insurance and sociodemographic characteristics are 42% less likely
to be using state-of-the-art inhaled anti-inflammatory medication
(including inhaled steroids) to prevent the onset or worsening of
an asthma episode.
• Mental Illness — Although depression is a serious
problem among Hispanics, they do not always receive the most advanced
medications, including selective serotonin reuptake inhibitors,
which have largely replaced tricyclic antidepressants.
Genetics represents the future of individualized pharmaceutical
therapy.
• Genetic Markers — Recent advances in pharmacogenetics
demonstrate that prescribing medications in the future will be informed
by specific genetic make-up of individual patients rather than imprecise
population markers.
• Metabolism — Mexican Americans metabolize drugs regulated
by the CYP2D6 gene faster than whites, impacting 30% of therapeutically
important medications.
• Diet and Genes — Foods such as corn, grapefruit juice,
and charbroiled beef featured in the Hispanic diet, have been shown
to alter the efficiency of the CYP3A4 gene, which mediates the metabolism
of over 50% of commonly used medicines.
For pharmaceutical therapy, many Hispanic populations have
a unique health profile.
• Optimal Dosage — Hispanics tend to respond to lower
doses of some antipsychotic medications. In one study, the average
therapeutic dose for Hispanics was half the dose commonly given
to other populations.
• Coexisting Issues— Chronic illnesses prevalent in
the Hispanic population (diabetes, depression, asthma, cardiovascular
disease) often coexist in the same individual and are often undertreated
or a patient given medications for one condition that exacerbates
a coexisting condition.
• Proficiency — Inadequate patient-provider communication
and the lack of cultural proficiency of services negatively influence
medication compliance, self-management of chronic disease, and overall
health outcomes.
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