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Studies focus on health care for Mexican Americans

Two recent studies, supported in part by the Agency for Healthcare Research and Quality (HS11618), focus on health care for Mexican Americans. In the first study, researchers examined the relationship between cognitive decline and stroke risk in Mexican Americans, and in the second study, they looked at receipt of inappropriate prescription medications among elderly Mexican Americans. The studies were carried out by researchers at the University of Texas Medical Branch in Galveston and are described here.

Ostir, G.V., Raji, M.A., Ottenbacher, K.J., and others (2003). "Cognitive function and incidence of stroke in older Mexican Americans." Journal of Gerontology: Medical Sciences 58A(6), pp. 531-535, 2003.

Previous studies have shown that cognitive impairment is high among older Mexican Americans. This study links cognitive impairment to stroke risk in this group and highlights the need to more aggressively identify and address cognitive decline in Mexican Americans. The study found that over a 7-year period, Mexican Americans with good cognitive function were about half as likely to report a stroke as those with poor cognitive function.

The researchers used data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE) to prospectively study 2,682 elderly Mexican Americans living in the Southwestern United States. They assessed stroke incidence 2, 5, and 7 years after a baseline assessment of those with no prior history of stroke who had completed the Mini-Mental State Examination (MMSE, a 30-item instrument to assess cognitive function).

MMSE score at baseline predicted risk of stroke over the 7-year followup period. Those with an MMSE score of 21 or higher (good cognitive functioning) were half as likely to report stroke at followup as those with a score of less than 21. Similar results were found after controlling for relevant risk factors for stroke such as age, sex, smoking status, education, body mass index, diabetes, heart attack, systolic blood pressure, and depressive symptoms. In addition, each 1-point increase in MMSE score was associated with a 5 percent reduction in stroke risk.

Raji, M.A., Ostir, G.V., Markides, K.S., and others (2003). "Potentially inappropriate medication use by elderly Mexican Americans." Annals of Pharmacotherapy 37, pp. 1197-1202.

Use of inappropriate prescription medicines has been linked to a host of problems in elderly individuals, ranging from falls and uncontrolled blood pressure to emergency department visits and hospital admissions. However, home interviews with 3,050 elderly Mexican Americans living in the Southwestern United States revealed that fewer of them used inappropriate medications than similar white and black populations.

About 12 percent of the Mexican Americans interviewed had used at least 1 of 32 potentially inappropriate prescription medications within 2 weeks of the interview. This rate is much lower than the rates reported in prior studies for older whites (27 percent) and blacks (24 percent) and similar to rates reported for older Alaska Natives (10 percent).

The four most commonly prescribed inappropriate medications in this study included chlorpropamide, propoxyphene, amitriptyline, and dipyridamole, accounting for 54 percent of all inappropriate prescribing. Unmarried individuals and those with one or more chronic diseases, many depressive symptoms, and more access to care (frequent physician visits and combined Medicaid and Medicare insurance) were more likely to have used at least 1 of the 32 potentially inappropriate drugs.

It is unclear why elderly Mexican Americans are prescribed fewer inappropriate medications than elderly whites and blacks. One possible explanation is that older Mexican Americans have lower rates of heart disease, cancer, and stroke than other populations, consequently requiring less medications. On the other hand, older Mexican Americans may simply have fewer contacts with clinicians and less access to health care services.

Editor's Note: Another AHRQ-funded study on a related topic found that white race was associated with use of complementary and alternative medicine for arthritis, while use of specialists and prescription arthritis medications was better explained by factors other than race/ethnicity. For more details, see Mikuls, T.R., Mudano, A.S., Pulley, L., and Saag, K.G. (2003). "The association of race/ethnicity with the receipt of traditional and alternative arthritis-specific health care." (AHRQ grant HS10389). Medical Care 41(11), pp. 1233-1239.

For another study on how AHRQ is strengthening research to reduce racial and ethnic disparities in health care, see Clancy, C.M., and Chesley, F.D. (2003, October). "Strengthening the health services research to reduce racial and ethnic disparities in health care." Health Services Research 38(5), pp. xi-xviii.

Reprints of this staff-authored article (AHRQ Publication No. 04-R011) are available from the AHRQ Publications Clearinghouse.

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