Wednesday, February 9, 2011

Data are limited

NOTE: This post is offered up by Amy Manning. Amy is a doctoral candidate at UB’s School of Social Work. Amy’s research focus is on prevention, specifically focusing on child and adolescent mental health issues.

The month of February is the National Heart Association Go Red for Women Day. Go Red For Women movement celebrates the energy, passion and power we have as women to band together to wipe out heart disease and stroke.

Being a Native woman, I thought it would be appropriate to spend some time looking at what the research says about cardiovascular health for Native American women. So I spent a little time searching the internet as well as the University Library looking for specific data.  After several searches and many reviews, the reoccurring phrase common in most of these studies as it relates to the Native American population is “data are limited.” Many of the studies published seem to exclude Native Americans from their analysis due to limited numbers of participants.  They were also combined them with other groups, thereby limiting the interpretability of the results.

What was frustrating, as a doctoral student researching health issues and trying to publish manuscripts, was reading through and finding that in most cases, excluding and lumping Native Americans into dissimilar groups was not even mentioned as a limitation of the study. Often times the authors praised themselves for having a heterogeneous sample, when in fact much was missing. I feel that we must do more as researchers and as Native Americans to ensure greater participation in research that could improve the health and welfare of our families and communities.  Imagine if your physician was unaware of the prevalence rates of heart disease among Native Americans because of the current literature? Unfortunately, that isn’t hard to imagine. The movement in healthcare now is to use evidence-based practices. This means medical providers look at the science and evidence of a particular problem and allow that research to guide the best intervention. If medical professionals were to seek the best practices for treating heart disease for Native Americans, they would discover what I just did – Native American’s are excluded or placed into another category resulting in the professional having no evidence to guide practice.
General Heart Data

From the American Heart Association I learned that heart disease is the number one killer of women in the United States. Twenty-five percent of all deaths among Native American women are caused by heart disease and stroke. Among all Native Americans, 12% have heart disease, 8% have coronary heart disease, 25% have hypertension, and 5% have had a stroke. The rate of coronary heart disease, and hypertension are elevated when compared to the white population, however, the percent of Native Americans who have had a stroke is more than DOUBLE compared to the white population.

Risk Factors

Risk factors for cardiovascular disease must be monitored and wellness interventions initiated if we are ever going to take control of these silent killers. Almost 50% of Native Americans have 2 or more risk factors for heart disease and stroke.

How could this be possible? The risk factors that are now known to contribute to heart disease include high cholesterol, tobacco use, inactivity, overweight and diabetes. Among the Native American population over 40% use tobacco, including 30% of Native American women.  About 30% of Native Americans have high cholesterol compared to 17% of the general population. Over 50% of Native American adults also report no physical activity, as in zero activity. Currently, only 21% of our young women in grades 9-12 meet basic physical activity guidelines. Physical inactivity is one thing that can lead to an individual being overweight, and as a group Native Americans are the most likely to be overweight out of any group, with 30.4% of adults being overweight. Almost 16% of the Native American population (male and female) have a diagnosed case of Diabetes, compared with 7% of the total general population. The risk for Native Americans developing diabetes is 2.2 times greater than the general population. Check out the rest of the American Heart Association report at here.


Dealing with this problem is easier said than done. It seems families could be the first line of education and agents of change. Communities also should come together and advocate changes. It may even take just one person to stand up and take control of their health to start the process of change. Change is never easy. We women need to be our own best advocates for our communities, families and our own health. All women need to know that if their medical health provider is not listening to their concerns -- they need to find another provider. We also need to stop explaining away symptoms. If something with your health isn’t right -- it isn’t right -- and you need to find out why. Too many times women’s first presentation of heart problems to a medical professional is when she arrives at the ER dead from cardiac arrest.

As a community, we have the highest prevalence rates of so many negative health and wellness issues. Wouldn’t it be wonderful if we, as a community, experienced the single most amazing turn-around for our health? I can guarantee you this – if a Native American women’s movement was able to turn this around – data would not be limited on us anymore.

So, what changes can you see happening? How do we start?

Thank you, Amy

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