2. A Quick Look
Study: Conducted to examine
prevalence, awareness and care patterns for GERD
across 4 ethnic groups (Caucasian, African-
American, Asian, and Hispanic).
Method: Used a population-based, cross
sectional, survey fielded in English, Chinese and
Spanish
Results: 1,172 participants were included for
analysis of GERD symptoms:
Monthly – 34.6%
Weekly – 26.2%
Daily – 8.2%
3. A Quick Look
As compared by ethnic groups:
Hispanics – 50%
Caucasians – 37%
African-Americans – 31%
Asians – 20%
Conclusion: The study confirms high prevalence
rates in the Hispanic community, with Asian
Americans experiencing higher rates in the U.S. than
the Far East.
Also confirms a need for culturally appropriate
education about GERD symptoms and treatment
4. Background Information
GERD defined as a chronic disorder characterized by
heart burn and regulation.
Other studies show higher rates in Western Nations
(20-40%) particularly in Caucasians.
Medical care was sought when symptoms impacted
quality of life, self-treatment was ineffective, and
when concern could be resolved with care and a
prescription medication.
Cultural and Ethnic factors that affected seeking
help: issues of trust, language, literacy and
comprehension barriers
5. Background Information
Personal beliefs can also have an affect on seeking
help. These include:
Beliefs about self-treatment
Lack of control of health
Modesty
Embarrassment
Fear of illness
Attitude of fatalism
It was found that medical information was sought
from the media and “word of mouth” more
frequently than from healthcare providers.
6. This Study
This study was conducted to better understand
prevalence, knowledge, and health seeking behaviors
among ethnic groups.
A small, population-based, observational study
(Philadelphia, PA) that looked at:
African Americans
Asian Americans
Hispanics
Caucasians
7. Method
Study Population
Included a minimum of 200 adults (≥18 years)
Had to be from one of the four groups
African-American
Asian
Hispanic/Latino
Caucasion
Targeted at least 200 from each group, attending local
community centers or faith-based community activities.
Survey Methods:
36 question, 8 page survey adapted from Srinivasan’s
description survey and Locke’s validated instrument
8. Method
Domains include:
Familiarity with term GERD
Prevalence of heartburn
Diagnosis of GERD
Medication use
Social impact
Attitudes about seeking care
Knowledge about heartburn or GERD
Sources of information
Beliefs about symptomatic relief for heartburn
Beliefs about symptoms associated with heartburn
Intentions for treating heartburn
Demographics (gender, marital status, education, employment
status, income, race/ethnicity, weight, and height)
9. Method
Statistical Methods an Analysis:
Data was entered into an Access database and analyzed using SAS 9.1.
The Prevalence of GERD was calculated for each of the ethnic groups
and then compared controlling for age, gender, and other
demographic variables
Knowledge, attitudes and care seeking patterns were assessed for
those reporting GERD symptoms and compared in the four ethnic
groups
Questionnaire also featured two questions to assess:
Prevalence of heartburn after a meal
Prevalence after going to sleep
Final measure for prevalence to account for all who indicated
experiencing heartburn in general, after a meal, and after going to
sleep.
10. Results
1,172 surveys were included in the analysis
African-Americans – 34%
Caucasians – 27%
Hispanics – 21%
Asians – 18%
Population Prevalence: Observed differences in
populations:
Monthly – 34.6%
Weekly – 26.2%
Daily - 8.2%
Statistically significant differences were found:
50% of Hispanics compared with 37.0% of Caucasians
30.8% of African-Americans compared with 19.9% of Asians
11. Results
Hispanics were shown to have highest rate of
prevalence across all frequencies and Asians were
shown to have the lowest across all frequencies.
Adjusted Monthly Prevalence:
Age and gender differences in prevalence were found between
ethnic groups.
These rates were:
Hispanics – 47.9%
Caucasians – 36.1%
African-Americans – 26.6%
Asians – 20.4%
12. Results
Conditional Prevalence after Eating or Sleeping:
Statistically significant differences found between the ethnic groups
for both conditions (after a meal and after going to sleep)
The “after a meal” rates were as follows and across all frequencies:
Hispanics – 50.4%
Caucasians – 40.7%
African-Americans – 35.4%
Asians – 27.5
The “after going to sleep” rates were as follows and across
all frequencies:
Hispanics – 38.1%
Caucasians – 29.6%
African-Americans – 23.4%
Asians – 19.5%
13. Results
General Occurrence of Heartburn
The differences between the ethnic groups were consistent
with the differences in monthly prevalence
The rates for heartburn in general were as follows:
Hispanics – 50.4%
Caucasians – 36.3%
African-Americans – 29.8%
Asians – 20.4%
14. Results
Awareness and Knowledge of GERD:
Study also assessed awareness and knowledge of GERD
symptoms
Familiarity with terms
74.4% was familiar with the term “Gastro-esophageal Reflux
Disease” or GERD
61.0% of males reported familiarity
80.2% of females reported familiarity
Hispanics had the highest prevalence of GERD but familiarity was
lower (72.4%) compared to Caucasians (78.2%) and Asians (74.4%)
15. Results
Awareness and Knowledge of GERD cont.:
Beliefs concerning continual occurrences of GERD:
76.3% who suffered symptoms believed serious heartburn could lead
to ulcers, while 5.6% disagreed
Hispanics were more likely to disagree while Asians were least likely
44.9% who suffered symptoms believed serious heartburn could lead
to cancer, while 19.7% disagreed and 35.4% were neutral
Participants across all ethnic groups were more confident that
heartburn could lead to ulcers and less confident that it could lead to
cancer
Beliefs concerning treatment techniques for GERD:
19.1% of African-Americans and 21.8% of Hispanics believed that
lying down for 2-3 hours after eating would help control heartburn
compared to 14.7% by Asians and 9.5% by Caucasians
46.2% of African-American and 45.5% of Hispanics believed that
smaller more frequent meals might control heartburn compared to
72.1% by Asians and 57.8% by Caucasians
16. Results
Awareness and Knowledge of GERD cont.:
Beliefs concerning treatment techniques for GERD:
19.1% of African-Americans and 21.8% of Hispanics believed that
lying down for 2-3 hours after eating would help control heartburn
compared to 14.7% by Asians and 9.5% by Caucasians
46.2% of African-American and 45.5% of Hispanics believed that
smaller more frequent meals might control heartburn compared to
72.1% by Asians and 57.8% by Caucasians
Care Seeking Patterns:
33.7% of those that suffered GERD symptoms had been
diagnosed by a doctor
No significant differences in diagnosis rates by a doctor
between gender, education level, or household income
17. Results
Care Seeking Patterns:
33.7% of those that suffered GERD symptoms had been
diagnosed by a doctor
No significant differences in diagnosis rates by a doctor
between gender, education level, or household income
18. Results
In the case of experiencing severe heartburn symptoms:
Hispanics were more likely to go to the clinic (28.9%) compared to
African-Americans (24.3%), Asians (20.6%), and Caucasians
(12.2%)
African-Americans (37.6%) and Hispanics (28.9%) were more likely
to go to the ER when suffering severe heartburn compared to
Asians (19.1%) and Caucasians (16.3%)
41.8% of Asians and 35.7% of Hispanics indicated that cost and lack
of health insurance would prevent then from seeing a doctor
Hispanics were more likely than other ethnic groups to not seek
care from a doctor due to not being able to take time away form
work or family
33.8% of Hispanics avoid seeking care from a doctor due to “fear or
anxiety about going to the doctor” which is significantly higher than
the other groups
19. Limitations of Study
Limitations of this study specific to definition, selection and
exploration of physiological, psychological and social reasons
for differences among ethnicities are as follows:
Designed to obtain unsolicited feedback at a community level from the four
designated ethnic groups
Certain neighborhoods were selected possibly resulting in selection bias
Study was conducted at community and faith-based facilities and health fairs
possibly resulting in selection bias
There was no “randomization” in selection of participants
Study instrument was adapted for Chinese and Spanish speakers and a
translator was available
Translators may have unknowingly “lead” the participant to answer a certain
way
Ethnicity was also self-selected by participants
The study design did not accommodate for considering
physiological, psychological and social reasons for differences among
ethnicities
20. Summary
The results show all four ethnic groups experience
heartburn
GERD symptoms are more frequent in Hispanic
Americans and lower in Asians living in the U.S.
compared to other ethnic groups
Prevalence rates of African-Americans and
Caucasians were similar to findings in other studies
Results reflect a need for education about GERD for
all populations
The need is most pressing in the Hispanic population
21. Resource
Yuen, Elaine; Romney, Martha; Toner, Richard W.; Cobb, Nicole M.;
Katz, Philip O.; Spodik, Maya;and Goldfarb, Neil I., "Prevalence, knowledge
and care patterns for gastro-oesophageal reflux disease in United States
minority populations." (2010). School of Population Health Faculty Papers.
Paper 42.
http://jdc.jefferson.edu/healthpolicyfaculty/42
Tables that follow are also from this study and show the data obtained in a
table format
