Trust and Understanding in Nueces County

Acculturation's toll on the Mexican-American population

Lewis Morgenstern Photo: Martin Vloet

Nueces County in southern Texas is geographically isolated and its population is evenly split between Mexican-Americans and non-Hispanic whites, making it an ideal laboratory for the research of Lewis Morgenstern (M.D. 1990), associate professor of neurology, emergency medicine and neurosurgery, and director of the U-M Stroke Program. Morgenstern is the principal investigator of BASIC, or Brain Attack Surveillance in Corpus Christi, a 10-year study, now half completed, exploring disparities in stroke treatment, prevention and medical outcomes.

BASIC strives to ascertain the incidence of stroke among Mexican-Americans and the risk factors contributing to it. The goal is to gain insights that will lead to more effective stroke-prevention initiatives. "The effort to reduce stroke's impact on the Hispanic population must mean more than simply translating brochures into Spanish," Morgenstern says. "We must look at the role that acculturation plays, especially issues of understanding and trust of the health care system."

In Nueces County, BASIC has found that Mexican-Americans who suffered strokes were younger, less educated, and had lower income than white stroke victims. They also were more likely to have diabetes and less likely to have atrial fibrillation, conditions which increase risk of stroke. The two populations had similar rates of alcohol use and smoking and were equally likely to have visited a doctor in the previous year.

Mexican-Americans were less likely than whites to be taking blood-thinning medication that can reduce the risk of a second stroke. They also expressed less confidence in their ability to prevent stroke, more distrust of the health care system, and more concern that money impedes their access to care.

These findings, Morgenstern says, suggest stroke prevention efforts targeting Mexican-Americans should emphasize the importance of reducing risk factors and address socio-economic issues. They also must overcome mistrust of the medical establishment and possible fatalistic beliefs held by some Hispanic populations — potentially by engaging the trusted family physician and churches in educational efforts.

The ramifications of Morgenstern's work are enormous: Hispanics are the largest minority population in the United States and Mexican-Americans are the largest sub-group within this growing population. "For the country as a whole, stroke in Hispanics is a huge economic and social burden," he says. "I don't think we recognize the impact this is going to have. By the middle of this century, it's going to be astronomical."

ALSO:

From Cause to Intervention

Adolescent Girls and Lifestyle

Trust and Understanding in Nueces County

Chronic Renal Disease and African-Americans