Leading Health Risks, Diseases And Causes Of Mortality Among Hispanics In United States Of America (USA)
B Kanna, S Fersobe, A Soni, W Michelen
disease, health, hispanics, mortality, risks
B Kanna, S Fersobe, A Soni, W Michelen. Leading Health Risks, Diseases And Causes Of Mortality Among Hispanics In United States Of America (USA). The Internet Journal of Health. 2007 Volume 8 Number 1.
According to the recent United States (US) Census, Hispanics account for 12.6% of the US population. Hispanics have unique risks, disease prevalence and mortality compared to the general USA population. These risk-disease relationships have not been elucidated carefully and completely as in the other ethnic groups. In order to understand Hispanic health within the paradigm of risk, disease and mortality, the key determinants of disease or health among Hispanics in the USA will be presented and discussed. Testing of the various risk-disease associations is clearly required to understand the peculiar health risks among Hispanics and the various sub-groups. This is especially significant from a public health standpoint as the Hispanic population is expected to rise in the next several decades.
According to the United States oF America (USA) Census 2000, there are more than 35 million Hispanics living in USA accounting for approximately 12.6% of the population. Hispanic Americans are the fastest growing demographic group in the United States with a 58% increase in population between 1990 and 2000. By recent estimates Hispanics would account for 24.4% of the total population (102.6 millions) in the year 2050. (1) In year 2000, 58.5 % of the Hispanics were Mexican Americans with a population of 20.6 million. Puerto Ricans and Cubans made up 9.6 and 3.5 percent respectively, while 28.4 percent of Hispanics were categorized in survey data as other Hispanics. Hispanics predominantly live in the South and West, and are more likely (91%) to live in large cities around the USA. New York City has the largest Hispanic population among all metropolitan cities in USA (2.9 millions) followed by Los Angeles (1.7 millions).
Hispanics have unique risks, disease prevalence and mortality compared to the general USA population. Though they share many aspects such as language, Hispanics vary significantly by country of origin. Their health profiles differ significantly among Hispanic cultures. This diversity and peculiarity in disease pre-disposition, prevalence and mortality is especially significant from a public health standpoint as the Hispanic population is expected to increase rapidly. Based on heightened risk for certain diseases such as diabetes, obesity and HIV along with poor socio-economic status, one would expect a higher mortality and morbidity in Hispanic populations. However, national mortality data (2) suggest lower age adjusted mortality rates for Hispanics (629.3 per 100,000 Hispanic population versus 837.5 per 100,000 among Caucasians in year 2002) (Figure1) though some population-based studies do not support this finding. However, mortality for Hispanic population may be seriously understated due to underreporting on death certificates. (3) Within the Hispanic groups, death rates vary considerably (4). Further, Hispanics suffer higher proportional mortality rates due to certain diseases and conditions such as accidents, diabetes, liver disease and homicides. (Table 1)
* AMR/100,000 – Age –adjusted mortality rate per 100,000 population
Source: National Center for Health Statistics.
The apparent mortality advantage is noted mainly among elderly Hispanics and not in younger Hispanics when compared to the White population (Figures 1 & 2) and may be related to the younger age distribution of the Hispanic population. (Figure 3)
About 50 – 70% of the populations in the neighborhood surrounding our institution in the South Bronx, New York City consist of Hispanics from various origins. (5) Among subjects who receive health care at our hospital, a majority are also Hispanics. (6) Several paradoxical and unique features of health risks, disease and mortality have been noted among our Hispanic patients. In order to understand these disparities in Hispanics' health within a paradigm of risk, disease and mortality, we present an analysis of contemporary data on the multiple factors that could explain this problem. In the following sections, the determinants of disease and mortality or health among Hispanics in USA are discussed in detail.
Heart disease is the leading cause of mortality among the Hispanic population in USA. According to the National Center for Health Statistics (NCHS), the age-adjusted death rate (ADR) for heart disease in Hispanics is 173.2. per 100,000 population. However, this is lower compared with ADR of 228.2 per 100,000 for Whites and 300.2 per 100,000 for African Americans. (7) The age-adjusted prevalence of heart diseases including coronary heart disease among Hispanics is lower (7.7% and 4.5%) than the US population (11.2 % and 6.0% respectively). (2)
In order to understand the prevalence and mortality from heart disease among Hispanics data on major risk factors for heart disease (8) is discussed below. (Figure 4)
Hispanics are at lower risk for lung cancer compared to other ethnic groups. This appears to be directly linked to the lower rate of cigarette smoking among Hispanics. (10) Lung cancer is the leading cause of cancer death among Hispanic men and second among Hispanic women. Death rates among Hispanic men are higher (39.6 per 100,000) compared to Hispanic women 14.9 per 100,000). (29) Lung cancer death rates especially are higher among Cuban-American men than Puerto Rican or Mexican men. (30)
In Hispanic men, this is the most commonly diagnosed cancer, but cancer incidence and prevalence are lower compared to Non-Hispanics. Between 1992 and 1999, prostate cancer rates among Hispanics were 25 % lower than non-Hispanics. However, prostate cancer is the second common cause of cancer deaths among Hispanics. (29)
In Hispanic women, the most commonly diagnosed cancer is breast cancer. Although less common than in non-Hispanic women, disease is advanced by the time diagnosis is made. Breast cancer is the leading cause of cancer deaths in Hispanic women as opposed to lung cancer in White women. The annual rate of decline in breast cancer mortality is slower among Hispanic women compared to Caucasians (1.8% versus 2.65 per year). (29)
Colorectal cancer is the third leading cancer among Hispanic women. For Hispanic men it ties with prostate cancer as the 2nd leading cause of death. Although the incidence rate for Hispanic is lower than non-Hispanic (43.8 Vs 64.1 respectively); the decline on death rates is at a lower pace for Hispanics than Whites (0.7 % decline per year for Hispanics, and 1.8 % decline per year for Whites). (29)
Rates of stomach cancer among Hispanics are 75% higher than others in the US. The increase may be attributed to diet rich in smoked foods, pickled vegetable, low in fresh vegetables and prevalence of helicobacter pylori infection in lower socio-economic strata
Hispanics experience a 60% higher rate of incidence of liver cancer compared to others. A higher prevalence of hepatitis B & C infection, alcohol use, consumption of hepatotoxins such as aflatoxins are probable risk factors for the increase rate of liver cancer in this population. (29)
Hispanic women in South America have thrice the risk of cervical cancer compared to US women. In the US, Hispanic women still have twice the risk of other women. Death rates among Hispanic women are about 40% higher than others. Increased incidence of human papilloma virus may be associated with the increased risk from cervical cancer. (29)
The age-adjusted prevalence of antibodies to Hepatitis C of 2.9% among Mexican Americans compared to 1.5% among non-Hispanic Whites. (35)
Cancer screening among Hispanics are now comparable to non-Hispanic Whites.
65.4% of Hispanic women aged 40 or above reported receiving a mammogram in the past year, compared with 62.9% of non-Hispanic White women. (40)
Pap testing among Hispanics (83.4%) is comparable to that of non-Hispanic white women (87.2%). (40)
In 2001, only 15.4% eligible Hispanics were estimated to have had a fecal occult blood test in the past year, compared with 24.1% of Whites and 21.6 % of African Americans. Among Hispanics, 31.2% were estimated to have had a screening sigmoidoscopy or colonoscopy in the past 5 years, compared with 39.2% of Whites and 35.3% of African Americans. (40)
Screening for prostate cancer, either through a prostate-specific antigen test or a digital rectal exam among Hispanics (46% & 41.4% respectively) were lower compared to White men (58.2 % & 57.4 % respectively) (40)
Overall, the injury rate for Hispanic Americans is lower than for non-Hispanics. (7)
Mexican Americans compared to Mexican-born immigrants. (12)
According to 3rd National Health and Nutrition Examination Survey data on patients <65 years of age, Mexican-Americans have lower rates of health insurance coverage than Caucasians and African-Americans. (54)
The National Institute on Alcohol Abuse and Alcoholism analysis of data from 1997 after inclusion of Hispanic origin on death certificates revealed that risk for liver cirrhosis mortality is higher among Hispanics than among non-Hispanic black and white Americans. (55)
Deaths due to homicide are higher among Hispanics compared to general population (11.6 vs. 6.1 per 100,000 population). The death rate is especially higher among younger age groups of 15-24 (29.6 per 100,000 population). However, the rates are showing a decreasing trend for all ethnic groups, in the last decade. (7)
VIII. Chronic lower respiratory diseases
According to analysis of the NHANES III data set showed that
According to National Center for Health Statistics data, (NCHS) Hispanics have the lowest age-adjusted mortality rates due to influenza and pneumonia among all ethnic groups. Influenza and pneumonia ranked as the 6 th leading cause of death in the Hispanic over 65 years old. (69)
b. Risks factors for influenza & Pneumonia: (Figure 10)
Based on 1983 and 1984 National Linked Birth and Infant Death data sets, among all Hispanic groups, the neonatal mortality risk was higher among Puerto Rican and lower among Cuban-Americans and Mexican-Americans. The post-neonatal mortality risk (28
Risk factors that can lead to chronic kidney disease include genetic background, diabetes mellitus, hypertension, obesity, elevated cholesterol levels, and a family history of chronic kidney disease, smoking, substance abuse, age, male gender, and being of non-White race. (23)
Limited access to high quality health care due to poverty directly or indirectly increases the risk for HIV infection. Recent immigrants face additional challenges, such as lack of Information about HIV/AIDS and social isolation, which increase the risk of exposure to HIV. (77, 78)
Values such as machismo
5. Malnutrition -
The true prevalence of epilepsy in the US is unknown. This is partly due to lack of methods in public health data collection systems to check for seizures or epilepsy. The incidence or prevalence and impact of epilepsy among Spanish-speaking populations and other distinct population groups are also unknown at this time. (87)
because of a dental problem.
Prevalence estimates of dementia among Hispanics are lacking. However, based on a
New York study, the incidence rate for AD was found to be significantly higher among Caribbean Hispanic elderly individuals compared to White individuals. (92)
Advanced age, presence of an
Cardiovascular risks pre-dispose Hispanics to an increase incidence of dementia. (93)
According to the Surgeon General's Report on Bone Health and Osteoporosis, in the United States, the prevalence of osteoporosis in Hispanic women is similar to that in White women. (96)
As presented above, mortality rates and the leading causes of death among Hispanics are different from those for non-Hispanic whites. For certain health conditions such as diabetes, liver disease, HIV, homicide, cervical and stomach cancers, child health Hispanics bear a disproportionately higher burden of disease, injury, death, disability and years of potential life lost when compared with non-Hispanic whites. Among risk factors, Hispanics have lower rates of health insurance, screening, vaccinations, prenatal care, physical activity and obesity, whereas tobacco use and exposure to secondhand smoke and alcohol intake are higher than non-Hispanic whites.
In addition, socioeconomic factors (e.g., education, employment, and poverty), environmental factors (e.g., neighborhood and work conditions), also contribute to ethnic health disparities. (26, 29, 40, 60, 68, 97) Acculturation and assimilation are important determinants of health risk and disease in the Hispanic population. (12) Recent immigrants can be at increased risk for chronic disease and injury, particularly those who lack fluency in English and familiarity with the U.S. health-care system or who have different cultural attitudes about the use of traditional versus conventional medicine. Such health disparities can mean decreased quality of life, loss of economic opportunities, and increased morbidity among US Hispanics. Further the expected increase in Hispanic population in the next few decades will magnify the adverse public health impact of such disparities in the United States.
Thus, there is an enormous need to perform systematic epidemiologic studies in the Hispanic population. Due to the diversity of the Hispanic cultures and ethnic origin, research must be conducted including all Hispanic subgroups. Multi-center studies are being advocated to analyze the effect of socio-economic, geographic, environmental, urbanization on Hispanic health. Hispanics of varying immigration status may be an interesting focus of study in order to elicit the effects of acculturation on the various sub-groups. Strong community support has been advocated for high participant recruitment and retention and to gain trust among Hispanic participants. New and valid data collection tools for use in Hispanic populations need to be developed and tested. Focus must also be placed on improving health care access and follow-up of health problems identified during studies. Valid US national estimates of risks, diseases and mortality must be determined among all Hispanic subgroups. The “Hispanic paradox”, is a term used to denote the phenomenon of lower mortality rates despite increased risks especially related to CVD. This may be related to under-reporting of disease and mortality. For this purpose, some areas of research that have been recommended by a National Heart, Lung, and Blood Institute (NHLBI) report on epidemiological research in Hispanic populations (98), include a) CVD
Based on the above recommendations, the National Institutes of Health have now funded the largest long-term study of health and disease in Hispanic populations called the Hispanic Community Health Study. The study involves 16,000 participants of Hispanic/Latino origin between ages 18 to 74 years, who will undergo a series of physical examinations and interviews to help identify the prevalence of and risk factors for a wide variety of diseases, disorders, and conditions. This study will also determine the role of cultural adaptation and disparities in the prevalence and development of disease. The study will emphasize differences among Mexican Americans, Puerto Ricans, Cuban Americans, and Central/South Americans. (99)
U.S.A. Department of Health and Human Services (DHHS) has also coordinated several initiatives to reduce health disparities, with public non-profit minority and Hispanic organizations in the US as well as the Healthy People 2010. (100)
As discussed, Hispanics have unique risks, disease prevalence and mortality compared to the general US population. These risk-disease relationships have not been elucidated carefully and completely as in the other ethnic groups. Lack of understanding is a serious impediment to health care of Hispanics who are the second largest US population group that is expected to increase rapidly in the next few decades. Hypothesis testing of the various risk disease associations and observation of disease mortality risk using sound scientific methods among large cohorts of patients is clearly required to understand the peculiar health risks among Hispanics and the various sub-groups.
Balavenkatesh Kanna MD, MPH, FACP Department of Medicine Lincoln Mental and Medical Health Center 234 East 149 St. Room 8-34 Bronx, New York 10451 Phone: (718) 579-4842 Fax: 718-579-4836 Email: Balavenkatesh.Kanna@nychhc.org