Disaggregation of Cause-Specific Cardiovascular Disease Mortality Among Hispanic Subgroups

Abstract

IMPORTANCE Hispanics are the largest minority group in the United States and face a disproportionate burden of risk factors for cardiovascular disease (CVD) and low socioeconomic position. However, Hispanics paradoxically experience lower all-cause mortality rates compared with their non-Hispanic white (NHW) counterparts. This phenomenon has been largely observed in Mexicans, and whether this holds true for other Hispanic subgroups or whether these favorable trends persist over time remains unknown. OBJECTIVE To disaggregate a decade of national CVD mortality data for the 3 largest US Hispanic subgroups. DESIGN, SETTING, AND PARTICIPANTS Deaths from CVD for the 3 largest US Hispanic subgroups—Mexicans, Puerto Ricans, and Cubans—compared with NHWs were extracted from the US National Center for Health Statistics mortality records using the underlying cause of death based on coding from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (I00-II69). Mortality data were evaluated from January 1, 2003, to December 31, 2012. Population estimates were calculated using linear interpolation from the 2000 and 2010 US Census reports. Data were analyzed from November 2015 to July 2016. MAIN OUTCOMES AND MEASURES Mortality due to CVD. RESULTS Participants included 688 074 Mexican, 163 335 Puerto Rican, 130 397 Cuban, and 19 357 160 NHW individuals (49.0 % men and 51.0% women; mean [SD] age, 75 [15] years). At the time of CVD death, Mexicans (age, 67 [18] years) and Puerto Ricans (age, 68 [17] years) were younger compared with NHWs (age, 76 [15] years). Mortality rates due to CVD decreased from a mean of 414.2 per 100 000 in 2003 to 303.3 per 100 000 in 2012. Estimated decreases in mortality rate for CVD from 2003 to 2012 ranged from 85 per 100 000 for all Hispanic women to 144 per 100 000 for Cuban men, but rate differences between groups vary substantially, with Puerto Ricans exhibiting similar mortality patterns to NHWs, and Mexicans experiencing lower mortality. Puerto Ricans experienced higher mortality rates for ischemic and hypertensive heart disease compared with other subgroups, whereas Mexicans experienced higher rates of cerebrovascular disease deaths. CONCLUSIONS AND RELEVANCE Significant differences in CVD mortality rates and changes over time were found among the 3 largest Hispanic subgroups in the United States. Findings suggest that the current aggregate classification of Hispanics masks heterogeneity in CVD mortality reporting, leading to an incomplete understanding of health risks and outcomes in this population.

Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults

“…Although our prior work has highlighted heterogeneity between Hispanic subgroups and CVD mortality,24 granulizing data even further by nativity status (especially for largely foreign‐born populations) has demonstrated further heterogeneity in outcomes. Foreign‐born Cubans were shown to have the largest CVD mortality differential compared with US‐born Cubans, highlighting a potentially missed opportunity in cardiovascular prevention among immigrants.…”

“…Population data were obtained from the 2000 and 2010 US Census data, and midyear estimates were calculated using linear interpolation and extrapolation out to 2012 to generate denominator data for age‐adjusted mortality rates (AMRs). Methods for linear interpolation have been described previously 24, 25. Educational attainment was categorized as no formal education, high school or GED (General Equivalency Diploma), some college, bachelor's degree or higher , and unknown , using both 2003 and 1989 revisions because different states adopted different revisions.…”

“…Methods for linear interpolation have been described previously. 24,25 Educational attainment was categorized as no formal education, high school or GED (General Equivalency Diploma), some college, bachelor's degree or higher, and unknown, using both 2003 and 1989 revisions because different states adopted different revisions.…”

“…Our previous work has documented marked heterogeneity in CVD mortality in the 3 largest Hispanic subgroups; Puerto Ricans had the highest rates of ischemic and hypertensive heart disease deaths compared with other Hispanic subgroups, whereas Mexicans had the highest rates of stroke deaths. 24 Given the importance of acculturation to Hispanic cardiovascular health, our current study aims to explore CVD mortality outcomes by nativity status (US versus foreign born) among Hispanic subgroups.…”

Disparities in mortality for chronic liver disease among Asian subpopulations in the United States from 2007 to 2016

“…Age-standardized mortality rates per 100 000 persons by race/ethnicity and by age groups (20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years) were calculated. The population for each Asian subgroup was calculated using previously described methods 6,18 of linear interpolation for 2007–2009, the US Census data for 2010, and extrapolation for 2011–2016 using full population data count stratified by Asian subgroups that were available during the study period from the 2000–2010 US Census reports. Using the direct method, age-specific mortality rates were standardized to the age distribution of the US standard population in 2000.…”