Introduction

With more than 7% of the population, Hispanic Americans are the second largest minority in the United States. The Hispanic population is comprised of persons from diverse origins including Mexican (60.6% of total Hispanic population), Puerto Rican (15.1%), Cuban (6.1%), Central and South American (10.2%) and other Hispanic origin (8.0%). In 1985, 16.9 million Hispanic Americans, comprising 7.2% of the entire population, lived in the U.S. The increase in the Hispanic population from 1980 to 1985 (16%) was almost 5 times larger than the increase of the total population (3.3%). About 90% of Hispanics live in urban areas, and half live in the two states of Texas and California. Place of residence varies according to Hispanic origin as nearly half of all Puerto Ricans live in the New York metropolitan area, almost two-thirds of Cubans live in Florida and nearly three-quarters of Mexican Americans live in Texas and California.

The Hispanic population is young, with 36% under age 18 and with a median age of 25.0 years. Less than half (47.9%) have graduated from high school. In 1985, the unemployment rate among Hispanics was nearly 50% higher than for the total population. The 1984 median family income for Hispanics was 71% of that for the entire population, and more than twice as many Hispanic families (25.2%) were below the poverty level as for the overall population (11.6%).

×Ö´®4

Morbidity and mortality data on Hispanics have been lacking since national reporting systems have not listed Hispanics as an ethnic group separate from other whites. A recently completed Hispanic Health and Nutrition Examination Survey will provide morbidity information, and a study of death certificates from selected states with coding for Hispanics Is underway at the National Center for Health Statistics to provide mortality information. Currently available data indicate that the health of Hispanics is closer to that of other whites than to the health of Blacks with whom Hispanics share socioeconomic conditions. Life expectancy and infant mortality rates among Hispanics are nearly equivalent to those of whites, while cardiovascular disease mortality and cancer incidence rates are lower among Hispanics than whites. Hispanics, however, face higher rates of diabetes, obesity, alcohol-related illness and mortality from homicide than the general population. As new sources of health data on Hispanics develop, so will our knowledge of the health needs of this growing ethnic group.

×Ö´®9

Demographic Data

By March 1985, 16.9 million persons of Hispanic origin, representing 7.2% of the entire population, were living in the United States.

From 1980 to 1985 the Hispanic population in the U.S. increased 16% compared to an increase of 3.3% for the overall population. ×Ö´®3

In 1985, the median age of the Hispanic population was 25.0 years compared to 31.9 years for the non-Hispanic population of the U.S. ×Ö´®5

90% of Hispanic Americans live in urban areas. The four cities of New York, Los Angeles, Chicago and San Antonio contain 21% of all Hispanics in the U.S. ×Ö´®4

In five states more than 10% of the state population is Hispanic: New Mexico, 37%; Texas, 21%; California, 19%; Arizona, 16%; Colorado, 12%.

×Ö´®6

Half of all Hispanics live in the two states of Texas and California. ×Ö´®9

Approximately 45% of Puerto Ricans living in the continental United States live in the New York City metropolitan area where they comprise 10% of the area's total population. ×Ö´®8

In 1985, 10.7% of Hispanics were under 5 years of age compared to 7.6% of the entire U.S. population, while 4.8% of Hispanics were 65 years and over compared to 12.0% of the total population. ×Ö´®7

Socioeconomic Data

Social, Educational and Economic Data ×Ö´®5

In 1982, 31.8% of first marriages to Hispanic women aged 15-44 years had dissolved (by divorce, separation or widowhood) compared to 30.1% of white marriages and 47.9% of Black marriages. ×Ö´®2

In 1980, the Hispanic civilian labor force was distributed into the following occupational categories: operators, fabricators and laborers, 28.9%; technical, sales and administrative support, 23.6%; service, 16.0%; precision production, craft and repair, 13.8%; managerial and professional specialty, 11.5%; and farming, forestry and fishing, 5.0%.

Health Care Utilization ×Ö´®6

19% of Hispanics compared to 13% of whites report having no usual source of medical care. ×Ö´®2

A physician's office is reported as the usual source of care by 54% of Hispanics and 70% of whites.

×Ö´®6

26% of Hispanics have no medical insurance compared to 9% of whites and 18% of Blacks. ×Ö´®6

The age-adjusted number of visits to physicians per person per year in 1978-80 national survey was higher among Puerto Ricans (6.1), Cubans (5.8) and other Hispanics (5.1) than among whites or Blacks (both 4.8). Mexican Americans had fewer physician visits per person per year (4.3) than any other group.

×Ö´®4

The percentage of persons with no physician contacts during the year preceding an interview in 1979-80 was higher among Mexican Americans (33.1) than other Hispanics (23.9), Blacks (23.8), whites (23.3), Cubans (23.3) or Puerto Ricans (20.4).

×Ö´®5

The percent of persons 4 years and older who had never received dental care in a 1978-80 national survey was higher among Mexican Americans (17.4) than Blacks (9.2), Puerto Ricans (6.9), other Hispanics (6.9), Cuban Americans (3.1) or whites (2.5). ×Ö´®9

The percent of persons 4-16 years old who had never received dental care in 1978-80 was higher among Mexican Americans (30.7) than Blacks (22.3), Puerto Ricans (17.2), other Hispanics (17.1), Cuban Americans (16.2) or whites (9.7).

In 1982 there were 1,212 family planning visits during the year per 1,000 Hispanic women compared to 1,034 visits for white women and 1,337 visits for Black women.

In 1982, 21% of Hispanics polled reported having trouble regarding access to medical care (e.g., could not find certain services, needed but did not get medical help, were refused care, and/or had major financial problems due to illness). In the same survey, 13% of whites and 22% of Blacks reported having trouble with access to medical care.

Morbidity

×Ö´®5

[Few national data sources exist to provide detailed morbidity information about Hispanics. The first national Hispanic Health and Nutrition Examination Survey was completed in 1986. After those data are analyzed, understanding of the health status of Hispanics will be more complete.]

×Ö´®6

General Health Status

×Ö´®9

In 1980, the percent of persons who assessed their own health as good or excellent was 87.3% among Hispanics, 86.8% among whites and 82.2% among Blacks.

The percent of persons reporting limitation of their major activity by chronic health conditions in 1979-80 was higher among Puerto Ricans (15.5) than Blacks (14.8), Mexican Americans (11.4), Cuban Americans (10.9), whites (10.3) or other Hispanics (10.0).

The reported incidence rate (per 100 persons per year) of acute medical conditions in 1978-80 was higher among Puerto Ricans (321.8) than whites (224.6), other Hispanics (223.3), Mexican Americans (188.9), Blacks (188.1) or Cuban Americans (172.5). ×Ö´®9

Hispanics are overrepresented in the farming, manufacturing and construction industries. Severe disability resulting from work-related injury was almost twice as high among Hispanics as among non-minority workers in 1980.

×Ö´®3

Cardiovascular Disease

[Cardiovascular disease risk factor data for Hispanics are presented in the Risk Factor Prevalence Data section of this chapter; cardiovascular disease mortality data are presented in the Mortality Data section. Morbidity data on cardiovascular diseases among Hispanics are lacking until analysis of the Hispanic Health and Nutrition Examination Survey is accomplished.]

×Ö´®7

Diabetes ×Ö´®2

The prevalence of diabetes among Mexican Americans is nearly twice that among whites. Over 95% of diabetes among Hispanics is of the noninsulin-dependent type.

A 1979-82 study in San Antonio, Texas found the prevalence of previously diagnosed diabetes among Mexican Americans ages 25-64 to be 4.5% of men and 4.6% of women. The 1976-80 National Health and Nutrition Examination Survey (NHANES II) found the prevalence of previously diagnosed diabetes among whites ages 20-64 to be 2.1% of men and 3.2% of women. ×Ö´®2

In the same San Antonio study of Mexican Americans ages 25-64 years using the oral glucose tolerance test as a means of screening for diabetes, 7.1% of men and 5.2% of women had results suggesting previously undiagnosed diabetes. Combined with 4.5% of men and 4.6% of women who had previously diagnosed diabetes, a total of 11.6% of Mexican American men and 9.8% of Mexican American women were considered diabetic. Comparable figures for whites ages 20-64 years from the 1976-80 NHANES II survey were 2.1% of men and 3.2% of women were previously diagnosed diabetics and 2.0% of men and 3.1% of women were newly diagnosed for a total prevalence of diabetes among whites of 4.1% of men and 6.3% of women. ×Ö´®6

Diabetes is more than twice as common among Mexican Americans of the lowest socioeconomic status as among those of the highest socioeconomic status. ×Ö´®3

Reproductive Health

×Ö´®3

In 1982, 24.7% of Hispanic women aged 15-44 years used any contraception at first intercourse compared to 33.6% of Black women and 46.6% of white women.

Mortality ×Ö´®2

[Hispanic ethnicity is not uniformly recorded on death certificates in all states. As a result no national mortality figures exist which separate Hispanics from other whites. By 1987 the National Center for Health Statistics expects to publish the results of a 15-state study on the mortality among Hispanics from the leading causes of death.]

×Ö´®5

Overall Mortality and Life Expectancy

×Ö´®6

The life-expectancy at birth for Hispanics in the Southwest is nearly the same as for whites in the same region. A 1969-71 study in California found the life-expectancy of men with Spanish surnames to be 68.3 years compared to 68.7 years for whites and 63.5 years for Blacks. Women of Spanish surname had a life expectancy of 75.2 years compared to 76.0 years for other whites and 71.5 years for Black women in the same study.

×Ö´®9

The risk of death from any cause under age 45 is 1.4 times greater in Mexican-born males and 1.2 times greater in Cuban-born males than among whites. The risk of death for foreign-born Hispanic females, however, is less than that for females under age 45 in the non-minority population.

Excess deaths are those deaths observed in a population in excess of the number expected from the rate observed in the white population. Homicide was the leading cause of excess deaths among both Mexican-and Cuban-born Hispanics in a 1978-80 study. ×Ö´®5

Mexican-born Hispanics experienced excess deaths from homicide, unintentional injuries (males only), diabetes (females only) and cirrhosis (males only). For cardiovascular disease, cancer and infant mortality, the number of deaths among Mexican-born Hispanics was less than the number expected by white mortality rates. ×Ö´®7

Cuban-born Hispanics had excess deaths from homicide, but fewer deaths from cardiovascular disease, cancer, infant mortality, cirrhosis, diabetes, unintentional injuries and all other causes than expected by the mortality rates for whites.

Cardiovascular Disease

×Ö´®8

Two studies have found cardiovascular disease to be the leading cause of death among Mexican Americans in the southwest. The cardiovascular disease death rate for Mexican Americans was 82% to 85% of the rate for non-Hispanic white males. The cardiovascular disease death rate for Mexican American females was virtually identical to that of non-Hispanic white females. ×Ö´®3

A 1979-81 study of Hispanic areas of Los Angeles county showed that age-adjusted mortality rates from major cardiovascular disease were lower for Hispanic men than for whites and Blacks (441.9 deaths per 100,000 compared to 536.2 and 558.2 respectively). The same was true for mortality from diseases of the heart (357.8/100,000 vs. 432.6 and 438.9), from ischemic heart disease (220.4/100,000 vs. 274.2 and 223.9), from myocardial infarction (98.2/100,000 vs. 235.7 and 106.9) and from hypertensive disease (20.4/100,000 vs. 22.0 and 57.0). ×Ö´®2

Hispanic women also had age-adjusted mortality rates that were lower than in whites and Blacks for major cardiovascular disease (316.7/100,000 vs. 335.7 and 384.4 respectively), from heart diseases (242.4/100,000 vs. 245.8 and 278.0), from ischemic heart disease (148.6/100,000 vs. 158.1 and 158.5) and from myocardial infarction (66.8/100,000 vs. 70.1 and 70.9). The mortality rate for hypertensive disease was higher among Hispanic women (18.6) than in white women (15.8), but lower than in Black women (40.2). ×Ö´®5

The above Los Angeles census tract study indicated that the stroke mortality rate (stroke deaths per 100,000 population) was lower among Hispanic (63.1) than white (75.4) and Black (94.6) males. Among females, the stroke mortality rate was lower in Hispanics (57.6) than whites (71.0) and Blacks (84.6). ×Ö´®4

Diabetes

×Ö´®8

Diabetes mortality rates in the San Antonio, Texas region in 1970-76 were 2-4 times higher among those with Spanish surnames than among other whites.

Homicide, Suicide and Unintentional Death ×Ö´®9

Compared to the white population, the relative risk of death from homicide is 6.4 times greater in Cuban-born males and 5.9 times greater in Mexican-born males under age 45. The relative risk of death from homicide is 2.4 for Cuban-born females and 1.5 for Mexican-born females under age 45. ×Ö´®4

Data from the five-state southwestern region where more than 60% of Hispanics reside, show that in 1976-80, the homicide mortality rate for Hispanics (20.5 homicide deaths per 100,000) was intermediate to the comparable crude rate for non-Hispanic whites or Anglos (7.9) and for Black and other races nationally (35.4). ×Ö´®3

In the 20-24 year age group, the homicide mortality rate for Hispanic males in the five southwestern states in 1976-80, was more than 4 times higher than the comparable Anglo rate and approached the rate for Black males nationally.

The suicide rate for Hispanics in the five southwestern states in 1976-80 was less than half the rate among Anglos. Among young males, the suicide rates were nearly equal for the two ethnic groups. ×Ö´®8

The suicide mortality rate for Hispanic males in the southwest peaked among those 20-24 years of age at 33.1 (per 100,000) compared to 37.4 for comparable Anglos of the same area. ×Ö´®1

The relative risk of death due to unintentional injuries for Mexican-born males under age 45 was 1.7 times that of white males, but was equal among females from the two ethnic groups.

Risk Factor Prevalence

×Ö´®4

A higher percentage of Hispanic males (24%) reported frequent heavy drinking than did white (21%) or Black (21%) males in a 1981 study in California. Among males 18 to 29 years of age 34% of Hispanics compared to 29% of whites and 17% of Blacks reported frequent heavy drinking.

×Ö´®7

In the same study, a higher percentage of Hispanic females (33%) reported abstinence than did white (18%) or Black (32%) females, and a lower percentage of Hispanic females (3%) reported frequent heavy drinking than did white (4%) or Black (5%) females.

A 1977 National Health Interview Survey (NHIS) found that 54.1% of Hispanics and 43.1% of whites had never smoked; that 33.5% of Hispanics and 35.2% of whites were current smokers; and that 12.3% of Hispanics and 21.7% of whites were former smokers.

×Ö´®4

The above NHIS showed that 13.6% of Hispanic compared to 29.8% of white smokers smoked more than 25 cigarettes per day.

The prevalence of obesity (defined as 20% or more over desirable weight) in those of very low socioeconomic status is higher among Mexican American men (25.8%) and women (44.8%) than in non-Hispanic white men (15.6%) and women (29.0%).

×Ö´®7

Cholesterol levels are slightly higher in Mexican American men than non-Hispanic white men, but similar for women of both ethnic groups. One study found the prevalence of hypercholesterolemia (cholesterol higher or equal to 260 mg/dl) to be slightly higher among Mexican American men (16.7%) than non-Hispanic white men (13.9%).

Studies of triglycerides have shown significantly higher levels among Mexican Americans than in non-Hispanic whites.

The level of physical exercise outside of work is on average lower in Mexican Americans than in non-Hispanic whites. Among men of the highest socioeconomic group, however, about 50% of both Mexican Americans and non-Hispanic whites exercise to reduce coronary heart disease risk. ×Ö´®1

Several studies have found the prevalence of high blood pressure to be similar among Hispanic Americans and whites. The Laredo Project found the prevalence of hypertension among Mexican American men to be intermediate between whites and Blacks, while hypertension was less common in Mexican American females than in Black or white females.

×Ö´®9

A 1975-76 study at the University of California at Davis found the prevalence of elevated diastolic blood pressure (greater than 95 mm Hq) to be higher in Spanish American men (15.6%) than in white men (11.7%).

Significant Trends

Demographic Trends ×Ö´®4

From 1970 to 1980 the Hispanic population increased 61% compared to an increase of 11.5% for the overall U.S. population. From 1980 to 1985 the Hispanic population again increased at a rate that was about 5 times the rate of the entire U.S. populaton (16% compared to 3.3%).

The Cuban population in Florida nearly doubled from 250,406 in 1970 to 470,250 in 1980. In 1980, 58.5% of Cuban-Americans lived in Florida. ×Ö´®3

Heart Disease Mortality

×Ö´®6

Between 1970 and 1975, the mortality rates from ischemic heart disease and acute myocardial infarction showed smaller declines among persons with Spanish surnames in Texas than in other whites and Blacks of both sexes.

×Ö´®3