Health Disparities Experienced by Hispanics --- United States
In the 2000 census, 35.3 million persons in the United States and 3.8 million persons in the Commonwealth of Puerto Rico identified themselves as Hispanic (i.e., Hispanic, Spanish, or Latino; of all races). Hispanics constituted 12.5% of the U.S. population in the 50 states; by subpopulation, they identified as Mexican (7.3%), Puerto Rican (1.2%), Cuban (0.4%), and other Hispanic (3.6%) (1). For certain health conditions, Hispanics bear a disproportionate burden of disease, injury, death, and disability when compared with non-Hispanic whites, the largest racial/ethnic population in the United States. The leading causes of death among Hispanics vary from those for non-Hispanic whites (Table). This week's MMWR is the second in a series focusing on racial/ethnic health disparities; eliminating these disparities will require culturally appropriate public health initiatives, community support, and equitable access to quality health care.
In 2001, Hispanics of all races experienced more age-adjusted years of potential life lost before age 75 years per 100,000 population than non-Hispanic whites for the following causes of death: stroke (18% more), chronic liver disease and cirrhosis (62%), diabetes (41%), human immunodeficiency virus (HIV) disease (168%), and homicide (128%); in 2000, Hispanics had higher age-adjusted incidence for cancers of the cervix (152% higher) and stomach (63% higher for males and 150% higher for females) (2). During 1999--2000, Mexican Americans aged 20--74 years reported higher rates of overweight (11% higher for males and 26% higher for females) and obesity (7% higher for males and 32% higher for females) than non-Hispanic whites (3); Mexican-American youths aged 12--19 years also reported higher rates of overweight (112% higher for males and 59% higher for females) (3).
Despite recent progress, ethnic disparities persist among the leading indicators of good health identified in the national health objectives for 2010 (4). Hispanics or Hispanic subpopulations trailed non-Hispanic whites in various measures*, including 1) persons aged <65 years with health insurance (66% Hispanics versus 87% non-Hispanic whites, 2002) and persons with a regular source of ongoing health care (77% versus 90%, 2002); 2) children aged 19--35 months who are fully vaccinated (73% versus 78%, 2002) and adults aged >65 years vaccinated against influenza (49% versus 69%, 2002) and pneumococcal disease (28% versus 60%, 2002) during the preceding 12 months; 3) women receiving prenatal care in the first trimester (77% versus 89%, 2002); 4) persons aged >18 years who participated in regular moderate physical activity (23% versus 35%, in 2002); 5) persons who died from homicide (8.2 versus 4.0 per 100,000 population, 2001); and 6) persons aged 6--19 years who were obese (24% [Mexican Americans] versus 12%, 1999--2000), and adults who were obese (34% [Mexican Americans] versus 29%, 1999--2000).
In other health categories (e.g., tobacco use and exposure to secondhand smoke, infant mortality, and low birthweight), Hispanics led non-Hispanic whites. In addition, since the 1970s, ethnic disparities in measles-vaccine coverage during childhood and in endemic measles have been all but eliminated (5); however, during 1996--2001, the vaccination-coverage gap between non-Hispanic white and Hispanic children widened by an average of 0.5% each year for children aged 19--35 months who were up to date for the 4:3:1:3:3 series of vaccines recommended to prevent diphtheria, tetanus, and pertussis; polio; measles; Haemophilus influenzae type b disease; and hepatitis B (6).
Reported by: Office of Minority Health, Office of the Director, CDC.
Socioeconomic factors (e.g., education, employment, and poverty), lifestyle behaviors (e.g., physical activity and alcohol intake), social environment (e.g., educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e.g., cancer screening and vaccination) contribute to racial/ethnic health disparities (7). Level of education has been correlated with prevalence of certain health risks (e.g., obesity, lack of physical activity, and cigarette smoking) (8). Recent immigrants also 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.
Since 1985, the U.S. Department of Health and Human Services (DHHS) has coordinated initiatives to reduce or eliminate racial/ethnic health disparities, including the Hispanic Agenda for Action, Educational Excellence for Hispanic Americans, Improving Access to Services for Persons with Limited English Proficiency, Hispanic Employment in the Federal Government, the Initiative to Eliminate Racial and Ethnic Disparities in Health, and Healthy People 2010. Information about these initiatives is available at http://www.cdc.gov/omh/aboutus/executive.htm. Ongoing public awareness campaigns include Closing the Health Gap and Take a Loved One to the Doctor Day.
To promote consistency in measuring progress toward Healthy People 2010 objectives, a DHHS workgroup recently recommended standards and techniques for measuring progress toward eliminating health disparities (9). The workgroup recommended that 1) progress toward eliminating disparities for individual subpopulations be measured in terms of the percentage difference between each subpopulation rate and the most favorable or "best" subpopulation rate in each domain and 2) all measures be expressed in terms of adverse events. DHHS conducts periodic reviews to monitor progress toward Healthy People 2010 objectives, and progress toward elimination of health disparities will become part of those reviews.
For Hispanics in the United States, health disparities can mean decreased quality of life, loss of economic opportunities, and perceptions of injustice. For society, these disparities translate into less than optimal productivity, higher health-care costs, and social inequity. By 2050, an estimated 102 million Hispanics will reside in the United States, nearly 24.5% of the total U.S. population (10). If Hispanics experience poorer health status, this expected demographic change will magnify the adverse economic, social, and health impact of such disparities in the United States.
The reports in this week's MMWR describe Hispanic access to health-care and preventive services, prevalence of diabetes among Hispanics, possible disproportionate perinatal exposure to HIV among Hispanics, and the effects of revised population counts on Hispanic teen birthrates. The issue also commemorates National Hispanic Heritage Month (September 15--October 15, 2004), Border Binational Health Week (October 11--17), and Latino AIDS Awareness Day (October 15).
- Grieco EM, Cassidy RC. Overview of race and Hispanic origin: census 2000 brief. United States census 2000. Washington, DC: US Department of Commerce, US Census Bureau; 2001. Available at http://www.census.gov/prod/2001pubs/c2kbr01-1.pdf.
- CDC. Health, United States, 2003: table 30. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2003. Available at http://www.cdc.gov/nchs/data/hus/tables/2003/03hus030.pdf.
- CDC. Health, United States, 2003: table 68. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2003. Available at http://www.cdc.gov/nchs/data/hus/tables/2003/03hus068.pdf.
- US Department of Health and Human Services. Data 2010: the healthy people 2010 database. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2004. Available at http://wonder.cdc.gov/data2010/focus.htm.
- Hutchins SS, Jiles R, Bernier R. Elimination of measles and of disparities in measles childhood vaccine coverage among racial and ethnic minority populations in the United States. J Infect Dis 2004;189(Suppl 1):S146--52.
- Chu SY, Barker LE, Smith PJ. Racial/ethnic disparities in preschool immunizations: United States, 1996--2001. Am J Public Health 2004;94:973--7.
- Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health 2003;93:200--8.
- Greenlund KJ, Zheng ZJ, Keenan NL, et al. Trends in self-reported multiple cardiovascular disease risk factors among adults in the United States, 1991--1999. Arch Intern Med 2004;164:181--8.
- Keppel KG, Pearcy JN, Klein RJ. Measuring progress in Healthy People 2010. Healthy People 2010 Stat Notes 2004;25:1--16.
- US Census Bureau. U.S. interim projections by age, sex, race, and Hispanic origin. Washington, DC: US Department of Commerce, US Census Bureau; 2004. Available at http://www.census.gov/ipc/www/usinterimproj.
* Differences not tested for statistical significance.
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