County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality - PubMed (original) (raw)

Multicenter Study

County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality

Fatima Rodriguez et al. J Am Heart Assoc. 2018.

Abstract

Background Hispanics are the fastest growing ethnic group in the United States, and little is known about how Hispanic ethnic population density impacts cardiovascular disease ( CVD ) mortality. Methods and Results We examined county-level deaths for Hispanics and non-Hispanic whites from 2003 to 2012 using data from the National Center for Health Statistics' Multiple Cause of Death mortality files. Counties with more than 20 Hispanic deaths (n=715) were included in the analyses. CVD deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10), I00 to I78, and population estimates were calculated using linear interpolation from 2000 and 2010 census data. Multivariate linear regression was used to examine the association of Hispanic ethnic density with Hispanic and non-Hispanic white age-adjusted CVD mortality rates. County-level age-adjusted CVD mortality rates were adjusted for county-level demographic, socioeconomic, and healthcare factors. There were a total of 4 769 040 deaths among Hispanics (n=382 416) and non-Hispanic whites (n=4 386 624). Overall, cardiovascular age-adjusted mortality rates were higher among non-Hispanic whites compared with Hispanics (244.8 versus 189.0 per 100 000). Hispanic density ranged from 1% to 96% in each county. Counties in the highest compared with lowest category of Hispanic density had 60% higher Hispanic mortality (215.3 versus 134.2 per 100 000 population). In linear regression models, after adjusting for county-level demographic, socioeconomic, and healthcare factors, increasing Hispanic ethnic density remained strongly associated with mortality for Hispanics but not for non-Hispanic whites. Conclusions CVD mortality is higher in counties with higher Hispanic ethnic density. County-level characteristics do not fully explain the higher CVD mortality among Hispanics in ethnically concentrated counties.

Keywords: enclaves; ethnicity; health disparities.

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Figures

Figure 1

Figure 1

Hispanic proportion of US counties from the 2000–2010 US census data.

Figure 2

Figure 2

Age‐adjusted cardiovascular mortality rate (per 100 000) for Hispanics and non‐Hispanic whites by Hispanic proportion.

Figure 3

Figure 3

Modeled estimates of age‐adjusted cardiovascular mortality rate (per 100 000) for Hispanics and non‐Hispanic whites by Hispanic proportion. The model estimates include midpoint values of Hispanic density on log scale (1.9% for category 1, 4.5% for category 2, 12.2% for category 3, 33.1 for category 4, and 73.7 for category 5) and mean values were used for other covariates (population size, proportion female, median household income, % under poverty line, % high school graduation, % some college, % unemployed, % black, % not proficient in English and % rural, % uninsured and primary care physician rate).

Figure 4

Figure 4

Box‐plot of fully adjusted cardiovascular mortality rate (per 100 000) for Hispanics and non‐Hispanic whites by Hispanic proportion. The displayed results were adjusted for the following county characteristics: population size, proportion female, median household income, % under poverty line, % high school graduation, % some college, % unemployed, %black, % not proficient in English and % rural, % uninsured and primary care physician rate).

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References

    1. Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, Palaniappan L, Pina IL, Ramirez SM, Rodriguez B, Sims M; American Heart Association Council on Epidemiology and Prevention, American Heart Association Council on Clinical Cardiology, American Heart Association Council on Cardiovascular and Stroke Nursing . Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation. 2014;130:593–625. - PMC - PubMed
    1. Writing Group Members , Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER III, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee; Stroke Statistics Subcommittee . Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:447–454. - PubMed
    1. Markides KS, Eschbach K. Aging, migration, and mortality: current status of research on the Hispanic paradox. J Gerontol B Psychol Sci Soc Sci. 2005;60:S68–S75. - PubMed
    1. Medina‐Inojosa J, Jean N, Cortes‐Bergoderi M, Lopez‐Jimenez F. The Hispanic paradox in cardiovascular disease and total mortality. Prog Cardiovasc Dis. 2014;57:286–292. - PubMed
    1. Sorlie PD, Backlund E, Johnson NJ, Rogot E. Mortality by Hispanic status in the United States. JAMA. 1993;270:2464–2468. - PubMed

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