Dominguez Kenneth, Penman-Aguilar Ana, Chang Man-Huei, Moonesinghe Ramal, Castellanos Ted, Rodriguez-Lainz Alfonso, Schieber Richard
MMWR Morb Mortal Wkly Rep. 2015 May 8;64(17):469-78.
Hispanics and Latinos (Hispanics) are estimated to represent 17.7% of the U.S. population. Published national health estimates stratified by Hispanic origin and nativity are lacking.
Four national data sets were analyzed to compare Hispanics overall, non-Hispanic whites (whites), and Hispanic country/region of origin subgroups (Hispanic origin subgroups) for leading causes of death, prevalence of diseases and associated risk factors, and use of health services. Analyses were generally restricted to ages 18-64 years and were further stratified when possible by sex and nativity.
Hispanics were on average nearly 15 years younger than whites; they were more likely to live below the poverty line and not to have completed high school. Hispanics showed a 24% lower all-cause death rate and lower death rates for nine of the 15 leading causes of death, but higher death rates from diabetes (51% higher), chronic liver disease and cirrhosis (48%), essential hypertension and hypertensive renal disease (8%), and homicide (96%) and higher prevalence of diabetes (133%) and obesity (23%) compared with whites. In all, 41.5% of Hispanics lacked health insurance (15.1% of whites), and 15.5% of Hispanics reported delay or nonreceipt of needed medical care because of cost concerns (13.6% of whites). Among Hispanics, self-reported smoking prevalences varied by Hispanic origin and by sex. U.S.-born Hispanics had higher prevalences of obesity, hypertension, smoking, heart disease, and cancer than foreign-born Hispanics: 30% higher, 40%, 72%, 89%, and 93%, respectively.
Hispanics had better health outcomes than whites for most analyzed health factors, despite facing worse socioeconomic barriers, but they had much higher death rates from diabetes, chronic liver disease/cirrhosis, and homicide, and a higher prevalence of obesity. There were substantial differences among Hispanics by origin, nativity, and sex.
Differences by origin, nativity, and sex are important considerations when targeting health programs to specific audiences. Increasing the proportions of Hispanics with health insurance and a medical home (patientcentered, team-based, comprehensive, coordinated health care with enhanced access) is critical. A feasible and systematic data collection strategy is needed to reflect health diversity among Hispanic origin subgroups, including by nativity.
据估计，西班牙裔和拉丁裔（统称西班牙裔）占美国人口的17.7%。目前缺乏按西班牙裔血统和出生地分层的全国性健康评估数据。
分析了四个全国性数据集，以比较西班牙裔总体、非西班牙裔白人（白人）以及西班牙裔国家/地区来源亚组（西班牙裔血统亚组）在主要死因、疾病患病率及相关风险因素以及医疗服务使用情况方面的差异。分析一般限于18至64岁年龄组，并尽可能按性别和出生地进一步分层。
西班牙裔平均比白人年轻近15岁；他们更有可能生活在贫困线以下且未完成高中学业。西班牙裔的全因死亡率低24%，在15种主要死因中有9种的死亡率较低，但与白人相比，糖尿病死亡率高51%、慢性肝病和肝硬化死亡率高48%、原发性高血压和高血压肾病死亡率高8%、凶杀案死亡率高96%，糖尿病患病率高133%，肥胖患病率高23%。总体而言，41.5%的西班牙裔没有医疗保险（白人中有15.1%），15.5%的西班牙裔表示因费用问题延迟接受或未接受所需医疗护理（白人中有13.6%）。在西班牙裔中，自我报告的吸烟率因西班牙裔血统和性别而异。在美国出生的西班牙裔肥胖、高血压、吸烟、心脏病和癌症的患病率高于外国出生的西班牙裔：分别高出30%、40%、72%、89%和93%。
尽管面临更严峻的社会经济障碍，但在大多数分析的健康因素方面，西班牙裔的健康状况优于白人，但他们因糖尿病、慢性肝病/肝硬化和凶杀案导致的死亡率要高得多，肥胖患病率也更高。西班牙裔在血统、出生地和性别方面存在很大差异。
在针对特定受众制定健康计划时，血统、出生地和性别的差异是重要的考虑因素。提高有医疗保险和医疗之家（以患者为中心、基于团队、全面、协调且可增加就医机会的医疗保健）的西班牙裔比例至关重要。需要一种可行且系统的数据收集策略来反映西班牙裔血统亚组之间（包括按出生地）的健康差异。
