Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
JAMA Cardiol. 2017 Mar 1;2(3):240-247. doi: 10.1001/jamacardio.2016.4653.
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.
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.
Mortality due to CVD.
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.
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.
西班牙裔是美国最大的少数族裔群体，面临着心血管疾病（CVD）风险因素和社会经济地位低下的不成比例的负担。然而，与非西班牙裔白人（NHW）相比，西班牙裔的全因死亡率却出人意料地较低。这种现象在墨西哥人中已被广泛观察到，但其他西班牙裔亚群是否存在这种情况，或者这些有利趋势是否会随着时间的推移持续存在，目前仍不得而知。
对美国 3 个最大的西班牙裔亚群（墨西哥人、波多黎各人、古巴人）的 10 年来全国 CVD 死亡率数据进行细分。
设计、设置和参与者：从美国国家卫生统计中心死亡率记录中提取了 3 个最大的美国西班牙裔亚群（墨西哥人、波多黎各人、古巴人和 NHW）的 CVD 死亡原因，其基础病因是基于国际疾病分类和相关健康问题第十次修订版（I00-II69）的编码。死亡率数据评估的时间范围为 2003 年 1 月 1 日至 2012 年 12 月 31 日。人口估计值是使用 2000 年和 2010 年美国人口普查报告中的线性插值计算得出的。数据分析于 2015 年 11 月至 2016 年 7 月进行。
CVD 死亡率。
参与者包括 688074 名墨西哥人、163335 名波多黎各人、130397 名古巴人和 19357160 名 NHW 个体（49.0%为男性，51.0%为女性；平均[标准差]年龄为 75[15]岁）。在 CVD 死亡时，墨西哥人（年龄为 67[18]岁）和波多黎各人（年龄为 68[17]岁）比 NHW 人（年龄为 76[15]岁）年轻。2003 年 CVD 死亡率平均为每 10 万人 414.2 人，到 2012 年降至每 10 万人 303.3 人。2003 年至 2012 年 CVD 死亡率的估计降幅范围为所有西班牙裔女性每 10 万人 85 人至古巴男性每 10 万人 144 人，但各亚群之间的死亡率差异很大，波多黎各人的死亡率模式与 NHW 相似，而墨西哥人的死亡率较低。与其他亚群相比，波多黎各人缺血性和高血压性心脏病的死亡率较高，而墨西哥人的脑血管病死亡率较高。
在美国 3 个最大的西班牙裔亚群中，发现 CVD 死亡率和随时间变化的显著差异。研究结果表明，目前对西班牙裔的综合分类掩盖了 CVD 死亡率报告中的异质性，导致对这一人群的健康风险和结果的理解不完整。
