1 table omitted
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 whites3;
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
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 eliminated5; 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
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).
*Differences not tested for statistical significance.
Health Disparities Experienced by Hispanics—United States. JAMA. 2004;292(19):2330-2331. doi:10.1001/jama.292.19.2330