Trends in AIDS among Hispanics in the United States, 1991-1996.

OBJECTIVES: This article describes recent trends in AIDS among US Hispanics. METHODS: Incidence rates were calculated from AIDS surveillance data for persons diagnosed from 1991 through 1996. Increases in the number of cases among Hispanics were calculated by linear regression. RESULTS: Of the 415,864 persons diagnosed with AIDS from 1991 through 1996, 19% were Hispanic. Among Hispanics with AIDS, 67% were born in the United States or Puerto Rico. The relative risk (RR) of AIDS for Hispanics compared with Whites was highest for women (RR = 7.0), followed by children (RR = 6.2) and men (RR = 2.8). Increases in the number of cases were higher among foreign-born Hispanics. CONCLUSIONS: An understanding of which Hispanic subgroups are at greatest risk for HIV infection is important for prevention efforts.     

Birthplace and the risk of AIDS among Hispanics in the United States.

To extend previous work showing that the risk of AIDS (acquired immunodeficiency syndrome) is higher in US Hispanics than in Whites who are not Hispanic, we compared US residents born in different Latin American countries. We computed the cumulative incidence (CI) of AIDS and the distribution of cases by mode of exposure. Cases were those reported to the Centers for Disease Control between June 1, 1981 and December 12, 1988, and populations specific for birthplace were from the 1980 census. The reference group was the White population that was not Hispanic, CI 25.7/100,000. We estimated a similar rate in Mexican-born persons (25.3/100,000). In the South and West, the rate in Mexican-born Hispanics was half the reference rate. In each US region, the CI of AIDS in heterosexual intravenous drug abusers (IVDAs) in Puerto Rican-born persons was several times greater than that in other Latin American-born persons. Puerto Rican-born persons were the only Latin American-born persons in whom most cases were in heterosexual IVDAs. The data suggest that resources for preventing AIDS in Hispanics are needed most in those of Puerto Rican ethnicity for AIDS related to intravenous drug abuse.     

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%). 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. 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.     

Addressing the HIV/AIDS Epidemic Among Puerto Rican People Who Inject Drugs: The Need for a Multiregion Approach

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue.Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence.These disparities should be addressed by the development of a federally supported Northeast–Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.Behavioral, biomedical, and structural interventions have led to significant reductions in HIV incidence in the United States. More than 30 years since HIV was first reported, the possibility of an AIDS-free generation in the United States has recently emerged. Current research and policy efforts focus on identifying those who may be unaware of their infection to engage and maintain them in antiretroviral treatment, and aim to reduce health disparities among racial/ethnic groups.Despite great advances in HIV prevention and care, insufficient progress has been made among Puerto Rican people who inject drugs (PRPWID). Research on the HIV/AIDS epidemic among people who inject drugs (PWID) has documented higher levels of risk behaviors and prevalence among individuals identified as Puerto Rican than among other groups since early in the epidemic, and these disparities persist. Although Puerto Ricans in the island and the continental United States represent about 9% of the US Hispanic population,1 nearly 23% of incident HIV cases among Hispanics in 2006 were among those born in Puerto Rico.2 Injection drug use accounted for the majority of AIDS cases in Puerto Rico early in the epidemic,3 and currently more than 20% of new infections in Puerto Rico are attributed to injection drug use, a higher percentage than for any other region of the United States 4 and for any other Hispanic subgroup.5To meet the challenge of eradicating HIV in the United States, health disparities within subgroups at high risk for HIV must be addressed. Furthermore, the HIV treatment–as–prevention paradigm6 in use to reduce HIV transmission will not suffice in reducing comorbidities associated with injection drug use (e.g., hepatitis C, overdoses), also found at disproportionately high rates among PRPWID. We focused on Puerto Rico and the northeastern United States, where the majority of Puerto Ricans live,1 to examine the history of the epidemic among PRPWID, the current state of the epidemic, and the availability of HIV prevention and treatment services. We also describe other challenges to health for PRPWID and interventions recently adopted in Puerto Rico and provide recommendations to further reduce HIV in this population.     

Mortality patterns among adult Hispanics: findings from the NHIS, 1986 to 1990.

OBJECTIVES: The purpose of this study was to assess the mortality pattern of the adult Hispanic population in the United States. METHODS: This was a cohort study using data from the National Health Interview Survey from 1986 through 1990. Deaths were ascertained by matching the National Death Index through 1991. RESULTS: This representative national sample included 297,640 non-Hispanic Whites, 53,552 Blacks, and 27,239 Hispanics, all aged 18 years or older at baseline. Different matching criteria resulted in modest differential estimates of the number of deaths by ethnic groups; these differences were quantitatively more important for Hispanics. Overall age-standardized mortality was lower among Hispanics. A prominent age by race interaction was apparent. The Hispanic: White mortality ratio was 1.33, 0.92, and 0.76 among men aged 18 through 44, 45 through 64, and 65 and older, respectively. Among women in the same age groups the Hispanic: White mortality ratio was 1.22, 0.75, and 0.70, respectively. CONCLUSIONS: Longitudinal cohorts provide an important source of health status information on Hispanics. These results suggest that overall mortality is lower among Hispanics than among non-Hispanic Whites, especially in the oldest age group. Among younger and middle-aged persons, the mortality of Hispanics is similar to or even higher than that of Whites.     

Prevalence of diabetes among Hispanics--selected areas, 1998-2002

Diabetes disproportionately affects Hispanics in the United States. However, the Hispanic population is composed of culturally distinct subpopulations that tend to be regionally concentrated, and the prevalence of diabetes can differ in these subpopulations. CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys to estimate the prevalence of diabetes among Hispanic and non-Hispanic white adults residing in six states and among Hispanics in Puerto Rico, assessing disparities by geographic location. This report summarizes the findings of that analysis, which indicated that Hispanics continued to have a higher prevalence of diabetes than non-Hispanic whites and that disparities in diabetes between these two populations varied by area of residence. These findings underscore the need to target Hispanics and other populations with higher prevalence of diabetes to eliminate racial/ethnic disparities.     

Risk of Cigarette Smoking Initiation During Adolescence Among US-Born and Non–US-Born Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos

Objectives. We assessed risk of cigarette smoking initiation among Hispanics/Latinos during adolescence by migration status and gender.Methods. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) surveyed persons aged 18 to 74 years in 2008 to 2011. Our cohort analysis (n = 2801 US-born, 13 200 non–US-born) reconstructed participants’ adolescence from 10 to 18 years of age. We assessed the association between migration status and length of US residence and risk of cigarette smoking initiation during adolescence, along with effects of gender and Hispanic/Latino background.Results. Among individuals who migrated by 18 years of age, median age and year of arrival were 13 years and 1980, respectively. Among women, but not men, risk of smoking initiation during adolescence was higher among the US-born (hazard ratio [HR] = 2.10; 95% confidence interval [CI] = 1.73, 2.57; P < .001), and those who had resided in the United States for 2 or more years (HR = 1.47; 95% CI = 1.11, 1.96; P = .01) than among persons who lived outside the United States.Conclusions. Research examining why some adolescents begin smoking after moving to the United States could inform targeted interventions.Cigarette smoking and tobacco exposure account for nearly 500 000 deaths in the United States each year, or 20% of US deaths annually.1 Every day in the United States nearly 4000 people aged 12 to 17 years smoke their first cigarette, and about 1000 youths become daily cigarette smokers.2 People who begin smoking regularly during adolescence often become addicted by 20 years of age,3 which underscores the importance of examining risk factors for smoking initiation in adolescents. In 2012, the prevalence of cigarette smoking among Hispanic/Latino persons aged 12 to 17 years was estimated to be less than that of non-Hispanic Whites, but higher than among non-Hispanic Blacks and Asians.4 Among Hispanics/Latinos, 5% of youths aged 12 to 17 years, 25% of adults aged 18 to 25 years, and 17% of adults aged 26 years and older were current cigarette smokers.4Several studies have examined the association of cigarette smoking and birthplace among US Hispanics/Latinos. Most have reported a higher proportion of smokers among US-born than non–US-born Hispanics/Latinos, especially among women. One study found that the risk of smoking initiation was lower for Mexican immigrants who were living in the United States than for the same individuals before migration.5 Several others have suggested that exposure and acculturation to the US environment may increase cigarette smoking behavior in non–US-born populations.6–9 However, these studies did not focus specifically on adolescents.Few data exist on individuals from different Hispanic/Latino backgrounds. For instance, Puerto Ricans have a high smoking prevalence, are the second-largest group of US Hispanics/Latinos, and frequently migrate between the US mainland and the US territory of Puerto Rico.10 A recent study reported differences in smoking prevalence among adult Hispanics/Latinos by gender and background. For instance, men and women of Puerto Rican and Cuban descent had a higher prevalence of smoking than was found in national data on non-Hispanic Whites. Women of Mexican and Central American background had a lower smoking prevalence than other racial/ethnic groups in the United States.11 A combination of factors, including but not limited to migration to the United States, country or region of origin, and gender, likely affect risk of cigarette smoking initiation and persistence in Hispanics/Latinos.We assessed the association between migration and time to smoking initiation during adolescence and whether risk of smoking initiation increased with time since migration. We also assessed whether this association differed by gender and Hispanic/Latino background. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) provided data on large groups of Hispanics/Latinos of various ethnocultural backgrounds. HCHS/SOL participants were aged 18 to 74 years, but we were able to use questionnaire data to determine smoking history during adolescence. We hypothesized that the risk of cigarette smoking initiation during adolescence would be higher in US-born Hispanics/Latinos than in those born outside the 50 states and Washington, DC; that among individuals born outside the United States, this risk would increase with time since migration to the mainland United States; and that the risk of smoking initiation during adolescence might be modified by gender and Hispanic/Latino background. The HCHS/SOL cohort provided a unique opportunity to address this question in a heterogeneous group of Hispanics/Latinos and to compare associations across many different backgrounds.     

Transnational Mortality Comparisons Between Archipelago and Mainland Puerto Ricans

Puerto Ricans in the US experience higher deaths from diabetes and other causes compared to non-Hispanic Whites and other Hispanic groups. We compared mortality in Puerto Rico to that of Puerto Ricans in the US as a first step to investigate if similar or worse mortality patterns originate from the sending country (Puerto Rico). Age-adjusted death rates were generated using national vital statistics databases in the US and territories for all-cause and the top ten causes of death among Hispanics in 2009. Mortality ratios in the archipelago of Puerto Rico (APR) were compared to mainland US Puerto Ricans (MPR). Rates for other ethnic/racial groups (Mexican Americans, Cubans, and non-Hispanic Whites, Blacks, American Indians, and Asians) were calculated to provide a context. APR had significantly higher all-cause mortality and death rates for diabetes, nephritis, pneumonia/influenza, and homicide/assault compared to MPR (APR/MPR ratio for all-cause: 1.08, diabetes: 2.04, nephritis: 1.84, pneumonia/influenza: 1.33, homicide/assault: 3.15). Death rates for diabetes and homicide/assault (particularly among men) were higher among APR compared to any other racial/ethnic groups in the US. In contrast, deaths from heart disease, cancer, and chronic liver disease were significantly lower for APR compared to MPR (MPR/APR ratio 0.72, 0.91, 0.41, respectively). Among APR women, death rates for these causes were also lower compared to any other group in the US. Substantial mortality variability exists between Puerto Ricans in Puerto Rico and those in the US, re-emphasizing the need to study of how socio-environmental determinants of health differ in sending and receiving countries. Explanations for disparate rates include access to and availability of healthcare and unique factors related to the migration experience of this group.     

Renal failure among male Hispanics in the United States.

This study examined epidemiologic patterns and time trends among male patients with Hispanic surnames in the Medicare End-Stage Renal Disease Program and compared US Hispanics with non-Hispanic Blacks and Whites. Male Hispanics had substantially higher proportions of end-stage renal disease attributed to diabetes than did Blacks and Whites. There were notable regional differences among Hispanics. Between 1980 and 1990, the incidence of treated renal failure among Hispanics increased more than that among Blacks or Whites. The increasing number of Hispanics in the United States with end-stage renal disease emphasizes the importance of explicit health evaluations and prevention strategies for Hispanic populations.     

Changes in the AIDS epidemiologic situation in Puerto Rico following health care reform and the introduction of HAART.

OBJECTIVES: To compare the occurrence of AIDS as well as the sociodemographic and clinical profiles of AIDS patients in Puerto Rico before and after the introduction of highly active antiretroviral therapy (HAART) and the privatization of the island's public health care system. METHODS: We compared the incident AIDS cases for two three-year periods, 1992-1994 and 1998-2000, in four populations: (1) entire United States, (2) Puerto Rico, (3) Bayamón Health Region (located in north-central Puerto Rico, it includes 11 of the island's 78 municipalities), and (4) an HIV cohort enrolled at the Universidad Central del Caribe (UCC) School of Medicine. The UCC is located in Bayamón, Puerto Rico, within an academic medical complex that houses the teaching hospital (Ramón Ruíz Arnaú University Hospital), the ambulatory health care facilities (Immunology Clinics) for patients with HIV, and administrative buildings. This represents the major government-sponsored health care infrastructure within the Bayamón Health Region. RESULTS: Incident AIDS declined substantially between the two periods in each of the four populations studied. The 48.1% decline in Puerto Rico exceeded the 40.9% decline in the United States. The decline in Puerto Rico likely resulted from increased availability and implementation of HAART and the delivery of health care to HIV/AIDS patients in an integrated fashion within each regional ambulatory clinic. In spite of this improvement, the absolute number of patients with AIDS on the island remains high. Substantial resources for treatment and prevention are required. The proportion of new AIDS cases was lower among women, persons 40 years of age or older, the less educated, and those living alone. Injection drug use remains the predominant mode of transmission in Puerto Rico. CONCLUSIONS: Further gains in Puerto Rico's fight against AIDS will depend on the island's ability to reduce the transmission that occurs through injection drug use; the use of HAART on a larger number of vulnerable patients, particularly intravenous drug users; educational interventions to improve medication compliance in certain risk groups; and specific measures aimed at decreasing the rate of injection drug use.     

HIV/AIDS among Hispanics--United States, 2001-2005

In the United States, Hispanics are affected disproportionately by human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Although Hispanics accounted for 14.4% of the U.S. population in 2005, they accounted for 18.9% of persons who received an AIDS diagnosis. The rate of HIV diagnosis among Hispanics also remains disproportionately high; in 2005, the annual rate of HIV diagnosis for Hispanics was three times that for non-Hispanic whites. To better characterize HIV infection and AIDS among Hispanics in the United States, CDC analyzed selected characteristics of Hispanics in whom HIV infection was diagnosed during 2001-2005 and those living with AIDS in 2005. The results indicated that the mode of HIV infection for Hispanics varied by place of birth, suggesting that all HIV-prevention measures might not be equally effective among Hispanics and that HIV educational activities should address cultural and behavioral differences among Hispanic subgroups.     

The shape of the HIV/AIDS epidemic in Puerto Rico.

This study presents information on AIDS patients in Puerto Rico, including their general sociodemographic profile, some risk-related parameters, characteristics of vulnerable groups, and elements of the clinical spectrum of the disease. Data were analyzed from the Puerto Rico AIDS Surveillance Program and available studies about the HIV/AIDS epidemic in Puerto Rico. A total of 23,089 AIDS cases was reported to the Puerto Rico AIDS Surveillance Program from January 1981 through February 1999. The HIV/AIDS epidemic has affected mostly males and females between the ages of 30 and 49, though cases have also been reported for other age groups. The cumulative proportion of persons with AIDS who are women has increased tremendously, from 11.4% for the 1981-1986 period to 21.6% for the entire 1981-1999 period. In Puerto Rico the category of injecting drug users (IDUs) accounts for the majority of the AIDS cases (52%), followed by heterosexual contact (22%), and men who have sex with men (17%). The three main diagnoses for AIDS on the island are wasting syndrome (30.7%); esophageal, bronchial, and lung candidiasis (29.4%); and Pneumocystis carinii pneumonia (26.8%). According to 1994 vital statistics for Puerto Rico, AIDS was the fourth-leading cause of death. The overall reported AIDS mortality rate was 42.0 per 100,000 persons, with the rate for males, 67.8, much higher than it was for females, 17.4. AIDS is the first cause of death among persons between 30 and 39 years old. Intense efforts are needed to better understand the epidemic in Puerto Rico and its biology, social and family impacts, and financial costs.     

Prevalence of neural tube defects and folic acid knowledge and consumption--Puerto Rico, 1996-2006

Birth defects are one of the leading causes of infant mortality in both the mainland United States and Puerto Rico. Neural tube defects (NTDs) are serious birth defects of the spine and brain; two of the most common NTDs are spina bifida and anencephaly. In the United States, NTD prevalence is higher among Hispanic women than among non-Hispanic white or non-Hispanic black women. In Puerto Rico, where most residents are Hispanic, the prevalence of NTDs (8.68 per 10,000 live births) is higher than in the mainland United States (5.59). Consumption of folic acid before and during early pregnancy can prevent NTDs. To assess trends in NTD prevalence and prevalence of knowledge and consumption of folic acid supplements in Puerto Rico, data were analyzed from the Birth Defects Surveillance System (BDSS) for 1996-2005 and the Behavioral Risk Factor Surveillance System (BRFSS) for 1997-2006. This report describes the results of those analyses, which indicated that prevalence of folic acid knowledge and consumption among women of childbearing age increased from 1997 to 2003 but decreased from 2003 to 2006. During similar periods, NTD prevalence declined from 1996 to 2003 but did not change significantly from 2003 to 2005. To resume the decline in prevalence of NTDs, additional measures might be needed to increase folic acid supplement use among Puerto Rican women of childbearing age.     

Hypertension-related mortality among Hispanic subpopulations--United States, 1995-2002

Hypertension remains a major public health problem in the United States even though effective therapy has been available for more than 50 years. Hypertension is a strong independent risk factor for heart disease and stroke and a predictor of premature death and disability from cardiovascular complications. Although age-adjusted prevalence of hypertension is lower among Hispanics than among blacks or non-Hispanic whites, recent data indicate that certain Hispanic subpopulations (Mexican Americans, Puerto Rican Americans, Cuban Americans, and other Hispanic Americans) are characterized by low levels of hypertension awareness, treatment, and control. Because Hispanics are the fastest growing and youngest racial/ethnic population in the United States, targeted strategies to reduce morbidity and mortality rates among this population are essential. Since 1995, information on Hispanic ethnicity has been provided on nearly all death certificates issued in the United States. Although data on Hispanic subpopulations are also available on death certificates, no national mortality statistics on hypertension-related deaths among specific Hispanic subpopulations have been published. To compare age-standardized, hypertension-related death rates among Hispanic subpopulations, CDC analyzed death certificate data from 1995 and 2002. This report describes the results of that analysis, which indicated that Puerto Rican Americans had consistently higher hypertension-related mortality (HRM) rates than all other Hispanic subpopulations and non-Hispanic whites. Comprehensive hypertension prevention and control programs are needed to target these Hispanic subpopulations.     

Development of sex-specific equations for estimating stature of frail elderly Hispanics living in the northeastern United States

BACKGROUND: The accurate measurement of stature is not possible in many frail elderly persons because of problems affecting their ability to stand straight. In such cases, knee height may be used to estimate stature. OBJECTIVE: This study was designed to explore the applicability of published regression equations to estimate stature of Puerto Rican and other Hispanic elderly persons living in the northeastern United States and to formulate ethnicity-specific equations for these persons. DESIGN: The study subjects (60-92 y of age) included 569 Hispanics and a comparison group of 153 non-Hispanic whites. Equations to estimate stature of Hispanics and Puerto Ricans living in the northeastern United States were developed with regression models in a randomly selected subgroup of the Hispanics. These equations were tested with the remaining Hispanic subgroup. RESULTS: The published equations significantly overestimated stature of our Hispanic subjects. Equations developed for Massachusetts Hispanics and Puerto Ricans provided estimates of stature that did not differ significantly from measured stature. We found further that equations for non-Hispanic whites published in 1985 predicted statures of our relatively low-income, non-Hispanic white subjects better than did newer 1998 equations developed from a national sample. CONCLUSIONS: The stature of elderly Hispanics from the northeastern United States can be estimated by using equations derived from the same population. These, or similar equations, should be used to estimate stature of frail elderly persons for whom standing height cannot be taken accurately. Socioeconomic status as well as ethnicity may affect results when knee height equations are used.     

Population-based case-control study of diabetes and breast cancer risk in Hispanic and non-Hispanic White women living in US southwestern states

Diabetes mellitus has been associated with breast cancer, although no studies appear to have adequately assessed the association in Hispanic women, a population with a high prevalence of diabetes. The authors investigated this association in a population-based case-control study of Hispanic and non-Hispanic White women living in the southwestern United States. Breast cancer cases diagnosed in 1999-2004 were identified through state cancer registries (1,526 non-Hispanic Whites, 798 Hispanics). Age- and ethnicity-matched controls (1,599 non-Hispanic Whites, 924 Hispanics) were selected from commercial mailing lists and driver's license and Social Security records. Diabetes history was assessed through interviewer-administered questionnaires. Odds ratios and 95% confidence intervals were calculated using logistic regression, adjusting for age, body mass index at age 15 years, and parity. Having any type of diabetes was not associated with breast cancer overall (odds ratio = 0.94, 95% confidence interval: 0.78, 1.12). Type 2 diabetes was observed among 19% of Hispanics and 9% of non-Hispanic Whites but was not associated with breast cancer in either group. Gestational diabetes was inversely associated with breast cancer in both ethnic groups, especially when first diagnosed at age < or =35 years (odds ratio = 0.54, 95% confidence interval: 0.37, 0.79). In this study, diabetes was not associated with breast cancer overall, although the inverse association with gestational diabetes warrants further investigation.     

Sudden cardiac death in Hispanic Americans and African Americans.

OBJECTIVES: The goal of this study was to estimate rates of sudden cardiac death in US Hispanics and African Americans. METHODS: Data on coronary deaths occurring outside of the hospital or in emergency rooms were examined for 1992. RESULTS: In 1992, 53% (8194) of coronary heart disease deaths among Hispanic Americans 25 years of age and older occurred outside of the hospital or in emergency rooms. The percentage was lower among Hispanics than among non-Hispanic Whites and Blacks. Age-adjusted rates per 100,000 were lower in Hispanics than in non-Hispanic Whites or Blacks (Hispanic men, 75; White men, 166; Black men, 209; Hispanic women, 35; White women, 74; Black women, 108). The percentages dying outside of the hospital or in emergency rooms were higher in young persons, those living in nonurban areas, and those who were single. CONCLUSIONS: The percentage and rate of coronary deaths occurring outside of the hospital or in emergency rooms were lower in Hispanics than in non-Hispanics; African Americans had the highest rates. Further research is needed on sudden coronary death in Hispanic Americans and African Americans.     

Hip fracture incidence among elderly Hispanics.

OBJECTIVES: This study estimated hip fracture incidence for elderly Hispanics in the United States. METHODS: A cohort of Spanish-surnamed 1992 Medicare enrollees was followed for 2 years. Hip fractures were identified by inpatient diagnostic code. RESULTS: For Hispanic women, the national age-adjusted hip fracture rate was 7.3 per 1000 person-years; for men, the rate was 3.3. Rates varied markedly, with higher rates for the predominantly Mexican-American southwestern states than for Puerto Ricans. CONCLUSIONS: Nationally, the Hispanic population is at intermediate risk of hip fracture between Blacks and Whites, but geographic variation suggests that Mexican Americans are at higher risk than Puerto Ricans.     

Prevalence of doctor-diagnosed arthritis and arthritis-attributable effects among Hispanic adults, by Hispanic subgroup--United States, 2002, 2003, 2006, and 2009

Arthritis affects approximately 50 million adults in the United States, making it one of the most prevalent health conditions among U.S. adults and the most common cause of disability. Arthritis is associated with substantial activity limitation, work disability, increased prevalence of obesity, reduced quality of life, and high health-care costs. Among U.S. adults, the prevalence of arthritis and arthritis-attributable effects (e.g., arthritis-attributable activity limitations [AAAL]) varies among racial/ethnic groups; non-Hispanic whites and non-Hispanic blacks have a higher prevalence of doctor- diagnosed arthritis compared with Hispanics, but Hispanics and non-Hispanic blacks have a higher prevalence of arthritis-attributable effects compared with non-Hispanic whites. The prevalence of arthritis and its effects among specific Hispanic subgroups has not been studied in a nationally representative sample of U.S. adults. To determine the annualized prevalence of arthritis and arthritis-attributable effects among Hispanic subgroups, CDC analyzed National Health Interview Survey (NHIS) data for 2002, 2003, 2006, and 2009 combined. This report describes the results of that analysis, which indicated that the age-adjusted prevalence of arthritis ranged from 11.7% among Cubans/Cuban Americans to 21.8% among Puerto Ricans; an estimated 3.1 million Hispanics had arthritis during these years. Among all subgroups of Hispanics with arthritis, at least 20% of persons with arthritis reported an arthritis-attributable effect: AAAL (range: 21.1% among Cubans/Cuban Americans to 48.5% among Puerto Ricans); arthritis-attributable work limitations (AAWL) (range: 32.9% among Central/South Americans to 41.6% among Mexican Americans); and severe joint pain (SJP) (range: 23.7% among Cubans/Cuban Americans to 44.1% among Puerto Ricans). These findings identify Hispanic subgroups with high burdens of arthritis who likely are in need of interventions designed to improve their quality of life.     

Hispanic Men in the United States: Acculturation and Recent Sexual Behaviors With Female Partners, 2006–2010

Objectives. We examined Hispanic men’s recent risky and protective sexual behaviors with female partners by acculturation.Methods. Using the 2006–2010 National Survey of Family Growth, we performed bivariate analyses to compare acculturation groups (Hispanic Spanish-speaking immigrants, Hispanic English-speaking immigrants, Hispanic US natives, and non-Hispanic White men) by demographics and recent sexual behaviors with women. Multivariable logistic regression models for sexual behaviors by acculturation group were adjusted for demographics.Results. Compared with Hispanic Spanish-speaking immigrants, non-Hispanic White men were less likely to report exchange of money or drugs for sex (adjusted odds ratio [AOR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9), but were also less likely to report condom use at last vaginal (AOR = 0.6; 95% CI = 0.4, 0.8) and anal sex (AOR = 0.4; 95% CI = 0.3, 0.7). Hispanic US natives were less likely to report condom use at last vaginal sex than were Spanish-speaking immigrants (AOR = 0.6; 95% CI = 0.4, 0.8). English- and Spanish-speaking immigrants did not differ in risky or protective sexual behaviors.Conclusions. Our findings suggest that targeted interventions focusing on unique sexual risks and sociodemographic differences by acculturation level, particularly nativity, may be helpful for preventing sexually transmitted infections.In the United States, Hispanics are one of the subpopulations disproportionately affected by sexually transmitted infections (STIs).1 In 2010, reported cases of chlamydia were 2.7 times higher for Hispanics than for non-Hispanic Whites.1 Similarly, primary and secondary syphilis cases were 2.2 times higher for Hispanics than for non-Hispanic Whites, an increase of 9.5% since 2009.1 Reported gonorrhea rates were also 2.2 times higher for Hispanics than for non-Hispanic Whites. Regarding gender, the racial/ethnic disparity in gonorrhea rates was higher for men (48.7 per 100 000 for Hispanics vs 19.5 per 100 000 for non-Hispanic Whites) than for women (51.1 per 100 000 for Hispanics vs 26.6 per 100 000 for non-Hispanic Whites).1 Among young adult men (18–26 years), STI disparities were even greater; among Hispanic men, the prevalence of chlamydia and gonorrhea was 5.3 and 4.1 times higher than for non-Hispanic White men, respectively.2Research has shown that Hispanics face many unique challenges that increase their risks for STIs, including immigration-related challenges, living apart from their spouse or regular partner, language barriers, racism, social isolation, and limited access to health care.1,3–5 Compared with non-Hispanic Whites, Hispanics often also have higher poverty, unemployment, and high school dropout rates, and are younger.1,4,6 From 2000 to 2010, the Hispanic population in the United States increased by more than 15.2 million (an increase of 43%), contributing to half of the total population growth in the country.7 Because of the growing Hispanic population, the disproportionate burden of STIs, and the numerous barriers and challenges increasing their risk for STIs, an assessment of the sexual behaviors of Hispanics, including risk and protective behaviors, are of public health importance.An epidemiological concept known as the Hispanic paradox posits that health outcomes for Hispanics tend to be more similar to those of non-Hispanic Whites than those of non-Hispanic Blacks because of less acculturation, or “Americanization,” among Hispanics, which has been shown to be associated with lower sexual risk behaviors and better health outcomes.8–10 Some research suggests that the Hispanic paradox is variable and fluid or may not exist at all.11,12 Although many studies have examined the relationship between acculturation and sexual risk behaviors that are related to STI transmission, most of this research has focused on Hispanic women, adolescents, or men who have sex with men.13–22 Fewer studies have examined differences among Hispanic men in their sexual behaviors with female partners in terms of acculturation group. One study found that low-income, recent-immigrant Hispanic men (living in the United States less than 5 years) were more likely to commercially exchange sexual services and less likely to have a main sex partner than established immigrants (living in the United States for more than 5 years).23 Conversely, established Hispanic immigrant men were more likely to report unprotected sexual intercourse and multiple sex partners than recent immigrants.23 For protective behaviors, condom use at last sex did not significantly differ by acculturation among Hispanic men, although condom use is positively associated with acculturation for women.18,24,25 All of these studies were restricted to specific local areas.Acculturation of Hispanics has been measured in many ways—the use of a single variable, a combination of variables, or scales developed to capture the various aspects of acculturation. Complex measures of acculturation include attitudinal and behavioral factors focused on cultural values.10 More intricate scales of acculturation include heritage and mainstream scales with measures of attitude, behavior, and social relations.10,26 However, it is difficult to include comprehensive measures of acculturation in national surveys that have limited space and competing interests. Measures such as language, country of origin, nativity, and length of time in the country are considered proxy measures of acculturation.11,13,19,27–29 The most frequently used variable to measure acculturation is language of interview (English or Spanish) or the language spoken at home.3,13,14,17,19,21,22,24,27–33 Although acculturation is a multifaceted concept, research suggests that language preference may be a reliable proxy for more complex acculturation measures of Hispanics living in the United States.17For an examination of differences in Hispanic men’s sexual behaviors with female partners by level of acculturation, a national-level examination is useful given the diversity of the Hispanic population in the United States, where origin (Mexican, Puerto Rican, Cuban, Central American, etc.) differs by geography.34 Using data from a national survey, we analyzed the recent sexual behaviors of acculturation groups of Hispanic men (categorized by language of interview and nativity) and compared them with those of non-Hispanic White men. Specifically, we sought to examine differences in recent risky and protective sexual behaviors with female partners among acculturation groups using the 2006–2010 National Survey of Family Growth (NSFG).