Regional and Hispanic Subgroup Disparities in the Prevalence of Diabetes & Hypertension Among Older Adults Catherine Pérez Jennifer A. Ailshire Conference Series on Aging in the Americas September 21, 2017
Population and Projections of Hispanics Aged 65+ 20.0 18.0 16.0 Population (in millions) 14.0 12.0 10.0 17.5 8.0 13.2 6.0 4.0 8.6 2.0 5.0 2.9 0.7 1.1 1.8 0.0 1980 1990 2000 2010 2020 2030 2040 2050 Source: Administration for Community Living, 2010
Diabetes and Hypertension in U.S. Adults 65+ 80.0 70.0 77.9 Prevalence (%) 60.0 50.0 40.0 30.0 61.7 60.2 34.7 35.0 20.0 10.0 19.8 0.0 Hispanics Blacks Whites Hispanics Blacks Whites Hypertension Diabetes Source: Behavioral Risk Factor Surveillance System, 2015
U.S. Census Regions Northeast Midwest South West
Where do Hispanics live in the U.S.? Larger Concentration of Puerto Ricans and Dominicans in the Northeast Larger Concentration of Central/South Americans Larger Concentration of Cubans Larger Concentration of Mexicans in Southwest Source: American Community Survey, 2015
Where do Mexicans live in the U.S.? Source: American Community Survey, 2015
Where do Puerto Ricans live in the U.S.? Source: American Community Survey, 2015
Where do Dominicans live in the U.S.? Source: American Community Survey, 2015
Where do Cubans live in the U.S.? Source: American Community Survey, 2015
Where do Central Americans live in the U.S.? Source: American Community Survey, 2015
Where do South Americans live in the U.S.? Source: American Community Survey, 2015
Sociocultural Groups & Ethnoraciality Groups which share economic, social, cultural, geographic, and/or religious characteristics. Maintenance of group boundaries. Formation of group identification based on (self/other) perceived similarities among members of a group. Basis for mobilization/exploitation of interests.
Research Questions Do Hispanic-White differentials in diabetes & hypertension reported at the national level vary by region and country of origin? Can individual-level factors account for regional differences in Hispanic subgroup disparities?
Data National Health Interview Survey, 2000-2015 Design Conducted by the National Center for Health Statistics Annual household interview survey Nationally-representative Community-dwelling Analytic Sample Hispanic and Non-Hispanic Whites aged 50 and older Mexicans (n=30,725) Puerto Ricans (n=5,480) Cubans (n=4,828) Dominicans (n=1,757) Central/South Americans (n=7,936) Whites (n=288,397)
Measures Diabetes Hypertension Glycosylated hemoglobin (HbA1c) 6.5% Blood pressure reading 140/90 mmhg Self-Reported Taking Medications Self-Reported Taking Medications
Analytic Strategy Logistic regression of diabetes & hypertension to obtain predicted probabilities Prevalence adjusted by age and sex Prevalence further adjusted for socioeconomic (education, poverty, insurance), cultural (language, nativity), and health characteristics (smoking, obesity) Analyses weighted to account for complex survey design and to represent the U.S. population Analyses performed using Stata v.14
Diabetes Prevalence by Race/Ethnicity for Age 50+ Hispanics 9.5% Whites 5.9% p<.001 Hispanics 11.7% Whites 7.7% p<.001 Hispanics 11.7% Whites 6.1% p<.001 Hispanics 9.7% Whites 7.4% p<.001 U.S. = 7.2% Hispanics = 10.1% Whites = 6.9%
Diabetes Prevalence by Region and Hispanic Subgroup Prevalence of Diabetes (%) 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 5.6 13.1 12.3 10.7 16.9 14.5 12.6 11.3 14.0 8.3 7.2 7.4 12.4 14.3 10.4 2.7 7.8 10.4 7.5 6.8 7.7 7.4 6.0 5.8 2.0 0.0 Note: p<.05 Mexicans Puerto Ricans Cubans Dominicans Central/South Americans Northeast Midwest South West Whites U.S. = 7.2% Hispanics = 10.1% Whites = 6.9%
Diabetes Prevalence by Region and Hispanic Subgroup Prevalence of Diabetes (%) 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 Mexican Puerto Rican Cuban Dominican Central/South American Northeast Midwest South West White
Hypertension Prevalence by Race/Ethnicity for Age 50+ Hispanics 18.2% Whites 22.1% p<.001 Hispanics 20.6% Whites 25.2% p<.001 Hispanics 24.2% Whites 22.6% p<.05 Hispanics 20.1% Whites 24.9% p<.001 U.S. = 23.5% Hispanics = 20.0% Whites = 24.0%
Hypertension Prevalence by Region and Hispanic Subgroup Prevalence of Hypertension (%) 35.0 30.0 25.0 20.0 15.0 10.0 5.0 22.9 22.2 19.9 31.0 27.7 26.3 26.4 24.5 24.4 21.0 21.5 30.5 16.4 11.6 27.6 20.9 19.6 19.3 17.7 16.2 25.124.8 22.2 22.0 0.0 Note: p<.05 Mexicans Puerto Ricans Cubans Dominicans Central/South Americans Northeast Midwest South West Whites U.S. = 23.5% Hispanics = 20.0% Whites = 24.0%
Adjusted Hypertension Prevalence by Region and Hispanic Subgroup Prevalence of Hypertension (%) 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 M1 M2 Mexican Puerto Rican Cuban Dominican Central/South American Northeast Midwest South West White
Conclusions Evidence of regional variation in Hispanic origin subgroup-white disparities in diabetes & hypertension. Certain Hispanic subgroups appear relatively worse off compared to Whites in national and regional estimates. Accounting for individual-level factors did not account for regional disparities across Hispanic subgroups, but estimates were attenuated.
Future Work
Implications Recognizing the various social processes that underlie Hispanic subpopulations is important if researchers are to implement social and health policies aimed at ameliorating the risks and negative health outcomes among disadvantaged groups.
Funding National Institute on Aging Multidisciplinary Training Grant award in Gerontology T32AG0037 T32AG0037/AG/NIA NIH HHS/United States
Corresponding Author Contact Information: Catherine Pérez-García perezcat@usc.edu