Module 3

Module III

HEART DISEASE

Heart disease mortality rates for Hispanic males and females compared with non-Hispanic whites and Blacks are shown in Table 1. Known risk factors for heart disease mortality include smoking, cholesterol level, and hypertension.

Table 1. Death rates for Diseases of the heart, by race and Hispanic origin, 1988-19901

	Hispanic	White	Black
Males	505.0	758.4	1,002.6
Females	286.5	392.9	618.2

1Rates are age-adjusted to the 1940 U.S. population.
Source: Table 31. National Center for Health Statistics. Healthy people 2000 review. Health, United States. 1992: Hyattsville, Maryland: Public Health Service, 1992.

Assignment:

Based on the mortality data in Table 1, write a brief statement about the levels of these risk factors you would expect to find in Hispanic groups compared with other groups.

The most recent survey of the health of the U.S. population, known as NHANES III, was begun in 1988 and all data collection was completed in 1994. However, the survey was designed to be carried out in two waves, one from 1988-1991, and the second from 1991-1994, so that preliminary estimates of health parameters could be calculated. Unlike previous national health surveys, NHANES III was designed to provide estimates for certain Hispanic subgroups. An analysis of cholesterol levels and hypertension prevalence in non-Hispanic Whites, Blacks and Mexican-Americans using data from the 1976-1980 National Health and Nutrition Examination Survey (NHANES II), the 1982-1984 Hispanic Health and Nutrition Examination Survey (HHANES) and the 1988-1991 NHANES I II has recently been published. Table 2. Prevalence of hypercholesterolemia and hypertension by race and Mexican-American origin.1

Mexican-
American2 White3 Black3
76-80 88-91 76-80 88-91 76-80 88-91

Elevated Cholesterol Level
Males 18.8% 20.3% 24.6% 19.3% 24.1% 16.5%

Females 20.0% 19.4% 28.0% 20.3% 24.9% 20.7%

Hypertension

Males 25.0% 26.9% 43.5% 25.1% 48.7% 37.4%

Females 21.8% 20.8% 32.3% 19.0% 47.5% 31.3%

		Mexican- American2	White3	Black3
	76-80	88-91	76-80	88-91	76-80	88-91
Elevated Cholesterol Level
Males	18.8%	20.3%	24.6%	19.3%	24.1%	16.5%
Females	20.0%	19.4%	28.0%	20.3%	24.9%	20.7%
Hypertension
Males	25.0%	26.9%	43.5%	25.1%	48.7%	37.4%
Females	21.8%	20.8%	32.3%	19.0%	47.5%	31.3%

1High serum cholesterol is defined as greater than or equal to 240 mg/dL; hypertension is defined by either having elevated blood pressure (systolic pressure of at least 140 mmHg or diastolic pressure of at least 90 mmHg) or taking antihypertensive med ication.
2Data for Mexican-Americans are for 1982-84.
3The race groups, white and black, include persons of both Hispanic and non-Hispanic origin. Conversely, persons of Hispanic origin may be of any race.

Source: Tables 78-79. National Center for Health Statistics. Healthy people 2000 review. Health, United States. 1993: Hyattsville, Maryland: Public Health Service, 1994.

Assignment:

Review the prevalence of elevated serum cholesterol and hypertension shown in Table 2, and answer the following questions:
1) What is the overall trend in the prevalence of these two risk factors from one examination period to another?
2) In which age/sex/ethnic group have the levels of these two risk factors declined the most? In which group have they declined the least?
3) Do the levels of hypercholesterolemia and hypertension reflected in Table 2 seem consistent with the mortality rates presented in Table 1?

Smoking is a major risk factor for heart disease. Information on tobacco use was collected in 1992 as part of the Behavioral Risk Factor Surveillance System survey. This is an annual telephone survey carried out by participating state health departments and coordinated by the Centers for Disease Control and Prevention to monitor trends in health behaviors and conditions.

Table 3 contains the proportions of persons surveyed in 1992 who reported being current smokers and who had never smoked by ethnicity and sex.

Table 3. Self-reported smoking status in the 1992 Behavioral Risk Factor Survey, by Sex and Ethnicity1

Hispanic White Black

Current Smoker

Males 23% 23% 25%

Females 15% 22% 20%

Never Smoked

Males 54% 45% 54%

Females 70% 54% 66%

1Unweighted frequencies calculated by V. Pavlik, Dept of Community Medicine, Baylor College of Medicine

Assignment:

Review Table 3 and answer the following questions:
1) Which group has the lowest prevalence of current smoking?
2) Which group is most likely to have never smoked?
3) How does the smoking status of Hispanic males compare with that of males in the other two ethnic groups?
4) Do you believe that tobacco use among Hispanics could account for some portion of the difference in their heart disease mortality?