title: Health disparities between island and mainland Puerto Ricans.
abstract: OBJECTIVE
  To detect health disparities among three populations--Puerto Ricans living in Puerto Rico as well as Puerto Ricans and non-Hispanic whites living on the United States (U.S.) mainland.
  
  
  METHODS
  Data from two similarly designed surveys conducted in 1999-2000 were analyzed. The Behavioral Risk Factor Surveillance System (BRFSS) provided data on Puerto Ricans living on the island and on non-Hispanic whites in the U.S. Another survey of Puerto Ricans living in New York City provided data on mainland Puerto Ricans. The age- and sex-standardized weighted prevalences of various health parameters (e.g., obesity, diabetes, smoking, and physical illness) and indicators of access to health care (e.g., frequencies of routine checkups and diabetes care) were compared between populations by means of standardized rate ratios (SRR).
  
  
  RESULTS
  Puerto Ricans living on the mainland and those living on the island had a similar prevalence of obesity (21% to 22%). Compared with islanders, mainland Puerto Ricans had a higher prevalence of diabetes (SRR = 1.4; 95% confidence interval [95% CI] = 1.01 to 2.0); those with diabetes also showed higher prevalences of smoking (SRR = 4.2; 95% CI = 2.3 to 7.7) and physical illness (SRR = 1.5; 95% CI = 1.1 to 2.0) than Puerto Ricans living on the island. While mainland Puerto Ricans were similar to non-Hispanic whites in terms of their utilization of primary prevention and diabetes care, island Puerto Ricans trailed behind significantly.
  
  
  CONCLUSIONS
  Puerto Ricans living on the U.S. mainland and those living in Puerto Rico both need to target lowering their prevalence of obesity and diabetes. For island Puerto Ricans, improved education about the significance of primary prevention and diabetes care is needed. For mainland Puerto Ricans, the accessibility of the primary health care system renders it a potentially effective venue for interventions, particularly for smoking cessation. More studies are warranted to identify factors associated with the poor health status observed in mainland Puerto Ricans.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, United States of America. ho@aecom.yu.edu
authors.forename: Gloria Y F
authors.initials: GY
authors.lastname: Ho
authors.forename: Hong
authors.initials: H
authors.lastname: Qian
authors.forename: Mimi Y
authors.initials: MY
authors.lastname: Kim
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Melnik
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Tucker
authors.forename: Ivonne Z
authors.initials: IZ
authors.lastname: Jimenez-Velazquez
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Lee-Rey
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Stein
authors.forename: Winna
authors.initials: W
authors.lastname: Rivera
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rohan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D002391:Catchment Area, Health; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011647:Puerto Rico / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology