Lower stroke mortality among Hispanics: an exploration of potential methodological confounders.
OBJECTIVE
Stroke mortality rates are reported to be lower for Hispanics than non-Hispanic Whites. We investigate the degree to which this lower reported mortality is explained by inaccuracies introduced through omission of nativity, imprecise measurement of cause of death, and under-ascertainment of Hispanic ethnicity on death certificates. We used national vital registration data for the years 1989-1991 and 1999-2002, including foreign- and US-born Hispanics and non-Hispanic Whites. Hispanic deaths were adjusted for misclassification of ethnicity on the death certificate. Denominators for the rates were derived from census estimates.


RESULTS
Adjustment for nativity and death certificate misclassification removes the stroke mortality advantage for US-born Hispanic men, but not women. After adjustment, US-born Hispanic men and women have higher rates of mortality from subarachnoid hemorrhage than non-Hispanic Whites (RR: 1.23 and 1.23, respectively), but lower rates of mortality from Ischemic (RR: 0.76 and 0.73, respectively) and chronic effects of stroke (RR: 0.87 and 0.73, respectively).


CONCLUSIONS
When adjusted for misclassification the lower stroke mortality remains for Hispanic men and women at older ages. Part of the previously reported advantage is a combination of imprecise measurement and data quality.
Howrey
Bret
B
University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0460, USA. bthowrey@utmb.edu
Goodwin
James S
JS
Eschbach
Karl
K
Freeman
Jean
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002545:Brain Ischemia / Q000208:ethnology / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000208:ethnology / Q000401:mortality; D015986:Confounding Factors, Epidemiologic; D003644:Death Certificates; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D017678:Sex Distribution; D020521:Stroke / Q000145:classification / Q000208:ethnology* / Q000401:mortality*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
Int J Epidemiol. 2006 Aug;35(4):903-19
16709619
Soc Biol. 1997 Fall-Winter;44(3-4):227-46
9446963
Am J Epidemiol. 2001 Dec 1;154(11):1057-63
11724723
Am J Public Health. 2006 Dec;96(12):2209-15
17077407
MMWR Morb Mortal Wkly Rep. 2005 May 20;54(19):477-81
15902069
Vital Health Stat 2. 1969 May;(34):1-47
5306137
Ethn Dis. 2003 Winter;13(1):126-33
12723021
JAMA. 1993 Nov 24;270(20):2464-8
8031341
West J Med. 1998 Sep;169(3):139-45
9771151
MMWR Morb Mortal Wkly Rep. 2002 May 24;51(20):429-33
12056498
Demography. 2004 Aug;41(3):385-415
15461007
JAMA. 2006 May 3;295(17):2037-45
16670412
MMWR Morb Mortal Wkly Rep. 2005 Jan 14;54(1):7-9
15647724
MMWR Morb Mortal Wkly Rep. 2006 May 19;55(19):529-32
16708056
Stroke. 1994 Nov;25(11):2120-5
7974531
Soc Sci Q. 2000;81(1):459-76
17879490
Epidemiology. 1992 Mar;3(2):181-4
1576225
Circulation. 2000 Dec 19;102(25):3137-47
11120707
Am J Public Health. 2007 Jul;97(7):1297-304
17538049
Public Health Rep. 2002 Jan-Feb;117(1):37-43
12297680
Am J Epidemiol. 2007 Mar 1;165(5):591-6
17158473
Demography. 1986 Feb;23(1):87-90
3956809
Public Health Rep. 1986 May-Jun;101(3):253-65
3086917
Vital Health Stat 2. 1999 Sep;(128):1-13
10611854
Demography. 2000 May;37(2):175-86
10836175
Ethn Dis. 2001 Autumn;11(3):496-518
11572416
Vital Health Stat 2. 2008 Oct;(148):1-23
19024798
Am J Public Health. 2001 Mar;91(3):392-9
11236403
MMWR Morb Mortal Wkly Rep. 2000 Feb 11;49(5):94-7
10718093
Hum Biol. 2002 Feb;74(1):83-109
11931581
Stroke. 1999 Aug;30(8):1501-5
10436090
Stroke. 2002 Jan;33(1):268-73
11779921
Am J Public Health. 2006 Sep;96(9):1686-92
16380579
Demography. 1994 Aug;31(3):427-58
7828765