title: Disaggregation of Cause-Specific Cardiovascular Disease Mortality Among Hispanic Subgroups.
abstract: Hispanics are the largest minority group in the United States and face a disproportionate burden of risk factors for cardiovascular disease (CVD) and low socioeconomic position. However, Hispanics paradoxically experience lower all-cause mortality rates compared with their non-Hispanic white (NHW) counterparts. This phenomenon has been largely observed in Mexicans, and whether this holds true for other Hispanic subgroups or whether these favorable trends persist over time remains unknown.
  
  
  
  To disaggregate a decade of national CVD mortality data for the 3 largest US Hispanic subgroups.
  
  
  
  Deaths from CVD for the 3 largest US Hispanic subgroups-Mexicans, Puerto Ricans, and Cubans-compared with NHWs were extracted from the US National Center for Health Statistics mortality records using the underlying cause of death based on coding from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (I00-II69). Mortality data were evaluated from January 1, 2003, to December 31, 2012. Population estimates were calculated using linear interpolation from the 2000 and 2010 US Census reports. Data were analyzed from November 2015 to July 2016.
  
  
  
  Mortality due to CVD.
  
  
  
  Participants included 688 074 Mexican, 163 335 Puerto Rican, 130 397 Cuban, and 19 357 160 NHW individuals (49.0% men and 51.0% women; mean [SD] age, 75 [15] years). At the time of CVD death, Mexicans (age, 67 [18] years) and Puerto Ricans (age, 68 [17] years) were younger compared with NHWs (age, 76 [15] years). Mortality rates due to CVD decreased from a mean of 414.2 per 100 000 in 2003 to 303.3 per 100 000 in 2012. Estimated decreases in mortality rate for CVD from 2003 to 2012 ranged from 85 per 100 000 for all Hispanic women to 144 per 100 000 for Cuban men, but rate differences between groups vary substantially, with Puerto Ricans exhibiting similar mortality patterns to NHWs, and Mexicans experiencing lower mortality. Puerto Ricans experienced higher mortality rates for ischemic and hypertensive heart disease compared with other subgroups, whereas Mexicans experienced higher rates of cerebrovascular disease deaths.
  
  
  
  Significant differences in CVD mortality rates and changes over time were found among the 3 largest Hispanic subgroups in the United States. Findings suggest that the current aggregate classification of Hispanics masks heterogeneity in CVD mortality reporting, leading to an incomplete understanding of health risks and outcomes in this population.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Fatima
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
authors.forename: Katherine G
authors.initials: KG
authors.lastname: Hastings
authors.affiliation: Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.
authors.forename: Derek B
authors.initials: DB
authors.lastname: Boothroyd
authors.affiliation: Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, New York.
authors.forename: Sandra
authors.initials: S
authors.lastname: Echeverria
authors.affiliation: Department of Medicine, University of California, San Francisco, School of Medicine.
authors.forename: Lenny
authors.initials: L
authors.lastname: Lopez
authors.affiliation: Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Cullen
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
authors.forename: Latha P
authors.initials: LP
authors.lastname: Palaniappan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology