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Published on October 1, 2007

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Growing Hispanic Population: Health Status and Policy Implications:  Growing Hispanic Population: Health Status and Policy Implications Kyriakos S. Markides Percent of Non-Hispanic Whites 65 and over in United States Population, 1980 to 2050:  Percent of Non-Hispanic Whites 65 and over in United States Population, 1980 to 2050 1980 1995 2050 80% 74% 67% Year Percent Non-Hispanic Whites Source: U.S. Bureau of the Census (1993) Proportions of Hispanic Elderly (65+) by Type of Hispanic Origin (1993):  Proportions of Hispanic Elderly (65+) by Type of Hispanic Origin (1993) Mexican Cuban Puerto Rican Other Hispanic 49% 15% 12% 24% Type of Hispanic Origin Percent Source: U.S. Bureau of the Census (1993) Projections of U.S. resident population by Age, Sex, Race and Hispanic Origin: 1999, 2025, 2050 (in thousands):  Projections of U.S. resident population by Age, Sex, Race and Hispanic Origin: 1999, 2025, 2050 (in thousands) Non- Hispanic White African American Asian/ Pacific Islander Hispanic Origin 1999 All Ages 31,356 196,079 33,107 2,024 10,253 65+ 1,845 28,999 2,702 147 779 2025 All Ages 61,433 209,340 43,528 2,668 20,846 65+ 6,105 47,260 6,268 338 2,670 2050 All Ages 98,229 212,991 53,466 3,241 35,760 65+ 13,442 52,684 9,997 530 5,366 Native American Age-Adjusted Death Rates by Sex, Race, Ethnicity, 1995-97 (per 100,000):  Age-Adjusted Death Rates by Sex, Race, Ethnicity, 1995-97 (per 100,000) All Causes Diseases of the Heart Cerebro- vascular Diseases Malignant Neoplasms Hispanic Male 477.6 117.4 22.4 94.2 Female 268.4 65.7 17.4 66.1 Non-Hispanic White Male 590.1 176.1 26.0 151.4 Female 363.8 93.4 22.9 109.5 African American Male 964.3 244.7 50.5 221.1 Female 559.0 152.4 38.9 159.2 Age-Adjusted Death Rates by Sex, Race, Ethnicity, 1995-97 (continued):  Age-Adjusted Death Rates by Sex, Race, Ethnicity, 1995-97 (continued) All Causes Diseases of the Heart Cerebro- vascular Diseases Malignant Neoplasms Native American Male 573.4 135.0 21.6 97.4 Female 365.1 75.3 20.1 74.0 Asian/Pacific Islander Male 361.7 99.4 28.6 94.3 Female 219.3 52.2 21.5 64.7 Health Status Indicators of Hispanic Elderly:  Health Status Indicators of Hispanic Elderly High Life Expectancy Diabetes (Mexican Americans, Puerto Ricans) Obesity Disability (Mexican Americans, Puerto Ricans) Low Rates of Institutionalization Low Medicare Coverage (especially among recent immigrants) Hispanic Mortality Patterns:  Hispanic Mortality Patterns Of the three major Hispanic Groups, Puerto Ricans appear to have the highest age-adjusted mortality rates and CUBAN AMERICANS the lowest Hispanic advantage holds for both genders and for all Hispanic subgroups Hispanic advantage also present at 65+ Hispanics have low mortality from major cancers, such as LUNG, COLON, BREAST and PROSTATE Hispanics have higher mortality from STOMACH, LIVER, GALLBLADDER, and CERVICAL cancers (continued on next slide) Hispanic Mortality Patterns (continued):  Hispanic Mortality Patterns (continued) High death rates from DIABETES in Mexican Americans and Puerto Ricans High death rates from LIVER DISEASE/CIRRHOSIS Puerto Ricans have higher total mortality rates in New York City than in Puerto Rico or elsewhere, primarily because of higher HOMICIDE and CIRRHOSIS of the liver Mexican Americans have higher mortality from ACCIDENTS, but lower suicide rates than Puerto Ricans and Cuban Americans An Epidemiologic Paradox:  An Epidemiologic Paradox Hispanics (except Cuban Americans) are socioeconomically disadvantaged, but have favorable overall mortality Risk factor profiles High rates of DIABETES. High rates of obesity. Similar rates of hypertension, cholesterol. High SMOKING rates among men, lower among women (fewer cigarettes). Cuban American males smoke the most. High ALCOHOL (binge) drinking rates among men, low among women. Alcohol consumption in women increases with acculturation . Low rates of physical ACTIVITY. Strong families. Migration selection. Other Health Status Indicators in old age in Hispanics:  Other Health Status Indicators in old age in Hispanics Functional limitations -- High in Mexican Americans and Puerto Ricans Self-assessed health -- Poorer in Mexican Americans and Puerto Ricans Mental Health -- High rates of DEPRESSION in Mexican Americans. Alzheimer’s disease? Institutionalization -- Low rates, more disabled Hispanic Elderly do not underutilize PHYSICIAN services, possibly because of Medicare A LONGITUDINAL STUDY OF THE HEALTH OF MEXICAN AMERICAN ELDERLY 1992-2003 FUNDED BY NIA:  A LONGITUDINAL STUDY OF THE HEALTH OF MEXICAN AMERICAN ELDERLY 1992-2003 FUNDED BY NIA UNIVERSITY OF TEXAS MEDICAL BRANCH, GALVESTON, TX PI, Kyriakos S. Markides,Ph.D. CO-INVESTIGATORS: David Chiriboga, Ph.D. James S. Goodwin, MD. Sandra A. Black, Ph.D. Christine Stroup-Benham, Ph.D. Laura Rudkin, Ph.D. Jean Freeman, Ph.D. Shiva Satish, M.D. Todd Q. Miller, Ph.D. Daniel H. Freeman, Jr., Ph.D -Biostatistician. Laura A. Ray, M.P.A. -Project Director NIA STAFF: Sidney Stahl, Ph.D. Manuel Miranda, Ph.D. FIELD STAFF: Louis Harris and Associates, Inc. Investigators - continued:  Investigators - continued UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER, SAN ANTONIO, TX PI, David V. Espino, M.D. CO-INVESTIGATORS: Michael J. Lichtenstein, M.D. Toni Miles, M.D., Ph.D. UNIVERSITY OF TEXAS, AUSTIN, TX PI, Ronald J. Angel, Ph.D. CO-INVESTIGATOR: Jacqueline Angel, Ph.D. A LONGITUDINAL STUDY of MEXICAN AMERICAN ELDERLY HEALTH:  A LONGITUDINAL STUDY of MEXICAN AMERICAN ELDERLY HEALTH To estimate the prevalence of key physical and mental health conditions and functional impairments in older Mexican Americans and compare this prevalence with that in other populations for whom data exist SPECIFIC AIMS: Specific Aims - continued:  Specific Aims - continued To investigate predictors of physical and mental health conditions and functional status at baseline. Predictors will include: Formal and informal supports Psychological resources Sociodemographic factors Health behaviors Migration history Acculturation Stressful life circumstances Access to and use of health services Specific Aims - continued:  Specific Aims - continued To investigate predictors of mortality over two years To study changes in health and functioning among survivors To examine changes in health behaviors and key social mediators of health status, including social networks and supports and various key transitions such as widowhood and changes in living arrangements, including institutionalization SAMPLING PROCEDURES:  SAMPLING PROCEDURES Area probability multi-stage sample of Mexican Americans aged 65 and over residing in the five Southwestern states (Texas, New Mexico, Colorado, Arizona, and California) (Non-institutionalized population). Data collected during 1993-1994. N = 3,050 SELECTED SAMPLE CHARACTERISTICS N=3,050:  SELECTED SAMPLE CHARACTERISTICS N=3,050 AGE RANGE 65-99 MEAN 73.0 yrs. GENDER MALE 43.3% FEMALE 56.7% MARITAL STATUS MARRIED 55.3% DIV/SEP 7.9% WIDOWED 31.6% NEVER MARRIED 5.3% Continued on next slide YEARS of SCHOOL MEAN 5.1 yrs. PLACE OF BIRTH MEXICO 46.8% U.S.A. 53.2% LIVING ARRANGEMENTS ALONE 20.9% 2 PERSONS 41.0% 3 PERSONS 15.3% 4+ PERSONS 22.8% SELECTED SAMPLE CHARACTERISTICS :  SELECTED SAMPLE CHARACTERISTICS SPEAKS ENGLISH NOT AT ALL 30.1% NOT TOO WELL 27.0% PRETTY WELL 17.0% VERY WELL 24.6% SOURCES OF INCOME SOCIAL SECURITY 96.1% PRIVATE PENSION 17.1% SSI 25.4% CHILDREN 7.0% RENT/STOCKS/ BONDS, ETC. 4.4% CONTINUED HOUSEHOLD INCOME $0- 4,999 13.2% $5,000- 9,999 37.7% $10,000-14,999 25.8% $15,000-19,999 11.7% $20,000-29,999 6.2% $30,000 + 5.4% HEALTH INSURANCE MEDICARE 87.4% MEDICAID 34.1% PRIVATE 23.5% PERCENT REPORTING SELECTED CHRONIC CONDITIONS :  PERCENT REPORTING SELECTED CHRONIC CONDITIONS MEXICAN AMERICANS GURALNIK (1989)* HYPERTENSION ARTHRITIS DIABETES HEART DISEASE STROKE CANCER HIP FRACTURE 65+ 41.2 39.9 22.7 19.8 6.2 5.3 3.4 41.8 49.0 9.5 14.0 5.4 6.6 NOT AVAILABLE *NHIS Supplement on Aging, 1984 (60 yrs. +) 60+ PERCENT REPORTING SELECTED CHRONIC CONDITIONS by AGE and GENDER:  PERCENT REPORTING SELECTED CHRONIC CONDITIONS by AGE and GENDER MALES 65-74 75 + (n= 863) (n= 431) 34.5 31.4 28.4 28.2 25.0 17.6 19.2 22.9 5.9 6.7 4.4 6.7 1.6 3.5 HYPERTENSION ARTHRITIS DIABETES HEART DISEASE STROKE CANCER HIP FRACTURE Slide22:  FEMALES 65-74 75 + (n=1139) (n= 615) 45.6 49.3 47.3 50.5 24.6 19.5 21.9 23.2 3.5 9.8 4.7 6.7 2.4 7.5 HYPERTENSION ARTHRITIS DIABETES HEART DISEASE STROKE CANCER HIP FRACTURE PERCENT REPORTING SELECTED CHRONIC CONDITIONS by AGE and GENDER continued Percent of Persons 65 and Over Who Report Difficulty Performing Selected Activities of Daily Living by Ethnicity:  Percent of Persons 65 and Over Who Report Difficulty Performing Selected Activities of Daily Living by Ethnicity Whites (n=24,753) Non-Whites (n=2,784) Mexican Americans (n=3,050) Note: Data on Whites and Non-Whites are from the 1986 National Health Survey (NCHS, 1993). Data on Mexican Americans are from the 1993-94 Hispanic EPESE. Slide24:  Percent of Persons 65 and Over Who Report Difficulty Performing Selected Activities of Daily Living by Ethnicity Whites (n=24,753) Non-Whites (n=2,784) Mexican Americans (n=3,050) Note: Data on Whites and Non-Whites are from the 1986 National Health Survey (NCHS, 1993). Data on Mexican Americans are from the 1993-94 Hispanic EPESE. Mean CES-D Scores and Prevalence of High Depressive Symptoms^, for Sociodemographic Characteristics (weighted):  Mean CES-D Scores and Prevalence of High Depressive Symptoms^, for Sociodemographic Characteristics (weighted) N Mean Score (SE) Prevalence(%) All CES-D Respondents 2823 10.54 (.191) 25.6 Gender: Females 1647 12.21 (.263) 31.9 Males 1176 8.30 (.258) 17.3*** Age Groups: 65-74 1895 10.12 (.233) 24.4 75-84 764 11.24 (.353) 28.1 85 + 164 12.16 (.896) 28.6* * p<.10; ** p<.01; *** p<.001 ^ Based on a total CES-D score of 16 or greater Changes in Blood Pressure and Risk Factors for Cardiovascular Disease among Older Mexican Americans from 1982-1984 to 1993-1994 :  Changes in Blood Pressure and Risk Factors for Cardiovascular Disease among Older Mexican Americans from 1982-1984 to 1993-1994 Results: Among 65-74 year old Mexican Americans, there were decreases over time (1982-84), HHANES to (1993-94), HEPESE in the percent who smoked cigarettes from 27.6% to 13.98% and in mean systolic blood pressure level. The percent of subjects categorized as obese or severely obese increased, as did the prevalence of diagnosed diabetes, increasing from 20.06% in 1982-84 to 29.81% in 1993-94. Mean diastolic blood pressure increased from 77.15 mmHg in 1982-84 to 81.21 mmHg in 1993-94. C. A. Stroup-Benham, K. S. Markides, D. V. Espino & J. S. Goodwin Factors Influencing Unawareness of Hypertension Among Older Mexican Americans S.Satish, K.S. Markides, D. Zhang & J.S. Goodwin:  Factors Influencing Unawareness of Hypertension Among Older Mexican Americans S.Satish, K.S. Markides, D. Zhang & J.S. Goodwin Results: Thirty-seven percent of hypertensives were unaware of their diagnosis. Unaware hypertensives had significantly higher blood pressures than did aware hypertensives. In multivariate analyses, factors associated with unawareness included male gender (O.R.>=1.8), being married (O.R.=1.6), poor memory (O.R.=1.6), having Medicaid (O.R.=1.6), having less than 2 visits to a doctor in the past year (O.R.=.2.8), having a history of heart disease (O.R.=0.57), or stroke (O.R.=0.37), and poor self-reported health (O.R.=.43). Depressive symptoms and Mortality in Older Mexican Americans Black, S.A. and Markides, K.S.:  Depressive symptoms and Mortality in Older Mexican Americans Black, S.A. and Markides, K.S. Results: Multivariate analyses indicated a synergistic effect for comorbid diabetes and depressive symptoms such that the odds of having died among diabetics with high levels of depressive symtpoms (OR=4.03, 95%CI=2.67-6.11) were three times that of diabetics without high levels of depressive symptoms. Conclusions: High Levels of depressive symptoms concomitant with major chronic medical conditions elevate the risk for death among older Mexican Americans. Given the fact that depression is often unrecognized and undertreated in the elderly, awareness of the potential for loss of life as well as the potential for treatment may help to improve this situation not only for older Mexican Americans, but for older adults in general. Lower Body Functioning as a Predictor of Subsequent Disability among Older Mexican Americans Ostir, G.V., Markides, K.S., Black, S.A. and Goodwin, J.S.:  Lower Body Functioning as a Predictor of Subsequent Disability among Older Mexican Americans Ostir, G.V., Markides, K.S., Black, S.A. and Goodwin, J.S. Results: Performance on 8-foot walk, repeated chair stands, and standing balance among non-disabled subjects at baseline were significantly associated with the onset of ADL and lower body disability two years later, controlling for age, gender, and the presence of medical conditions. The results were significant for each performance measure and for a measure combining all three. Conclusions: This study offers further evidence that performance-based measures of lower body function are able to predict future disability in Mexican American elderly as has been found with other elderly populations. These measures were able to detect changes over a relatively short period of time (2 years). In addition, the study found that the short walk (8-foot walk) was the most sensitive measure in predicting future disability. Depressive Symptomatology and Low Positive Well-Being Predict the Onset of Functional Disability in Older Mexican Americans: Results from the Hispanic EPESE Glenn Ostir, Kyriakos S. Markides, Sandra A. Black, and James S. Goodwin:  Depressive Symptomatology and Low Positive Well-Being Predict the Onset of Functional Disability in Older Mexican Americans: Results from the Hispanic EPESE Glenn Ostir, Kyriakos S. Markides, Sandra A. Black, and James S. Goodwin Scores on the Center for Epidemiologic Studies Depression (CES-D) Scale were linearly associated with the probability of becoming disabled in Activities of Daily Living (ADL’s) two years later among initially nondisabled persons controlling for age, gender, presence of medical conditions and socioeconomic factors. Furthermore, scores on a four-item positive well-being scale were associated with a lower probability of becoming ADL-disabled. The same two variables were similarly associated with the development of lower body difficulties two years later. Slide31:  Stressors/Transitions Major Life Events (e.g. widowhood) Financial Strain etc. Stage I Stage II Stage III Stage IV Sociodemographic Variables Age, Gender, Social Class, Acculturation, Migration History Social Support Medical Conditions Cognitive Status Functional Status Depression Mortality Institutionalization Changes in Living Arrangements Figure 1. Conceptual Model

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