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Chartbook on Health of by Roberto E. Torres, Ph.D. Michigan State University
Research Report No. 3 October 1990
About the Author: Roberto E. Torres Dr. Roberto E. Torres is currently a post doctoral Fellow at the Julian Samora Research Institute at Michigan State University. Dr. Torres holds a Ph.D. in Socio-Technological Planning with a specialization in health care planning. His publications include "Health Status Assessment of Latinos in the Midwest," Working Paper #5, Julian Samora Research Institute, July, 1990.
SUGGESTED CITATION Torres, Roberto E., (Ph.D.) Chartbook on Health of Latinos in the Midwest, JSRI Research Report #3, The Julian Samora Research Institute, Michigan State University, East Lansing, Michigan, 1990.
According to the U.S. Bureau of the Census (1985), the Latino population will be the largest minority group in the United States by the end of the century. If the current rate of growth continues, these numbers will increase from 15.4 million to an estimated 39.4 million by the year 2000. Therefore, the growing presence of Latino individuals in the economic, political, and social life of the U.S. makes their current health status an issue of major consideration to American society (De la Rosa, 1989). There exists very little information on the health status of Latinos in the U.S. Midwest region. The need to have knowledge on the health problems of Latinos in the Midwest acquires importance if we just consider that in 1980 a million Latinos resided in five midwestern states, that is, Illinois, Indiana, Michigan, Ohio and Wisconsin. Latino health statistics for this region are not only scarce, but also highly dispersed among a variety of different sources such as article journals, state health departments and unpublished documents. It is the intention of this Chartbook to present them in an organized fashion and in graphic form for easier interpretation. At the same time, the Chartbook can be used as a data resource for individuals interested in utilizing Midwest Latino health statistics. The Julian Samora Research Institute is committed to the generation, transmission, and application of knowledge to serve the needs of Latino communities in the Midwest. To this end, it has organized a number of publication initiatives to facilitate the timely dissemination of current research and information relevant to Latinos. The Julian Samora Research Institute Research Report Series (RR) publishes monograph length reports of original empirical research on Latinos in the nation conducted by the Institute's faculty affiliates and research associates, and/or projects funded by grants to the Institute. Table of Contents
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References There is a critical lack of health status data relating to Latinos, specially in the Midwest region. The limited nature of the data to be presented in this report does not allow drawing definitive conclusions about the Latino health status in the Midwest. Information is uneven and incomplete. However, these statistics provide clues as to the magnitude and nature of the health problems suffered by Latinos in this region. The Latino statistics presented in this report were obtained from studies published in scientific journals, statistical reports prepared by state health departments, reports prepared by Spanish Speaking Affairs Commissions and unpublished data from government agencies. It should be highlighted that the Shai and Rosenwaike study (1987) was an exceptionally important data source in the preparation of this report, since it is one of the few studies analyzing the mortality patterns of Mexicans and Puerto Ricans in a Midwest urban setting (in this case, in metropolitan Chicago, the largest Latino concentration in the region). However, several limitations should be made explicit. For example, statistics from the Shai and Rosenwaike study (1987) refer only to the population 15-74 year old. It should be also noted that statistics from this study as well as from the Mallin and Anderson study (1988) refer to first-generation Puerto Rican and Mexican-Born individuals in Chicago and Illinois respectively, which excludes Puerto Rican and Mexicans born and raised in the U.S. If more detailed information is necessary, readers should consult cited sources on the concepts and methodologies used. Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References
Cirrhosis
Cancer
Heart Disease/Cerebrovascular Conditions
Diabetes
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References
Maternal Mortality
Pregnancy/Delivery-Related Complications and Concurrent Illnesses
Infant and Child Mortality
Prematurity
Low Birth Weight
Prenatal Care
Teenage Pregnancy
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References Acquired Immunodeficiency Syndrome (AIDS)
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References
Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References The following technical terms used in this Chartbook are defined in the following pages to provide a clear understanding of the statistics presented: 1) Mortality Rate (also known as death rate) - an estimate of the proportion of a population that dies during a specific period. The numerator is the number of persons dying during the period;the denominator is the size of the population, usually estimated as the mid-year population. The mortality rate in a population is generally calculated by the formula:
In this report, the term "general mortality" refers to the overall mortality rate of a population (e.g. Latino, Puerto Rican, White Non-Latino, etc.), considering all causes of death of that group. Mortality rates by specific cause such as cirrhosis, cancer, etc. are calculated using the same formula, only that the numerator includes the number deaths assigned to a specific cause during a specified period. This rate is usually expressed by 100,000 inhabitants. 2) Maternal Mortality Rate - the risk of dying from causes associated with childbirths; for this purpose the deaths used in the numerator are those arising during pregnancy or from puerperal causes, i.e., deaths occurring during and/or due to deliveries, complications of pregnancy, childbirth, and the puerperium. Women exposed to the risk of dying from puerperal causes are those who have been pregnant during that period. Their number being unknown, the number of life births is used as the conventional denominator for computing comparable maternal mortality rates. The formula is:
3) Infant Mortality Rate - a measure of the yearly rate of deaths in children less than one year old. The denominator is the number of live births in the same year. The formula is:
4) Cumulative Incidence Rate - the number or proportion of a group of people who experience the onset of a health-related event during a specified time interval;to calculate the figures presented in this Chartbook, the number of AIDS cases in an specific ethnic group (e.g. Latinos, Mexican-Americans, etc.) was divided by the total population of that ethnic group and multiplied by 100,000. 5) Incidence Rate - the rate at which new events occur in a population; the incidence rate most often used in public health practice is calculated by the formula:
6) Latino - refers to U.S. residents of Mexican, Puerto Rican, Cuban, Central or South American origin living in the mainland; residents from Puerto Rico were not included in this definition. 7) Midwest - the region's definition for this report includes Illinois, Indiana, Michigan, Ohio, Wisconsin, Nebraska, Kansas, Minnesota, Missouri, Iowa, and North and South Nebraska. It is also important to note that a number of graphics in this report are expressed in terms of the percentage of the Latino mortality rate that is below or above the White Non-Latino mortality rate in Metropolitan Chicago. These percentages were obtained by utilizing the standardized mortality ratio (SMR) statistic presented in the Shai and Rosenwaike study (1987). Since the SMR is hard to interpret by non-health profession readers, a decision was made to translate the ratio to a percentage-wise format. The SMR is calculated by dividing the mortality rate of the Latino group by the mortality rate for the White Non-Latino group. For example, in Fig. 10, the 29% of Puerto Rican-Born female mortality rate due to diabetes above the White Non-Latino female rate was obtained by dividing the rate for Puerto Rican-born females by the rate for White Non-Latino females. In this case, the SMR is 1.29, which indicates that the Latino rate is 29% higher than the White Non-Latino rate. This percentage was calculated by subtracting 1.29 from 1.0 and multiplying the difference by 100. When interpreting the SMR statistic, any value higher than 1.0 indicates a higher mortality rate for the Latino group compared to the White Non-Latino group. An SMR of 1.0 indicates that both groups have the same mortality rate. Any value less than 1.0 indicates a lower mortality rate for the Latino group in comparison to the White Non-Latino group. For example, according to Fig. 10, the percentage of Puerto Rican-born male mortality due to diabetes in Metropolitan Chicago is 71% below the mortality rate for the White Non-Latino male population. The SMR for this groups was .29 in the Shai and Rosenwaike study. The method to derive the -71% was to subtract .29 from 1.0 and multiplying the difference by 100. Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References Chicago Department of Health (1988). "Fact Sheet on Hispanic Health: Chicago Resident 1986." Chicago: Office of Management Information Systems/Data Processing, May, 1988. De la Rosa, M. (1985). The State of Hispanic Health in Ohio, Commission on Spanish Speaking Affairs, Columbus, Ohio. ________. (1989). "Health Care Needs of Hispanic Americans and the Responsiveness of the Health Care System." Health and Social Work, 14, 104-113. Last, J.M. (1988). A Dictionary of Epidemiology. New York: Oxford University Press, 1988. Mallin, K. and K. Anderson (1988). "Cancer Mortality in Illinois Mexican and Puerto Rican Immigrants, 1979-1984." International Journal of Cancer, 41, 670-676. Michigan Department of Public Health (1988). Minority Health in Michigan: Closing the Gap. Michigan: Michigan Department of Public Health. ________ (1990) Michigan HIV/AIDS Report, Vol. 5, Number 3. Ohio Department of Health (1980). 1980 Vital Statistics Annual Report, Columbus, Ohio: Ohio Department of Health, 1980. Selik, R., K. G. Castro, M. Pappaioanou and J. W. Buehler (1989). "Birthplace and the Risk of AIDS among Hispanics in the United States." American Journal of Public Health, 79, 836-839. Shai, D. and I. Rosenwaike (1987). "Mortality Among Hispanics in Metropolitan Chicago: An Examination Based on Vital Statistics Data." Journal of Chronic Disease, 40, 445-451. The Latino Institute (1987). Tocar el Corazón: Needs Assessment for Project Alivio. Chicago: The Latino Institute. U.S. Bureau of the Census (1980). Persons of Spanish Origin by State: 1980 Census of Population, Supplementary Report (PC-8-0-s1-7). Washington, D. C.: U.S. Government Printing Office. In "Health Care Needs of Hispanic Americans and the Responsiveness of the Health Care System." p. 104 (see De la Rosa,1989). ________. (1985). Persons of Spanish Origin in the United States. Current Population Reports (Series P-20, No. 403). Washington, D.C.: U.S. Government Printing Office. In "Health Care Needs of Hispanic Americans and the Responsiveness of the Health Care System." p. 104 (see De la Rosa,1989). Wisconsin Department of Health and Social Services (1988a). Minority Groups in Wisconsin: Measures of Health. Wisconsin: Division of Health. ________. (1988b). Wisconsin Maternal and Child Health Statistics 1988. Wisconsin: Division of Health. Foreword | Highlights | Data Sources and Limitations | General Mortality | Chronic Diseases | Maternal And Child Health | Drug Abuse | Acquired Immunodeficiency Syndrome (AIDS) | Tuberculosis | Homicide | Appendix: Definitions | References |
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