The rapid growth in the Hispanic population, and especially in the number of Hispanic youth, repr... more The rapid growth in the Hispanic population, and especially in the number of Hispanic youth, represents one of the most dramatic and important demographic trends affecting the U.S. Contemporary working-age Hispanic adults will age to become the first sizable wave of Hispanic seniors. More consequential, the large number of contemporary Hispanic children and adolescents will age to swell the ranks of Hispanic young and middle-aged adults within a decade or two. The health status and health behaviors of today’s Hispanic youth will play a central role in shaping the long-term health and health care needs not only of Hispanics in the U.S. but of all Americans. Yet efforts to provide a detailed and comprehensive description of the health and health behaviors of Hispanics are complicated by a variety of factors. Hispanics living in the U.S. represent an increasing diversity of national origin groups, and health status differs across national origin groups. Relatively new groups, such as Dominicans, Salvadorans, Guatemalans, and Colombians, have grown rapidly, adding their numbers to well-established populations of Mexican, Puerto Rican, and Cuban origin. Additionally, the health of U.S. Hispanics differs by generational status. On numerous dimensions, foreign-born Hispanics – i.e., immigrants to the U.S. – have better health indicators than their U.S.-born counterparts. Among the foreign-born, moreover, health status and health behaviors may differ by degree of acculturation to U.S. culture. In this context, the gaps in the available data on the health and health behavior of Hispanics impose serious limitations. One frequent and noteworthy problem is the lack of detailed data for subgroups of Hispanics defined by national origin and generation in the U.S. Most studies group Hispanics into a single category or focus on Hispanics of Mexican origin, who are by far the most numerous. Another problem is the relative lack of detailed epidemiologic data on the incidence and prevalence of common and important diseases, such as cardiovascular disease. Moreover, for many conditions data are unavailable to assess incidence or prevalence according to immigrant status or, among the foreign-born, by length of residence in the U.S. and degree of acculturation. Despite these limitations, researchers have learned a great deal about the health status and health behaviors of Hispanics over the last 25 years. The story that has emerged is a complex one, with some findings that warrant optimism and others that merit serious concern. The picture of both advantage and disadvantage that has surfaced must be appreciated and understood in order to develop interventions and design policies to improve Hispanic health. In this chapter, we provide an overview of the health status and health behaviors of Hispanics in the U.S. The chapter is divided into several sections: First we discuss mortality rates among Hispanics, compare them with rates for non-Hispanic whites and non-Hispanic blacks, and illustrate the variation in mortality across Hispanic national origin groups. The next three sections cover the health status and health behaviors of Hispanic adults, the health status and health behaviors of Hispanic children and adolescents, and birth outcomes. The fifth section discusses the so-called “epidemiological paradox,” one of the most fascinating findings regarding the health of Hispanics and a source of controversy since it was first described. Finally, we conclude with a summary of our findings and what they mean for the health and health care needs of future generations of Hispanics in the U.S.
Epidemiologic studies have reported differences in the use of cardiovascular procedures according... more Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. The physicians' mean (+/-SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1+/-19.3 percent, vs. 69.2+/-18.2 percent for men; P<0.001), younger patients (63.8+/-19.5 percent for patients who were 55 years old, vs. 69.5+/-17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3+/-19.0 percent, vs. 64.4+/-18.3 percent for patients with possible angina and 77.1+/-14.0 percent for those with definite angina; P=0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race-sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.
The rapid growth in the Hispanic population, and especially in the number of Hispanic youth, repr... more The rapid growth in the Hispanic population, and especially in the number of Hispanic youth, represents one of the most dramatic and important demographic trends affecting the U.S. Contemporary working-age Hispanic adults will age to become the first sizable wave of Hispanic seniors. More consequential, the large number of contemporary Hispanic children and adolescents will age to swell the ranks of Hispanic young and middle-aged adults within a decade or two. The health status and health behaviors of today’s Hispanic youth will play a central role in shaping the long-term health and health care needs not only of Hispanics in the U.S. but of all Americans. Yet efforts to provide a detailed and comprehensive description of the health and health behaviors of Hispanics are complicated by a variety of factors. Hispanics living in the U.S. represent an increasing diversity of national origin groups, and health status differs across national origin groups. Relatively new groups, such as Dominicans, Salvadorans, Guatemalans, and Colombians, have grown rapidly, adding their numbers to well-established populations of Mexican, Puerto Rican, and Cuban origin. Additionally, the health of U.S. Hispanics differs by generational status. On numerous dimensions, foreign-born Hispanics – i.e., immigrants to the U.S. – have better health indicators than their U.S.-born counterparts. Among the foreign-born, moreover, health status and health behaviors may differ by degree of acculturation to U.S. culture. In this context, the gaps in the available data on the health and health behavior of Hispanics impose serious limitations. One frequent and noteworthy problem is the lack of detailed data for subgroups of Hispanics defined by national origin and generation in the U.S. Most studies group Hispanics into a single category or focus on Hispanics of Mexican origin, who are by far the most numerous. Another problem is the relative lack of detailed epidemiologic data on the incidence and prevalence of common and important diseases, such as cardiovascular disease. Moreover, for many conditions data are unavailable to assess incidence or prevalence according to immigrant status or, among the foreign-born, by length of residence in the U.S. and degree of acculturation. Despite these limitations, researchers have learned a great deal about the health status and health behaviors of Hispanics over the last 25 years. The story that has emerged is a complex one, with some findings that warrant optimism and others that merit serious concern. The picture of both advantage and disadvantage that has surfaced must be appreciated and understood in order to develop interventions and design policies to improve Hispanic health. In this chapter, we provide an overview of the health status and health behaviors of Hispanics in the U.S. The chapter is divided into several sections: First we discuss mortality rates among Hispanics, compare them with rates for non-Hispanic whites and non-Hispanic blacks, and illustrate the variation in mortality across Hispanic national origin groups. The next three sections cover the health status and health behaviors of Hispanic adults, the health status and health behaviors of Hispanic children and adolescents, and birth outcomes. The fifth section discusses the so-called “epidemiological paradox,” one of the most fascinating findings regarding the health of Hispanics and a source of controversy since it was first described. Finally, we conclude with a summary of our findings and what they mean for the health and health care needs of future generations of Hispanics in the U.S.
Epidemiologic studies have reported differences in the use of cardiovascular procedures according... more Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. The physicians' mean (+/-SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1+/-19.3 percent, vs. 69.2+/-18.2 percent for men; P<0.001), younger patients (63.8+/-19.5 percent for patients who were 55 years old, vs. 69.5+/-17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3+/-19.0 percent, vs. 64.4+/-18.3 percent for patients with possible angina and 77.1+/-14.0 percent for those with definite angina; P=0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race-sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.
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Papers by Jose Escarce