Beneficial hispanic stroke mortality: An exploration of potential explanatory factors

Stroke mortality rates are reported to be lower for Hispanics than non-Hispanic Whites. This project investigates factors that contribute to this lower rate in three ways: 1) examine the role of immigrant status in stroke incidence and mortality, 2) investigate the impact of cause of death ambiguity, and 3) examine the role of misreport of ethnicity on death certificates. \r\nIn examining the effect of immigrant status I used the Hispanic Established Populations for the Epidemiologic Study of the Elderly (EPESE) and the East Boston EPESE. This research compares baseline health characteristics of immigrants with native-born respondents. Additionally, I examine differences in stroke mortality, as well as the risk of stroke between waves. In both EPESE samples significant differences in demographics and co-morbidities existed at baseline between immigrants and the US born. However, the odds of stroke mortality or having a stroke during follow-up were not significantly different for immigrants and the US born in either the East Boston or Hispanic data. \r\n To examine the impact of cause of death coding and misreport of ethnicity on death certificates, I 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. These data were linked to census estimates and 5% census samples for the corresponding time periods, allowing for estimates of the foreign born population. Adjustment for nativity and death certificate misclassification removed 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 stroke than Whites (RR 1.27 and 1.27 respectively), but lower rates of mortality from Ischemic (RR 0.85 and 0.79 respectively) and chronic effects of stroke (RR 0.95 and 0.79 respectively). \r\n These results suggest that health benefits immigrants receive do not continue in older age with regards to stroke. Additionally, after adjustment for misclassification, the lower stroke mortality advantage for Hispanic men disappears, while an advantage still remains for Hispanic women. Part of the previously reported advantage is a combination of imprecise measurement and data quality.\r\n

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Grantor

The University of Texas Medical Branch

Year dc:date.issued

2009

Author dc:creator

• Bret Howrey

Advisor dc:contributor.advisor

• James S. Goodwin

Committee members dc:contributor.committeemember

• Mukaila Raji
• Ken Ottenbacher
• Karl Eschbach
• Jean Freeman
• David Espino
• Daniel Freeman

• stroke
• mortality
• hispanic
• health immigrant

Statement dc:rights

• Copyright © is held by the author. Presentation of this material on the TDL web site by The University of Texas Medical Branch at Galveston was made possible under a limited license grant from the author who has retained all copyrights in the works.

Language dc:language.iso

eng

Dc Identifier Other

etd-06302009-143305

OAI identifier oai:identifier

oai:utmb-ir.tdl.org:2152.3/136