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pdfData Book
A Report to the Communities
Hispanic Community
Health Study
Study of Latinos
Data Book
A Report to the Communities
NIH Publication No. 13-7951
September 2013
Table of Contents
I. Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
II. Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
III. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Study Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
How To Read This Data Book – A Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Definition of Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Description of Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
IV. Field Center Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Bronx Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Chicago Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Miami Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
San Diego Field Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
V. Description of Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Participants by Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Participants by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Participants by Education and Income levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Participants by Preferred Language Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Participants by Place of Birth and Time Living in the United States . . . . . . . . . . . . . . . . . . . . . 18
VI. Disease Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Coronary Heart Disease and Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Hearing Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
VII. Risk Factors for Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . 28
Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Prediabetes and Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Symptons of Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Anxiety Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Sleep Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Multiple Risk Factors for Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
VIII. Lifestyle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
IX. Awareness, Treatment, and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Awareness, Treatment, and Control of Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Awareness, Treatment, and Control of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
X. Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Health Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Types of Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
XI. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
XII. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4 hchs/sol data book: a report to the communities
I. Preface
We are pleased to present a summary of medical research results of the Hispanic Community Health Study/Study of Latinos
to the communities and participants from the largest health study of Hispanic/Latino populations in the United States. This
study seeks to understand the health issues affecting Hispanic/Latino groups in the United States and includes research on
many diseases and conditions of particular importance to the Hispanic/Latino communities.
The participants in this study have understood the value of research on the causes of health conditions to improve the
lives of Hispanics/Latinos in particular and all Americans in general. They have contributed many hours participating in a
clinical evaluation, responding to many questions about their health status and engaging in other measures after they left
the field center. The success of this study is due to their dedication and contribution of time and effort. The sponsoring
organizations at the National Institutes of Health, the universities and researchers involved in this study, and all who will
benefit from this research thank the participants for their commitment.
This report provides data from the first examination of participants who attended the Hispanic Community Health Study/
Study of Latinos. It highlights health areas that are having a positive impact in these communities and those that need
greater attention to improve lives. All who have made this study possible deserve the Nation’s thanks.
Gary H. Gibbons, M.D.
Director
National Heart, Lung, and Blood Institute
National Institutes of Health
section i: preface 5
II. Acknowledgments
Special appreciation is extended to the participants who contributed their time and effort and to the extraordinary staff
who conducted the study. A list of staff can be seen at http://www.cscc.unc.edu/hchs/
Investigators contributing to this report:
Abreu, Maria de los Angeles, MPA, CCPR
Giachello, Aida, PhD
University of North Carolina at Chapel Hill
Northwestern University
Arredondo, Elva, PhD
González, Sara, PhD
San Diego State University
Albert Einstein College of Medicine
Avilés–Santa, Larissa, MD, MPH
Heiss, Gerardo, MD, PhD
National Heart, Lung, and Blood Institute, NIH
University of North Carolina at Chapel Hill
Barr, R. Graham, MD, DrPH
Isasi, Carmen, MD, PhD
Columbia University
Albert Einstein College of Medicine
Beck, James, PhD
Kaplan, Robert, PhD
University of North Carolina at Chapel Hill
Albert Einstein College of Medicine
Birnbaum–Weitzman, Orit, PhD
Redline, Susan, MD, MPH
University of Miami
The Brigham & Women's Hospital
Buelna, Christina, MA
Rodríguez, Bárbara, MS(c)
San Diego State University
San Diego State University
Cai, Jianwen, PhD
Sanchez, Carlos, MD
University of North Carolina at Chapel Hill
University of Illinois, Chicago
Castañeda, Sheila F., PhD
Schneiderman, Neil, PhD
San Diego State University
University of Miami
Cruickshanks, Karen J., PhD
Siega–Riz, Anna Maria, PhD, RD, LDN
University of Wisconsin
University of North Carolina at Chapel Hill
Daviglus, Martha, L., MD, PhD
Silsbee, Lorraine, MHS
University of Illinois, Chicago; Northwestern University
National Heart, Lung, and Blood Institute, NIH
6 hchs/sol data book: a report to the communities
Smoller, Sylvia, PhD
Talavera, Gregory A., MD, MPH
Albert Einstein College of Medicine
San Diego State University
Sorlie, Paul, PhD
Wilkins, Tania M., MS
National Heart, Lung, and Blood Institute, NIH
University of North Carolina at Chapel Hill
Sotres, Daniela, DrPH
Youngblood, Marston, MA, MPH
University of North Carolina at Chapel Hill
University of North Carolina at Chapel Hill
Talavera, Ana, MPH
San Diego State University
funding acknowledgment
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a collaborative study supported by contracts
from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01–HC65233),
University of Miami (N01–HC65234), Albert Einstein College of Medicine (N01–HC65235), Northwestern University
(N01–HC65236), and San Diego State University (N01–HC65237). The following Institutes/Centers/Offices contributed
to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Deafness and Other Communication
Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney
Diseases, National Institute on Minority Health and Health Disparities, National Institute of Neurological Disorders and
Stroke, NIH Office of Dietary Supplements.
editorial acknowledgment
With thanks to Nancy Eng, NHLBI
section ii: acknowledgments 7
III. Introduction
photo by larissa avilés-santa
study description
The Hispanic Community Health Study/Study of Latinos
(HCHS/SOL), which began in 2006, is a comprehensive
longitudinal multicenter community–based cohort study of
Hispanic/Latino populations in the United States. Between
2008 and 2011, 16,415 U.S. Hispanic/Latino adults were
recruited from a random sample of households in four
communities located in the Bronx, Chicago, Miami, and
San Diego, and they underwent a baseline clinic
examination. Each community had more than 4,000
above: Study recruiter, San Diego
participants from diverse Hispanic/Latino backgrounds
who self–identified as Cuban, Dominican, Puerto Rican,
underwent an extensive clinic examination to determine
Mexican, Central American, or South American and were
baseline cardiovascular prevalence and to identify potential
of diverse socioeconomic groups. They were selected to be
risk and protective factors. The baseline examination was
representative of the target population in each community
administered in English or Spanish based on the participant’s
rather than the entire U.S. population. Study participants
preference. Baseline questionnaires included information
were selected to obtain approximately one–third between
on personal and family health, acculturation (including
18–44 years of age and two–thirds between 45–74 years of
language and cultural food preferences), physical activity,
age (Lavange et al., 2010; Sorlie et al., 2010).
diet, sleep, occupation, and other personal characteristics.
Clinical assessments included hearing, vision, and dental
The goals of the study are to identify risk factors that
exams, and many types of blood tests. Physical activity and
may have a protective or harmful role in the development
sleep were assessed by use of measurement devices that
of cardiovascular disease in Hispanics/Latinos and to
participants took home with them. After the clinic visit,
evaluate the role of acculturation in the prevalence and
participants were followed regularly by telephone calls to
development of risk factors and disease. Study participants
track important health events (Sorlie et al., 2010).
how to read this data book – a guide
This page is a guide on how to understand the numbers
outcomes were calculated for sex, age, and background
and charts included in this book. Questions about health
groups. All percentages and averages are “weighted” to
status were asked of all participants. The percentage of
account for how households and people were sampled
persons who responded that they had a disease, condition,
to be comparable to the 2010 U.S. Census population.
or behavior relevant to this research is presented in charts
All percentages and averages were also age–adjusted so
for different groups by age, sex, background, or community.
that comparisons between sexes and among background
groups could be compared equally. Age–adjustment was
In this Data Book, percentages and averages for health
done because substantial differences exist in age among
8 hchs/sol data book: a report to the communities
backgrounds. For example, Cubans are, on average, older
Participants), where numbers of participants represent
and Mexicans are, on average, younger. The only un–
the actual counts of participants in each group.
weighted estimates appear in Section V (Description of
definition of groups
Age: 18 to 44 years, 45 to 64 years, and 65 to 74 years.
Hispanic/Latino background group: Central American,
Cuban, Dominican, Mexican, Puerto Rican, and South
Sex: men and women.
American.
Community: Bronx, Chicago, Miami, and San Diego.
description of charts
Chart 1: Percent of Participants by Level of Education (Pie Chart Example)
The title describes the chart as the percentage of
participants with different levels of education in
16%
different colors.
33%
These numbers show the percentage of participants
23%
in each education group. For example, in this chart, 33
percent of the participants (orange area) had less than
27%
Less Than
High School
High School Grad
a high school education.
Some College
College Degree
The legend shows different colors for different groups.
In this chart, these colors are levels of education.
Chart 2: Number of Participants by Background – Chicago (Bar Chart Example)
This title describes the chart as the number of
3000
participants by background in Chicago.
2500
2,409
2000
This number shows the number of participants by
1500
background. In Chicago, 2,409 participants were of
Mexican background.
1000
500
0
770
418
Central
American
25
Cuban
374
27
Dominican
Mexican
Puerto
Rican
South
American
The legend shows different groups by age, sex,
background or community. In this chart, the
background groups are shown.
section iii: introduction 9
IV. Field Center
Descriptions
bronx field center
The Bronx Field Center is located in Bronx, New York,
which is one of five boroughs of New York City. New York
City's Hispanic/Latino population grew by 8.1 percent in
the past decade, reaching 2,336,076 in 2010. Hispanics/
Latinos now account for 28.6 percent of the overall New
York City population (New York City Department of City
Planning [NYCDCP], 2011). The Bronx has one of the
highest concentrations of Hispanic/Latino persons in any
U.S. urban area—over half of the 1.4 million residents of
the Bronx are of Hispanic/Latino background (NYCDCP,
2011).
Puerto Ricans are the largest Hispanic/Latino background
group in the Bronx, followed by Dominicans, Mexicans, and
Central and South Americans. While the Bronx Hispanic
population has tended to concentrate in the southern and
western portions of the borough, the greatest population
gains over recent years in the Hispanic/Latino population
were in neighborhoods outside these areas (NYCDCP,
2011).
The Bronx has played an important role in shaping
Hispanic/Latino history in the United States. Sonia
Sotomayor, who in 2009 became the first person of
Hispanic/Latino heritage to serve on the U.S. Supreme
Court, was born and raised in the Bronx. Dr. Helen
Rodriguez–Trias, a public health and human rights activist
who was the first Latina to head the American Public
Health Association, was on the faculty of Albert Einstein
College of Medicine in the Bronx. The Bronx also
top to bottom: Fordham Road; Bronx-Manhattan
popularized both salsa and hip–hop music.
skyline; Fordham Plaza
10 hchs/sol data book: a report to the communities
A Bronx Participant
“I started this program in 2008, I am participating until now, 2013. I believe this
study is very important so that they could find solutions for the sickness of the
Spanish people, and at the same time they can prevent all the sickness such as
diabetes, high blood pressure, obesity, and more. I congratulate the people that
created the program, it's very important. Thank you very much!”
photos by larissa avilés-santa
photos by larissa avilés-santa
chicago field center
left to right: Mural on a private residence; Chicago skyline; East end of Paseo Boricua, Humboldt Park
In 2010, nearly 2.7 million people were living in Chicago
and immigration status. These are vibrant communities
and 29 percent were of Hispanic/Latino background
with high concentrations of businesses (e.g., ethnic food
(U.S. Census Bureau, 2010). Chicago has the third largest
restaurants and bodegas/tiendas de abarrotes), botánicas
concentration of Mexicans/Mexican-Americans in the
(folk medicine pharmacies), and a diversity of other
United States and the second largest concentration of
establishments. Devotion to religious practices and an
Puerto Ricans. Although the vast majority of Hispanics/
emphasis on family ties are prevalent, with individuals
Latinos (74 percent) living in Chicago are Mexicans/
frequently living in an extended family system where
Mexican-Americans, many other ethnic groups, including
many generations (grandparents, parents, and siblings)
individuals from Central and South America and the
live together on different levels of a multi–unit building.
Caribbean (Ready & Brown–Gort, 2005), also reside here.
The Hispanic/Latino communities of Chicago are well
Participants were recruited from six Chicago communities
organized and have a tradition of caring and problem–
(Albany Park, Belmont–Cragin, Hermosa, Humboldt Park,
solving leaders who have established health, human
Irving Park, and Logan Square) located on the north/
services, and educational organizations and community
northwest side of the city. These communities reflect the
coalitions to respond to community needs. In addition, the
diversity of Hispanics/Latinos in terms of socioeconomic
Hispanic/Latino communities in Chicago are rich in
status, national origins and backgrounds, language use,
culture and arts. Ethnic pride and nationalism are
section iv: field center descriptions 11
expressed through public murals at almost every corner of
struggles, or religious beliefs and practices and serve to
the Hispanic/Latino neighborhoods in the city. These
inspire all members of the diverse communities from
murals tell stories of social justice (or injustice), political
which Chicago HCHS/SOL participants were recruited.
A Chicago Participant
“The study is superb and I enjoyed my visit to the clinic.”
photo by larissa avilés-santa
miami field center
clockwise from top left: Mosaic tiles in
Maximo Gomez/Domino Park; City of Hialeah
entrance; Miami Freedom Tower Building
In 2010, more than 2.5 million people were living in Miami–
Dade County, located in southeastern Florida. Within the
county, 51 percent of the residents are foreign born and
64 percent report speaking Spanish at home (U.S. Census
Bureau, 2010). The percent of persons of Hispanic/Latino
background has continued to increase over the past decade
and today accounts for 65 percent of the population (U.S.
Census Bureau, 2010).
Participants in the Miami Field Center were recruited from
of Coral Gables has 47,000 residents with 54 percent
Miami, Hialeah, and Coral Gables. Miami is the largest
Hispanic/Latino (U.S. Census Bureau, 2010). In each of
community with almost 400,000 residents of which 70
these areas, the majority background group is Cuban, with
percent are of Hispanic/Latino background (U.S. Census
the next being Central American. These communities
Bureau, 2010). The city of Hialeah has 225,000 residents
represent a diversity of education and income.
with 95 percent of them Hispanic/Latino, and the city
12 hchs/sol data book: a report to the communities
Miami has played a unique role in the history of
Island” of Florida and stands today as a memory of the
immigration in the United States. In the 1960s, substantial
waves of immigration. The Spanish language is spoken
immigration occurred from Cuba to the Miami area in
by more persons in Miami than in any other U.S. city. Little
three waves and included many persons who were well
Havana, a neighborhood in Miami, once almost exclusively
educated or who had high skill levels. In 1980, another
the residence of Cubans, now has immigrants from other
wave of Cuban immigration occurred followed more
Latin American countries. It is still the center of social,
recently by immigration from Central and South
cultural and political activity for Cubans (Wikipedia,
America. The Freedom Tower in Miami was the “Ellis
Miami).
A Miami Participant
“This is an excellent study because many people need to know
about our health, and this was a good opportunity given to us.”
san diego field center
photo by larissa avilés-santa
clockwise from top left: Third Avenue, Chula Vista; San Diego trolley; Murals in Chicano Park
San Diego is California’s most southern city and is located
of Hispanic/Latino residents than other regions in San
next to the northern border of Mexico. San Diego is the
Diego. San Diego is locally known as “the South Bay”
birthplace of California and home to a rich multicultural
and includes the communities of San Ysidro, Chula Vista,
heritage. The San Diego–Tijuana bordercrossing is the
National City, Imperial Beach, and Bonita.
busiest in the world (Becker & Armendariz, 2012), which
makes it a unique and vibrant bi–national community.
Mexico’s influence on San Diego County is cultural,
According to the 2010 Census, around one–fourth of San
political, spiritual, and economic. Culturally, Mexican
Diegans are Mexican or Mexican American (U.S. Census
influences can be found in local artwork in murals at
Bureau, 2010).
college campuses and Chicano Park. Politically, community
property and water rights were based on Spanish and
Recruitment of the San Diego HCHS/SOL participants
Mexican traditions that considered water a community
focused on communities that have higher concentrations
resource to be divided as the community decided.
section iv: field center descriptions 13
Spiritually, the Mexican religious traditions are evident in
major role in the development and maintenance of San
San Diego churches that celebrate Día de Guadalupe and
Diego’s agricultural economy. The influence of Mexican
La Posada. San Diego is home to the first Church in
culture is undeniable and continues to shape the
California, the Mission Basilica San Diego de Alcala, which
development of San Diego (Kucher, 2010).
was founded in 1769. Economically, Mexican labor plays a
A San Diego Participant
“The program was very good and I feel that what I did will be
very useful for future generations. Thank you very much.”
Field Center Locations
Bronx
Chicago
San Diego
Miami
14 hchs/sol data book: a report to the communities
V. Description of
Participants
participants by background
Background was determined by participants’ self–report of heritage or descent. The very few participants who described
their background as mixed/other or who didn’t describe a specific background are not shown.
Chart 3: Number of Participants by Background – Bronx
In the Bronx Field Center, most
2000
participants are of Puerto Rican
1,837
background, followed by those of
1500
Dominican background.
1,380
1000
500
0
219
45
Central American
Cuban
208
Dominican
Mexican
187
Puerto Rican
South American
Chart 4: Number of Participants by Background – Chicago
In the Chicago Field Center,
3000
most participants are of Mexican
background, followed by those of
2,409
2250
Puerto Rican, Central American and
South American background.
1500
750
770
418
0
Central American
25
27
Cuban
Dominican
374
Mexican
Puerto Rican
South American
section v: description of participants 15
Chart 5: Number of Participants by Background – Miami
In the Miami Field Center,
3000
most participants are of Cuban
background, followed by those
2250
2,269
of Central American and South
American background.
1500
1,034
750
0
Central American
Cuban
468
64
38
82
Dominican
Mexican
Puerto Rican
South American
Chart 6: Number of Participants by Background – San Diego
In the San Diego Field Center, the
4000
vast majority of participants are of
3,817
Mexican background.
3000
2000
1000
0
61
9
2
Central American
Cuban
Dominican
Mexican
39
43
Puerto Rican
South American
Chart 7: Number of Participants by Age and Sex
In the study, 6,701 participants are
6000
in the 18 to 44 age group, 8,382 are
5,203
in the 45 to 64 age group, and 1,332
4500
are in the 65 to 74 age group.
3,801
3000
2,900
3,179
Sixty percent of the participants are
1500
women and 40 percent are men.
501
0
Age 18-44
Age 45-64
Men
831
Age 65–74
Women
16 hchs/sol data book: a report to the communities
participants by education and income levels
Participants reported their highest level of education. Education levels were grouped into four categories: less than high
school, high school graduate, some college, and college degree or more.
Participants reported their annual household income. They were grouped into four categories: $20,000 or less, $20,001
to $50,000, $50,001 or more, and unknown. A small number of participants did not provide information on annual
income and are included in the unknown group.
Chart 8: Percent of Participants by Level of Education
Most participants completed
some high school or graduated
16%
from high school. Sixteen percent
graduated from college with a
33%
degree, and another 23 percent
23%
attended at least some college.
Thirty–three percent have less
27%
Less Than
High School
High School Grad
than a high school education.
Some College
College Degree
Chart 9: Percent of Participants by Yearly Household Income
Forty–two percent of the
participants have a yearly household
10%
12%
income of $20,000 or less.
42%
36%
$20,000
or Less
$20,001–
$50,000
$50,001
or More
Unknown
section v: description of participants 17
participants by preferred language use
At the examination visit, each participant was asked which language he or she preferred to use during the visit.
Chart 10: Percent of Participants by Language Preference
The majority, about 3 of every 4
persons, requested the use of
Spanish instead of English.
24%
76%
Spanish
English
participants by place of birth and time living in the
united states
Participants reported their place of birth. They also reported the number of years they lived in the 50 States or District of
Columbia. Responses were grouped into three categories: less than 10 years, 10 to 19 years, and 20 or more years.
Chart 11: Percent of Participants by Place of Birth
Approximately three–fourths of the
participants were not born in the 50
States or District of Columbia.
21%
In this chart, participants from
79%
Puerto Rico are reported among
those born outside the 50 States or
District of Columbia.
Not Born
in the U.S.
Born
in U.S.
18 hchs/sol data book: a report to the communities
Chart 12: Percent of Participants by Number of Years Living in the United States
Almost half of all participants lived
at least 20 years in the 50 States or
District of Columbia. One-fourth
25%
lived in the United States less than 10
48%
years and approximately one-fourth
lived in the United States 10-19 years.
27%
Less Than
10 Years
10–19
Years
20+
Years
photo by larissa avilés-santa
photo by larissa avilés-santa
clockwise from top left: Dietary interview; Height measurement; Lung function test; Measurement of ankle
blood pressure
section v: description of participants 19
VI. Disease Conditions
coronary heart disease and stroke
Coronary Heart Disease (CHD) is a broad term used to
describe certain conditions that affect the heart. These
conditions produce narrowed or blocked arteries that
lead to a lack of blood flow to the heart muscle which can
lead to damage to the heart. This is called a heart attack
(Mayo Clinic, Heart disease). A stroke occurs when blood
flow to a part of the brain is partially or totally blocked.
This blockage of blood to the brain can lead to brain cell
death, causing permanent damage (Pub Med Health,
Stroke, 2012).
CHD and stroke can be prevented by maintaining
a healthy lifestyle (Mayo Clinic, 5 medication–free
above: This figure shows how the arteries become
strategies to help prevent heart disease). This includes:
• Not smoking
blocked and harm the heart and the brain.
• Exercising on a regular basis
• Eating foods that are low in saturated fats, trans fats,
and sodium; and including vegetables, fruits, whole
grains, lean meats and low–fat dairy products
• Maintaining a healthy weight
• Getting regular health screenings that include
checking blood pressure, cholesterol levels, and
diabetes screening
Coronary
heart
disease
was
determined
by
a
participant’s self–reported responses to questions about
previous heart attacks, coronary bypass surgery, or other
procedures used to clear blocked arteries. The charts
show the percentage of participants with CHD.
20 hchs/sol data book: a report to the communities
Chart 13: Percent with Coronary Heart Disease by Age and Sex
More men than women reported
16
14
having CHD. For all men and
13.6
12
women, CHD increased with age.
The highest percentage with CHD
10
was in men aged 65–74 years.
8
6
6.0
5.9
4
2
1.1
0
3.4
0.8
Age 18-44
Age 45-64
Age 65–74
Women
Men
Chart 14: Percent with Coronary Heart Disease by Background
The highest percentage of self–
6
reported CHD was for participants
5
of Puerto Rican background. The
4.9
4
lowest percentages were among
3
3.2
those of Central American, Mexican,
3.3
2.6
2
1
0
2.1
and South American backgrounds.
1.6
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
Chart 15: Percent with Stroke by Age and Sex
Stroke was determined by a participant’s self–reported history of stroke.
A higher percentage of men than
7
6
women reported a history of stroke.
5.9
For both groups, having a stroke
5
history increased with age. The
4
3
3.2
2.5
2
1
0
highest percentage of stroke was in
men aged 65–74 years.
1.8
0.3
0.8
Age 18-44
Age 45-64
Men
Age 65–74
Women
section vi: disease conditions 21
Chart 16: Percent with Stroke by Background
A higher percentage of participants
5
of Dominican and Puerto Rican
4
backgrounds reported a history
of stroke than those in the other
3
1
0
groups. The lowest percentages were
2.5
2
1.5
Central American
1.4
Cuban
2.3
American and Mexican backgrounds.
1.1
Dominican
Mexican
reported by participants of South
0.9
Puerto Rican
South American
pulmonary disease
Asthma and chronic obstructive pulmonary disease (COPD)
are common lung diseases that cause shortness of breath,
wheeze, cough, and phlegm. These symptoms occur due to
the airways of the lung tightening. Sometimes the airway
tightens enough to cause “attacks” of severe shortness
of breath and wheeze that can require urgent care from a
physician. Asthma usually occurs in children and young
adults and is the leading cause of hospital visits in these
groups. Many children grow out of asthma and asthma is
often a reversible disease. COPD is like asthma but occurs
in older adults, is not reversible, and is the third leading
cause of death in the United States (Murphy et al., 2012).
Both are treated most commonly with inhalers. Asthma was
determined by a participant’s reported medical history of
asthma.
top to bottom: Lung function test; Asthma inhaler
22 hchs/sol data book: a report to the communities
Chart 17: Percent with Asthma by Age and Sex
Asthma was equally common among
40
men and women in the 18 to 44 age
group. Above that age, it was more
30
common in women.
20
15.5
12.1
10
0
20.9
20.0
17.2
Age 18-44
11.0
Age 45-64
Men
Age 65–74
Women
Chart 18: Percent with Asthma by Background
Participants of Puerto Rican, Cuban,
40
and Dominican backgrounds were
35.8
two to five times more likely to
30
report ever having asthma in their
20
lives than were participants of
21.2
Mexican background.
16.0
10
11.6
9.3
7.4
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• If you have asthma, visit your health care provider on a regular basis, take prescribed medications, and avoid known
asthma triggers (NHLBI, Take Action: Stop Asthma Today!, 2010).
section vi: disease conditions 23
Chronic obstructive pulmonary disease (COPD) was determined by a participant’s reported medical history.
Chart 19: Percent with COPD by Age and Sex
COPD increased with age in men
20
and women. Women had more self–
reported COPD than men.
15
12.6
10
10.5
9.5
7.0
5
0
Age 45-64
Ages 65–74
Men
Women
Chart 20: Percent with COPD by Background
The percentage of participants
20
who reported a history of COPD
16.8
15
was highest among those of Puerto
Rican background and lowest
10
5
0
among those of Central American
10.1
6.3
5.0
Central American
and South American backgrounds.
7.2
4.7
Cuban
Dominican
Mexican
Puerto Rican
South American
Major risk factors for COPD include age, smoking (ever) and a prior history of asthma. Additional factors such as occupational
exposures, environmental exposures, access to health care, and differences in diagnosis and reporting could help explain
these results. Additional research using lung function (breathing test) measures will help understand these results.
• If you have COPD or think you may be at risk, you can take steps to make breathing easier and live a longer and
more active life. Get a simple breathing test and talk with your doctor or health care provider about treatment
options (NHLBI, Take the first step to breathing better).
24 hchs/sol data book: a report to the communities
oral health
Participant’s teeth were examined to determine the
presence of dental decay and number of missing teeth.
Decay will weaken the tooth and, if not treated, will get
worse and much of the tooth surface will be destroyed.
The tooth can become very painful, fall out, or need to be
pulled. If the tooth was treated by a dentist, it is called a
filled tooth.
The low percent with unfilled cavities in the older group
was often due to that group having more missing teeth that
photo by larissa avilés-santa
above: Oral health exam
are no longer at risk for decay, but may cause problems in
biting and chewing food.
Chart 21: Percent with at Least One Unfilled Dental Cavity by Age and Sex
50
Younger participants had the
45
most unfilled dental cavities. In
40
35
all age groups, women had a lower
37.7
30
percentage of untreated cavities
32.4
28.7
25
24.2
20
15
than men.
20.8
16.5
10
5
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 22: Percent with at Least One Unfilled Dental Cavity by Background
50
The percent of participants with
45
one or more unfilled cavities was
40
35
30
highest in participants of Central
35.4
25
American background and lowest
33.7
29.8
28.3
20
20.7
15
in participants of Dominican
22.9
background.
10
5
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
section vi: disease conditions 25
Chart 23: Percent with at Least One Missing Tooth by Age and Sex
In the two oldest age groups, about
100
90
three–fourths of participants are
80
79.6
75.1
70
76.7
75.8
missing at least one tooth.
60
50
40
30
41.7
36.3
20
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 24: Percent with at Least One Missing Tooth by Background
90
There are differences in the percent
80
having at least one missing tooth
70
60
63.2
66.3
62.7
50
60.8
65.3
Mexican background had the lowest
percent missing, about 50 percent.
49.4
40
by background. Those reporting
30
In the other groups, 60 to 66 percent
20
have one or more missing teeth.
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• A healthy mouth is important for general health and well–being. Having a healthy mouth makes it easier to eat well and
enjoy food, speak clearly and smile.
• You can keep your mouth healthy by brushing and flossing, eating healthy foods, using fluoride toothpaste, and not
smoking. Visiting a dentist for check–ups is also important, so any problems can be found and treated before they
become serious.
26 hchs/sol data book: a report to the communities
hearing loss
Hearing impairment was determined by using a hearing
test called audiometry to measure how well people can
hear sounds. Hearing impairment is a common, but often
unrecognized, problem, as people get older. Poorer hearing
can contribute to social isolation and a feeling of being left
out of conversations.
above: Hearing test
Chart 25: Percent with Hearing Impairment by Age and Sex
The percentage of participants
70
60
with hearing impairment increased
62.2
with age. About one in every two
50
40
participants aged 65–74 years had
43.8
hearing problems. Men had more
30
30.5
hearing impairment than women.
20
10
18.3
5.2
0
4.9
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 26: Percent with Hearing Impairment by Background
The percentage of participants
25
with hearing impairment was
20
15
21.0
16.5
17.6
highest among those of Puerto
16.6
14.8
14.5
10
Rican background. The percentages
among the other background groups
were fairly similar.
5
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• Protecting ears from loud noises at work or at home can help to prevent hearing loss.
• Hearing impairments may be helped by medical treatment, hearing aids, or learning techniques to improve the ability to hear
what family and friends are saying. A person experiencing hearing problems should seek help from a doctor or audiologist.
section vi: disease conditions 27
VII. Risk Factors for
Cardiovascular Disease
hypertension
Hypertension is another word for high blood pressure. When
blood pressure is measured, two numbers are provided—the
systolic pressure when the heart is pumping (top number),
and the diastolic pressure when the heart is relaxed (bottom
number). An example of a blood pressure reading is 120/72.
If the top number is greater than 140 or the bottom number
greater than 90, or if a person is taking medication for blood
pressure, a person is described as having hypertension.
Hypertension is harmful because it can lead to heart attacks
and strokes (NHLBI, What is high blood pressure? 2012).
• Know your blood pressure numbers. Have your blood
pressure checked at least once per year, or more often if
you have hypertension.
• Eat a diet that includes fruits, vegetables, fat–free dairy
products and is rich in whole grains, fish, poultry, beans,
seeds, and nuts.
above: Blood pressure measurement
• Limit sodium, sweets, sugary beverages and red meats.
Chart 27: Percent with Hypertension by Background
The percentage of participants with
90
80
70
77.4
72.4
60
50
40
41.6
40.3
30
20
10
0
9.2
6.8
Age 18-44
Age 45-64
Men
Age 65–74
Women
28 hchs/sol data book: a report to the communities
hypertension increased with age.
Chart 28: Percent with Hypertension by Background
The percentages of participants
40
with a history of hypertension were
32.2
30
31.8
lowest among those of Mexican
31.5
and South American backgrounds
26.1
20
21.7
20.3
and highest among those of Cuban,
Dominican, and Puerto Rican
10
0
backgrounds.
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
cholesterol
Blood cholesterol level, presented in milligrams per
decileter (mg/dL), is a measure of several kinds of fat
carried in the blood. Although not all kinds of fat in the
blood are harmful, the higher the total blood cholesterol
number, the greater the risk of hardening of the arteries
and of getting heart disease. Therefore, it is important to
get blood tests for cholesterol from time to time.
In the United States and most countries in the Americas,
photo by larissa avilés-santa
cholesterol levels are measured in the amount of
cholesterol in the blood. Doctors and patients use
guidelines when cholesterol is tested. A total cholesterol
level less than 200 mg/dL is “desirable” because it means
a lower risk for CHD. A total cholesterol level of 200 to
239 mg/dL is ”borderline high.” A value of 240 mg/dL
and above is “high blood cholesterol” because it doubles
above: Blood draw for lab tests
the risk of CHD compared to those whose cholesterol is
“desirable” (NHLBI, At a Glance: What you need to know
about high blood cholesterol, 2009).
section vii: risk factors for cardiovascular disease 29
Chart 29: Percent with Undesirable Cholesterol Levels by Age and Sex
This chart shows the percentages
70
60
of participants with undesirable
61.1
50
58.0
51.9
to or greater than 200 mg/dl. The
40
30
38.2
36.8
percentage of participants with
undesirable cholesterol was lowest
26.2
20
cholesterol levels that were equal
in the youngest group. More men
10
and women aged 45–64 years had
0
Age 18-44
Age 45-64
Men
undesirable cholesterol levels than
Age 65–74
the men and women, respectively, in
Women
the other age groups.
Chart 30: Percent with Undesirable Cholesterol Levels by Background
The percentages of participants
60
with undesirable cholesterol
50
47.3
48.0
47.8
43.3
40
36.7
30
levels were lowest among those
of Dominican and Puerto Rican
36.4
backgrounds.
20
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• Know your cholesterol level and have it checked periodically by your health care provider.
• To maintain healthy levels of blood cholesterol, reduce saturated and trans fats in your diet, be physically active, and
maintain a healthy weight.
30 hchs/sol data book: a report to the communities
prediabetes and diabetes
Prediabetes and diabetes are serious illnesses that affect millions of persons in the United States. Diabetes was determined in
participants by measuring the levels of blood glucose (sugar). This was measured both while fasting and after drinking a sugar
drink. Hemoglobin A1c is another blood value that was measured. It shows a person’s average blood glucose level over a longer
period of time. Participants could have normal, medium, or high values of blood glucose based on these tests. If a participant
was normal on all three, they did not have prediabetes or diabetes. If they were at the medium levels, they had prediabetes. If
they were high on one or more, they were considered to have diabetes.
photo by larissa avilés-santa
left to right: Oral glucose tolerance test (diabetes test); Testing blood glucose level
section vii: risk factors for cardiovascular disease 31
Chart 31: Percent with Prediabetes by Age and Sex
Prediabetes was lowest in the
50
46.9
44.7
40
30
42.4
40.7
18–44 age group and highest in the
45–64 age group. In the middle and
oldest age groups, the percentages
33.0
of participants with prediabetes
23.7
20
were similar for men and women,
respectively.
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 32: Percent with Prediabetes by Background
Approximately one in three
50
participants had prediabetes in
40
30
36.1
37.7
37.0
32.1
each background group. There was
34.4
36.3
little difference in prediabetes by
background.
20
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
32 hchs/sol data book: a report to the communities
Chart 33: Percent with Diabetes by Age and Sex
Almost one out of two participants
50
46.6
45.8
40
in the oldest age group had diabetes
and one in four in the middle age
group had diabetes.
30
26.0
25.2
20
10
0
6.0
6.1
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 34: Percent with Diabetes by Background
The percentage of participants with
25
diabetes was lowest in those of
20
15
18.4
17.8
18.9
South American background.
19.2
14.0
10
10.7
5
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
Other results from this study showed that:
• A similar number of men and women had either diabetes or prediabetes in each age group.
• The number of participants with either prediabetes or diabetes increased as their weight increased.
• Among participants aged 40 to 49 years, 6 in every 10 had either diabetes or prediabetes.
• One out of three participants with diabetes was not aware of having the disease.
section vii: risk factors for cardiovascular disease 33
obesity
Obesity is determined by measuring a person’s weight and
between 18.5 and 24.9), overweight (BMI between 25 and
height. Together these two make up a measure called the
29.9), or obese (BMI 30 or more). Several studies have
body mass index (BMI) that indicates whether a person
shown that obesity increases the chance of chronic diseases
is underweight (BMI less than 18.5), healthy weight (BMI
such as diabetes and heart disease.
Table 1: Ranges of BMI for Categories of Weight
Category of Weight
BMI
Underweight
less than 18.5
Healthy weight
18.5 – 24.9
(normal weight)
Overweight
25 – 29.9
Obesity
greater than or equal to 30
Calculate your own BMI at this website:
http://nhlbisupport.com/bmi/bmicalc.htm
above: Scale
Chart 35: Percent with Obesity by Age and Sex
In men, the percentage of obesity
60
was about the same for each age
50
48.7
47.3
40
30
38.0
36.5
of obesity was lowest in the
37.0
34.1
youngest age group.
20
10
0
Age 18-44
group. For women, the percentage
Age 45-64
Men
Age 65–74
Women
34 hchs/sol data book: a report to the communities
Chart 36: Percent with Obesity by Background
Obesity was highly prevalent in all
60
of the background groups. It was
50
highest among those of Puerto
46.8
40
38.5
37.1
30
41.1
Rican background.
38.8
30.3
20
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• For a large number of HCHS/SOL participants, excess weight was a problem. Achieving and maintaining a healthy
weight are important steps for preventing health problems.
smoking
Chart 37: Percent of Current Cigarette Smokers by Age and Sex
The percentage of current smokers
40
was higher for men than women
30
in all age groups. In men, the
27.6
percentage of smokers declined
20
22.0
13.9
10
0
with age.
18.3
16.4
10.1
Age 18-44
Age 45-64
Men
Age 65–74
Women
section vii: risk factors for cardiovascular disease 35
Chart 38: Percent of Current Cigarette Smokers by Background
The highest percentage of
40
participants reporting to be current
33.8
30
smokers was among those of
Puerto Rican background, followed
27.2
by those of Cuban background.
20
10
The lowest percentage of current
16.7
14.3
13.3
11.4
smokers was in participants of
Dominican background.
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• Smoking can increase your risk for heart disease, stroke, cancer, and lung disease. If you smoke, quitting will benefit
many aspects of your overall health.
36 hchs/sol data book: a report to the communities
symptoms of depression
Participants answered questions that describe some feelings or actions that accompany depression. People who are
depressed have symptoms of sadness, lack of energy, feelings of loneliness, problems with sleep, and other emotional
and physical feelings.
The medical condition of depression needs to be diagnosed by a mental health professional, but questionnaires can
measure whether people have a high level of depressive symptoms or high risk of depression. Persons with high
depressive symptoms may be at a greater risk of heart disease and stroke.
Chart 39: Percent with High Levels of Depressive Symptoms by Age and Sex
More women than men in all age
45
40
groups reported high depressive
39.3
35
34.3
30
23.7
20
15
women reported high depressive
29.0
25
symptoms: about one in three of
symptoms. About one in five men
22.9
18.9
reported high depressive symptoms.
10
The highest percentage of high
5
depressive symptoms was reported
0
Age 18-44
Age 45-64
Men
in women aged 45–64 years and the
Age 65–74
lowest was reported in men aged
Women
18–44 years.
Chart 40: Percent with High Levels of Depressive Symptoms by Background
The highest percentage of
45
participants reporting high
40
38.0
35
depressive symptoms was among
30
25
20
24.9
27.9
those of Puerto Rican background
27.4
24.2
22.3
and lowest was among those of
Mexican background.
15
10
5
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• Depression can be successfully treated with therapy or medications. If depressive symptoms continue and a person
cannot seem to “shake it off,” the person should see a professional and seek help for depression.
section vii: risk factors for cardiovascular disease 37
anxiety symptoms
Being anxious at times of stress is very common. In
to 10 such statements were added and a person could
HCHS/SOL, participants stated how they generally felt
have a total score ranging from 10 (not at all anxious) to
in response to statements such as: “I feel nervous and
40 (very highly anxious). The median anxiety score is the
restless.” They could answer that they feel that way almost
score where half the participants are higher and half are
never, sometimes, often or almost always. Their responses
lower, in other words, the half–way point.
Chart 41: Median Anxiety Score by Age and Sex
40
Women were slightly more anxious
35
than men, but there was very little
30
difference by age.
25
20
15
10
16.2
14.7
16.4
14.7
15.0
13.4
5
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 42: Median Anxiety Score by Background
40
There was very little difference in
35
anxiety by background.
30
25
20
15
10
14.7
14.3
Central American
Cuban
15.6
15.5
Dominican
Mexican
16.8
14.4
5
0
Puerto Rican
South American
• Being anxious at times of stress is very common, but some people feel anxious most of the time even when there is
no explanation for it. Anxiety is a risk factor for heart disease and may be accompanied by depression. Persons who
are anxious or depressed should seek help from a mental health professional.
38 hchs/sol data book: a report to the communities
sleep problems
Sleep apnea is a disorder defined by an increased number
of breathing pauses during sleep, usually associated with
symptoms of loud snoring, snorting and gasping for air, or
“stop breathing.” This often results in lower oxygen levels
in the blood and increased stress on the heart.
Sleep apnea was diagnosed after an overnight sleep study
was performed. The sleep study reports the number of
times per hour of sleep someone has breathing pauses.
photo by larissa avilés-santa
above: In HCHS/SOL, participants wore a sleep
In this report, participants with 15 or more pauses were
monitor for a night in their home. The monitor
considered to have sleep apnea. The photo shows the sleep
measured airflow and oxygen levels during sleep,
monitor worn in HCHS/SOL, which recorded breathing,
allowing sleep apnea to be detected.
snoring, oxygen levels, and head position.
Chart 43: Percent with Sleep Apnea by Age and Sex
The percentage of participants with
35
sleep apnea increased with age and
30
29.5
25
was higher in men than in women at
22.0
20
21.1
all ages.
15
10
5
10.2
7.4
0
1.8
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 44: Percent with Sleep Apnea by Background
The highest percentage of
15
participants reporting sleep
12.6
10
10.1
9.3
10.2
apnea was among those of Cuban
11.1
background and the lowest was
8.1
background.
5
0
among those of South American
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
section vii: risk factors for cardiovascular disease 39
There are other sleep problems that may be signs of sleep apnea. These are sleepiness, loud snoring, and stopped breathing.
These charts show the frequency of symptoms of sleep problems among participants.
Chart 45: Percent of Women with Sleep Problems by Background
Although the percentages of sleep
50
problems varied by background
somewhat, approximately one in
40
35.5
32.6
31.8
30
20
34.0
of snoring and one in five women
reported daytime sleepiness.
21.9
20.9
20.6
19.2
18.7
three women reported symptoms
34.6
32.6
12.6
10
6.9
9.9
7.7
7.0
5.7
4.2
0
Central American
Cuban
Dominican
Mexican
Snoring
Sleepiness
Puerto Rican South American
Stop Breathing
Chart 46: Percent of Men with Sleep Problems by Background
Reports of snoring were more
50
43.8
40
to women. In men, a higher
37.3
37.2
frequent in men compared
43.1
42.4
35.2
percentage of participants who
stopped breathing during sleep
30
24.1
20
10
0
were among those of Cuban and
22.0
18.4
18.4
19.0
Puerto Rican backgrounds and
16.5
8.4
Central American
lowest among those of South
11.0
10.4
7.6
Cuban
Sleepiness
Dominican
Snoring
6.4
Mexican
American background.
4.1
Puerto Rican South American
Stop Breathing
• Sleep apnea is very common, but is usually not diagnosed or treated. Sleep apnea can increase risk for hypertension (high
blood pressure) and diabetes. Sleep apnea can be treated. All persons, men and women, young and old who have loud
snoring, stop breathing during sleep have un–refreshing sleep or have daytime sleepiness should discuss this with their
doctor, who can determine whether further testing or treatment is indicated. Ways to improve sleep include maintaining a
healthy weight and sleeping at least 7 hours nightly (NHLBI, At a Glance: Healthy Sleep, 2009).
40 hchs/sol data book: a report to the communities
multiple risk factors for cardiovascular disease
High blood pressure, high cholesterol level, obesity, diabetes, and cigarette smoking are major risk factors for heart disease and
strokes. The more risk factors someone has, the higher their risk of heart disease and stroke. The charts that follow describe
the percent of HCHS/SOL participants who have 0, 1, 2, and 3 or more of these risk factors. A health goal is for participants at
all ages to have as few risk factors as possible (Daviglus et al., 2013).
Chart 47: Percent of Women with Multiple Risk Factors by Age
In women, about 43 percent of those
50
40
43.8
42.6
but only about 7 percent of those
34.1
33.1
30
aged 18–44 years had no risk factors,
30.2
27.1
aged 65–74 years had no risk factors.
26.8
20
18.5
15.9
10
14.9
7.2
5.8
0
Age 18-44
Age 45-64
0 Risk Factors
1 Risk Factors
Age 65–74
2 Risk Factors
3+ Risk Factors
Chart 48: Percent of Men with Multiple Risk Factors by Age
Similarly in men, younger age groups
50
44.2
40
age groups. In the oldest age group,
34.7
30
28.9
28.7
20
had fewer risk factors than older
30.6
24.6
29.7
27.7
about 44 percent had three or more
unfavorable risk factors.
19.4
10
12.0
11.9
6.7
0
Age 18-44
0 Risk Factors
Age 45-64
1 Risk Factors
Age 65–74
2 Risk Factors
3+ Risk Factors
• Prevent heart disease by not smoking, having a healthy lifestyle, eating a balanced diet, and maintaining routine physical
activity. These daily lifestyle habits work together to prevent the development of diabetes, weight gain, high blood
pressure, and high cholesterol levels.
• If you already have one or more risk factors, two are better than three, one is better than two, and zero is best of all.
section vii: risk factors for cardiovascular disease 41
VIII. Lifestyle
diet
Dietary information was obtained by asking participants
what they ate on the previous day. A dietary pattern was
determined by gathering dietary information at their
initial examination and a month or two later by telephone.
Dietary data are tabulated into groups of higher and
lower amounts of intake. For fruits and vegetables, the
group is for those eating 5 or more fruits and vegetables
per day. Sodium is presented for those consuming less
than 2,300 mg of sodium per day. Fats are presented for
those consuming less than 10 percent of calories from
fat. These groupings are commonly used in presenting
consumption of fruits and vegetables, sodium and fat.
Chart 49: Percent Eating 5 or More Fruits and Vegetables by Age and Sex
A healthy diet should include plenty
60
54.3
50
40
56.6
of fruits and vegetables. More men
consumed at least 5 fruits and
45.0
41.9
30
42.1
33.6
per day than women. This percentage
improved in older ages.
20
10
0
vegetables (without fried potatoes)
Age 18-44
Age 45-64
Men
Age 65–74
Women
42 hchs/sol data book: a report to the communities
Chart 50: Percent Eating 5 or More Fruits and Vegetables by Background
While almost half of all
60
40
participants from Cuban and
55.0
50
49.4
47.4
43.9
South American backgrounds
reported eating at least 5 fruits and
38.9
vegetables per day, only one out of
30
five Puerto Ricans met this target.
20
19.2
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
Chart 51: Percent Consuming Less Than 2,300 mg Sodium by Age and Sex
The percentage of participants
50
44.2
40
sodium per day increased with age.
35.4
30
Across age groups, women consumed
less sodium than men.
23.4
20
10
3.6
0
consuming less than 2,300 mg of
10.6
7.0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 52: Percent Consuming Less Than 2,300 mg Sodium by Background
A higher percentage of Dominican
50
followed by Puerto Rican, Mexican,
40
and Central American backgrounds
reported consuming less than
33.2
30
2,300 mg of sodium per day.
20
20.5
18.2
21.7
13.3
10
0
4.8
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
section viii: lifestyle 43
Chart 53: Percent Consuming Less Than 10% Calories from Saturated Fat by Age and Sex
80
About half of all participants
70
reported consuming less than 10
percent of calories from saturated
60
54.5
50
40
46.2
54.8
54.9
54.8
46.2
fat. Men and women had equal
percentages.
30
20
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 54: Percent Consuming Less Than 10% Calories from Saturated Fat by Background
Nearly two out of three participants
80
of Dominican, South American and
70
60
67.8
61.2
61.5
reported meeting intake of less
50
48.5
47.7
40
than 10 percent of calories from
39.3
30
Central American backgrounds
saturated fat; one out of two
20
participants of Mexican and Cuban
10
backgrounds met this intake.
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
A healthy diet includes:
• Eating enough fruits and vegetables
• Being aware of sodium intake (check food labels and select foods with lower sodium values)
• Reducing calories from saturated fats
44 hchs/sol data book: a report to the communities
physical activity
The number of minutes a day in physical activity was
determined from self–report of various levels of activity
performed by the participants. Recreational physical
activities may include walking, riding a bike, swimming,
jogging, dancing, gardening, and other types of leisure
activities.
Moderate intensity activity raises your heart rate to a point
where you sweat and feel you're working, yet you are able
to carry on a conversation during the activity. Examples of
moderate level activities include gardening, walking to the
store, and shopping for groceries.
During vigorous activity, breathing and heart rate are fast.
Examples of vigorous activity include very hard physical
labor like home construction, walking while carrying heavy
loads, riding a bike, swimming, and running.
top to bottom: Group physical activity; Carpenter
Chart 55: Average Minutes per Day of Recreational Physical Activity by Age and Sex
Men aged 18–44 years reported more
50
40
recreational physical activity than
43.1
older men and women of all ages.
30
20
19.9
15.8
10
0
9.9
Age 18-44
Age 45-64
Men
12.7
10.2
Age 65–74
Women
section viii: lifestyle 45
Chart 56: Average Minutes per Day of Recreational Physical Activity by Background
Participants of Cuban background
50
reported less recreational physical
40
activity than the other background
groups.
30
28.3
20
23.3
19.8
17.7
18.0
Cuban
Dominican
22.0
10
0
Central American
Mexican
Puerto Rican
South American
Work–related physical activity includes physical activities performed during the work day for at least 10 minutes at a time.
Chart 57: Average Minutes per Day of Work–Related Physical Activity by Age and Sex
Men aged 18–44 years reported more
140
120
minutes per day of work–related
126.8
physical activity than older men and
100
women of all ages. Men and women
89.8
80
aged 65–74 years engaged in fewer
60
51.3
40
minutes of work–related physical
51.3
activity than younger participants.
20
21.8
19.2
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 58: Average Minutes per Day of Work–Related Physical Activity by Background
140
Participants of Cuban background
120
reported fewer minutes per day of
100
work–related physical activity than
80
91.7
60
other background groups.
88.0
59.4
66.3
63.5
68.1
40
20
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
46 hchs/sol data book: a report to the communities
Physical activity plays an important role in controlling weight. You gain weight when the calories you burn during physical
activity are less than the calories you eat or drink. Regular physical activity helps strengthen bones; improves mental health;
improves ability to perform daily activities and prevent falls. Also, it helps to lower risk for heart disease, stroke, type 2
diabetes, and other health problems. In general, individuals who engage in regular physical activity may live longer.
• Moderate–intensity activity, like brisk walking, is generally safe for most people. Everyone can gain the health benefits
of physical activity—age, ethnicity, shape or size do not matter. A healthy lifestyle that involves physical activity can
help prevent many health problems.
• Aim for at least 150 minutes of physical activity per week (or 30 minutes per day, 5 or more days per week).
For more information: http://health.gov/paguidelines/guidelines/summary.aspx
section viii: lifestyle 47
IX. Awareness, Treatment,
and Control
awareness, treatment, and control of hypertension
In this study, participants were asked if their doctor or a medical provider had told them that they had high blood pressure
or hypertension. If they reported yes, then they were considered to be aware of their hypertension.
Chart 59: Percent Aware of Hypertension by Age and Sex
For hypertensive men, awareness of
100
90
their hypertension increased with
80
70
72.6
60
50
78.5
78.3
78.5
69.9
age. Hypertensive women generally
were more aware of hypertension
57.7
than men.
40
30
20
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 60: Percent Aware of Hypertension by Background
Hypertensive men of Central
100
90
American background were less
80
70
60
50
74.9
70.5
59.8
66.3
aware and participants of Cuban
73.4
63.5
background were more aware of
their hypertension.
40
30
20
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• Assessment of blood pressure though routine medical practice or community screenings can increase awareness of
hypertension so that treatment can be obtained.
48 hchs/sol data book: a report to the communities
The goal is for all persons with high blood pressure to be under treatment for hypertension.
Chart 61: Percent Under Hypertension Treatment by Age and Sex
In the 18-44 age group, about half
100
90
of the women and about a third
80
70
72.4
68.8
60
50
54.3
71.4
55.9
for hypertension. In the 65–74 age
group, participants under treatment
40
30
of the men were under treatment
increased to almost three–fourths
37.7
under treatment.
20
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 62: Percent Under Hypertension Treatment by Background
A higher percentage of
100
90
participants of Cuban and Puerto
80
Rican backgrounds were under
70
60
60.6
50
40
30
hypertension treatment than the
54.6
59.4
50.3
50.8
other background groups. The
lowest percentage of participants
43.0
20
under treatment was among those of
10
Central American background.
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• There are many kinds of medications that can lower
blood pressure to healthier levels. A person who
has hypertension should be under medical care of
someone who can recommend the best treatment.
above: Blood pressure monitor
section ix: awareness, treatment and control 49
Chart 63: Percent with Hypertension Under Control by Age and Sex
The poorest control was seen in the
100
90
hypertensive group of men aged
80
70
18–44 years, with only one–fourth
60
of them under control.
50
40
20
45.7
41.8
30
34.1
39.7
34.2
23.3
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 64: Percent with Hypertension Under Control by Background
Hypertensive participants of Cuban
100
90
and Puerto Rican backgrounds
80
had the highest percentages of
70
60
participants with hypertension
50
under control. Only about 20 percent
40
41.9
30
32.8
33.8
31.3
20
10
0
of hypertensive participants of
38.9
19.5
Central American
Central American background had
their condition under control.
Cuban
Dominican
Mexican
Puerto Rican
South American
• If you have hypertension, follow the advice of a health professional to keep your blood pressure under control.
50 hchs/sol data book: a report to the communities
awareness, treatment, and control of diabetes
Participants were asked whether they were aware they had diabetes.
Chart 65: Percent Aware of Diabetes by Age and Sex
About two-thirds of participants
100
90
who had diabetes were aware of it.
80
60
50
Older participants were more likely
77.4
70
64.4
61.6
69.3
66.8
56.4
than younger participants to be
aware of their diabetes. In the oldest
40
30
age group, more men than women
20
were aware of having diabetes.
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 66: Percent Aware of Diabetes by Background
More than 70 percent of participants
100
90
of Puerto Rican and Dominican
80
70
60
50
61.6
60.8
58.4
backgrounds were aware that they
72.1
70.2
had diabetes, whereas fewer from
56.4
40
Central American, Mexican, Cuban,
and South American backgrounds
30
were aware.
20
10
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
• Medicines, diet and exercise can all help lower sugar in the blood and prevent diabetes complications.
section ix: awareness, treatment and control 51
Chart 67: Percent Under Diabetes Treatment by Age and Sex
The percentage of participants
100
90
under treatment for diabetes
80
70
increased with age. It was higher
73.2
60
40
30
59.3
56.1
50
48.4
40.5
in women than in men aged 45–64
years, but was higher in men than
women aged 65–74 years.
40.5
20
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 68: Percent Under Diabetes Treatment by Background
More diabetic participants of Puerto
100
90
Rican background reported being
80
treated for diabetes than those of
70
Central American and Dominican
60
50
40
49.3
48.8
41.8
30
46.5
backgrounds who, in turn, were
53.0
40.0
more likely to be treated than
20
those of Mexican, Cuban, or South
10
American backgrounds.
0
Central American
Cuban
Dominican
Mexican
Puerto Rican
South American
52 hchs/sol data book: a report to the communities
Chart 69: Percent with Diabetes Under Control by Age and Sex
100
Only about half of all participants
90
with diabetes had their condition
80
under control. Control over diabetes
70
60
61.5
50
40
30
52.9
54.3
54.3
increased slightly with age.
54.0
41.2
20
10
0
Age 18-44
Age 45-64
Men
Age 65–74
Women
Chart 70: Percent with Diabetes Under Control by Background
100
More diabetic participants
90
of Cuban and Puerto Rican
80
backgrounds had control over their
70
diabetes than those of Mexican,
60
57.4
50
40
43.9
47.7
49.6
Dominican
Mexican
54.7
47.1
30
Dominican, South American, and
Central American backgrounds.
20
10
0
Central American
Cuban
Puerto Rican
South American
• Taking medications prescribed by the doctor can help lower blood sugar to an acceptable level and prevent
diabetes complications.
section ix: awareness, treatment and control 53
X. Health Insurance
health insurance coverage
Having health insurance is an indicator of access to medical care in the United States. It increases the chance of having
access to recommended preventive tests and services, and getting specialized medical care.
Chart 71: Percent Without Health Insurance By Age and Field Center
Among the four field centers, the
80
70
highest percentage of participants
70.7
without health insurance was in the
60
56.8
50
54.1
Miami Field Center 18–64 age group
40
and the lowest percentage without
30
20
27.7
26.1
10
0
Bronx
19.2
16.9
4.1
health insurance was in the Bronx
Field Center 65–74 age group. The
younger age group was more likely
Chicago
Age 18–64
Miami
San Diego
to be without health insurance than
the older age group.
Age 65–74
types of health insurance
Chart 72: Percent with Employer Health Insurance by Age and Field Center
Approximately half of the
60
50
participants in the Chicago and
50.3
49.2
San Diego Field Centers 18–64 age
40
group had insurance through their
30
20
20.5
14.9
10
0
employers.
27.0
17.8
16.9
3.8
Bronx
Chicago
Age 18–64
Miami
San Diego
Age 65–74
54 hchs/sol data book: a report to the communities
Chart 73: Percent with Medicaid Health Insurance by Age and Field Center
Most participants from the Bronx
80
70
60
and Miami had insurance through
69.4
65.1
50
Medicaid.
52.4
40
42.8
35.4
30
20
22.4
22.8
10
11.3
0
Bronx
Chicago
Age 18–64
Miami
San Diego
Age 65–74
Chart 74: Percent with Medicare Health Insurance by Age and Field Center
The majority of participants in
90
80
70
75.4
69.2
60
the 65–74 age group were insured
75.2
71.1
through Medicare.
50
40
30
20
10
0
11.0
8.8
Bronx
9.8
5.0
Chicago
Age 18–64
Miami
San Diego
Age 65–74
section x: health insurance 55
XI. Summary
This Data Book provides a glimpse into the potential
and vegetables. Younger men, both in work and recreation,
value of the Hispanic Community Health Study/Study
were the most physically active. Although the percentage
of Latinos. It describes the health status of a sample
of patients with hypertension (high blood pressure) was
of persons of diverse backgrounds and locations and
not excessive, it is of significant concern because many
identifies risk factors for cardiovascular diseases in
participants were either not being treated or did not have
this population. The study can serve as the foundation
their condition under control. Similarly, for diabetes, about
for future research into possible causes of and ways to
two–thirds were aware of their diabetes, but less than half
prevent the important health problems shown in these
had it under control.
pages. The goal is to improve the health of everyone by
identifying the best ways to prevent health problems and
For some of these diseases and conditions with known
applying the best treatments for diseases.
prevention and treatment, the health message is clear:
As shown in this Data Book, prediabetes, diabetes, and
• For prevention, follow recommendations to increase
obesity continue to be very common in Hispanic /Latino
physical activity, and improve diet, and follow the
populations. Prediabetes if not appropriately managed,
advice of a doctor or health provider.
can progress to diabetes. Additionally, obesity, which
is very prevalent in this study population, can lead to
diabetes and high blood pressure.
• For treatment, first know your blood pressure,
cholesterol, and blood glucose numbers to have
greater self–awareness of your health status.
A new finding from this study showed that a substantial
number of persons reported having sleep disturbances.
Other studies have shown the harmful consequences of
• Seek advice from a medical provider on the best way
to be treated for these conditions.
sleep disturbances to cardiovascular health.
• Finally, follow all advice given.
Cardiovascular disease is caused by a combination of risk
factors and the Data Book reports the percent of participants
In closing, an appreciation goes to all who have made this
with up to three or more of harmful factors. In the oldest
study possible. First, thanks go to the participants who
age group, about three–fourths have two or more of these
devoted their time, energies, and dedication. Second, a
harmful factors.
vast number of physicians, nurses, technical personnel,
administrators, computer experts, and statisticians have
Some of the unhealthy behaviors, such as cigarette smoking,
made this beginning possible. Finally, appreciation is given
are at low levels in some of the background groups, but
to all of the new staff, trainees and other individuals who
much too high in others. On the other hand, a substantial
developed an appreciation of the complexity and value of
number of persons ate high numbers of servings of fruits
research that can improve the health of all Americans.
56 hchs/sol data book: a report to the communities
XII. References
Becker, A & Armendariz A. (2012, June 22). California border crossing: San Ysidro port of entry is the busiest land border in the
world. Huffington Post. http://www.huffingtonpost.com/2012/06/22/california–border–crossing_n_1619067.html [Accessed
5–5–2013]
Daviglus ML, Talavera GA, Avilés–Santa ML, Allison M, Cai J, Criqui MH, Gellman M, Giachello AL, Gouskova N, Kaplan RC,
LaVange L, Penedo F, Perreira K, Pirzada A, Schneiderman N, Wassertheil–Smoller S, Sorlie PD, Stamler J. (2012). Prevalence
of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds
in the United States. JAMA. 308(17):1775–84.
Kucher, K. (2010, September 16). In Depth: Mexico’s bicentennial and San Diego. U~T San Diego. http://www.utsandiego.com/
news/2010/sep/16/mexicos–impact–region/?page=2#article
Lavange LM, Kalsbeek WD, Sorlie PD, Avilés–Santa LM, Kaplan RC, Barnhart J, Liu K, Giachello A, Lee DJ, Ryan J, Criqui
MH, Elder JP. (2010). Sample design and cohort selection in the Hispanic Community Health Study/Study of Latinos. Ann
Epidemiology. 20(8):692–9.
Mayo Clinic. 5 medication–free strategies to help prevent heart disease. http://www.mayoclinic.com/health/heart–disease–
prevention/WO00041 [Accessed 5–6–2013]
Mayo Clinic. Heart disease. Definition. http://www.mayoclinic.com/health/heart–disease/DS01120. [Accessed 5–6–2013]
Murphy, SL, Xu,J, & Kochanek, KD. Preliminary Data for 2010. (2012). National Center for Health Statistics. National Vital
Statistics Reports. 60(4). (http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf ) [Accessed 5–6–2013]
National Heart, Lung, and Blood Institute. (2009, August). At–a–glance: Healthy Sleep. NIH Publication No. 09–7426. http://
www.nhlbi.nih.gov/health/public/sleep/healthy_sleep_atglance.pdf
National Heart, Lung, and Blood Institute. National Institutes of Health. (2009, August). At a glance: What you need to know
about high blood cholesterol. NIH Publication No.09–7424. http://www.nhlbi.nih.gov/health/public/heart/chol/cholesterol_
atglance.pdf [Accessed 5–6–2013]
National Heart, Lung, and Blood Institute. National Heart, Lung, and Blood Institute. Take Action: Stop Asthma Today! (2010,
September). NIH Publication No. 10–7542. http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci–action–guide.pdf
National Heart, Lung and Blood Institute. Take the first step to breathing better. Learn more about COPD. http://www.nhlbi.nih.
gov/health/public/lung/copd/index.htm [Accessed 5–6–2013]
section xii: references 57
National Heart, Lung, and Blood Institute. (2012, August). What is high blood pressure? http://www.nhlbi.nih.gov/health/
health–topics/topics/hbp/ [Accessed 5–6–2013]
New York City Department of City Planning. (2011, March). NYC 2010: Results from the 2010 census. Population growth and
race/Hispanic composition. http://www.nyc.gov/html/dcp/pdf/census/census2010/pgrhc.pdf [Accessed 5–6–2013]
Pub Med Health: Stroke. (last reviewed 2012, May). A.D.A.M. Medical Encyclopedia. http://www.ncbi.nlm.nih.gov/
pubmedhealth/PMH0001740/ [Accessed 5–7–2013]
Ready T & Brown–Gort A. (2005). The State Of Latino Chicago: This Is Home Now. Institute of Latino Studies. University of
Notre Dame. http://www.csu.edu/CERC/documents/StateofLatinoChicago.pdf [Accessed 2–7–2012]
Sorlie PD, Aviles–Santa LM, Wassertheil–Smoller S, Kaplan RC, Daviglus ML, Giachello AL, Schneiderman N, Raij L, Talavera
G, Allison M, Lavange L, Chambless LE, Heiss G. (2010). Design and implementation of the Hispanic Community Health
Study/Study of Latinos. Annals of Epidemiology, 20(8):629–641.
U.S. Census Bureau. 2010 Census/American Fact Finder. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml
[Accessed 5–6–2013]
Wikipedia, Miami: http://en.wikipedia.org/wiki/Miami [Accessed 2/15/2013]
58 hchs/sol data book: a report to the communities
The NHLBI Health Information Center is a service of the National Heart, Lung and Blood Institute (NHLBI) of the National
Institutes of Health. The NHLBI Health Information Center provides information to health professionals, patients, and the
public about the treatment, diagnosis and prevention of heart, lung, and blood diseases and sleep disorders.
for more information
NHLBI Health Information Center
P.O. Box 3015
Bethesda, MD 20824–0101
Phone: 301–592–8573 (or dial 7–1–1 for access to free Telecommunications Relay Services, TRS)
Fax: 301–592–8563
Email: [email protected]
Websites:
NHLBI: www.nhlbi.nih.gov
HCHS/SOL: www.saludsol.net
NHLBI Health Topics Index
Health Topics includes articles on sleep disorders, tests, and procedures, along with videos and Spanish-language articles.
Website: www.nhlbi.nih.gov/health/health-topics/by-alpha/
DISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person
in the United States shall, on the grounds of race, color, national origin, handicap or age, be excluded from participation
in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with
respect to any education program or activity) receiving Federal financial assistance. In addition, Executive Order 11141
prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and
Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for
employment because of race, color, religion, sex or national origin. Therefore, the National Heart, Lung, and Blood Institute
must be operated in compliance with these laws and Executive Orders.
| File Type | application/pdf |
| File Modified | 2013-11-22 |
| File Created | 2013-11-22 |