Background: Hispanics are the fastest growing ethnic group in the U.S., and little is known how Hispanic ethnic density impacts CVD mortality.
Methods: We examined county-level deaths for Hispanics and non-Hispanic Whites (NHWs) using national mortality records from 2003 to 2012. We included counties with more than twenty Hispanic deaths (n=715). CVD deaths (mortality) were identified using ICD-10: I00-I78, and population estimates were calculated using linear interpolation from 2000 and 2010 Census data. Age- and sex- adjusted CVD mortality rates (AMRs) were calculated per 100,000 population. Multivariate regression was used to examine the association of Hispanic ethnic density with Hispanic and NHW AMRs. County level AMRs were adjusted for county-level socioeconomic (median household income, education, proportion Blacks, limited English proficiency, rural and employment), behavioral/metabolic (diabetes, physical inactivity, adult smoking), and health care factors (uninsured, primary care physician rate, preventable hospital stay) based on the 2012 County Health Rankings Database.
Results: CVD AMRs were higher among NHWs compared to Hispanics (244.8 vs. 189.0). Hispanic density ranged from <1% to 96%. Counties in the highest compared to lowest quartile of Hispanic density had 44% higher Hispanic mortality, and 11% higher NHW mortality (Figure). Mortality was more positively correlated with Hispanic density for Hispanics (r2=0.22, p<0.0001) than NHWs (r2=0.01, p=0.02). In fully adjusted models (socioeconomic, behavioral/metabolic, and health care factors), the mortality gradient for NHWs reversed while the mortality gradient for Hispanics in counties with higher Hispanic density increased (32% higher, p<0.001).
Conclusions: Hispanic CVD mortality increased with increasing Hispanic density. Traditional risk factors do not explain the higher mortality among Hispanics in ethnically concentrated counties.