Beneficial hispanic stroke mortality: An exploration of potential explanatory factors

Show full item record

Title: Beneficial hispanic stroke mortality: An exploration of potential explanatory factors
Author: Bret Howrey
Abstract: 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
URI: http : / /hdl .handle .net /2152 .3 /136
Date: 2009-06-11

Citation

Beneficial hispanic stroke mortality: An exploration of potential explanatory factors. Doctoral dissertation, The University of Texas Medical Branch. Available electronically from http : / /hdl .handle .net /2152 .3 /136 .

Files in this item

Files Size Format View
dissertation_bthowrey.pdf 570.3Kb application/pdf View/Open

This item appears in the following Collection(s)

Show full item record

Search DSpace

Advanced Search

Browse