Miriam E. Tucker

May 20, 2014

LAS VEGAS — An ongoing federally funded study of the health of Hispanics in the United States is yielding nuanced and complex data, with one clear finding: There is no single "Hispanic" profile.

But it does show that metabolic syndrome and diabetes is a big problem, albeit one that varies across the different Latino groups, study project manager Larissa Avilés-Santa, MD, from the National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, said here at the American Association of Clinical Endocrinologists (AACE) 23rd Annual Scientific and Clinical Congress.

Metabolic syndrome overall among the Hispanic groups is 35%, compared with just 22.5% in the US population as a whole. And the prevalence of diabetes is 16.9% among Hispanics, compared with 11.3% for all US adults. But this prevalence varies, from just 10.2% among those of South American origin to 18.3% for those with Mexican backgrounds.

And curiously, while Mexicans have the highest rates of diabetes among the Hispanic groups, they join South Americans at the bottom of the list for hypertension (around 20% for both), while those of Caribbean origin (Puerto Rico, Dominican Republic) have the highest hypertension rates (around 30% for both).

"One of the main messages is that Hispanics are not a monolith. It has been assumed for a long time that Hispanics are one unique group, that we all behave the same, eat the same, dance the same…and that is not the case. Although there are cultural, historical, and religious similarities, we also have differences," Dr. Avilés-Santa told Medscape Medical News.

She had this advice for doctors: "Assuming homogeneity is not the way to address clinical care with Hispanics. It's better to ask questions, get to know the patient, and go from there."

And session moderator Jaime Davidson, clinical professor of internal medicine at the University of Texas Southwestern Medical School, Dallas, advised endocrinologists: "We need to get more involved. There are not enough of us. Any girl born in the US to Latino parents has a 1 in 2 chance of developing diabetes in her lifetime. It's almost the same for males. This is a real epidemic."

Largest Study of Hispanic Health in United States

The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is the largest study of Hispanic health in the United States and began in 2006. It is cofunded by the NHLBI along with 6 other institutes of the NIH and aims to identify cardiovascular and pulmonary risk factors — and protective factors — among diverse US Hispanic/Latino groups.

There are 16,415 participants aged 18 to 74 at 4 field centers (San Diego; Chicago; Miami; and Bronx, New York), and the trial has now been funded through to 2019. Most (79%) were born outside the United States/Puerto Rico.

Mexicans/Mexican-Americans are the largest group, 39%, followed by 17% who self-identified as Puerto Rican, 14% Cuban, 11% Central American, 9% Dominican, 7% South American, and 3% from more than 1 country.

Participants undergo extensive evaluation at baseline and are reassessed at regular intervals. "It's an epidemiological study, not a clinical trial. It's a study to collect information in order to better understand Hispanic healthcare," Dr. Avilés-Santa said.

Why Do US Hispanics Live Longer?

Officials hope the study will answer a curious paradox that initially came to light in 2010, the first year that complete data on Hispanics in the United States were available.

Despite lower socioeconomic status and higher rates of cardiovascular risk factors, Hispanics actually live longer than do non-Hispanic whites or African Americans. In 2011, life expectancy for Hispanics overall was 81.4 years, compared with 78.7 years for the US population as a whole.

Hispanic women have the highest life expectancy, 83.7 years, according to data from the Centers for Disease Control and Prevention

"We want to go underneath and understand [what is] happening in every Hispanic group," Dr. Avilés-Santa said. "Are we living longer and healthier? [If so] we want to know what we're doing well. Or are we living longer with more health problems? And, what can we do about it?" she told a media briefing at AACE.

Indeed, Dr. Davidson told Medscape Medical News, "There is a lot of enigma here. With so much diabetes, so much amputation, so much end-stage renal disease, how do we happen to live longer? Hopefully the future will give us the answers."

Dr. Avilés-Santa said the data so far indicate that doctors need to watch out for a high burden of risk factors and for diabetes at a young age among different Latino groups.

They also need to be on the lookout for hypercholesterolemia and for cardiac structural abnormalities prior to a clinical diagnosis of diabetes. Other important findings include the fact that many older Hispanic people have unrecognized diabetes, and there are issues around sleep-disordered breathing and unrecognized dyspnea and pulmonary disease.

In addition, the study is also investigating social determinants of health such as insurance coverage, and in a separate arm, genetic analyses are being performed.

While the study is aiming to unearth as much information as possible, it still may not ultimately explain all the variation, Dr. Avilés-Santa acknowledged.

"Language barriers, discrimination, resilience, faith, beliefs about health and disease….All of this may play a big role in the difference we're observing among Hispanic groups," she concluded.

Dr. Avilés-Santa is a federal employee and has no relevant financial relationships. Dr. Davidson has received advisory board, speaker, and/or consultant honoraria from Eli Lilly, Aspire Bariatrics, AstraZeneca/Bristol-Myers Squibb, Janssen, and Novo Nordisk .

American Association of Clinical Endocrinologists (AACE) 23rd Annual Scientific and Clinical Congress. Presented May 15, 2014.

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