Award Date


Degree Type


Degree Name

Master of Public Health (MPH)


Environmental and Occupational Health

First Committee Member

Paulo S. Pinheiro

Second Committee Member

Guogen Shan

Third Committee Member

Jennifer Pharr

Fourth Committee Member

Diane Thomason

Number of Pages



Introduction: Hispanics are the largest racial/ethnic minority group in the United States (US), comprising 17% of the total US population in 2014, and projected to increase to 28.6% by 2060. Yet, the intra-ethnic heterogeneity for the second and fourth leading causes of death among Hispanic populations, heart disease and stroke, has never been comprehensively studied. We examined ischemic heart disease (IHD) and stroke mortality among distinct Hispanic subgroups: Caribbean Hispanics (including Puerto Ricans, Cubans, and Dominicans), Mexicans, Central Americans and South Americans, comparing their mortality with non-Hispanic whites (NHWs).

Methods: Five years (2008-2012) of death certificate data from Florida and California were used to calculate age-adjusted cause-specific mortality rates for ischemic heart disease and stroke. Mortality outcomes were compared with age-adjusted mortality rate ratios computed using negative binomial regression.

Results: Hispanics had stroke mortality rates equivalent to or higher than NHWs. The highest rate was seen in US-born Mexicans in California, 41.9 deaths per 100,000 (95% CI: 40.0- 44.0), compared to 36.3 (95% CI: 35.8-36.9) in NHWs. In Florida, Puerto Rican men had the greatest stroke mortality risk, 19% higher than NHWs. In aggregate, Hispanics had lower ischemic heart disease mortality rates than NHWs, 32% and 25% lower among females and males in Florida, respectively. South American men and women had the lowest IHD and stroke rates in both states.

Discussion: There was notable intra-ethnic variability in mortality, with the worst Hispanic outcomes seen among Cuban men and Puerto Rican women in Florida and US-born Mexicans and Caribbeans of both sexes in California. Our results for both IHD and stroke demonstrate that among Hispanics, US-born and/or those with a longer stay in the US were the most disadvantaged, suggesting the importance of looking at acculturation patterns that negatively influence health, including diet and obesity.


Florida; Hispanics; ischemic heart disease; mortality; stroke


Epidemiology | Public Health

File Format


Degree Grantor

University of Nevada, Las Vegas




IN COPYRIGHT. For more information about this rights statement, please visit

Included in

Epidemiology Commons