Hispanic Community Health Study Data Book: A Report To The Communities

Data 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
Symptoms 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

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
study description
photo by larissa avilés-santa

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

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%
23% These numbers show the percentage of participants
in each education group. For example, in this chart, 33
27% percent of the participants (orange area) had less than

a high school education.
Less Than
High School High School Grad 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)
3000 This title describes the chart as the number of

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
770
500
418 374
The legend shows different groups by age, sex,
25 27
0
Central Cuban Dominican Mexican Puerto South background or community. In this chart, the
American Rican American
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

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!”
chicago field center

photos by larissa avilés-santa
photos by larissa avilés-santa

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.”
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

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
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
Chicago Bronx
San Diego
Miami

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
2000 In the Bronx Field Center, most

1,837 participants are of Puerto Rican
1500
background, followed by those of
1,380
Dominican background.
1000
500
219 45 208 187

0
Central American Cuban Dominican Mexican Puerto Rican South American
Chart 4: Number of Participants by Background – Chicago
3000 In the Chicago Field Center,

most participants are of Mexican
2,409
background, followed by those of
2250
Puerto Rican, Central American and
South American background.
1500
750 770
418 374
25 27
0
section v: description of participants 15

Chart 5: Number of Participants by Background – Miami
3000 In the Miami Field Center,

most participants are of Cuban
background, followed by those
2250 2,269
of Central American and South
American background.
1500
1,034
750
468
64 38 82
0
Chart 6: Number of Participants by Background – San Diego
4000 In the San Diego Field Center, the

3,817 vast majority of participants are of
Mexican background.
3000
2000
1000
61 9 2 39 43
0
Chart 7: Number of Participants by Age and Sex
6000 In the study, 6,701 participants are

in the 18 to 44 age group, 8,382 are
5,203
4500 in the 45 to 64 age group, and 1,332
3,801 are in the 65 to 74 age group.
3000 3,179
2,900
Sixty percent of the participants are
1500
women and 40 percent are men.
501
831
0
Age 18-44 Age 45-64 Age 65–74
Men Women

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
33% graduated from college with a

degree, and another 23 percent
23%
attended at least some college.
Thirty–three percent have less
27% than a high school education.
Less Than
High School High School Grad Some College College Degree
Chart 9: Percent of Participants by Yearly Household Income
Forty–two percent of the
10% participants have a yearly household

income of $20,000 or less.
12%
42%
36%
$20,000 $20,001– $50,001

or Less $50,000 or More Unknown

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
21% States or District of Columbia.
In this chart, participants from

Puerto Rico are reported among
79% those born outside the 50 States or
District of Columbia.
Not Born Born

in the U.S. in U.S.

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 10–19 20+

10 Years Years Years

clockwise from top left: Dietary interview; Height measurement; Lung function test; Measurement of ankle
blood pressure

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
strategies to help prevent heart disease). This includes: above: This figure shows how the arteries become
• 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.

Chart 13: Percent with Coronary Heart Disease by Age and Sex
16 More men than women reported

14 having CHD. For all men and
13.6
12 women, CHD increased with age.
10 The highest percentage with CHD
8 was in men aged 65–74 years.
6
6.0 5.9
4
3.4
2 1.1 0.8
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 14: Percent with Coronary Heart Disease by Background
6 The highest percentage of self–

reported CHD was for participants
5
4.9 of Puerto Rican background. The
4
lowest percentages were among
3 3.2 3.3 those of Central American, Mexican,
2.6 and South American backgrounds.
2 2.1
1.6
1
0
Chart 15: Percent with Stroke by Age and Sex
Stroke was determined by a participant’s self–reported history of stroke.
7 A higher percentage of men than

6 women reported a history of stroke.
5.9
5
For both groups, having a stroke
history increased with age. The
4
highest percentage of stroke was in
3 3.2
2.5
men aged 65–74 years.
2
1.8
1
0.8 0.3
0
Age 18-44 Age 45-64 Age 65–74
Men Women
section vi: disease conditions 21

Chart 16: Percent with Stroke by Background
5 A higher percentage of participants

of Dominican and Puerto Rican
4
backgrounds reported a history
3 of stroke than those in the other
groups. The lowest percentages were
2.5
2 2.3
reported by participants of South
1
1.5 1.4 American and Mexican backgrounds.
1.1
0.9
0
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

Chart 17: Percent with Asthma by Age and Sex
40 Asthma was equally common among

men and women in the 18 to 44 age
30 group. Above that age, it was more
common in women.
20
20.0 20.9
17.2
15.5
10 12.1 11.0
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 18: Percent with Asthma by Background
40 Participants of Puerto Rican, Cuban,
35.8
and Dominican backgrounds were
30 two to five times more likely to
report ever having asthma in their
20 21.2 lives than were participants of
16.0 Mexican background.
10 11.6
9.3
7.4
0
• 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).

Chronic obstructive pulmonary disease (COPD) was determined by a participant’s reported medical history.
Chart 19: Percent with COPD by Age and Sex
20 COPD increased with age in men

and women. Women had more self–
15 reported COPD than men.
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
20 The percentage of participants

who reported a history of COPD
16.8
15 was highest among those of Puerto
Rican background and lowest
10
10.1
among those of Central American
and South American backgrounds.
7.2
5 6.3
5.0 4.7
0
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).

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
are no longer at risk for decay, but may cause problems in above: Oral health exam
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 37.7
all age groups, women had a lower
30 32.4 percentage of untreated cavities
25 28.7
24.2
than men.
20
20.8
15
16.5
10
5
0
Age 18-44 Age 45-64 Age 65–74
Men 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
highest in participants of Central
35
35.4
30 33.7 American background and lowest
29.8
25 28.3 in participants of Dominican
20 22.9
20.7 background.
15
10
5
0

Chart 23: Percent with at Least One Missing Tooth by Age and Sex
100 In the two oldest age groups, about

90
three–fourths of participants are
80
70 75.1
79.6
76.7 75.8 missing at least one tooth.
60
50
40
41.7
30 36.3
20
10
0
Age 18-44 Age 45-64 Age 65–74
Men 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
by background. Those reporting
60 66.3 65.3
63.2 62.7 60.8 Mexican background had the lowest
50
49.4 percent missing, about 50 percent.
40
30 In the other groups, 60 to 66 percent

20 have one or more missing teeth.
10
0
• 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.

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

60
62.2
with hearing impairment increased
50 with age. About one in every two
40 43.8
participants aged 65–74 years had
30
hearing problems. Men had more
30.5
hearing impairment than women.
20
18.3
10
5.2 4.9
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 26: Percent with Hearing Impairment by Background

with hearing impairment was
20 21.0
highest among those of Puerto
17.6
15 16.5 16.6 Rican background. The percentages
14.5 14.8
among the other background groups
10
were fairly similar.
5
0
• 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.

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.
• Limit sodium, sweets, sugary beverages and red meats. above: Blood pressure measurement
Chart 27: Percent with Hypertension by Background
90 The percentage of participants with

80
hypertension increased with age.
70
77.4
72.4
60
50
40
40.3 41.6
30
20
9.2
10 6.8
0
Age 18-44 Age 45-64 Age 65–74
Men Women

Chart 28: Percent with Hypertension by Background
40 The percentages of participants

with a history of hypertension were
30 32.2 31.8 31.5 lowest among those of Mexican
26.1 and South American backgrounds
20 21.7
20.3
and highest among those of Cuban,
Dominican, and Puerto Rican
10
backgrounds.
0
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,

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
70 This chart shows the percentages

60 of participants with undesirable
61.1
58.0
50 cholesterol levels that were equal
51.9
40 to or greater than 200 mg/dl. The
36.8 38.2 percentage of participants with
30
26.2 undesirable cholesterol was lowest

20
in the youngest group. More men
10
and women aged 45–64 years had
0
Age 18-44 Age 45-64 Age 65–74 undesirable cholesterol levels than
the men and women, respectively, in
Men Women
the other age groups.
Chart 30: Percent with Undesirable Cholesterol Levels by Background
60 The percentages of participants

with undesirable cholesterol
50
47.3 47.8 48.0 levels were lowest among those
40 43.3
of Dominican and Puerto Rican
36.7 36.4
30 backgrounds.
20
10
0
• 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.

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.
left to right: Oral glucose tolerance test (diabetes test); Testing blood glucose level

Chart 31: Percent with Prediabetes by Age and Sex
50 Prediabetes was lowest in the

46.9 18–44 age group and highest in the
44.7
40 42.4
40.7 45–64 age group. In the middle and
30 33.0 oldest age groups, the percentages
of participants with prediabetes
20 23.7
were similar for men and women,
10 respectively.
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 32: Percent with Prediabetes by Background
50 Approximately one in three

participants had prediabetes in
40
each background group. There was
37.0 37.7
36.1 36.3
30 32.1
34.4 little difference in prediabetes by
background.
20
10
0

Chart 33: Percent with Diabetes by Age and Sex
50 Almost one out of two participants

45.8 46.6 in the oldest age group had diabetes
40
and one in four in the middle age
30 group had diabetes.
25.2 26.0
20
10
6.0 6.1
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 34: Percent with Diabetes by Background

diabetes was lowest in those of
20
18.9 19.2
South American background.
17.8 18.4
15
14.0
10
10.7
0
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.

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
60 In men, the percentage of obesity

50 was about the same for each age
48.7 47.3 group. For women, the percentage
40
38.0 37.0
of obesity was lowest in the
36.5
30 34.1
youngest age group.
20
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women

Chart 36: Percent with Obesity by Background
60 Obesity was highly prevalent in all

of the background groups. It was
50
46.8 highest among those of Puerto
40
38.5
41.1
38.8 Rican background.
37.1
30
30.3
20
10
0
• 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
40 The percentage of current smokers

was higher for men than women
30 in all age groups. In men, the
27.6
percentage of smokers declined
20 22.0 with age.
18.3
16.4
13.9
10
10.1
0
Age 18-44 Age 45-64 Age 65–74
Men Women

Chart 38: Percent of Current Cigarette Smokers by Background
40 The highest percentage of

participants reporting to be current
33.8
30 smokers was among those of
27.2 Puerto Rican background, followed
20 by those of Cuban background.
16.7 The lowest percentage of current
14.3
10 13.3
11.4 smokers was in participants of
Dominican background.
0
• 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.

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
45 More women than men in all age

40
groups reported high depressive
39.3
35
34.3 symptoms: about one in three of
30
25 29.0 women reported high depressive

20 23.7 22.9 symptoms. About one in five men
15 18.9 reported high depressive symptoms.
10 The highest percentage of high
5
depressive symptoms was reported
0
Age 18-44 Age 45-64 Age 65–74 in women aged 45–64 years and the
lowest was reported in men aged
Men Women
18–44 years.
Chart 40: Percent with High Levels of Depressive Symptoms by Background

40 participants reporting high
35 38.0
depressive symptoms was among
30
those of Puerto Rican background
25 27.9 27.4
20
24.9 24.2 and lowest was among those of
22.3
15 Mexican background.
10
0
• 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.

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 16.4
16.2 15.0
14.7 14.7
10 13.4
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 42: Median Anxiety Score by Background
40 There was very little difference in

35 anxiety by background.
30
25
20
15 16.8
14.7 15.6 15.5
14.3 14.4
10
0
• 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.

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
photo by larissa avilés-santa times per hour of sleep someone has breathing pauses.
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

30 sleep apnea increased with age and
29.5
25 was higher in men than in women at
20 22.0 all ages.
21.1
15
10
10.2
5 7.4
1.8
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 44: Percent with Sleep Apnea by Background

participants reporting sleep
12.6
apnea was among those of Cuban
10 11.1
10.1 10.2 background and the lowest was
9.3
8.1 among those of South American
5 background.
0

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
50
Although the percentages of sleep
problems varied by background
40 somewhat, approximately one in
35.5
32.6 32.6
34.6 three women reported symptoms
31.8 34.0
30 of snoring and one in five women
reported daytime sleepiness.
20.9 21.9
18.7 19.2 20.6
20
12.6
9.9
10 7.7
6.9 7.0
5.7
4.2
0
Sleepiness Snoring Stop Breathing
Chart 46: Percent of Men with Sleep Problems by Background
50
Reports of snoring were more
43.8 43.1
frequent in men compared
42.4
40 to women. In men, a higher
37.2 37.3
35.2
percentage of participants who
30 stopped breathing during sleep
24.1 were among those of Cuban and
22.0
19.0 18.4 18.4
20 Puerto Rican backgrounds and
16.5
lowest among those of South
11.0 10.4
8.4
10 7.6 American background.
6.4
4.1
0
Sleepiness Snoring 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).

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
50 In women, about 43 percent of those
43.8
aged 18–44 years had no risk factors,
40 42.6
but only about 7 percent of those
30 33.1 34.1 aged 65–74 years had no risk factors.
30.2
27.1 26.8
20
18.5
15.9 14.9
10
7.2
5.8
0
Age 18-44 Age 45-64 Age 65–74
0 Risk Factors 1 Risk Factors 2 Risk Factors 3+ Risk Factors
Chart 48: Percent of Men with Multiple Risk Factors by Age
50 Similarly in men, younger age groups
44.2
had fewer risk factors than older
40
age groups. In the oldest age group,
34.7
30 about 44 percent had three or more
28.9 30.6 29.7
28.7 27.7
24.6
unfavorable risk factors.
20
19.4
10 12.0 11.9
6.7
0
Age 18-44 Age 45-64 Age 65–74
0 Risk Factors 1 Risk Factors 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.

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
60 A healthy diet should include plenty

56.6 of fruits and vegetables. More men
50 54.3
45.0
consumed at least 5 fruits and
40 41.9 42.1
vegetables (without fried potatoes)
30 33.6
per day than women. This percentage
20 improved in older ages.
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women

Chart 50: Percent Eating 5 or More Fruits and Vegetables by Background
60 While almost half of all

55.0 participants from Cuban and
50
49.4 South American backgrounds
47.4
40 43.9
38.9 reported eating at least 5 fruits and
30 vegetables per day, only one out of
20 five Puerto Ricans met this target.
19.2
10
0
Chart 51: Percent Consuming Less Than 2,300 mg Sodium by Age and Sex

44.2
consuming less than 2,300 mg of
40
sodium per day increased with age.
35.4
30 Across age groups, women consumed
less sodium than men.
20 23.4
10
10.6
3.6 7.0
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 52: Percent Consuming Less Than 2,300 mg Sodium by Background
50 A higher percentage of Dominican

followed by Puerto Rican, Mexican,
40
and Central American backgrounds
30 33.2 reported consuming less than
2,300 mg of sodium per day.
20
20.5 21.7
18.2
10 13.3
4.8
0
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
60 percent of calories from saturated
50 54.5 54.8 54.9 54.8
fat. Men and women had equal
40 46.2 46.2
percentages.
30
20
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 54: Percent Consuming Less Than 10% Calories from Saturated Fat by Background
80 Nearly two out of three participants

70 of Dominican, South American and
67.8
60
61.2 61.5
Central American backgrounds
50 reported meeting intake of less
47.7 48.5
40 than 10 percent of calories from
39.3
30 saturated fat; one out of two
20
participants of Mexican and Cuban
10
backgrounds met this intake.
0
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

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
50 Men aged 18–44 years reported more

recreational physical activity than
40 43.1
older men and women of all ages.
30
20
19.9
15.8
10 12.7
9.9 10.2
0
Age 18-44 Age 45-64 Age 65–74
Men Women

Chart 56: Average Minutes per Day of Recreational Physical Activity by Background
50 Participants of Cuban background

reported less recreational physical
40
activity than the other background
30 groups.
28.3
20 23.3 22.0
19.8
17.7 18.0
10
0
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
140 Men aged 18–44 years reported more

120 126.8 minutes per day of work–related
100 physical activity than older men and
80 89.8 women of all ages. Men and women
60
aged 65–74 years engaged in fewer
51.3 51.3 minutes of work–related physical
40
activity than younger participants.
20
19.2 21.8
0
Age 18-44 Age 45-64 Age 65–74
Men 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
91.7 other background groups.
80 88.0
60 66.3 68.1
59.4 63.5
40
20
0

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

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
100 For hypertensive men, awareness of

90
their hypertension increased with
80
70
78.5 78.3 78.5 age. Hypertensive women generally
72.6
69.9
60 were more aware of hypertension
50 57.7
than men.
40
30
20
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 60: Percent Aware of Hypertension by Background
100 Hypertensive men of Central

90 American background were less
80
aware and participants of Cuban
70 74.9 73.4
70.5
60 66.3
63.5
background were more aware of
59.8
50 their hypertension.
40
30
20
10
0
• Assessment of blood pressure though routine medical practice or community screenings can increase awareness of
hypertension so that treatment can be obtained.

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
100 In the 18-44 age group, about half

90
of the women and about a third
80
70
of the men were under treatment
68.8 72.4 71.4
60 for hypertension. In the 65–74 age
50 55.9
54.3 group, participants under treatment
40
30 37.7 increased to almost three–fourths
20 under treatment.
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 62: Percent Under Hypertension Treatment by Background
100 A higher percentage of

90 participants of Cuban and Puerto
80
Rican backgrounds were under
70
60 hypertension treatment than the
60.6 59.4
50 54.6
50.3 50.8
other background groups. The
40
43.0 lowest percentage of participants
30
20 under treatment was among those of
10 Central American background.
0
• 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
100 The poorest control was seen in the

90
hypertensive group of men aged
80
70
18–44 years, with only one–fourth
60 of them under control.
50
40 45.7
41.8 39.7
30 34.1 34.2
20
23.3
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 64: Percent with Hypertension Under Control by Background
100 Hypertensive participants of Cuban

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
38.9 of hypertensive participants of
30 33.8
32.8 31.3
20 Central American background had
19.5
10 their condition under control.
0
• If you have hypertension, follow the advice of a health professional to keep your blood pressure under control.

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
100 About two-thirds of participants

90
who had diabetes were aware of it.
80
70 77.4 Older participants were more likely
69.3
60
61.6 64.4 66.8 than younger participants to be
50 56.4
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 Age 65–74
Men Women
Chart 66: Percent Aware of Diabetes by Background
100 More than 70 percent of participants

90 of Puerto Rican and Dominican
80
backgrounds were aware that they
70
70.2 72.1
60 had diabetes, whereas fewer from
61.6 60.8
58.4 56.4
50 Central American, Mexican, Cuban,
40
and South American backgrounds
30
20 were aware.
10
0
• Medicines, diet and exercise can all help lower sugar in the blood and prevent diabetes complications.

Chart 67: Percent Under Diabetes Treatment by Age and Sex

90
under treatment for diabetes
80
70
increased with age. It was higher
73.2
60 in women than in men aged 45–64
56.1 59.3
50
years, but was higher in men than
40 48.4
30
40.5 40.5 women aged 65–74 years.
20
10
0
Age 18-44 Age 45-64 Age 65–74
Men Women
Chart 68: Percent Under Diabetes Treatment by Background
100 More diabetic participants of Puerto

90 Rican background reported being
80
treated for diabetes than those of
70
60 Central American and Dominican
50 53.0 backgrounds who, in turn, were
40
49.3 48.8 46.5
41.8 40.0 more likely to be treated than
30
20 those of Mexican, Cuban, or South
10 American backgrounds.
0

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
70
under control. Control over diabetes
60
61.5
increased slightly with age.
50 52.9 54.3 54.3 54.0
40
41.2
30
20
10
0
Age 18-44 Age 45-64 Age 65–74
Men 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
60 diabetes than those of Mexican,
57.4
50 54.7 Dominican, South American, and
47.7 49.6
40 47.1
43.9 Central American backgrounds.
30
20
10
0
• Taking medications prescribed by the doctor can help lower blood sugar to an acceptable level and prevent
diabetes complications.

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
80 Among the four field centers, the

70
70.7 highest percentage of participants
60 without health insurance was in the
56.8
50 54.1
Miami Field Center 18–64 age group
40
and the lowest percentage without
30
27.7
health insurance was in the Bronx
20 26.1
16.9
19.2 Field Center 65–74 age group. The
10
4.1 younger age group was more likely
0
Bronx Chicago Miami San Diego to be without health insurance than
the older age group.
Age 18–64 Age 65–74
types of health insurance

Chart 72: Percent with Employer Health Insurance by Age and Field Center
60 Approximately half of the

50 participants in the Chicago and
50.3 49.2
San Diego Field Centers 18–64 age
40
group had insurance through their
30
employers.
27.0
20
20.5
17.8 16.9
10 14.9
3.8
0
Bronx Chicago Miami San Diego
Age 18–64 Age 65–74

Chart 73: Percent with Medicaid Health Insurance by Age and Field Center
80 Most participants from the Bronx

70 and Miami had insurance through
69.4
65.1
60 Medicaid.
50 52.4
40 42.8
30 35.4
20 22.4 22.8
10
11.3
0
Age 18–64 Age 65–74
Chart 74: Percent with Medicare Health Insurance by Age and Field Center
90 The majority of participants in

80
the 65–74 age group were insured
70 75.4 75.2
69.2 71.1 through Medicare.
60
50
40
30
20
8.8 11.0 9.8
10 5.0
0
Age 18–64 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 • For treatment, first know your blood pressure,
diabetes and high 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. • Seek advice from a medical provider on the best way
Other studies have shown the harmful consequences of 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.

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]

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: NHLBIinfo@nhlbi.nih.gov
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.
Suggestion Citation: Hispanic Community Health Study/Study of Latinos Data Book: A Report to the Communities (NIH
Publication No. 13-7951). Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health,
National Heart, Lung, and Blood Institute. September 2013.

Hispanic Community Health Study Data Book: A Report To The Communities

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Data Book

A Report to the Communities

A Report to the Communities

NIH Publication No. 13-7951

IV. Field Center Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

V. Description of Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

VI. Disease Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

IX. Awareness, Treatment, and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Gary H. Gibbons, M.D.

Investigators contributing to this report:

Abreu, Maria de los Angeles, MPA, CCPR Giachello, Aida, PhD

Arredondo, Elva, PhD González, Sara, PhD

Avilés–Santa, Larissa, MD, MPH Heiss, Gerardo, MD, PhD

Barr, R. Graham, MD, DrPH Isasi, Carmen, MD, PhD

Beck, James, PhD Kaplan, Robert, PhD

Birnbaum–Weitzman, Orit, PhD Redline, Susan, MD, MPH

Buelna, Christina, MA Rodríguez, Bárbara, MS(c)

Cai, Jianwen, PhD Sanchez, Carlos, MD

Castañeda, Sheila F., PhD Schneiderman, Neil, PhD

Daviglus, Martha, L., MD, PhD Silsbee, Lorraine, MHS

6 hchs/sol data book: a report to the communities

Sorlie, Paul, PhD Wilkins, Tania M., MS

Sotres, Daniela, DrPH Youngblood, Marston, MA, MPH

Talavera, Ana, MPH

section ii: acknowledgments 7

photo by larissa avilés-santa

how to read this data book – a guide

8 hchs/sol data book: a report to the communities

Community: Bronx, Chicago, Miami, and San Diego.

The title describes the chart as the percentage of

27% percent of the participants (orange area) had less than

Chart 2: Number of Participants by Background – Chicago (Bar Chart Example)

3000 This title describes the chart as the number of

section iii: introduction 9

Puerto Ricans are the largest Hispanic/Latino background

The Bronx has played an important role in shaping

10 hchs/sol data book: a report to the communities

chicago field center

photos by larissa avilés-santa

section iv: field center descriptions 11

“The study is superb and I enjoyed my visit to the clinic.”

miami field center

clockwise from top left: Mosaic tiles in

In 2010, more than 2.5 million people were living in Miami–

12 hchs/sol data book: a report to the communities

“This is an excellent study because many people need to know

san diego field center

photo by larissa avilés-santa

section iv: field center descriptions 13

A San Diego Participant

Field Center Locations

14 hchs/sol data book: a report to the communities

Chart 3: Number of Participants by Background – Bronx

2000 In the Bronx Field Center, most

219 45 208 187

Chart 4: Number of Participants by Background – Chicago

3000 In the Chicago Field Center,

section v: description of participants 15

3000 In the Miami Field Center,

Chart 6: Number of Participants by Background – San Diego

4000 In the San Diego Field Center, the

Chart 7: Number of Participants by Age and Sex

6000 In the study, 6,701 participants are