Wisconsin Department of Health ServicesJanuary 2014 P-00522T

Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Hispanics/Latinos

HISPANIC/LATINO POPULATION

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Key points

Data• Demographic and socioeconomic data• Access to and use of health care services• Risk behaviors and health outcomes

References

Links to additional reports and resources

Contacts

Chapter Outline

Chapter outline

2

HISPANIC/LATINO POPULATION

Report Overview

• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track the progress on objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.

• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.

• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

3

HISPANIC/LATINO POPULATION

Report Format

Full Report• Format: PDF • Intended use: reference document

Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to

– Decision-makers– Service providers– Community leaders– The public

Sample annotated slide

Report overview

4

HISPANIC/LATINO POPULATION

Report Outline

Executive Summary

Section 1: Introduction

Section 2: Demographic overview

Section 3: Health focus areas

Section 4: Infrastructure focus areas

Section 5: Data summaries by population

Section 6: Technical notes

Report overview

5

HISPANIC/LATINO POPULATION

Report Outline: Detail

Section 3: Health focus areas

• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure

Section 4: Infrastructure focus areas• Access to health services

Report overview

6

HISPANIC/LATINO POPULATION

Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography

Report overview

7

HISPANIC/LATINO POPULATION

Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• The 95% confidence intervals are denoted by error bars. Where

confidence intervals do not overlap, as shown in the example on

the right, differences are statistically significant. Larger confidence

intervals may indicate less reliable estimates that should be

interpreted with caution.

• Population estimates that are considered unreliable are excluded.

• Misclassification of racial/ethnic groups may affect the accuracy of rates.

• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

Report overview

8

HISPANIC/LATINO POPULATION

Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

9

HISPANIC/LATINO POPULATION

Historical trauma• Historical trauma is the cumulative exposure to traumatic events

that not only affect the individual exposed, but continue to affect subsequent generations.

• Descendants of those who experienced the traumatic stressor may still exhibit symptoms.

• Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty.

• Current manifestations may include:• Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse,

suicide, homicide, and domestic violence; and • Higher rates of chronic diseases.

Report overview

Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp

10

HISPANIC/LATINO POPULATION

Key Points: Hispanic/Latino population

• Demographics: The Hispanic/Latino population in Wisconsin is younger than the general population, widely distributed geographically, and growing.

• Socioeconomic status: Hispanics in Wisconsin are more likely to live in poverty and less likely to have a college degree compared to non-Hispanic Whites.

• Access to health care: Hispanics have less access to health care compared to other racial/ethnic groups.

11

Key points

HISPANIC/LATINO POPULATION

Key Points: Hispanic/Latino population

• Key health issues for Hispanic adults include: consequences of lack of exercise, obesity, high blood pressure, diabetes, unintended pregnancies, lack of emotional support, and (among Hispanic men) alcohol and tobacco use.

• Better data on Hispanics are needed due to small sample sizes, racial/ethnic misclassification, data access issues, and differences between foreign- and U.S. born- Hispanics.

12

Key points

HISPANIC/LATINO POPULATION

Demographic and socioeconomic data

13

HISPANIC/LATINO POPULATION

Demographic characteristics

Wisconsin’s Hispanic/Latino population is increasing in numbers, young, and diverse in terms of country of origin. Nearly one-third are foreign born.

• Wisconsin's Hispanic population, 2010: 336,056; 5.9% of state total

• Change in the Hispanic population, 2000 to 2010: 73% increase

• Median age, 2010: Hispanic, 23 years (Whites, 41.5 years)

The median age is the age at which half the population is older and half is younger.

• Percent of Hispanics who were foreign-born, 2010: 32% (Total population, 4%)

Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.

14

Demographic and socioeconomic data

HISPANIC/LATINO POPULATION

Socioeconomic data

Wisconsin’s Hispanic population has a higher poverty rate and less education compared to Whites.

• Median household income in Wisconsin, 2008-2010: Hispanics, $36,800 (Whites, $53,000)

• Poverty rate, 2010: Hispanics, 28% (Whites, 10%) The poverty rate is the percent living below the federal poverty level.

• Bachelor’s degree or more education (age 25 and older), 2007-2010: Hispanics, 11% (Whites, 27%)

• Married-couple households as a percent of family households, 2008-2010: Hispanics: 61% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%)

Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau, American Community Health Survey.

15

Demographic and socioeconomic data

HISPANIC/LATINO POPULATION

Hispanic/Latino population by county, Wisconsin, 2010

Source: U.S. Census, 2010.

Demographic and socioeconomic data

Hispanic35 - 3,522

3,523 - 12,124

12,125 - 28,925

Hispanics as a percentof total population

0.6% - 2.3%

2.4% - 4.3%

4.4% - 7.6%

7.7% - 13.3%

126,039

16

HISPANIC/LATINO POPULATION

Level of urbanization of Wisconsin residents, by race/ethnicity, 2007-2011

Source: American Community Survey, 2007-2011..

White Black American Indian Asian Hispanic0%

10%

20%

30%

40%

50%

60%

70%

80%

11% 67% 12% 24% 37%59% 28% 39% 66% 48%30% 4% 49% 10% 15%

Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties

17

Demographic and socioeconomic data

HISPANIC/LATINO POPULATION

Source: American Community Survey, 2010.

Country of origin of foreign-born Hispanic/Latino residents, Wisconsin, 2010

Mexico; 80%

South America; 9%

Central America; 7%

Carribean; 3% Other; 2%

18

Demographic and socioeconomic data

HISPANIC/LATINO POPULATION

Access to and use of health care services

19

HISPANIC/LATINO POPULATION

Lack of health insurance coverage and Medicaid enrollment among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Access to health care

20

No health insurance coverage, ages 18-64

Receive Medicaid or BadgerCare, all adults

0%

10%

20%

30%

40%

50%

60%

13% 12%19% 39%35% 21%19% 27%

WhiteBlackHispanicAmerican Indian

HISPANIC/LATINO POPULATION

Public health insurance coverage and inadequacy of health insurance among children ages 6-17, by race/ethnicity, Wisconsin, 2011-2012

Source: 2011-2012 National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children.

Public insurance Current insurance not adequate0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

27% 26%71% 26%51% 22%

WhiteBlackHispanic

Access to heath care

21

HISPANIC/LATINO POPULATION

Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, 2008-2011

Did not have a doctor's visit in past year

Do not have a personal doctor Unable to obtain medical care due to cost

0%

10%

20%

30%

40%

50%

60%

35% 16% 10%21% 16% 18%33% 20% 20%25% 17% 21%33% 16%

White Black

Hispanic Asian

American Indian

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

22

Access to health care

HISPANIC/LATINO POPULATION

Age-adjusted rates of tooth removal and dental visits in the past year among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010.

Had at least 1 permanent tooth removed Did not visit dentist within past year0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

35% 27%60% 35%46% 44%40% 20%51% 44%

WhiteBlackHispanicAsianAmerican Indian

Oral Health

23

HISPANIC/LATINO POPULATION

Source: 2011-2012 National Survey of Children's Health.Note: Wisconsin estimates were only available for White, Black, and Hispanic children.

Lack of routine preventive medical and dental care among children, by race/ethnicity, Wisconsin, 2011-2012

Did not receive routine preventive medical and dental care during the past 12 months 0%

10%

20%

30%

40%

50%

60%

70%

30% 42% 41%

WhiteBlackHispanic

24

Access to health care

HISPANIC/LATINO POPULATION

Risk factors among youth and adults

25

HISPANIC/LATINO POPULATION

Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, 2008-2011

Physical health

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. 26

Fair or poor health Physical health not good on at least one day during past month

Of those with at least one day of poor health, percent whose poor health limited usual activities on

at least one day during past month

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12% 35% 67%31% 49% 68%23% 42% 75%17% 46% 64%32% 78%

WhiteBlackHispanicAsianAmerican Indian

HISPANIC/LATINO POPULATION

Age-adjusted rate of physical inactivity among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

Did not participate in any physical activity in past month, other than at job

-10%

0%

10%

20%

30%

40%

50%

60%

22% 37% 33% 28% 26%

WhiteBlackHispanicAsianAmerican Indian

Physical Activity

27

HISPANIC/LATINO POPULATION

Obesity among children (ages 2-4 years) enrolled in WIC, by race/ethnicity, Wisconsin, 2001 and 2010

White Black Hispanic Asian American Indian0%

5%

10%

15%

20%

25%

30%

35%

40%

10% 8% 16% 18% 18%12% 11% 18% 17% 27%

2001 2010

Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey, 2010.Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.

Nutrition

28

HISPANIC/LATINO POPULATION

Age-adjusted rate of frequent mental distress among Wisconsin adults, by race/ethnicity, 2009-2011

Frequent mental distress 0%

5%

10%

15%

20%

25%

30%

35%

40%

9% 18% 18% 11%

WhiteBlackHispanicAmerican Indian

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Question asked in 2009-2011. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Mental health

29

HISPANIC/LATINO POPULATION

Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by race/ethnicity, 2008-2010

Mental health

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions were not asked in 2011. Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age-adjusted. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Insufficient sleep Sometimes, rarely, or never receive emotional support0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

20% 16%23% 27%23% 28%18% 23%

White Black

Hispanic American Indian

30

HISPANIC/LATINO POPULATION

Age-adjusted rate of smoking among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Tobacco use and exposure

Current smoker0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

20% 29% 27% 34%

White Black

Hispanic American Indian

31

HISPANIC/LATINO POPULATION

Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, 2009-2011

Healthy growth and development

Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, 2009-2011. 32

Percent of births in which pregnancy was unintended0%

10%

20%

30%

40%

50%

60%

70%

32% 65% 43%

White Black

Hispanic

HISPANIC/LATINO POPULATION

Health Outcomes

33

HISPANIC/LATINO POPULATION

Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Ever been told you have high cholesterol Ever been diagnosed with high blood pressure0%

10%

20%

30%

40%

50%

60%

31% 25%40% 39%28% 35%23% 38%

White Black

Hispanic American Indian

Chronic diseases

34

HISPANIC/LATINO POPULATION

Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Ever been diagnosed with diabetes Ever been told you have prediabetes0%

5%

10%

15%

20%

25%

7% 6%17% 7%10% 8%16%

WhiteBlackHispanicAmerican Indian

35

Chronic diseases

HISPANIC/LATINO POPULATION

Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010

Source: Wisconsin Inpatient Hospitalization Discharges, 2010.Note: Hospitalization rates considered unreliable are excluded.

0

5

10

15

20

25

30

5.6 2.026.3 7.414.9 17.1

White Black

Hispanic Other

Rat

e p

er

10

,00

0 p

op

ula

tio

n

36

Chronic diseases

HISPANIC/LATINO POPULATION

Incidence of end-stage renal disease incidence among Wisconsin adults, by race/ethnicity, age-adjusted rate per 100,000, 2009

Incidence of end-stage renal disease with diabetes as primary diagnosis0

10

20

30

40

50

60

8.7 45.1 44.3

WhiteBlackHispanic

Age-

adju

sted

rate

per

100

,000

pop

ulati

on

Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (RenDER) System.Note: Incidence rates considered unreliable are excluded.

37

Chronic diseases

HISPANIC/LATINO POPULATION

Reported cases of HIV (ages 15-59) by race and ethnicity, rate per 100,000, Wisconsin, 2007-2011

Source: Wisconsin HIV Surveillance System.Note: Hispanic population may include individuals of various races.

Reproductive and sexual health

Male Female0

10

20

30

40

50

60

70

80

6169 2529 69 76

White Black

Hispanic Asian

American Indian

Ra

te p

er

10

0,0

00

po

pu

lati

on

38

HISPANIC/LATINO POPULATION

References

1. Overview of Race and Hispanic Origin: 2010, 2010. Census Briefs, March 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

2. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach

3. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

4. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

5. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

6. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

7. Centers for Disease Control and Prevention (CDC). Health Care: See Why Being Insured Matters. http://www.cdc.gov/features/vitalsigns/HealthcareAccess/

8. Cheung PT, Wiler JL, Lowe RA, Ginde AA (2012). National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries. Annals of Emergency Medicine. 60(1). http://www.annemergmed.com/webfiles/images/journals/ymem/FA-PTCheung.pdf

39

References

HISPANIC/LATINO POPULATION

9. Kaiser Commission on Medicaid and the Uninsured. Next Steps in Covering Uninsured Children. Findings from the Kaiser Survey of Children’s Health Coverage. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7844.pdf

10. CDC. Regular Check-Ups Are Important. http://www.cdc.gov/family/checkup/

11. American Dental Association. American Dental Association Statement on Regular Dental Visits. http://www.ada.org/8700.aspx

12. CDC: Physical Activity. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html

13. CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm

14. CDC. Self-Reported Frequent Mental Distress Among Adults --- United States, 1993—2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a1.htm

15. CDC. Insufficient sleep is a public health epidemic. http://www.cdc.gov/features/dssleep/

16. CDC. Health-related quality of life: Well-being concepts. http://www.cdc.gov/hrqol/wellbeing.htm#four

17. CDC. PNSS Health Indicators. http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm#Smoking/Drinking Indicators

40

References

HISPANIC/LATINO POPULATION

18. CDC. Unintended Pregnancy Prevention. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/

19. CDC. Cholesterol. http://www.cdc.gov/cholesterol/20. CDC. High Blood Pressure Facts. http://www.cdc.gov/bloodpressure/facts.htm21. CDC. National diabetes fact sheet: National estimates and general information on

diabetes and prediabetes in the United States, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

22. Agency for Healthcare Research and Quality. Diabetes mellitus: hospital admission rate for long-term complications. http://www.qualitymeasures.ahrq.gov/content.aspx?id=38559

23. National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Statistics, 2011. http://diabetes.niddk.nih.gov/dm/pubs/statistics/

24. Ward MM, et al. Access to care and the incidence of end-stage renal disease due to diabetes. http://care.diabetesjournals.org/content/32/6/1032.full.pdf+html

25. CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

41

References

HISPANIC/LATINO POPULATION

Links to additional reports and resources

• Centers for Disease Control and Prevention, Minority Health, Hispanic or Latino Populations: http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html

• Centers for Disease Control and Prevention, Immigrant and Refugee Health: http://www.cdc.gov/immigrantrefugeehealth/

• U.S. Department of Health and Human Services, Office of Minority Health, Hispanics/Latinos: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=33

• American Diabetes Association: Información en Español: http://www.diabetes.org/espanol/

• The National Women’s Health Information Center (en Español): http://es.bodylogicmd.com/enlaces/the-national-womens-health-information-center

• National Alliance for Hispanic Health: http://www.hispanichealth.org/• National Council of La Raza: http://www.nclr.org/

42

Links

HISPANIC/LATINO POPULATION

Contacts

Evelyn Cruz, Minority Health OfficerWisconsin Division of Public Health, Office of Policy and Practice AlignmentE-mail: Evelyn2.Cruz@dhs.wisconsin.gov

Karl Pearson, DemographerWisconsin Division of Public Health, Office of Health InformaticsE-mail: KarlT.Pearson@dhs.wisconsin.gov

43

Contacts