CHAPTER 6
HEALTH

Minority groups face particular health-care challenges in addition to those of the general population. The Office of Minority Health was created in 1985 to advocate culturally and linguistically competent services and prevention efforts for minority communities. Among their main areas of concern:

• Infant mortality (death) rates for African-Americans and Native Americans/Alaska Natives are significantly higher than they are for whites.
• African-American men under age sixty-five develop prostate cancer at a rate nearly twice that of white Americans.
• Asians and Pacific Islanders (APIs) have the highest rates of tuberculosis.
• Hispanics have two to three times the rate of stomach cancer.
• Native Americans/Alaska Natives suffer from diabetes at nearly three times the average rate, while African-Americans suffer 70 percent higher rates than whites.
• More than 75 percent of AIDS cases among women and children occur among racial or ethnic minorities.

SOCIAL CHARACTERISTICS OF MINORITY POPULATIONS THAT AFFECT HEALTH

The demographic profiles of non-Hispanic African-Americans, Hispanics, Asians, Pacific Islanders, Native Americans, and Alaska Natives differ considerably from those of the nonminority population. Because a high percentage of minorities live in urban areas, they are exposed to a greater number of environmental hazards, including pollution, traffic hazards, substandard and/or overcrowded housing, and crime. Occupational risks are also greater for minorities because a greater percentage of them are employed in potentially dangerous jobs. In addition, the amount of stress in changing cultural environments and the lack of resources for solving stressful situations can play a critical role in the mental health of minority groups.

Differences exist within each minority group concerning the number and status of native-born versus foreign-born persons, age at time of immigration, and how fully group members have assimilated into American society. Moreover, dietary patterns are different among the various minority groups and vary according to how thoroughly minorities have adopted nonminority eating patterns.

SELF-ASSESSMENT OF HEALTH

In addition to indicating physical and mental illnesses, the way people feel often reflects their attitudes toward themselves and society. In 2001, 15.5 percent of non-Hispanic African-Americans reported their health as fair or poor, compared to 7.9 percent of non-Hispanic white individuals. Approximately 14.5 percent of Native Americans and Alaska Natives reported their health as fair or poor, as did 8.1 percent of Asians. Approximately 12.7 percent of Hispanics reported their health as fair or poor, and 12.5 percent of Mexican-origin Hispanics reported their health as fair or poor. (See Table 6.1.)

PREGNANCY AND BIRTH

The importance of early prenatal care cannot be overemphasized, as doctors are now better able to detect, and often correct, potential problems early in pregnancy. While every pregnant woman should receive prenatal care, the National Center for Health Statistics believes the United States is capable of guaranteeing that more than 90 percent of pregnant women receive prenatal care during the first trimester of pregnancy.

In 2001, 83.4 percent of all women in the United States received prenatal care during their first trimester of pregnancy, but that percentage was significantly lower among some minority groups. While 88.5 percent of non-Hispanic white women received prenatal care during

their first trimester, only 74.5 percent of African-American women did so. Asian and Pacific Islander (API) women were likely to get prenatal care early in their pregnancies, as 84 percent received care in their first trimester in 2001. Only 75.7 percent of Hispanic women and 69.3 percent of Native American women, however, did so. (See Table 6.2.)

Births and Fertility

Of the 4.1 million births in 2000, 2.4 million were white, 604,346 were African-American, and 815,868 were Hispanic. However, despite a higher number of white births compared to African-American and Hispanic births, the fertility rate—the number of live births per 1,000 women ages fifteen to forty-four in a specified

group—for Hispanics and African-Americans was higher than that of white Americans. The fertility rate for non-Hispanic white Americans was 58.5 in 2000, compared to 73.7 for non-Hispanic African-Americans and 105.9 for Hispanics. (See Table 1.4 in Chapter 1.)

Low Birth Weight and Infant Mortality

Moderately low birth weight is defined as being equal to 1,500 to 2,499 grams (3.3 to 5.5 pounds). Very low birth weight is less than 1,500 grams. Low-birth-weight babies, as well as premature babies (born before thirty-seven weeks of gestation), often suffer serious health problems and encounter development problems later in life. In 2001 African-Americans were more likely to have low-birth-weight babies than other racial and ethnic groups. In that year, 13.1 percent of non-Hispanic African-American babies were born with low birth weights, followed by 9.3 percent of Puerto Rican–origin Hispanics and 8.7 percent of Filipinos. Chinese women, at 5.3 percent, were least likely to give birth to low-birth-weight babies. (See Table 6.3.)

The percentage of babies born with low birth weights has increased over the past two decades. While the percentage of non-Hispanic African-American low-birth-weight births declined slightly from 13.3 percent in 1990 to 13.1 percent in 2001, it is still higher than the 12.7 percent registered in 1980. The percentage of low-birth-weight births among white non-Hispanics, Hispanics, Native Americans and Alaska Natives, and APIs has increased since 1980. Approximately 5.7 percent of non-Hispanic white women gave birth to low-birth-weight babies in 1980, compared to 6.7 percent in 2001. Among Hispanics, 6.1 percent of babies born in 1980 had low birth weights, compared to 6.5 percent in 2001. Among Native Americans and Alaska

Natives, 6.4 percent of babies born in 1980 had low birth weights, compared to 7.3 percent in 2001. Approximately 6.7 percent of APIs had low-birth-weight babies in 1980, compared to 7.5 percent in 2001. (See Table 6.3.)

The infant mortality rate (rate of deaths before one year of age) has declined for most races and ethnic groups. In 2001 non-Hispanic African-Americans suffered the highest rate of infant mortality, with 13.5 deaths per 1,000 live births. That rate was more than double the rate for non-Hispanic whites, which was 5.7 deaths per 1,000 live births. Hispanic women had 5.4 deaths per 1,000 live births, while Native Americans and Alaska Natives had 9.7 deaths (a substantial increase over 8.3 percent in 2000) and APIs had 4.7 deaths per 1,000 live births. (See Table 6.4.)

DOCTOR AND DENTIST VISITS

Since the 1980s, as more outpatient clinics and other out-reach health facilities have opened, most Americans have had increased opportunities to seek medical help. The National Center for Health Statistics (NCHS) reported that in 2001 minorities were more likely than whites to have made no health-care visits to a doctor's office or an emergency department during the past twelve months. While 14.3 percent of non-Hispanic whites made no visits to a doctor's office or an emergency department, 16.4 percent of non-Hispanic African-Americans made no such visits. Among Hispanics, 27 percent of the population made no health-care visits to a doctor's office in 2001. Approximately 31.4 percent of Mexican-origin Hispanics made no visits to a doctor's office in 2001. Native Americans/Alaska Natives and APIs were also more likely than non-Hispanic whites to refrain from seeing a doctor. Approximately 21.4 percent of Native Americans and Alaska Natives made no visits to a doctor's office in 2001, compared to 20.8 percent of Asians. (See Table 6.5.)

Among non-Hispanic whites between the ages of eighteen and sixty-four, 68.7 percent reported in 2001 that they had visited a dentist within the past year. Only 57.1 percent of non-Hispanic African-Americans had been to a dentist in the past year, as had only 49.2 percent of Hispanics. Among Native Americans and Alaska Natives, 47.7 percent of people between the ages of eighteen and sixty-four had visited a dentist; among Asians, 64.3 percent had visited a dentist. (See Table 6.6)

HEALTH INSURANCE

According to the NCHS, in 2001, 19.2 percent of non-Hispanic African-Americans under the age of sixty-five had no private health insurance coverage, compared to 11.9 percent of their non-Hispanic white counterparts. More than a third (34.8 percent) of all Hispanics had no insurance, while 17.1 percent of Asians failed to have health insurance. (See Table 6.7.)

In 2001 Medicaid (the federally funded health-care program for low-income people) covered 7 percent of non-Hispanic whites, 20.3 percent of non-Hispanic African-Americans, 15.5 percent of Native Americans/Alaska Natives, and 8.8 percent of Asians under age sixty-five in 2001. Approximately 16 percent of all Hispanics were covered by Medicaid, including 28.5 percent of all Puerto Ricans. (See Table 6.8.)

CIGARETTE SMOKING

In 2001 Native Americans and Alaska Natives were more likely to smoke than any other group, with 40.4 percent

reported as smokers. Next came non-Hispanic whites with 27.4 percent, non-Hispanic African-Americans with 25.7 percent, Hispanics with 23.1 percent, and Asians with 16.2 percent. Among Asian subgroups, Vietnamese (26.5 percent) and Koreans (27.2 percent) had the largest number of smokers. Among Hispanics, 30.4 percent of

Puerto Ricans smoked cigarettes, by far the highest rate for a Hispanic subgroup. (See Table 6.9.)

DRUG ABUSE AMONG MINORITY POPULATIONS

In 2001, 67.7 percent of non-Hispanic white Americans aged eighteen and over reported that they had consumed alcohol within the past month, compared to 51.5 percent of Native Americans/Alaska Natives, 49.8 percent of Hispanics, 46.5 percent of non-Hispanic African-Americans, and 44.7 percent of Asians. (See Table 6.10.) In terms of binge drinking, defined as five or more drinks on one occasion in at least one day in the previous month, Native Americans and Alaska Natives had the greatest percentage, with 34.6, followed by Hispanics with 32.2

percent, non-Hispanic whites with 32 percent, Asians with 23.2 percent, and non-Hispanic African-Americans with 20.5 percent. (See Table 6.10.)

Illicit Drug Use

According to the Centers for Disease Control and Prevention (CDC), illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens (including LSD and PCP), inhalants, or any prescription-type psychotherapeutic drug used nonmedically. In 2001, 7.4 percent of non-Hispanic African-Americans over the age of twelve had used an illicit drug in the past month. Among non-Hispanic whites, the percentage was 7.2 percent, for Hispanics it was 6.4 percent, and Asians just 2.8 percent. On the other hand, 7.5 percent of Native Hawaiian and other Pacific Islanders and 9.9 percent of Native Americans and Alaska Natives reported use of an illicit drug. (See Table 6.11.)

MARIJUANA USE.

In 2001, 5.6 percent of non-Hispanic whites and non-Hispanic African-Americans over the age of twelve and 4.2 percent of Hispanics reported that they had smoked marijuana in the past month. Only 1.7 percent of Asians over the age of twelve said they had smoked marijuana in the past month. On the other extreme, 7.1 percent of Native Hawaiians and other Pacific Islanders and 8 percent of Native Americans and Alaska Natives reported marijuana use. (See Table 6.11.)

AIDS AND MINORITIES

Acquired immune deficiency syndrome (AIDS) is caused by a virus that affects the body's immune system, making it difficult to fight invasions from infection or other foreign substances. As a result, persons infected with the AIDS virus are subject to a number of opportunistic infections, primarily Pneumocystis carinii pneumonia and Kaposi's sarcoma, a form of skin cancer.

AIDS, which is caused by the human immunodeficiency virus (HIV), is not transmitted casually, but only through the transfer of bodily fluids, such as blood and semen. The CDC reports only four methods of transmission: contaminated blood, sexual transmission, contaminated syringes from intravenous drug use, and perinatal (around the time of birth) transmission from a mother to her child or through breast milk.

Minorities have been especially hard hit by the AIDS epidemic. The CDC noted that, of the estimated 280,286 persons living with AIDS in 2002, nearly 50 percent (141,184) were non-Hispanic African-Americans. Approximately 38.3 percent (107,992) were non-Hispanic whites, and 10 percent (28,364) were Hispanics. Asians and Pacific Islanders (APIs) and Native Americans/Alaska Natives are the least likely groups to have AIDS, at less than 1 percent each. (See Table 6.12.)

More pediatric AIDS cases have been reported among non-Hispanic African-Americans and Hispanics than other groups. Through December 2001, 5,337 pediatric AIDS cases had been reported among non-Hispanic African-Americans, and 2,060 pediatric AIDS cases had been reported among Hispanics. In comparison, 1,579 cases had been reported among non-Hispanic whites, 54 cases had been reported among APIs, and 31 had been reported among Native Americans/Alaska Natives. (See Table 6.13.)

Although everyone can become infected with AIDS in the same ways, the proportions of the methods of transmission differ considerably by race. For non-Hispanic white men who contracted AIDS through December 2001, 74 percent did so from homosexual contact and 9 percent from intravenous drug use. While most non-Hispanic African-American men with AIDS (37 percent) and Hispanic men with AIDS (42 percent) acquired the disease through homosexual activity, a significant proportion of non-Hispanic African-American men (33 percent) and Hispanic men (34 percent) with AIDS contracted the disease through intravenous drug use. For API men with AIDS, most (71 percent) acquired the disease through sex with other men, while 5 percent reported being infected through intravenous drug use. Native American and Alaska Native men with AIDS cited the leading causes as sex with men (55 percent) and intravenous drug use (16 percent). (See Table 6.14.)

Approximately 41 percent of non-Hispanic white women who contracted AIDS through December 2001 did so via intravenous drug use, and 40 percent did so via heterosexual contact. Among non-Hispanic African-American women, 39 percent contracted the disease via drug use while 39 percent did so through heterosexual contact. Among Hispanic women, 38 percent contracted AIDS via intravenous drug use while 47 percent did so via heterosexual contact. Among API women, 49 percent contracted AIDS via heterosexual contact, while among Native Americans and Alaska Natives, 37 percent did so via heterosexual activity. (See Table 6.15.)

HEALTH OF AFRICAN-AMERICANS

Cancer

Cancer distribution among various population groups varies according to racial and ethnic background. Such risk factors as occupation, use of tobacco and alcohol, sexual and reproductive behaviors, and nutritional and dietary habits influence the development of cancer. In addition to

early detection, socioeconomic status can be an important factor in receiving and surviving cancer treatment.

Cancer incidence and mortality rates are generally higher for African-Americans than for white Americans. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) is the most authoritative source of information on cancer incidence, mortality, and survival in the United States. In SEER Cancer Statistics Review, 1975–2000 (Bethesda, MD, 2003), the NCI reported that the incidence rates between 1996 and 2000 were 521.7 per 100,000 African-Americans and 479.8 per 100,000 whites. The five-year survival rate for cancer in African-Americans diagnosed between 1992 and 1999 was about 53.3 percent, compared to 64.4 percent for whites. Much of this difference in survival can be attributed to later diagnosis in African-Americans. According to data compiled by the NCHS, types of cancer for which African-Americans have significantly higher incidence and mortality rates include stomach, esophagus, myeloma, pancreas, larynx, and prostate. The most fatal type of cancer for both male and female African-Americans is lung cancer.

BREAST CANCER.

According to Cancer Facts and Figures for African Americans 2003–2004, produced by the American Cancer Society, African-American women experience a slightly lower rate of breast cancer than their white counterparts, but they are more likely to die as a result of their cancer. According to figures released by the National Cancer Institute in 2002, the incidence rate for African-American women was 123.7 per 100,000 for the years 1995–1999, while white women experienced breast cancer at a rate of 140.9 per 100,000. However, deaths from breast cancer during the same period occurred at a rate of 37.1 per 100,000 among African-American women and 28.2 per 100,000 among white women. For years experts assumed that the difference was due to poor health care and late treatment for African-American women. Recent studies, however, indicate that African-American women may be more susceptible to a more deadly form of the cancer. Tumors from African-American women were found to have more actively dividing cells than tumors from white women. The tumor cells in African-American women also lacked hormone receptors, another indicator of a poor prognosis. After peaking in the early 1990s, the death rate from breast cancer for African-American women had shown improvement by 2001, at 34.4 per 100,000. (See Table 6.16.)

PROSTATE CANCER.

African-American men have a particularly high incidence and mortality rate of prostate cancer. Between 1995 and 1999, the prostate cancer incidence rate among African-American men was 266.8 cases per 100,000 population, compared to a rate of only 163.2 cases per 100,000 population among whites. The mortality rate for those same years among African-American men averaged 72.8 deaths from prostate cancer per 100,000 population, compared to 31.2 deaths per 100,000 for white men, according to the American Cancer Society.

In 2001, while the mortality rate from prostate cancer among African-American men was a full ten points lower than it was in 1995, at 66.1 deaths per 100,000 population, it remained significantly higher than for other racial and ethnic groups. (See Table 6.16.)

Heart Disease, Hypertension, and Stroke

Rates of heart disease vary considerably by race, with higher rates for African-Americans. Along with age and sex, race, as part of heredity, is one of the risk factors for heart disease that cannot be changed. However, due to their higher rates of incidence of heart disease and stroke, African-Americans are encouraged to control other risk factors, including use of tobacco and alcohol, blood pressure and cholesterol levels, physical activity, weight, and stress.

According to the American Heart Association, the prevalence of hypertension, or high blood pressure, in both African-American males and females is significantly higher than in white males and females. The Association reported that in 2001 approximately 41.6 percent of African-American males and 44.7 percent of African-American females suffered from high blood pressure. African-Americans develop high blood pressure at younger ages than whites do. Hypertension is also generally more severe in African-Americans than in whites and, as a result, African-Americans have greater rates of both nonfatal and fatal strokes. Geography also appears to play

a role, with African-Americans who live in the South experiencing greater prevalence of high blood pressure and stroke than those in other areas of the country. High blood pressure remains a leading cause of stroke for non-Hispanic African-Americans age twenty and older.

Researchers are not yet sure why African-Americans have a greater tendency toward high blood pressure, but a possible genetic predisposition toward high blood pressure in African-Americans may stem from a strong tendency to retain salt in their bodies. Scientists have hypothesized that this developed as an adaptation to living in a very hot climate where excessive salt loss could result in death.

Approximately 20 percent of African-Americans experience high serum cholesterol levels of greater than 240 mg/dl, which is about the same rate as other racial and ethnic groups in the United States. However, the American Heart Association warns that another 25 percent have total blood cholesterol levels over 200 mg/dl and are thus at risk of developing high cholesterol.

Sickle-Cell Anemia

Sickle-cell anemia, a hereditary disease that primarily strikes African-American people in the United States, is a blood disorder in which defective hemoglobin causes red blood cells to become sickle shaped, rather than round. This can create blockages in small arteries and can result in many problems, including chronic anemia, episodes of intense pain, strokes, and death. Scientists believe the genetic trait arose randomly in Africa and survived as a defense against malaria. The disease can be inherited only when both parents have the sickle-cell trait and the child inherits the defective gene from both parents. One of every twelve African-Americans is a carrier for sickle-cell anemia, and about one of every 500 African-American infants is born with it. According to the National Institutes of Health (NIH), many non-African-Americans with ancestors from malaria regions—parts of Greece, Italy, the Near East, and India—also have the disease. However, of the 72,000 Americans the NIH estimated had sickle-cell anemia in 2002 most were of African descent.

Alzheimer's Disease

The results of a study, "The APOE4 Allele and the Risk of Alzheimer Disease among African-Americans, Whites, and Hispanics," conducted between 1991 and 1996 by Columbia University, were published in the Journal of the American Medical Association (vol. 279, no. 10, March 1998). The findings indicated that African-Americans and Hispanics might be at greater risk for Alzheimer's disease than whites. In 1992 scientists first

discovered that people with the apolipoprotein-E gene, or APOE4 (approximately 25 percent of the total population), are at greater risk for developing the disease. The Columbia University research, however, showed that the increased risk associated with the APOE4 gene applies only to whites. The study showed that African-Americans and a group of Hispanic Americans, mainly from the Caribbean, who do not have the gene, are still at greater risk for Alzheimer's disease than whites.

The researchers surveyed 1,079 elderly men and women and found that African-Americans who lacked the APOE4 gene were four times more likely than whites to get Alzheimer's disease. Since the APOE4 could not account for the increased cases in African-Americans and Hispanics, researchers now believe that there are other genetic or environmental factors affecting minorities that increase their risk of developing Alzheimer's disease. None of the subjects of the study had the disease when the study began, but 221 developed Alzheimer's by the time the study ended.

Diabetes

Another health problem in the African-American community is the high incidence of diabetes. Diabetes was the seventh-leading cause of death for African-American men in 2001 and the fourth-leading cause of death for African-American women in the same year. One of the reasons diabetes is such a dangerous disease is because it can cause many different complications, including heart disease, kidney failure, and loss of circulation in the extremities. Lack of circulation in the lower limbs can lead to infection of small wounds and gangrene eventually requiring leg amputation. According to the CDC, 11.4 percent of all non-Hispanic blacks age twenty years or older have diabetes, compared with 8.4 percent of non-Hispanic whites and 8.2 percent of all Hispanic Americans of similar age.

Life Expectancy

Women tend to live longer than men, and whites are likely to live longer than African-Americans. In 2001, when comparing the life expectancies at birth of African-Americans and whites, African-American men (68.6 years) had the shortest life expectancy, while white women (80.2 years) had the longest life expectancy. African-American females had a life expectancy of 75.5 years, and white men could expect to live approximately seventy-five years. (See Table 6.17.)

In 2001, as reported by the Centers for Disease Control, African-Americans died at a higher rate than white Americans, with an age-adjusted rate of 1,101.2 African-American deaths per 100,000 people, compared with 836.5 white deaths per 100,000. (See Table 6.16.) During the same year, the number of infants who died during the first year of life for African-Americans was 2.5 times greater than for the white population, and maternal mortality, the number of women who died during childbirth or from its complications, was 3.4 times greater for African-Americans than for white women. On the other hand, non-Hispanic African-American individuals are significantly less likely than non-Hispanic whites to die of suicide. In 2001 the African-American suicide rate, at 5.5 per 100,000 population, was half that of the non-Hispanic white population, which numbered 12.5 per 100,000. (See Table 6.16.)

Leading Causes of Death

Heart disease was the leading cause of death among non-Hispanic African-Americans in 2001, according to the National Center for Health Statistics. That year more than 25 percent of deaths of African-American males and 28.7 percent of deaths of African-American females were attributed to heart disease. Cancer was the second-leading cause of death among African-Americans, and stroke the third leading cause among African-American women, though men died more often from unintentional injuries.

HOMICIDE.

Homicides are disproportionately high in the non-Hispanic African-American population, and the

high homicide rate among African-Americans might be one of the reasons African-American men in their twenties and thirties have a higher death rate than men that age in other ethnic and racial groups. In 2001 there were 267.2 deaths per 100,000 non-Hispanic African-American men between the ages of twenty-five and thirty-four. In comparison, there were 131.4 deaths per 100,000 in that age group among non-Hispanic white males, 182.2 deaths per 100,000 in that age group among Native American males, 61.2 per 100,000 among Asian and Pacific Islander males,

and 115.5 per 100,000 among Hispanic males. (See Table 6.18.) The age-adjusted rate of deaths attributable to homicide ranges from 5.6 per 100,000 for non-Hispanic white males to 36.2 for black males. (See Table 6.19.)

HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE.

The difference in death rate from HIV disease among the racial and ethnic groups is staggering, with a much higher rate among African-Americans than any other group of Americans. In 2001, the death rate from HIV disease per 100,000 population among African-Americans was 22.8 compared with 6.2 deaths among Hispanics, 2.7 deaths among Native Americans/Alaska Natives, 2.1 deaths among non-Hispanic whites, and .07 deaths among APIs. (See Table 6.16.)

HISPANICS AND HEALTH

The U.S. Hispanic population faces significant obstacles to good health. For instance, in 2002 Hispanics made up 21.8 percent of the population living below the poverty level. (See Table 5.6 in Chapter 5.) Furthermore, Hispanic Americans are also over-represented in low-paying jobs in the manufacturing and construction industries, as well as farming and metal mining, all of which report a high number of work-related injuries. According to the study Occupational Hispanic Workers issued by the Bureau of Labor Statistics in 2002, between 1992 and 1999 more than 5,100 Hispanic workers lost their lives while on the job. The highest incidence of fatal injuries occurred in the construction, agriculture, retail, and service industries.

Despite these difficulties, Hispanics exhibit good health as a group in a number of areas. For example, the Hispanic population has seen a decline in the proportion of people who have died of heart disease in recent years. In 2001 there were 192.2 deaths per 100,000 people from heart disease among Hispanics, down from 217.1 deaths per 100,000 people in 1990. Hispanics also had a lower proportion of lung cancer rates in 1998 than other races and ethnic groups. There were 23.8 lung cancer deaths per 100,000 people among Hispanics, compared to 62.5 deaths per 100,000 among Black or African-Americans, and 57.7 deaths per 100,000 among non-Hispanic white Americans. (See Table 6.16.)

Health Insurance

Having health insurance is commonly associated with employment, retirement, and income. Hispanics are less likely than any other population group to have medical insurance. In 2001, 34.8 percent of Hispanics had no medical health insurance, compared to 11.9 percent of non-Hispanic whites and 19.2 percent of non-Hispanic African-Americans. Among Hispanic subgroups, a higher percentage of Mexicans (39 percent) than Cubans (19.2 percent) and Puerto Ricans (16 percent) had no insurance. (See Table 6.7.)

Infant Mortality

Recent studies question the commonly assumed connection between lower levels of income and education and high infant mortality. Between 1998 and 2001 Hispanics had a consistently lower infant mortality rate than non-Hispanic whites. There were 5.4 deaths per 1,000 live births among Hispanics in 2001, compared to 5.7 deaths per 1,000 live births among non-Hispanic whites. The infant mortality rate was significantly higher among African-Americans and Native Americans/Alaska Natives. Among non-Hispanic African-Americans, there were 13.5 infant deaths per 1,000 live births, and among Native Americans/Alaska Natives, there were 9.7 deaths per 1,000 live births. (See Table 6.4.) Researchers have speculated that greater social support, less high-risk behavior, and dietary factors may explain the differences.

Cancer

In addition to lower fatalities from lung cancer, Hispanics are also less likely than other racial and ethnic groups to die from breast cancer. Among Hispanic women, in 2001 there were 16.3 breast cancer deaths per 100,000 people, compared to 34.4 deaths per 100,000 population among Black or African-Americans and 26 deaths among non-Hispanic whites per 100,000 population. That same year there were 23.5 prostate cancer-related deaths per 100,000 population among Hispanics, compared to 66.1 deaths per 100,000 population among Black or African-Americans and 26.7 deaths per 100,000 population among non-Hispanic whites. (See Table 6.16.)

Heart Disease

Even though Hispanics have a lower death rate from heart disease than most groups, it is still a leading killer of Hispanics. In 2001 Hispanics—with a rate of 192.2 deaths per 100,000 population—were more likely than Asians/Pacific Islanders (137.6 deaths per 100,000) and Native Americans/Alaska Natives (159.6 deaths per 100,000), but less likely than non-Hispanic whites (245.6 per 100,000) or African-Americans (316.9 per 100,000), to die of heart disease. (See Table 6.16.)

Diabetes

Diabetes is a major problem for Hispanics. In the United States, Hispanics have a higher death rate from diabetes than whites but with a lower rate than African-Americans and Native Americans/Alaska Natives. In 2001 there were 36.7 Hispanic deaths from diabetes per 100,000 people, compared to only 16.9 for Asians and Pacific Islanders, 22.1 for non-Hispanic whites, 40.4 for Native Americans/Alaska Natives, and 49.2 for Blacks and African-Americans. (See Table 6.16.)

Other Causes of Death

In 1990 Hispanics, like African-Americans, had a higher homicide rate than most other groups. However, between 1990 and 2001, the homicide death rate among Hispanics dropped from 16.2 deaths per 100,000 to 8.3 homicides per 100,000 in 2001. The 2001 suicide rate among Hispanics was 5.7 per 100,000 while the national average was 10.7. The death rate for Hispanics from lower respiratory diseases in 2001 was 20.7 per 100,000 population, considerably lower than the national average of 43.7. (See Table 6.16.)

HEALTH CARE FOR NATIVE AMERICANS

Native American diets have been negatively affected by the introduction of nonnative foods. Although there are considerable tribal variations in diet, studies show that the less Native Americans eat of their traditional foods, the greater their levels of obesity and adult-onset diabetes. High-carbohydrate, high-sodium, and high-saturated-fat contents can characterize most current Native American diets. Also, Native American diets are relatively low in meat and dairy products. Factors contributing to these eating habits include food availability, preference for non-native food, and place of residence.