By Lisa Rapaport

(Reuters Health) – Hispanics in the U.S. have lower rates of death from heart disease overall than non-Hispanic whites, except in communities where Hispanics make up most of the population, a recent study finds.

Overall, counties with higher Hispanic populations also face more economic disadvantages, a lack of access to quality healthcare, and language barriers, researchers report in the Journal of the American Heart Association.

“I think that these neighborhood-specific factors largely explain the disparity,” said lead study author Dr. Fatima Rodriguez of Stanford University in California in an email.

As the proportion of Hispanic residents in a community rose, so did their risk for heart disease deaths. But ethnic community makeup wasn’t related to cardiovascular death rates for non-Hispanic white residents, the researchers found.

For the study, researchers analyzed data from 715 counties across the U.S. and looked at death records for 382,416 Hispanics and 4,386,624 non-Hispanic whites. Overall, Hispanics had lower death rates from heart disease than non-Hispanic whites: 189 per 100,000 population compared with 245 per 100,000.

But compared to Hispanics in counties with the lowest proportion of Hispanics in the population, Hispanics in counties with the most Hispanic residents had higher death rates from heart disease: 215 per 100,000 people versus with 134 per 100,000.

Compared to white people and individuals from some other racial and ethnic groups, Hispanics living in the U.S. also experience a disproportionate burden of cardiovascular disease risk factors including obesity, high blood pressure and diabetes, previous research has found.

Hispanics in predominantly Hispanic counties had a greater risk of dying from conditions like heart attacks and strokes even after accounting for socioeconomic factors and health factors that could independently make fatalities from cardiovascular disease more likely.

Hispanics are one of the largest and fastest-growing ethnic groups in the U.S. and will likely account for 28 percent of the population by 2060, according to the U.S. Census Bureau.

In the study, counties with higher proportions of Hispanic residents were more likely to be lower-income, with more families lacking education and living below the poverty line.

Counties with larger Hispanic populations also more uninsured individuals, fewer primary care physicians, and more residents with limited English proficiency. These more predominantly Hispanic counties were also more likely to be rural.

Most of the counties in the study with the greatest proportion of Hispanic residents were in the Southwestern U.S., South Florida, and in a few regions in the Northeast.

The study wasn’t a controlled experiment designed to prove whether or how the proportion of Hispanic residents in a community might directly impact health outcomes or death rates for Hispanic individuals. Another limitation is that researchers used county-level data as a proxy for neighborhood composition, and it’s possible that neighborhoods shaped health in ways the study could not measure, the authors note.

“Given the residential racial/ethnic segregation across communities in the U.S. and the fact that localities with a higher share of Hispanics/Latinos also tend to have higher rates of uninsurance and poor quality healthcare, people living in these communities are more likely to experience barriers, including affordability and geographic access, in the prevention and treatment of cardiovascular disease,” said Dima Qato, a researcher at the University of Illinois at Chicago who wasn’t involved in the study.

“We need to do more in these communities to better ensure they have better access to insurance, primary healthcare services, and essential medicines specifically for cardiovascular care,” Qato said by email.

SOURCE: Journal of the American Heart Association, online September 19, 2018.