Hispanic Health and Health Hispanic Health and Health Care Issues in Texas and the Care Issues in Texas and the

United StatesUnited States

Karl Eschbach, Ph.D.Karl Eschbach, Ph.D.

University of Texas Medical University of Texas Medical BranchBranch

Purpose

• To give a context for understanding To give a context for understanding health care accessibility issues for health care accessibility issues for Hispanics in Texas and the United Hispanics in Texas and the United StatesStates

Topics of remarks

1) Population growth 1) Population growth

2) Composition of the Hispanic 2) Composition of the Hispanic populationpopulation

3) Health status of Hispanics3) Health status of Hispanics

4) Health care access4) Health care access

5) Regional burden in Texas5) Regional burden in Texas

6) The undocumented population6) The undocumented population

Hispanics as percentage of U.S. population, 1940-2004

0

5

10

15

1940 1950 1960 1970 1980 1990 2000 2004

Hispanics in Texas and United States

• United States, 2004: United States, 2004: – 41.3 million;41.3 million;

– 14.1 %14.1 %

• Texas, 2003:Texas, 2003:– 7.6 million7.6 million

– 34.2 %34.2 %

Source: U.S. Census Estimates Program

Projected Hispanic Growth to 2040, U.S. & Texas

Sources: U.S. Census Bureau; Texas State Data Center

Composition

• 86%+ of Texas Hispanics are Mexican 86%+ of Texas Hispanics are Mexican origin (U.S.=60%)origin (U.S.=60%)

• 31% of Texas Hispanics are immigrants 31% of Texas Hispanics are immigrants (U.S.=40%)(U.S.=40%)

• Hispanics have lower average educationHispanics have lower average education• Concentration in service work, precision Concentration in service work, precision

production, craft, repair, construction and production, craft, repair, construction and transportationtransportation

Health status: the Hispanic Paradox

• Low age-specific mortality rates for Low age-specific mortality rates for the Hispanic population of the United the Hispanic population of the United States compared to the non-Hispanic States compared to the non-Hispanic White population despite socio-White population despite socio-economic disadvantage.economic disadvantage.

Mortality by Hispanic Status (Sorlie et al JAMA 1993)

• Standarized mortality rate ratio forStandarized mortality rate ratio for Hispanics vs. Non-Hispanic Whites:Hispanics vs. Non-Hispanic Whites:

.74 men.74 men .82 women.82 women

• Lower heart disease and cancer mortalityLower heart disease and cancer mortality

• Birth outcomes are similar to non-Hispanic Birth outcomes are similar to non-Hispanic WhitesWhites

• Hispanic advantage is larger for immigrantsHispanic advantage is larger for immigrants

Cause of the mortality advantage

• Better health behaviorsBetter health behaviors

• Health selective migrationHealth selective migration

Implications

• Hispanics do not impose an Hispanics do not impose an excessive health care burden excessive health care burden because of poor health habits, extra because of poor health habits, extra burden of illness, higher use of burden of illness, higher use of medical caremedical care

Limited access to health insurance coverage

• Concentration in industries and Concentration in industries and occupations with limited insurance occupations with limited insurance coverage.coverage.

• Unauthorized migration status limits Unauthorized migration status limits access to public programs.access to public programs.

Health Insurance, U.S. Hispanics, 2003

Source: National Health Interview Survey, 2003

No health insurance, 2003, National data

Source: National Health Interview Survey, 2003

Implications of lower insurance coverage

• Lower rates of health care utilizationLower rates of health care utilization• Lower screening and immunization Lower screening and immunization

ratesrates• Less likely to have a regular provider Less likely to have a regular provider

of careof care• Shorter survival after diagnosisShorter survival after diagnosis• Informal cross-border health care Informal cross-border health care

utilizationutilization

Unauthorized immigrant populations

• 80%+ of recent Mexican immigrants 80%+ of recent Mexican immigrants are unauthorizedare unauthorized

• 1.4 million in Texas, 10 million in U.S.1.4 million in Texas, 10 million in U.S.

• 31 % of undocumented households 31 % of undocumented households include citizen childreninclude citizen children

Source: Jeffrey Passel, Pew Hispanic Center

Implications

• Texas and the United States depend on Texas and the United States depend on immigrant laborimmigrant labor

• Neither employers or federal/state Neither employers or federal/state government take responsibility for government take responsibility for paying for medical carepaying for medical care

• Burden falls on the local hospital Burden falls on the local hospital districts and other providers and on the districts and other providers and on the immigrantsimmigrants

County of residence of Texas Hispanics

Blue=U.S. Born

Red=Immigrants

Implications of regional concentration

• Local concentrations of un-insured Local concentrations of un-insured immigrant populations in major immigrant populations in major metropolitan centers burdens local metropolitan centers burdens local hospital districts.hospital districts.

• South Texas border communities South Texas border communities have low coverage rates despite have low coverage rates despite more native presence. more native presence.

Conclusions

• Hispanics are a rapidly growing Hispanics are a rapidly growing populationpopulation

• Hispanics are a relatively healthy Hispanics are a relatively healthy populationpopulation

• Health insurance rates are far lowerHealth insurance rates are far lower• Health care access is impairedHealth care access is impaired• Burden on local health care providers Burden on local health care providers • Trends will magnify these problems if they Trends will magnify these problems if they

are not addressedare not addressed