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Try out PMC Labs and tell us what you think. Learn More. To characterize the health status of older island Puerto Ricans, a segment of the U. Data from the Puerto Rican Elderly Health Conditions Project and the Health and Retirement Study are used to examine differences in disease, disability, and self-rated health among island Puerto Ricans and the mainland U. Differences are further examined by gender. Island Puerto Ricans were less likely to have heart disease, stroke, lung disease, cancer, activities of daily living ADL limitations, and poor self-rated health, but more likely to have hypertension and diabetes.
Island Puerto Rican women had worse health relative to island Puerto Rican men. Recent challenges in the funding and provision of health care in Puerto Rico are worrisome given the large of aging island adults, many of whom have hypertension and diabetes, two conditions that require long-term medical care.
Research on Hispanic aging has largely overlooked an entire segment of the U. Hispanic population: Island Puerto Ricans.
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Puerto Ricans born on the island are natural-born citizens of the United States, though as Americans living on the island, they do not have the full set of rights afforded to U. Like the rest of the United States, the population of Puerto Rico is aging rapidly.
This segment of the aging U. Hispanic group 3. The objective of the current study is to assess the health status of older island Puerto Ricans and compare their health with that of the mainland U. Largely a result of the recent, rapid aging of the population, the proportion of older adults in Puerto Rico is approximately equivalent to that of the United States Werner, The aging of the population of Puerto Rico over time, compared to that of the mainland United States, is shown in Figure 1.
The proportion of older adults in Puerto Rico was half that of the United States inonly catching up to the United States relatively recently in The proportion of the male population aged 65 and older in Puerto Rico reached that of the United States even earlier in The recent rapid growth in the older adult population in Puerto Rico may place strains on the social and health systems on the island.
For instance, aging populations have greater rates of morbidity and disability, and these conditions in the context of a growing old age population are seen by some as a looming economic and social burden Coleman, Puerto Rico faces unique challenges to the health care system, however, including outmigration of physicians to the U. The implications of an aging island Puerto Rican population remain largely unknown, however, as we have limited knowledge of the health status of older adults living on the island.
Using population statistics data from the World Bank, we plotted the percentage of the total, male, and female population that was aged 65 and older in Puerto Rico and the United States from to Although a of studies have documented the health of older U. There are several reasons to expect that the health status of island-dwelling Puerto Ricans differs from the U.
Historically, Puerto Rico has lagged behind the U. For instance, the U. Island-residing Puerto Ricans in the early 20th century experienced similar life circumstances and demographic forces as those in other developing Latin American countries, including overpopulation and lower levels of economic development.
Puerto Rico continues to be socioeconomically disadvantaged relative to the United States. Island-residing Puerto Ricans are more likely to report fair-to-poor self-rated health than those living in the mainland United States 35 percent compared to 18 percent and have higher infant mortality rates 7.
The relatively disadvantaged social and economic position of Puerto Rico suggests island Puerto Rican older adults should have worse health than their mainland U. Despite historically poor social and economic conditions, however, Puerto Rico may provide a more supportive context for healthy aging than in the mainland United States. Residents of Puerto Rico have a strong national identity and are embedded in a collectivist culture that shares the Spanish language, cultural traditions, and an emphasis on familism, an ideology that values the role of family San Juan PR aged women dating older men taking care of the well-being of its members.
The sociocultural resources available to island-dwelling older adults may result in a health advantage of island Puerto Ricans over mainland U. Examination of the health status of older island-dwelling Puerto Ricans must consider the potential for variation by gender.
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Women tend to utilize health care services e. While gender patterns in health have been established in the older U. The objective of the present study is to characterize the health status of aging island Puerto Ricans in the context of other older U. Puerto Ricans born on the island are U. Thus, we focus on comparisons of island Puerto Ricans with U. Using these two population-representative studies, we examine sub-population differences in multiple measures of health, including chronic disease, disability, and self-rated health.
Because prior research suggests health status differs between older men and women, we examine health profiles both in the total population and separately by gender. PREHCO is a two-wave panel survey of the noninstitutionalized population aged 60 and older that began in with a follow-up interview in We use the baseline data for this study.
Aging in puerto rico: a comparison of health status among island puerto rican and mainland u.s. older adults
The sample is a multistage, stratified sample of older adults residing in Puerto Rico, with oversamples of regions heavily populated by people of African descent and of individuals older than The resident populations of the island municipalities of Culebra and Vieques were excluded from the study. A total of 4, face-to-face interviews were conducted in Spanish between May and Maywith an overall response rate of The survey was deed to gather quality data on issues related to the health of older adult Puerto Ricans.
The questionnaire included modules on demographic characteristics, health statuses, cognitive and functional performance, labor and economic status, income and assets, health insurance and use of health services, family structure, intergenerational transfers, housing, anthropometric measurements, and physical performance.
All interviews were conducted in Spanish. Data on the mainland U. The HRS began inwith follow-up interviews occurring approximately every two years. The sample is a multistage area probability sample of U. We use a multidimensional model of health that includes chronic disease conditions, disability, and self-rated health.
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Chronic conditions —Respondents reported whether a doctor ever told them that they had any of the following six conditions: a high blood pressure or hypertension, b heart disease, c diabetes, d stroke, e lung disease, and f cancer. Disability —We utilize six indicators of problems with activities of daily living ADLs including difficulty with a bathing, b eating, c dressing, d walking across a room, e getting in and out of bed, and f using the toilet Katz, As would be expected in a noninstitutionalized older adult population, most of the sample did not report having any ADL difficulties.
For the purposes of this analysis, we created a dichotomized variable indicating whether the respondent had no disability versus having any disability. The word fair has a more negative connotation in English compared with the word regular in Spanish. All other groups were born in one of the 50 U. Mainland Whites are those who self-reported their race as White and did not identify as Hispanic.
Mainland Blacks are those who self-reported their race as Black and did not identify as a Hispanic. Mainland Hispanics are those who self-reported that they are of Hispanic origin regardless of racial identification. Approximately 75 percent of the U. Individual covariates include age, marital status, educational attainment, and insurance status. Age is a continuous variable.
Marital status is a dichotomous variable. Educational attainment, a measure of socioeconomic status, is measured by the of years of schooling completed.
Insurance status is determined by whether the respondent has any employer-provided insurance, is covered by a federal government health insurance program, or has private health insurance. The primary goal of this analysis is to compare the health of island Puerto Ricans to mainland U.
First, we examined the distribution of sample characteristics by group. Next, we estimated logistic regression models to determine the relative likelihood of reporting a chronic condition or disease, any ADL limitation, and poor self-rated health. All models are adjusted for sociodemographic characteristics. We report the p value associated with each test. Analyses were conducted using Stata version Among island Puerto Ricans, 56 percent of the sample is female, with similar proportions of females as mainland Whites and mainland Hispanics.
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Island Puerto Ricans were about 70 years old, on average, slightly older than mainland Hispanics. However, island Puerto Rican females were younger compared with mainland White and mainland Black females.
The proportion of island Puerto Ricans who were married was lower than that of mainland Whites and Hispanics but higher than the proportion of married mainland Blacks. Island Puerto Ricans, on average, had about 8 years of education, compared with nine, 11, and 13 years of education among Hispanics, Blacks, and Whites, respectively.
Women had less education compared with their male counterparts, with the exception of mainland Black women. N s are unweighted. A large proportion of respondents reported hypertension, with rates ranging from 51 to 69 percent. Island Puerto Ricans reported more hypertension than mainland Whites and mainland Hispanics. While heart disease was the second most common chronic condition reported by mainland Whites, island Puerto Ricans, mainland Blacks, and mainland Hispanics reported diabetes as the second most common chronic condition.
About 20 percent of mainland Black and mainland Hispanic respondents reported any disability; In contrast, only 12 percent of island Puerto Ricans reported any disability. Similarly, mainland Blacks and mainland Hispanics, on average, reported more poor self-rated health than island Puerto Ricans.
Odds ratios are presented with 95 percent confidence intervals. Odds ratios between zero and one indicate less risk for having a condition, and ratios greater than one indicate greater risk of having a condition. Mainland Hispanics did not differ from mainland Whites.
No gender differences were found within mainland Blacks and Hispanics. By contrast, island Puerto Ricans, mainland Blacks, and mainland Hispanics were less likely to have heart disease compared with mainland Whites. No gender differences were found within mainland Hispanics.
We also find that, compared with mainland Whites, island Puerto Ricans, mainland Blacks, and mainland Hispanics were more likely to report diabetes. Similar gender differences were found among mainland Blacks and mainland Hispanics. Mainland Hispanic men and women did not differ in reporting diabetes.