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© 2003 American Public Health Association
RESEARCH AND PRACTICE |
Kushang V. Patel and Kyriakos S. Markides are with the Department of Preventive Medicine and Community Health and the Sealy Center on Aging, University of Texas Medical Branch, Galveston. Sandra A. Black is with the Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore.
Correspondence: Requests for reprints should be sent to Kyriakos S. Markides, PhD, Department of Preventive Medicine and Community Health, 301 University Blvd, Galveston, TX 77555-1153 (e-mail: kmarkide{at}utmb.edu).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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Although numerous investigators have examined the physical manifestation of coronary heart disease (CHD) and its prognostic implications, most of these studies were conducted in samples of middle-aged men and used the Rose Questionnaire on Angina.1–6 Few, however, have examined the manifestation of CHD in the Mexican American population, and none has provided stable estimates of Rose angina in elderly Mexican Americans.7,8 In this brief, we examine the prevalence of and risk factors for exertional chest pain in Mexican Americans aged 65 and older with data from the Hispanic Established Population for the Epidemiological Study of the Elderly.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Sample
The Hispanic Established Population for the Epidemiological Study of the Elderly is an ongoing study of an area probability sample of 3050 community-dwelling Mexican Americans aged 65 years or older residing in Arizona, California, Colorado, New Mexico, and Texas. Baseline data collection took place during 1993 to 1994, with a response rate of 83%. Details of the Hispanic Established Population for the Epidemiological Study of the Elderly survey methods have been published elsewhere.9 Analyses in the current study included 2428 participants who completed the chest pain questionnaire items (333 subjects with a history of heart attack and 289 subjects too ill or cognitively impaired to answer chest pain questions were excluded).
Measures
Items from the Rose Questionnaire on Angina were used to classify exertional chest pain. Specifically, exertional chest pain was defined as ever having had pain or discomfort or pressure or heaviness in the chest on physical exertion.10,11 Medical conditions and other risk factors were assessed through self-report questions and anthropometric and clinical measurements. The Center for Epidemiological Studies Depression Scale was used to assess depressive symptoms.12–14 A value of 16 or greater was used to classify respondents with high levels of depressive symptoms. Six yes-or-no questions that measured stressful life events within the past year were summed into an index of stressors, with higher scores indicating greater amounts of stress.
Analyses
Prevalence estimates of exertional chest pain were calculated for each sex and age stratum (65–69 years, 70–79 years, and 
80 years). Age-adjusted estimates of exertional chest pain prevalence were calculated by using the direct method with the 1990 US population as the standard. Mantel–Haenszel odds ratios were used to assess the relation between sex and exertional chest pain after adjusting for age. Multivariate logistic regression was then used to determine risk factors for exertional chest pain. All analyses were performed with SAS and SUDAAN statistical packages.15,16
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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The age-adjusted prevalence of exertional chest pain was 7.1% for men and 12.8% for women (Table 1
). Mantel–Haenszel odds ratios showed that women were 89% more likely to report exertional chest pain than were men after adjusting for age (Mantel–Haenszel odds ratio = 1.89; 95% confidence interval = 1.42, 2.52).
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Table 2
shows that women had a significantly higher likelihood of exertional chest pain than did men, even when adjusting for other factors. High levels of depressive symptoms (Center for Epidemiological Studies Depression Scale score 16) were associated with more than a 2-fold increased likelihood of exertional chest pain. The likelihood of exertional chest pain increased 1.3 times for each reported life stressor. Diabetes and hypertension also were associated with an increased likelihood of exertional chest pain. Finally, low-income respondents, uninsured respondents, and former smokers (compared with never smokers) were significantly more likely to report exertional chest pain.
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DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Data from the Hispanic Established Population for the Epidemiological Study of the Elderly show that the age-adjusted prevalence of exertional chest pain for older Mexican American women is significantly higher than that for Mexican American men. This large sex difference is surprising given the higher heart disease mortality rates of Hispanic men.17 This counterintuitive pattern may be partially explained by the higher prevalence of vasospastic and microvascular angina in women, which does not necessarily lead to myocardial infarction.18–20 In addition, our prevalence estimates for both men and women were higher than those reported for older non-Hispanic Whites from other Established Populations for the Epidemiological Study of the Elderly samples.10 Data from the San Antonio Heart Study also showed a higher prevalence among middle-aged Mexican Americans than among middle-aged non-Hispanic Whites.7 This pattern is also surprising considering that CHD mortality rates for non-Hispanic men and women have consistently been higher than those for Hispanic people.17 This finding is consistent with the Hispanic paradox21,22 whereby Mexican Americans report higher prevalence of risk factors for heart disease than do nonHispanic Whites but maintain a heart disease mortality advantage.
Study limitations include absence of data on important risk factors for CHD (e.g., cholesterol) and possible concomitant respiratory disease that might be associated with exertional chest pain. Nevertheless, high prevalence of exertional chest pain may be partly due to high prevalence of depressive symptomatology in our sample.23,24 Previous research has shown that Mexican Americans tend to somatize their emotional problems.25 Because pathophysiological evidence shows that depression and stress could exacerbate a coronary condition,26–28 our findings should encourage clinicians to address these health issues with older Mexican American patients.
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Acknowledgments |
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Support was provided by grants from the National Institute on Aging (R01 AG10939 and T32 AG00 270-02). Fieldwork was completed by Harris Interactive, Inc.
Human Participant Protection
The Hispanic Established Population for the Epidemiological Study of the Elderly was approved by the institutional review board of the University of Texas Medical Branch.
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Footnotes |
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K. V. Patel, S. A. Black, and K. S. Markides equally contributed to the study design and writing of this brief. K. V. Patel performed the data analysis with consultation from S. A. Black and K. S. Markides.
Accepted for publication June 7, 2002.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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