Ischemic heart disease and diabetes mellitus in the Hispanic and non-Hispanic populations: implications for the compression of morbidity debate.

Vital record on over 297000 decedents in Bexar County San Antonio Texas from 1935-85 were used to investigate trends in the diabetes mellitus-heart disease association among Anglo-Americans Mexican-Americans and Mexican immigrants. Anglos were found to have lower levels of diabetes mellitus than Hispanics and Mexican-Americans and Mexican immigrants has similar levels; in all 3 groups students females has significantly higher rates than males. In contrast males showed a higher mortality than females for ischemic heart disease within each population group at every time period. For each time period sex age and ethnic/nativity group there was a prominent significant association between diabetes as an underlying cause of death and acute myocardial infarction as an associated cause. The importance of diabetes as an underlying cause of death increased for all groups in 1935-85 and unlike the case for heat disease where there has been a convergence in trends Mexican-origin populations have continued to be at a substantial relative disadvantage. Although diabetes is more prevalent in Mexican-origin populations the consequences of also having acute myocardial infarction are greatest for Anglo females. Despite a compression of mortality within each sex and ethnic/nativity group persistent differences across groups indicate that there are numerous behavioral factors that influence the development duration and outcome of disease. The growing disadvantage of Anglo females in term of the diabetes mellitus-acute myocardial infarction association in particular should be investigated further.