Design and Implementation of the Hispanic Community Health Study/Study of Latinos
Introduction
The rapid growth of the Hispanic/Latino population in the United States has underscored the need for a thorough evaluation of the health risks and disease burden in Hispanics, the impact of immigration and acculturation on health, and the causes of disease, including genetic and environmental, in a population with diverse life styles, behaviors, exposures, ethnicity and places of origin. The terms Hispanic or Latino are used interchangeably in this study to refer to populations who self-identify in this manner. The Hispanic/Latino population grew from 22.4 to 35.3 million persons from 1990 to 2000, became the largest minority in the United States in 2003, and is expected to triple by 2050 1, 2. Despite increasing obesity and diabetes, and a generally lower socioeconomic status, cardiovascular mortality is often observed to be lower in Hispanics/Latinos, a pattern often referred to as the Hispanic Paradox 3, 4, 5, 6. Data show that the longer Hispanic/Latino immigrants live in the United States, the worse some cardiovascular risk factors become (7). The diversity by country of origin may influence disease risk by varying degrees, as suggested by the differing levels of some risk factors and some morbidities observed in Hispanics/Latinos of different countries of origin 8, 9, 10.
In response to a working group in 2003 titled “Epidemiologic Research in Hispanic Populations; Opportunities, Barriers and Solutions” (11), the National Heart, Lung and Blood Institute (NHLBI) initiated in 2006 the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). To maximize productivity and scientific opportunities that could be realized within the HCHS/SOL, scientific direction and financial resources were also obtained from six other Institutes or Centers within the National Institutes of Health (National Center on Minority Health and Health Disparities, the National Institute of Deafness and Other Communications Disorders, the National Institute of Dental and Craniofacial Research, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the Office of Dietary Supplements). This study describes the objectives, design, content, and implementation of this landmark study that addresses cardiovascular disease, stroke, asthma, chronic obstructive lung disease, sleep disorders, dental caries and periodontal disease, hearing impairment and tinnitus, diabetes, kidney and liver disease, and cognitive impairment. The protocol and manuals of operation are found in the study web site (12).
Section snippets
Materials and Methods
The HCHS/SOL has the following specific operational objectives:
- 1.
To identify, sample and recruit up to 4000 persons who self identify as Hispanics or Latinos, 18 to 74 years of age, from each of four communities in the United States with a stable population and strong community structure (a total of up to 16,000 persons) with participants from each of the following origins: Mexican, Cuban, Puerto Rican and Dominican, and Central and South American;
- 2.
To conduct a detailed and standard
Discussion
Although the HCHS/SOL is the most comprehensive study of Hispanics/Latinos in the United States to date, limitations exist. First, whereas the community-based sampling design will permit inferences to the larger population from which it is drawn, inferences cannot be made regarding prevalence of risk factors or disease to the larger Hispanic Community across the United States. Because many of the procedures have also been conducted by the NHANES and other studies, the HCHS/SOL will conduct
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