Hispanic Established Population for Epidemiologic Studies of the Elderly

In 1992, it became apparent that although important epidemiological data on elderly non-Hispanic Whites and African Americans had become available through the Established Populations for Epidemiologic Studies of the Elderly (EPESE) project begun during the 1980s in East Boston (Massachusetts), New Haven (Connecticut), North Carolina, and rural Iowa, comparable data were not available for Hispanic elderly. Much of the other existing knowledge in the area was based on data from the Hispanic Health and Nutrition Examination Survey (HHANES) conducted from 1982 to 1984. The HHANES covered Mexican Americans in the Southwest, Cuban Americans in Dade County (Florida), and Puerto Ricans in the greater New York City area. Unfortunately, the study was limited to persons under 75 years of age, and the number of elderly persons included in the study was too small to provide stable estimates of their health status. In addition, the HHANES did not include instruments measuring the physical functioning of participants.

In response to a special initiative of the National Institute on Aging, a fifth EPESE project was initiated, the Hispanic EPESE, which included elderly Mexican Americans from five southwestern states: Texas, California, New Mexico, Arizona, and Colorado. The primary purpose of the study was to provide estimates of the prevalence of key physical health conditions, mental health conditions, and functional impairments in older Mexican Americans and to compare this prevalence with that in other populations. In addition, the researchers wanted to investigate predictors and correlates of these health outcomes cross-sectionally.

The baseline data were collected in 1993 and 1994, with follow-up at 2 years in 1995 and 1996. To the extent possible, the study was modeled after the existing EPESE studies, particularly the Piedmont (North Carolina) EPESE. The Hispanic EPESE aimed at obtaining a representative sample of community-dwelling Mexican American elderly residing in the five southwestern states mentioned previously. Approximately 85% of Mexican American elderly persons reside in these states, and the researchers were able to obtain U.S. Census Bureau 1990 data that are generalizable to roughly 500,000 older people. The final sample size of 3,050 participants at baseline is comparable to that of the other EPESE studies and is sufficiently large to provide stable estimates of most health characteristics of interest.

The major goal of the Hispanic EPESE is to study the prevalence of important health problems and associated factors among older Mexican Americans. Specifically, the Hispanic EPESE is designed to estimate the prevalence and incidence of key physical health conditions, mental health conditions, cause specific mortality, impairments and disabilities, and use of hospitals and nursing homes among Mexican Americans age 65 years and older living in the southwestern United States. The study aims to evaluate associated risk factors and to quantify the changes in these related factors. A further purpose of the study is to assess changes in physical, social, and cognitive functioning as well as mental well-being.

Funding was obtained for two additional follow-ups at 5 years (1998–1999) and 7 years (2000–2001). Four [Page 272]important health outcomes were examined: mortality, physical function, depression, and institutionalization. Focus on the uniqueness of the Mexican American population included immigrant status, level of acculturation, strong family supports, high levels of extended living arrangements, high rates of poverty and low literacy, and poor access to health care. Also, of the medical conditions, the researchers focused primarily on diabetes, which is highly relevant in this population.

...