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PAHO Basic Health Indicator Data Base
This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.

Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.

The data presented is updated annually with the latest country information.

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• HEALTH SITUATION ANALYSIS AND TRENDS SUMMARY
  GENERAL SITUATION AND TRENDS| SPECIFIC HEALTH PROBLEMS | RESPONSE OF THE HEALTH SYSTEM
  
  

• GENERAL SITUATION AND TRENDS
  Puerto Rico is the easternmost and smallest island of the Greater Antilles with an area of 9,104 km ² . In addition to the main island, it includes the islands of Vieques, Culebra, and Mona, as well as several islets. It is located in the Caribbean Sea , east of the Dominican Republic and west of the British Virgin Islands . Government: The island is divided into 78 municipalities, and the capital, San Juan , is on the northeastern coast. As a result of the Spanish American War in 1898, Puerto Rico became an unincorporated territory of the United States of America ; in 1917, the U.S. Congress granted Puerto Ricans American citizenship. In 1952 established its own government for local affairs. The Government of the Commonwealth of Puerto Rico consists of the legislative, executive, and judicial branches.
  
  Demography: In April 2000 the total population was 3,808,100, 8.1% more than that reflected in the 1990 census. The average annual population growth rate for the period 1990-2000 was 0.8%, but it dropped 19% during that period. Population density was 429 per km ² in 2000. The median age of the population increased 13% between 1990 and 2000, from 28 to 32. In 2000, 11% of the population was 65 years or older and 24 % was under 15. Life expectancy at birth for both sexes in 1998 was 75.2 (79.3 for females and 71.4 for males).
  
  Economy: In fiscal year 2000 GDP totaled US$ 63.1 million, an increased of US$ 3.1 million (5.2%) from 1999. The manufacturing sector, which represented 43.5% of the total GDP, grew just 3.0 % in fiscal year 2000, after significant growth of 15.9% in fiscal year 1999. The financial, insurance, and real estate sector, which accounted for 14.1% of GDP, showed deceleration of 19.7% as compared to the previous year. The trade sector, which accounted for 13.4% of the total, represented an increase of 6.9% in its share of GDP, less than that achieved in 1999 (8.4%). The government sector share of GDP fell by 0.9% in 2000, and in 1999, it registered growth of 5.2%. In fiscal year 2000, there were 144,000 unemployed, down 11.7% from 1999. That resulted in an unemployment rate of 11.0% (12.5% for males and 8.8% for females) and a reduction of 1.5 percentage points with respect to the previous year.
  
  Mortality: The overall mortality rate rose slightly, from 7.4 per 1,000 population in 1990 to 7.5 per 1,000 in 1999. In the same period, the number of deaths increased 12%. Heart disease has continued to be the leading cause of death (139 per 100,000 population)- a 10 % decrease with respect to 1997. Cardiovascular diseases (including heart disease, cerebrovascular disease, hypertension, and atherosclerosis) caused 29% of all deaths. Malignant neoplasms were the second leading cause of death (115 per 100,000 population), and decreased by 3.2% in comparison with 1997. As in previous years, diabetes mellitus was in third place, with a rate of 56 per 100,000; hypertensive diseases (4.1 per 100,000) and accidents (32 per 100,000) were fourth and fifth, respectively.
  
  
  
  

• SPECIFIC HEALTH PROBLEMS

Analysis by population group

Infants (0-4 years): Infant mortality showed a declining trend, from 13.4 per 1,000 live births in 1990 to 10.6 per 1,000 live births in 1999. According to the 2000 census, the population of children under 5 was 295,406 (male-female ratio = 0.95), which represented 7.8 % of the total population. In 1999, there were 632 deaths in children under 1 year (10.6 per 1,000 live births). The neonatal mortality rate was 7.3 per 1,000 live births, and the postneonatal mortality rate was 3.2 per 1,000 live births. Disorders related to prematurity and malnutrition were the leading cause of infant mortality (160 per 100,000 live births); congenital anomalies were in second place (130 per 100,000 live births); bacterial sepsis and respiratory distress syndrome were in third place, both with a rate of 90 per 100,000 live births; other, unspecified respiratory problems (40 per 100,000 live births) and diseases of the circulatory system (30 per 100,000 live births) were in fourth and fifth place, respectively.

Children (1-4 years): Deaths recorded in 1999 represented 11% of all deaths, with accidents being the leading cause. During 1993-1997, the neonatal mortality rate dropped from 9.7 to 8.1 deaths per 1,000 live births and the postneonatal mortality rate dropped 12.3%. In 2000, the 5-9 years age group totaled 305,162 (8% of the total population). In 1999, the mortality rate for this age group was 21 per 100,000. Accidents were the leading cause of death, with a rate of six per 100,000. This was followed by malignant neoplasms and congenital anomalies, each with a rate of 3 per 100,000.

Adolescents (10-14 years and 15-19 years): In 2000, adolescents aged 10-19 represented 16.2% of the total population. In 1999, the overall mortality rate in the 10-14 years age group was 0.22 per 1,000, and in the 15-19 years age group, it was 0.83 per 1,000. The two leading causes of death for the 10-14 years age group were all accidents (6.4 per 100,000) and neoplasms (3.2 per 100,000). In the 15-19 year-old population, the two leading causes of death were homicides (34 per 100,000) and accidents (27 per 100,000). A survey on risk behavior found that the percentage of sexually active students in this group declined from 36% in 1995 to 31% in 1997. Some 63% reported drinking alcohol, 15% reported using marijuana, and 2% reported using cocaine. The number reported carrying a weapon during the preceding month fell from 16% in 1995 to 14% in 1997; In 1995, 31 % reported having participated in a physical fight during the last year, and 18% had attempted suicide, dropping to 26% and 11%, respectively, in 1997. In 1997 and 1999, 20% of births were to adolescent mothers.

Adults (20 -59 years): In 1999, 62% of the population was aged 15-59 years (48% males and 52% females). Twenty-four percent of all deaths recorded in 1999 were in this age group, with a rate of 2.9 per 1,000. Among 15-24 year-olds, the mortality rate was 1.1 per 1,000; of these deaths, 46.4% were homicides and 29% were caused by accidents. In the 25-49 years age group, the mortality rate was 2.5 per 1,000 (3.8 per 1,000 males and 2.5 per 1,000 females). The leading causes of death for males aged 25-39 were homicide and accidents, while for women they were accidents and malignant neoplasms. In the 40-44 years age group, AIDS and accidents were the leading causes of death for men, and malignant neoplasms and AIDS were the leading causes of death for women. In men aged 45-49, the leading causes of death were malignant neoplasms and liver disease; in women, they were malignant neoplasms and heart disease. The leading causes of death for both sexes in the 50-59 years age group were heart disease and malignant neoplasms. The birth rate fell from 18 per 1,000 population in 1997 to 15 per 1,000 population in 1999. Most of the births registered in 1999 were to mothers aged 20-24 with an age specific fertility rate of 111.

Elderly: A 14% of Puerto Rico 's population was 60 or older in 1999. In that year, the mortality rate for this age group was 3,971 per 100,000. The leading causes of death were heart disease (997 per 100,000 males and 746 per 100,000 females); malignant neoplasms (869 per 100,000 males and 441 per 100,000 females), and diabetes mellitus (360 per 100,000 males and 320 per 100,000 females). Other important causes of death were cirrhosis and other chronic liver diseases, hypertension, cerebrovascular disease, and pneumonia and influenza.

Workers: In 1999, 93 people died as a result of work-related accidents, for a rate of 2.4 per 100,000. The highest number of deaths from this cause was in the age group 50-54 years (10%). In addition, the highest number of deaths by occupation occurred in machine operators (19%) and craftspeople (13%).

Disabled: In 2000, there were 153,598 people with visual disabilities and 191,997 with developmental problems.


Analysis by type of health problem

Communicable diseases: Infectious and parasitic diseases caused 6% of all deaths in 1999 and 7% in 1990. In 1999, the mortality rate was 43 per 100,000 population (55 per 100,000 males and 31 per 100,000 females). The leading causes were septicemia, which was responsible for 3% of the deaths, and HIV/AIDS, which caused 2% of the deaths. In 1990, the leading causes of death were HIV/AIDS (4%) and septicemia (2%). There were 2046 lab confirmed cases of dengue in 1995 and 1,804 in 1996. Some 2,543 cases were reported in 2000, 807 of which were found positive.

Diseases preventable by immunization: In 2000, 30 cases of pertussis, 1 of measles, 4 of meningitis caused by Haemophilus influenzae type b, and 313 of hepatitis B were reported; 2 deaths from tetanus were also reported. In May 2000, a study conducted by the Vaccination Section found annual coverage of 88% in 1998 and more than 94% in 1999 and 2000 for the DPT4, OPV3, Hib3, and MMR1 series of vaccines. In 1997, vaccination of all children against chicken pox at 12 months of age became mandatory. Since 2001, children and adolescents ages 0 to18 must have 3 doses of hepatitis B vaccine in order to enter the Puerto Rican school system. Moreover, the new vaccine to control bacterial pneumonia was also included in the vaccination regimen.

Infectious intestinal diseases: In 2000, the incidence of intestinal infections due to salmonella was 20 per 100,000, and the incidence of shigellosis was 1 per 100,000. No cases of cholera have been reported in recent decades.

Chronic communicable diseases: The mortality rate from tuberculosis fell from 17 per 100,000 in 1997 to 9 per 100,000 in 1999. In 2000, there was a tuberculosis incidence rate of 5 per 100,000 population, a 15% decrease in cases as compared to the previous year. The number of tuberculosis cases has declined each year since 1997. In 1998, 27% of the tuberculosis patients had AIDS, while in 2000, 26% of the tuberculosis patients had AIDS.

Zoonoses: No case of human rabies has been reported in the last three decades.

HIV/AIDS and other sexually transmitted infections (STI): The incidence rate of AIDS decreased between 1990 and 2000, with rates of 54 and 24 per 100,000 population, respectively (Figure 5). In 1994, AIDS was the fourth leading cause of death, and in 1999 it fell to thirteenth place. In 1999, there were 610 AIDS deaths (75% in males), for a rate of 16 per 100,000 population. As of April 30, 2001, there were 25,525 confirmed adult and adolescent cases and 395 confirmed child cases of AIDS, of which a total of 16,301 (63%) had died. The greatest risk factors were drug use in males (55%) and heterosexual contact in females (59%). The incidence rates for primary and secondary syphilis rose 21% between 1999 and 2000 (3.8 and 4.6 cases per 100,000 population, respectively). The incidence rate for gonorrhea showed an increase of 35% between 1999 and 2000 (8 and 14 cases per 100,000 population, respectively). In 2000 there were 71 reported chlamydia infections per 100,000 population and in 1999 there were 37 per 100,000 population.

Nutritional and metabolic diseases: Diabetes mellitus mortality increased 17% between 1990 and 1999; in 1999, it was the third leading cause of death, with a rate of 56 per 100,000 population (55 per 100,000 females and 58 per 100,000 males). The prevalence of diagnosed diabetes fell from 11% in 1997 to 8.5 % in 2000.

Diseases of the circulatory system: Cardiovascular diseases are the leading cause of death. The mortality rate from this cause rose from 205 per 100,000 population in 1997 to 218 per 100,000 in 1999, when cardiovascular diseases accounted for 29% of all deaths. Heart disease had the highest mortality rate with 139 per 100,000.Ischemic heart disease mortality rate in men was 90 per 100,000 and in women was 67 per 100,000.

Neoplasms maligns: In 1999, malignant neoplasms were the second leading cause of death in Puerto Rico . The mortality rate from this cause dropped from 118 per 100,000 in 1997 to 115 per 100,000 in 1999. The most frequent sites were the digestive organs and the peritoneum, with a rate of 37 per 100,000; of these, 28% were tumors of the colon. Neoplasms of the genitourinary organs were second, with a rate of 21 per 100,000 (63% in males and 38% in females); the most common in males was the prostate (24 per 100,000) and in females, the ovaries (4 per 100,000). Neoplasms of the respiratory and intrathoracic organs were third, with a rate of 17 per 100,000; of these, neoplasms of the trachea and lung had the highest numbers (22 per 100,000 males and 9 per 100,000 females).

Accidents and violence: Accidents were the 4th leading cause of death in 1997 (42 per 100,000 population), dropping to fifth place in 1999 (33 per 100,000); in males, they decreased from 64 per 100,000 in 1997 to 53 per 100,000 in 1999, and in females, they decreased from 21 per 100,000 to 14 per 100,000. In 1999, 48% of deaths due to accidents were the result of motor vehicle accidents. Homicides were the twelfth leading cause of death in 1999, with a rate of 19 per 100,000 (34 per 100,000 males and 3 per 100,000 females). Of all homicides, 89% were by firearm (94% of these deaths were males) and 63% of the deaths of 15-29 year olds were by firearm (92% in males).

Mental health: In 1999, the mortality rate due to suicide was 8 per 100,000 (14 per 100,000 males and 2 per 100,000 females). The highest suicide rates were in the 65 years and older age group (35 per 100,000), the 20-64 years age group (22 per 100,000), and the 10-19 years age group (4 per 100,000). The leading method was hanging (62%), followed by firearms (19%). The mortality rate from mental and behavioral disorders decreased from 12 per 100,000 population in 1990 to 11 per 100,000 in 1999 (18 per 100,000 males and 4 per 100,000 females). In 1999, mental and behavioral disorders due to the use of psychoactive substances accounted for 78% of the total; of these, those due to alcohol use represented 66% (13 per 100,000 males and 1 per 100,000 females).

• RESPONSE OF THE HEALTH SYSTEM

The Government of Puerto Rico initiated the health reform process in 1993, aimed at monitoring the delivery of public and private health services, eliminating discrimination in medical care, ensuring access to quality services for all, managed care, and redefining the governmental function as the indigent medical service provider. In 1998 the Puerto Rico Health Facilities and Services Administration was dissolved and its powers were integrated into the Department of Health. The Department consists of the Department of Health, which governs and oversees health service delivery by private entities; the Substance Abuse and Mental Health Services Administration, which delivers medical care, registers manufacturing, distribution, and shipment of controlled substances, and grants licenses to institutions for the prevention and treatment of substance addiction and the rehabilitation of drug and alcohol addicts and facilities for the mentally ill.

Health system: The Puerto Rico Medical Services Administration, which provides health services, education and conducts research. The Cardiovascular Center of Puerto Rico and the Caribbean, whose mission is to provide the most advanced treatments to patients with cardiovascular disease in Puerto Rico and the Caribbean Islands and to promote education, research, and the development of health professionals in this field; and finally, the Correctional Health Program, who protects, restores, and maintain the physical, dental, and mental health of the penitentiary population. In 1996, the Puerto Rico Health Insurance Administration was established as an independent public corporation. It negotiates and contracts quality health insurance for its insured population, particularly the indigent, and sets up control mechanisms to prevent unjustified increases in health service costs and insurance premiums.

Health promotion: The Office of the Undersecretary for Health Promotion and Protection is responsible for health promotion and disease prevention. In fiscal year 1999-2000 the health education and HIV/AIDS prevention sections were integrated; a project to prevent vertical transmission of HIV and to detect syphilis and HIV/AIDS in women of childbearing age was implemented; there was a decrease of half in the incidence of neural tube defects with the folic acid campaign; cleft lip or cleft palate was included in the Registry of Congenital Conditions; and the 2000-2005 Strategic Plan for Breast-feeding Promotion in Puerto Rico was developed.

Epidemiological surveillance system: The surveillance system operates through the notification of diseases by public and private sector doctors, hospitals, and laboratories. The data goes to the Epidemiology Division and to the CDC. Active surveillance is conducted through weekly telephone reporting (or daily for any urgent situation) for 17 diseases that could cause outbreaks. Passive surveillance is conducted by regional epidemiologists recording communicable diseases on a weekly basis and by tuberculosis and sexually transmitted infection programs.

Potable water, excreta disposal and sewerage services: As of October 1999, some 3.2 million people had household potable water service and 1.7 million households were connected to the sewerage system. Disinfected drinking water is typically supplied 24 hours a day in urban areas. Much of the solid waste (2.4 million tons in 1998) was dumped in municipal dumps and only 18% was recycling. The Office of the Undersecretary for Public Assistance administers Department of Family Services aid to children, the physically and mentally disabled, the elderly, the homeless, and families.

Individual health care services: Under health reform, the regionalized model of care was modified for privatization of public facilities and the country was divided into regions in which the Government finances a medical insurance program contracted to the private sector. In late 2000, all 78 municipalities had been incorporated into the health reform plan, with 99% insured and 1.8 million participants in the Government of Puerto Rico health insurance plan. The health services delivery system now consists of public, privatized public, and private facilities. There were 71 hospitals operating in Puerto Rico in 2000. Of the 13 public hospitals, 5 are general, 3 are specialized, 4 are psychiatric, and 1 is a U.S.Veterans Administration hospital. Of the 45 private hospitals, 39 are general, 3 are specialized, and 3 are psychiatric. The 13 privatized facilities are general hospitals. The 71 hospitals have 12,178 beds available and 10,050 in use. The public hospitals have a total of 3,043 beds available and 2,170 in use. The private hospitals have 6,877 beds available and 6,194 in use.

Human resources: According to the registry of health professionals, in 1998-2001, there were 64,890 professionals, of which 74% were active in Puerto Rico and 3.6% were active in the United States . During the same period, 45% of the professional nurses, 45% of the auxiliary nurses, and 30% of the doctors were in the public sector, while 55% of the nurses in both categories and 70 % of the doctors were in the private sector. Of the 7,623 physicians practicing in Puerto Rico , 70 % worked in the private sector. Between 1995-1998 and 1998-2001, the ratio of doctors per 10,000 population declined approximately 4%, and the ratio of nurses declined 5%. In 1999, there were 2.5 dentists per 100,000 population. The majority of health professionals graduate from the School of Medical Sciences of the Commonwealth's University of Puerto Rico . As of the year 2000, the School of Medical Sciences had trained 28,288 health sciences professionals of all kinds. With the privatization of the public health institutions, the Substantive Law on the Development of Medical Education in Puerto Rico was developed. The Law organizes the island into academic regions, each with a university hospital sponsored by a medical school.

Health sector expenditure and financing: The main sources of financing are Commonwealth funds service fees, and U.S. federal funds. The total consolidated budget for health for fiscal year 1999-2000 was US$ 993.3 million; of that amount, $570.3 million came from federal contributions. In the same fiscal year, Government of Puerto Rico Health Insurance had a revised budget of US$ 1,045.8 million and covered 1.8 million persons.