文章基本信息

标题：Hispanic Paradox in Biological Risk Profiles
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作者：Eileen M. Crimmins ; Jung Ki Kim ; Dawn E. Alley 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：7
页码：1305-1310
DOI：10.2105/AJPH.2006.091892
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined biological risk profiles by race, ethnicity, and nativity to evaluate evidence for a Hispanic paradox in measured health indicators. Methods. We used data on adults aged 40 years and older (n = 4206) from the National Health and Nutrition Examination Surveys (1999–2002) to compare blood pressure, metabolic, and inflammatory risk profiles for Whites, Blacks, US-born and foreign-born Hispanics, and Hispanics of Mexican origin. We controlled for age, gender, and socioeconomic status. Results. Hispanics have more risk factors above clinical risk levels than do Whites but fewer than Blacks. Differences between Hispanics and Whites disappeared after we controlled for socioeconomic status, but results differed by nativity. After we controlled for socioeconomic status, the differences between foreign-born Hispanics and Whites were eliminated, but US-born Mexican Americans still had higher biological risk scores than did both Whites and foreign-born Mexican Americans. Conclusions. There is no Hispanic paradox in biological risk profiles. However, our finding that foreign-born Hispanics and Whites had similar biological risk profiles, but US-born Mexican Americans had higher risk, was consistent with hypothesized effects of migrant health selectivity (healthy people in-migrating and unhealthy people out-migrating) as well as some differences in health behaviors between US-born and foreign-born Hispanics. Many studies report that Hispanics in the United States have better or similar health to that of non-Hispanic Whites (hereafter referred to as Whites), despite Hispanics having lower incomes and less education. 1 ^, 2 Most studies that examine differences in adult mortality find that Hispanics have relatively lower mortality rates compared with Whites. 2 ^– 6 This better-than-expected health and mortality of Hispanics, given their lower socioeconomic status (SES), has been called the Hispanic paradox. 6 ^, 7 Not all empirical findings support the existence of a Hispanic paradox. Differentials depend on the domain of health and the population investigated. Evidence for a Hispanic mortality advantage is strongest among men, persons of advanced age, and those born in Mexico. 6 However, some studies have found no difference in mortality between Hispanics and Whites, 8 and others have questioned the data quality in estimates of mortality among Hispanics. 9 ^, 10 Ethnic differences are even less clear-cut in analyses of function, disability, 11 ^, 12 and morbidity. 3 Self-reports of health status may be influenced by cultural differences in reporting or differences in health knowledge acquired through interaction with the medical system. 13 Analyses of self-reported health status usually find that Hispanics report worse health than Whites. 1 ^, 14 Researchers have argued recently that the migrants who immigrate are different from persons from the same country of origin who do not migrate may also play a large role in observed Hispanic health advantages, suggesting that the “paradox” may not be so paradoxical in a population that is heavily weighted with immigrants. 15 ^, 16 The healthy migrant hypothesis provides 1 explanation for better-than-expected health outcomes among Hispanics. 17 ^, 18 It has been suggested that Hispanics who immigrate to the United States are healthier than Hispanics who remain in their country of origin; this selection of healthy persons from the sending population can improve the level of health in the receiving population. Another explanation of the Hispanic paradox is the “salmon hypothesis,” which suggests that sick persons return to their place of origin. 16 ^, 17 Palloni and Arias 16 second explanation for their finding that the mortality advantage is limited to foreign-born Hispanics, particularly those who were born in Mexico. Both of these explanations for the Hispanic paradox imply that the Hispanic health advantage is a feature exclusive to foreign-born Hispanics, rather than US-born Hispanics. Measurements of biological risk factors for poor health (e.g., blood pressure, blood glucose, and cholesterol) should provide objective indicators of health status that are related to subsequent onset of disease, loss of function, and mortality. 19 ^– 21 We examined differences in 10 physiological indicators by race, ethnicity, and nativity. 21 These indicators represent multiple physiological processes and have individually and cumulatively been linked to important age-related health outcomes, including cardiovascular disease, cognitive decline, physical disability, and death. 22 ^– 24 We examined both a summary indicator of risk as well as blood pressure, metabolism, and inflammation risk profiles to investigate whether it was possible to identify which physiological systems accounted for overall differentials by race, ethnicity, and nativity. If differentials were concentrated among 1 or 2 sets of indicators rather than spread across categories, this would provide another indicator of how health differences arise. Risk profiles based on multiple factors are useful in the analyses of a variety of health outcomes. 25 ^– 27 The total number of indicators of physiological status outside the normal operating range has been shown to be a better predictor of health outcomes than individual markers, 21 ^, 24 but differences in risk by type of marker may be informative for the analysis of racial and ethnic differences. It is possible that differentials in risk factors by race, ethnicity, and nativity may be more concentrated in some physiological systems than in others. For instance, Blacks have been shown to have a higher prevalence of hypertension, a cardiovascular risk factor, than either Whites or Hispanics of Mexican origin (Mexican Americans). 28 Conversely, metabolic syndrome is more prevalent in Mexican Americans than it is in Blacks. 29 Blacks also have been shown to have higher levels of inflammatory markers such as C-reactive protein 30 ^, 31 and fibrinogen. 32 Differences in Hispanics are more complicated and vary by subgroup. One study of all subgroups of Hispanic women found that C-reactive protein levels were similar to those in White women, 31 but an analysis of Mexican American women found them to have higher levels of C-reactive protein than Whites. 30 We used measured indicators of physiological status to determine whether Hispanics had biological risk profiles similar to those of Whites. We further examined how biological risk profiles vary by nativity in the total Hispanic population and in Hispanics of Mexican origin. If there is a Hispanic paradox in biological profiles, Hispanics would be expected to have better risk profiles compared with Whites after control for SES.