Hispanic paradox

The Hispanic paradox, or Latino paradox, also known as the "epidemiologic paradox," refers to the epidemiological finding that Hispanic and Latino Americans tend to have health outcomes that paradoxically are comparable to, or in some cases better than, those of their U.S. non-Hispanic White counterparts, even though Hispanics have lower average income and education. (Low socioeconomic status is almost universally associated with worse population health and higher death rates everywhere in the world.)[1] The paradox usually refers in particular to low mortality among Latinos in the United States relative to non-Hispanic Whites.[2] First coined the Hispanic Epidemiological Paradox in 1986 by Kyriakos Markides,[3] the phenomenon is also known as the Latino Epidemiological Paradox.[4] According to Markides, a professor of sociomedical sciences at the University of Texas Medical Branch in Galveston, this paradox was ignored by past generations, but is now "the leading theme in the health of the Hispanic population in the United States."[4]

The specific cause of the phenomenon is poorly understood, although the decisive factor appears to be place of birth,[5][6] raising the possibility that differing birthing or neonatal practices might be involved via a lack of breastfeeding combined with birth trauma imprinting (both common in American obstetrics[7]) and consequent mental and physical illness, the latter compounded by the impact of psychological problems on the capacity for social networking.[8] It appears that the Hispanic Paradox cannot be explained by either the "salmon bias hypothesis" or the "healthy migrant effect,"[9] two theories that posit low mortality among immigrants due to, respectively, a possible tendency for sick immigrants to return to their home country before death and a possible tendency for new immigrants to be unusually healthy compared to the rest of their home-country population. Historical differences in smoking habits by ethnicity and place of birth may explain much of the paradox, at least at adult ages.[10] Others have proposed that the lower mortality of Hispanics could reflect a slower biological aging rate of Hispanics.[11] However, some believe that there is no Hispanic Paradox, and that inaccurate counting of Hispanic deaths in the United States leads to an underestimate of Hispanic or Latino mortality.[12]

Statistical findings

Mortality

Though they are often at lower socioeconomic standing, most Hispanic groups, excepting Puerto Ricans, demonstrate lower or equal levels of mortality to their non-Hispanic White counterparts.[13] The Center for Disease Control reported in 2003 that Hispanic’s mortality rate was 25 percent lower than non-Hispanic whites and 43 percent lower than African Americans.[4] This mortality advantage most commonly found among middle-aged and elderly Hispanics. The death rates of Hispanics to non-Hispanic whites was found to exceed 1.00 in the twenties, decreases by age 45, then is severely reduced to 0.75-.90 by at age 65, persisting until death. When controlling for socioeconomic factors, the health advantage gap for Mexican Americans, the largest Hispanic population in the US, increases noticeably.[13]

Hispanics do not have a mortality advantage over non-Hispanic Whites in all mortality rates; they have higher rates for mortality from liver disease, cervical cancer, AIDS, homicide (males), and diabetes.[2]

Infant mortality

Another important indicator of health is the infant mortality rate, which is also either equal or better in Hispanic Americans than in non-Hispanic Americans. A study by Hummer, et al. found that infants born to Mexican Immigrant women in the United States have about a 10% lower mortality in the first hour, first day, and first week than that of infants born to non-Hispanic white, U.S.-born women.[14] In 2003, the national Hispanic infant mortality rate was found to be 5.7, nearly equal to that of non-Hispanic Americans and 58 percent lower than that of African Americans.[4] Hispanic immigrants also have a 20% lower infant mortality rate than that of U.S.-born Hispanics, though the latter population usually has a higher income and education, and are much more likely to have health insurance.[15]

Reasons for the paradox

Socio-economic factors

According to Alder and Estrove (2006), the more socioeconomically advantaged individuals are, the better their health.[16] Access to health insurance and preventative medical services are one of the main reasons for socioeconomic health disparities. Economic hardship within the household can cause distress and affect parenting, causing health problems among children leading to depression, substance abuse, and behavior problems. Low socioeconomic status is correlated with increased rates of morbidity and mortality. Mental health disorders are an important health problem for those of low socioeconomic status; they are two to five times more likely to suffer from a diagnosable disorder than those of high socioeconomic status, and are more likely to face barriers to getting treatment. Furthermore, this lack of treatment for mental disorders can affect educational and employment opportunities and achievement.[17]

Residential segregation

Important to the understanding of migrant community health is the increasingly stratified American society, manifested in residential segregation. Beginning in the 1970s, the low to moderate levels of income segregation in the United States began to degrade.[18] As the rich became richer, so did their neighborhoods. This trend was inversely reflected in the poor, as their neighborhoods became poorer. As sociologist Douglas Massey explains, “As a result, poverty and affluence both became more concentrated geographically.”[18] Professor of public administration and economics John Yinger writes that “one way for poor people to win the spatial competition for housing is to rent small or low-quality housing.” However, he continues, low-quality housing often features serious health risks such as lead paint and animal pests. Though lead-based paint was deemed illegal in 1978, it remains on the walls of older apartments and houses, posing a serious neurological risk to children. Asthma, a possible serious health risk, also has a clear link to poverty. Moreover, asthma attacks have been associated with certain aspects of poor housing quality such as the presence of cockroaches, mice, dust, dust mites, mold, and mildew. The 1997 American Housing Survey found that signs of rats or mice are almost twice as likely to be detected in poor households as in non-poor households.[19]

Hypotheses

Barrio advantage

One hypothesis for the Hispanic Paradox proposes that living in the same neighborhood as people with similar ethnic backgrounds confers significant advantages to one’s health. In a study of elderly Mexican-Americans, those living in areas with a higher percentage of Mexican-Americans had lower seven-year mortality as well as a decreased prevalence of medical conditions, including stroke, cancer, and hip fracture.[20] Despite these neighborhoods' relatively high rates of poverty due to lack of formal education and low paying, service sector jobs, residents do not suffer from the same mortality and morbidity levels seen in similarly disadvantaged socioeconomic neighborhoods. These neighborhoods do have intact family structures, community institutions, and kinship structures that span households, all of which are thought to provide significant benefits to an individual’s health.[20] These social network support structures are especially important to the health of the elderly population as they deal with declining physical function. Another reason for this phenomenon could be that those Hispanic-Americans that live among those of similar cultural and social backgrounds are shielded from some of the negative effects of assimilation to American culture.[20]

Acculturation

The extent of a Hispanic American’s acculturation in the United States, or their assimilation to mainstream American culture, is relative to his or her health.[2] One of the main negative effects of acculturation on health has been on substance abuse. More assimilated Latinos have higher rates of illicit drug use, alcohol consumption, and smoking, especially among women.[21] Another negative effect of acculturation is changes in diet and nutrition. More acculturated Latinos eat less fruits, vegetables, vitamins, fiber and protein and consume more fat than their less acculturated counterparts.[21] One of the most significant impacts of acculturation on Latino health is birth outcomes. Studies have found that more acculturated Latinas have higher rates of low birthweight, premature births, teenage pregnancy and undesirable prenatal and postnatal behaviors such as smoking or drinking during pregnancy, and lower rates of breastfeeding.[21] Acculturation and greater time in the United States has also been associated with negative mental health impacts. US-born Latinos or long term residents of the United States had higher rates of mental illness than recent Latino immigrants.[22] In addition, foreign-born Mexican Americans are at significantly lower risk of suicide and depression than those born in the United States.[22] The increased rates of mental illness is thought to be due to increased distress associated with alienation, discrimination and Mexican Americans attempting to advance themselves economically and socially stripping themselves of traditional resources and ethnically-based social support.[23]

Healthy migrant effect

The “healthy migrant effect” hypothesizes that the selection of healthy Hispanic immigrants into the United States is reason for the paradox.[2] International immigration statistics demonstrate that the mortality rate of immigrants is lower than in their country of origin. In the United States, foreign-born individuals have better self-reported health than American-born respondents. Furthermore, Hispanic immigrants have better health than those living in the US for a long amount of time.

Salmon bias

A second popular hypothesis, called the “Salmon Bias”, attempts to factor in the occurrence of returning home to Mexico.[2] This hypothesis purports that many Hispanic people return to Mexico after temporary employment, retirement, or severe illness, meaning that their deaths occur on Mexican soil and are not taken into account by mortality reports in the United States. This hypothesis considers those people as “statistically immortal” because they artificially lower the Hispanic mortality rate. Certain studies hint that it could be reasonable. These studies report that though return migration, both temporary and permanent, depend upon specific economic and social situations in communities, up to 75% of household in Mexican immigrant neighborhoods do some kind of return migration from the U.S. However, Abraido-Lanza, et al. found in 1999 that the “Salmon Hypothesis” cannot account for the lower mortality of Hispanics in the US because, according to their findings, the Hispanic paradox is still present when non-returning migrants are observed (e.g. Cubans).[2]

Slow biological aging

Horvath et al. (2013) have proposed that the lower mortality of Hispanics could reflect a slower biological aging rate of Hispanics.[11] This hypothesis is based on the finding that blood and saliva from Hispanics ages more slowly than that of non-Hispanic whites, African Americans, and other populations according to a biomarker of tissue age known as epigenetic clock.[11]

Comparison with other ethnicities

One of the most important aspects of this phenomenon is the comparison of Hispanics' health to non-Hispanic African Americans' health. Both the current and historical poverty rates for Hispanic and non-Hispanic African American populations in the United States are consistently starkly higher than that of non-Hispanic White and non-Hispanic Asian Americans.[19] Dr. Hector Flores explains that “You can predict in the African–American population, for example, a high infant-mortality rate, so we would think a [similar] poor minority would have the same health outcomes.” However, he said, the health poor outcomes are not present in the Hispanic population.[4] For example, the age-adjusted mortality rate for Hispanics living in Los Angeles County was 52 percent less than the blacks living in the same county.[4]

Criticism

Some public health researchers have argued that the Hispanic paradox is not actually a national phenomenon in the United States. In 2006, Smith and Bradshaw argued that no Hispanic paradox exists. They maintain that life expectancies were nearly equal for non-Hispanic White and Hispanic females, but less close for non-Hispanic White and Hispanic Males.[12] Turra and Goldman argue that the paradox is concentrated among the foreign born from specific national origins, and is only present in those of middle to older ages. At younger ages, they explain, deaths are highly related to environmental factors such as homicides and accidents. Deaths at older ages, they maintain, are more related to detrimental health-related behaviors and health status at younger ages. Therefore, immigration-related processes only offer survival protection to those at middle and older ages; the negative impact of assimilation into poor neighborhoods is higher on the mortality of immigrants at a younger age.[13] In contrast, Palloni and Arias hypothesize that this phenomenon is most likely caused by across-the-board bias in underestimating mortality rates, caused by ethnic misidentification or an overstatement of ages.[24] These errors could also be related to mistakes in matching death records to the National Health Interview Survey, missing security numbers, or complex surnames.[13]

See also

References

  1. ↑ Franzini L, Ribble JC, Keddie AM (2001). "Understanding the Hispanic paradox". Ethn Dis. 11 (3): 496–518. PMID 11572416.
  2. 1 2 3 4 5 6 Abraído-Lanza, Ana F; Dohrenwend, Bruce P; Ng-Mak, Daisy S; Turner, J Blake (1999). "The Latino mortality paradox: A test of the "salmon bias" and healthy migrant hypotheses". American Journal of Public Health. 89 (10): 1543–8. doi:10.2105/AJPH.89.10.1543. PMC 1508801Freely accessible. PMID 10511837.
  3. ↑ Markides, K. S.; Coreil, J. (1986). The health of Hispanics in the Southwestern United States: An epidemiological paradox. Public Health Reports, 101, 253-265.
  4. 1 2 3 4 5 6 Chung, Juliet (29 Aug 2006). "Hispanic Paradox: Income may be lower but health better than most". The Seattle Times.
  5. ↑ Bower, Bruce (1998). "Immigrants go from health to worse". Science News. 154 (12): 180. doi:10.2307/4010766. JSTOR 4010766.
  6. ↑ Bower, Bruce (2004). "Immigration blues: Born in the USA: Mental-health deficit". Science News. 166 (25–26): 387–8. doi:10.2307/4015677. JSTOR 4015677.
  7. ↑ Winkel R. "Munchausen Obstetrics". Retrieved April 23, 2010.
  8. ↑ Berkman, Lisa F.; Syme, S. Leonard (1979). "Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents". American Journal of Epidemiology. 109 (2): 186–204. PMID 425958.
  9. ↑ Turra CM, Elo IT (2008). "The Impact of Salmon Bias on the Hispanic Mortality Advantage: New Evidence from Social Security Data". Popul Res Policy Rev. 27 (5): 515–530. doi:10.1007/s11113-008-9087-4. PMC 2546603Freely accessible. PMID 19122882.
  10. ↑ Blue L, Fenelon A (June 2011). "Explaining low mortality among US immigrants relative to native-born Americans: the role of smoking". Int J Epidemiol. 40 (3): 786–93. doi:10.1093/ije/dyr011. PMC 3147070Freely accessible. PMID 21324939.
  11. 1 2 3 Horvath S, Gurven M, Levine ME, Trumble BC, Kaplan H, Allayee H, Ritz BR, Chen B, Lu AT, Rickabaugh TM, Jamieson BD, Sun D, Li S, Chen W, Quintana-Murci L, Fagny M, Kobor MS, Tsao PS, Reiner AP, Edlefsen KL, Absher D, Assimes TL (2016). "An epigenetic clock analysis of race/ethnicity, sex, and coronary heart disease.". Genome Biol. 17 (1): 171. doi:10.1186/s13059-016-1030-0. PMC 4980791Freely accessible. PMID 27511193.
  12. 1 2 Smith DP, Bradshaw BS (September 2006). "Rethinking the Hispanic paradox: death rates and life expectancy for US non-Hispanic White and Hispanic populations". Am J Public Health. 96 (9): 1686–92. doi:10.2105/AJPH.2003.035378. PMC 1551967Freely accessible. PMID 16380579.
  13. 1 2 3 4 Turra, Cassio M.; Goldman, Noreen (2007). "Socioeconomic Differences in Mortality Among U.S. Adults: Insights Into the Hispanic Paradox". The Journals of Gerontology: Series B. 62 (3): S184–92. doi:10.1093/geronb/62.3.S184. PMID 17507594.
  14. ↑ Hummer, Robert A.; Powers, Daniel A.; Pullum, Starling G.; Gossman, Ginger L.; Frisbie, W. Parker (2007). "Paradox Found (Again): Infant Mortality Among the Mexican-Origin Population in the United States". Demography. 44 (3): 441–57. doi:10.1353/dem.2007.0028. PMC 2031221Freely accessible. PMID 17913005.
  15. ↑ http://www.hispanicbusiness.com/editors_picks/2009/7/7/the_hispanicparadox_us_hispanics_live.htm[][][]
  16. ↑ Adler, Nancy E.; Ostrove, Joan M. (1999). "Socioeconomic Status and Health: What We Know and What We Don't". Annals of the New York Academy of Sciences. 896: 3–15. Bibcode:1999NYASA.896....3A. doi:10.1111/j.1749-6632.1999.tb08101.x. PMID 10681884.
  17. ↑ "Socioeconomic Status and Health" (PDF). APA Public Interest Government Relations Office. Archived from the original (PDF) on October 21, 2012.
  18. 1 2 Massey, Douglas S. (2004). "The New Geography of Inequality in Urban America". In Henry, C. Michael. Race, Poverty, and Domestic Policy. New Haven: Yale University Press. pp. 173–87. ISBN 978-0-300-12984-7.
  19. 1 2 Yinger, John (2009). "Housing Discrimination and Residential Segregation as Causes of Poverty". In Danziger, Sheldon H.; Haveman, Robert H. Understanding Poverty. Harvard University Press. pp. 359–91. ISBN 978-0-674-03017-6.
  20. 1 2 3 Eschbach, Karl; Ostir, Glenn V.; Patel, Kushang V.; Markides, Kyriakos S.; Goodwin, James S. (2004). "Neighborhood Context and Mortality Among Older Mexican Americans: Is There a Barrio Advantage?". American Journal of Public Health. 94 (10): 1807–12. doi:10.2105/AJPH.94.10.1807. PMC 1448538Freely accessible. PMID 15451754.
  21. 1 2 3 Lara, Marielena; Gamboa, Cristina; Kahramanian, M. Iya; Morales, Leo S.; Hayes Bautista, David E. (2005). "ACCULTURATION AND LATINO HEALTH IN THE UNITED STATES: A Review of the Literature and its Sociopolitical Context". Annual Review of Public Health. 26: 367–97. doi:10.1146/annurev.publhealth.26.021304.144615. PMID 15760294.
  22. 1 2 "Latino Community Mental Health Fact Sheet" (PDF). Nami Multicultural Action Center.
  23. ↑ Kaplan, Mark S.; Marks, Gary (1990). "Adverse effects of acculturation: Psychological distress among Mexican American young adults". Social Science & Medicine. 31 (12): 1313–9. doi:10.1016/0277-9536(90)90070-9. PMID 2287960.
  24. ↑ Palloni, Alberto; Arias, Elizabeth (2004). "Paradox Lost: Explaining the Hispanic Adult Mortality Advantage". Demography. 41 (3): 385–415. doi:10.1353/dem.2004.0024. JSTOR 1515185. PMID 15461007.
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