Latinos are the fastest-growing population in the United States: the US Bureau of Census (2012) projects that the Latino population will increase from 51 million in 2010 to 129 million by 2060. The health of this rapidly growing population presents an unexpected profile that questions some of the basic assumptions about the factors that create health profiles of subpopulations in the United States. Statistically, Latinos have significantly lower income, education, and access to health care than non-Latino whites (NLWs). Yet, despite these disadvantages, data indicate that Latinos have lower all-cause mortality and longer life expectancy than NLWs. This phenomenon is commonly referred to as the Latino epidemiological paradox (LEP). In this article, we cover evidence of the LEP in chronic diseases (heart disease, stroke, and cancer) and birth outcomes (infant mortality rates, incidence of low birth weight). We review the controversy surrounding the paradox, as well as hypotheses that critique its existence, including data artifacts and the possibility that healthy-immigrant selection and return migration might be driving paradox data. We discuss Latino health behaviors, which, while generally are very good, change in a predictable direction when health is evaluated with nativity, language, time in the United States, and degree of acculturation. We also discuss poor access to health care among Latinos, as well as the pessimistic bias in Latino reports of their own health. Finally, we conclude with the main exceptions to the paradox (i.e., diabetes and homicide). The literature on Latinos alternates terminology, referring to similarly defined groups of people either as Latino or Hispanic. Because different articles use different terminology (Hispanic, Latino, Mexican American, etc.) and different operationalizations (self-report, language, surname, etc.), the term “Latino” will be used uniformly to refer to this group. While it is an imperfect term, we argue that it is the best term to define the group of people discussed herein. In a similar fashion, the various terms and operationalizations that are used to describe what the census terms “Non-Hispanic White” (European ancestry, white, etc.) will be termed non-Latino white.
The Latino Epidemiological Paradox
Latinos have, on average, lower income, education, and access to health care than non-Latino whites (NLWs). Despite these disadvantages, data indicate that Latinos have lower all-cause mortality and longer life expectancy than NLWs—a phenomenon commonly referred to as the Latino epidemiological paradox (LEP). The National Vital Statistics System (NVSS) periodically releases mortality information with population statistics by race and ethnicity for various causes of death. Data presented in an NVSS report (Murphy, et al. 2013) can be used to calculate age-adjusted mortality rates: Latinos have approximately 24 percent lower age-adjusted heart disease mortality, 20 percent lower cancer mortality, and 15 percent lower stroke mortality than NLWs. Murphy, et al. 2013 also indicates a two-to three-year-longer life expectancy for Latinos over NLWs. The paradox is also evident at the other end of the life spectrum; data from Mathews and MacDorman 2012 indicate that infant mortality rates between Latina and NLW mothers are nearly identical. Beyond raw, national mortality data, the literature on the paradox is expansive. Since there is a large body of research linking lower socioeconomic status with poorer health outcomes, evidence of the Latino paradox was initially surprising and is still considered controversial. Latino health researchers since the mid-1980s have engaged in extensive dialogue attempting to unpack the paradox. The authors of Markides and Coreil 1986 were the first to coin the term “epidemiological paradox,” and reviews of the paradox literature may be found in Markides and Eschbach 2005 and Markides and Eschbach 2011. On the basis of their review of the literature, the authors concluded that the most likely explanation for the paradox is healthy-immigrant selection. However, they encourage further research to better understand the mechanisms behind the paradox. Ruiz, et al. 2013 reports the results of the only meta-analysis, to date, on longitudinal studies that specifically compare Latino mortality at the individual level with other race/ethnic groups. Using fifty-eight studies on a variety of health conditions and tapping into over 4.6 million people (26 percent of whom are Latino), the meta-analysis concluded that data support the existence of the paradox. Suggestions were made for future studies to focus on the reasons for Latino resilience. Risk and resilience factors may include biological, behavioral, psychological, social, and cultural differences, but the future challenges are to pinpoint what these factors may be.
Markides, Kyriakos S., and Jeannine Coreil. “The Health of Hispanics in the Southwestern United States: An Epidemiologic Paradox.” Public Health Reports 101.3 (1986): 253–265.
This is the first article to identify and name the “epidemiological paradox” among Latinos.
Markides, Kyriakos S., and Karl Eschbach. “Aging, Migration, and Mortality: Current Status of Research on the Hispanic Paradox.” In Special Issue on Health Inequalities across the Life Course. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60.S2 (2005): S68–S75.
This article reviews the LEP literature through 2005. The literature up to that point still indicated evidence of a mortality advantage among Latinos, at the very least among Mexican Americans.
Markides, Kyriakos S., and Karl Eschbach. “Hispanic Paradox in Adult Mortality in the United States.” In International Handbook of Adult Mortality. Edited by Richard G. Rogers and Eileen M. Crimmins, 227–240. International Handbooks of Population 2. Dordrecht, The Netherlands: Springer, 2011.
This article reviews the LEP literature between 2005 and 2011, finding that immigrant health selection remains the best explanation for the paradox.
Mathews, T. J., and Marian F. MacDorman. “Infant Mortality Statistics from the 2009 Period Linked Birth / Infant Death Data Set.” National Vital Statistics Reports 61.8 (2012).
Data from this report indicate that Latina and NLW mothers have nearly identical infant mortality rates. Please refer to the Centers for Disease Control and Prevention (CDC) website for annual updates.
Murphy, Sherry L., Jiaquan Xu, and Kenneth D. Kochanek. “Deaths: Final Data for 2010.” National Vital Statistics Reports 61.4 (2013).
Population statistics on race and ethnicity in the United States can be used to calculate age-adjusted mortality rates. Please refer to the CDC website for annual updates.
Ruiz, John M., Patrick Steffen, and Timothy B. Smith. “Hispanic Mortality Paradox: A Systematic Review and Meta-analysis of the Longitudinal Literature.” American Journal of Public Health 103.3 (2013): e52–e60.
This is a comprehensive meta-analysis of studies comparing Latino mortality with non-Latinos. The analyses support the existence of the LEP.
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