A comprehensive analysis of the mortality experience of hispanic subgroups in the United States: Variation by age, country of origin, and nativity

Explaining Chronic Illness and Self-Rated Health Among Immigrants of Five Hispanic Ethnicities

The largest racial/ethnic minority group in the United States, Hispanics, especially Hispanic immigrants, have been considered healthier than groups of other ethnicity (including Whites, the majority). However, chronic illnesses such as cancer and diabetes are often seen in this culturally, ethnically diverse group. The present study had two aims. First was to explain two health outcomes, which were presence of chronic illness (any of the five common conditions cardiovascular disease, stroke, hypertension, cancer, and/or diabetes/prediabetes) and self-rated health, in terms of links to certain factors in acculturation, social status, health, social support, and lifestyle. Second was to determine how uniform these links might be across five ethnic groups: Mexican, Puerto Rican, Cuban, Dominican, Central/South American. We combined data from 17 years of the National Health Interview Survey (1999-2015) and subjected these secondary measures to logistic and linear regression, separately by ethnicity, to explain both outcomes. With few exceptions, results generally linked illness/health to the tested independent variables. Additionally, results confirmed ethnicity to moderate the outcomes' associations with the independent variables. Ethnicity-specific analysis showed the two outcomes to exhibit dissimilar relationships with certain independent variables across ethnic groups. Research that (as has been common) lumps together respondents whose Hispanic ethnicities may differ disregards some meaningful variation rather than accounting for it. In future research-and in subsequent evidence-based policy/practice development-all essential sociocultural factors, including ethnicity, should be carefully outlined, advancing good health for the entire Hispanic immigrant population.

Life Expectancies With Depression by Age of Migration and Gender Among Older Mexican Americans

BACKGROUND AND OBJECTIVES

Prior studies examining depression among older Mexican Americans suggest both women and immigrants are at higher risk of depressive symptomatology than males and U.S.-born Mexican Americans. We use data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine whether life expectancy with depression and without depression varies by nativity, age of migration, and gender.

RESEARCH DESIGN AND METHODS

Sullivan-based life tables were used to estimate depression life expectancies among Mexican Americans aged 65 years and older residing in the Southwestern United States. Depression is based on the 20-item Center for Epidemiological Studies Depression scale (CES-D). The CES-D is a continuous scale (0-60) with higher values indicating worse mental health. We dichotomize depression as a score of 16 or greater.

RESULTS

Immigrant women, particularly those who migrated in late-life (after age 50) are at a significant disadvantage in the number of years after age 65 lived with depression and the ratio of years spent without depression relative to U.S.-born women. Among men, only late-life immigrants were disadvantaged in the number of years spent with depression. Early- and mid-life immigrant males did not differ from U.S.-born males.

DISCUSSION AND IMPLICATIONS

Our results highlight the heterogeneity among older Mexican Americans in life expectancies with depression. These findings illustrate the importance of considering age of migration as a high-risk factor for depression among Mexican-origin immigrants. Including this risk factor as a part of depression screening is a key step for timely interventions in preventing disability and comorbidities associated with untreated depression.

The impact of cardiovascular risk factors on cognition in Hispanics and non-Hispanic whites

Among non-Hispanic whites, cardiovascular risk factors are associated with increased mortality and poorer cognition. Prevalence of cardiovascular risk factors among aging Hispanics is also high and Hispanics generally have poorer access to healthcare, yet they tend to have advantageous cardiovascular disease rates and outcomes and live longer than non-Hispanic whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. Although robust data support these ethnic benefits on physical health and mortality, it is unknown if it extends to include cognition resilience advantages in older adulthood. The present study compared relationships between cardiovascular risk and cognition (executive functions and episodic memory) in late middle age and older Hispanics (n = 87) and non-Hispanic whites (n = 81). Participants were selected from the National Alzheimer's Coordinating Center and Alzheimer's Disease Neuroimaging Initiative databases. Hispanics and non-Hispanic white groups were matched on age (50-94 yr, mean age = 72 yr), education, gender, cognitive status (i.e., cognitively healthy versus mildly cognitively impaired), and apolipoprotein E4 status. History of hypertension and higher body mass index were both associated with poorer executive functions among Hispanics but not non-Hispanic whites. Our findings suggest greater vulnerability to impairments in executive functions among Hispanics with hypertension and obesity, contrary to the notion of a Hispanic health paradox for cognitive aging.

California Healthy Places Index: Frames Matter

INTRODUCTION

We describe the California Healthy Places Index (HPI) and its performance relative to other indexes for measuring community well-being at the census-tract level. The HPI arose from a need identified by health departments and community organizations for an index rooted in the social determinants of health for place-based policy making and program targeting. The index was geographically granular, validated against life expectancy at birth, and linked to policy actions.

MATERIALS AND METHODS

Guided by literature, public health experts, and a positive asset frame, we developed a composite index of community well-being for California from publicly available census-tract data on place-based factors linked to health. The 25 HPI indicators spanned 8 domains; weights were derived from their empirical association with tract-level life expectancy using weighted quantile sums methods.

RESULTS

The HPI's domains were aligned with the social determinants of health and policy action areas of economic resources, education, housing, transportation, clean environment, neighborhood conditions, social resources, and health care access. The overall HPI score was the sum of weighted domain scores, of which economy and education were highly influential (50% of total weights). The HPI was strongly associated with life expectancy at birth (r = 0.58). Compared with the HPI, a pollution-oriented index did not capture one-third of the most disadvantaged quartile of census tracts (representing 3 million Californians). Overlap of the HPI's most disadvantaged quartile of census tracts was greater for indexes of economic deprivation. We visualized the HPI percentile ranking as a web-based mapping tool that presented the HPI at multiple geographies and that linked indicators to an action-oriented policy guide.

PRACTICE IMPLICATIONS

The framing of indexes and specifications such as domain weighting have substantial consequences for prioritizing disadvantaged populations. The HPI provides a model for tools and new methods that help prioritize investments and identify multisectoral opportunities for policy action.

Familism and inflammatory processes in African American, Latino, and White youth

OBJECTIVE

African Americans and Latinos make up the two largest minority groups in the United States, and compared with Whites, these ethnic minority groups face disproportionate risk for certain physical health problems. However, factors that may protect these groups against early risk for poor health are not entirely understood. Familism, which emphasizes family interdependence and commitment, and is more prevalent among Latino and African American families, may be one such factor. The current study examined whether values and behaviors related to familism were differentially associated with inflammatory processes among White, African American, and Latino youth.

METHOD

Participants were 257 youth who completed measures of familism values and behaviors and whose parents reported on their ethnicity. Participants also provided blood samples for the assessment of proinflammatory cytokine responses to bacterial challenge and of sensitivity to anti-inflammatory features of cortisol and interleukin (IL)-10.

RESULTS

Significant familism values and behaviors by ethnicity interactions were observed. For Latino and African American youth but not for White youth, more familism values were associated with greater sensitivity to IL-10. Additionally, for African American youth, more familism behaviors were associated with decreased cytokine responses to bacterial challenge and greater sensitivity to cortisol and IL-10. By contrast, familism behaviors were associated with lower sensitivity to cortisol in White youth and were not associated with any inflammatory outcomes in Latino youth.

CONCLUSION

This pattern of findings suggests that for African American youth and to some extent for Latino youth, familism values and behaviors may be protective against the elevated risk for poor health they face. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Biological Risk Profiles Among Latino Subgroups in the Health and Retirement Study

BACKGROUND AND OBJECTIVES

Latinos residing in the United States exhibit an increased risk for cardiovascular and metabolic diseases compared to non-Latino whites. This elevated risk contributes to a significantly higher prevalence of diabetes and hypertension among Latino adults. Examining biological risk profiles of older Latinos as a "pan-ethnic group" and by Latino subpopulations may help to explain the increased burden of disease in later life among this population. The objective of this study is to document biological risk profiles among a nationally representative sample of older U.S. Latinos by nativity and country of origin.

RESEARCH DESIGN AND METHODS

We use the 2006-2012 Health and Retirement Study to compare cardiovascular, metabolic, inflammatory and cumulative biological risk among U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, U.S.-born "other" Latinos, foreign-born "other" Latinos, and non-Latino whites.

RESULTS

Older Latinos exhibit heterogeneous biological risk profiles. U.S.-born Mexicans, foreign-born Mexicans, U.S.-born "other" Latinos, and foreign-born "other" Latinos exhibited a higher rate of cardiovascular risk relative to non-Latino whites. In addition, U.S.-born Mexicans, foreign-born Mexicans, island-born Puerto Ricans, and foreign-born "other" Latinos had a higher rate of metabolic risk than non-Latino whites. Island-born Puerto Ricans were the only group to exhibit higher inflammation than non-Latino whites. The observed differences were largely attenuated by socioeconomic status, indicating that high levels of risk among older Latino subpopulations compared to non-Latino whites are associated with lower socioeconomic status.

DISCUSSION AND IMPLICATIONS

Older U.S. Latinos are a demographically diverse population with unique sociocultural characteristics which may contribute to differences in biological risk across the life course that influence disease progression. Examining Latinos by nativity and country of origin may help identify risks specific to individual subpopulations that can lead to culturally appropriate interventions which help prevent and reduce the burden of cardiovascular and metabolic diseases.

Disparities in functional disability among Arab Americans by nativity, immigrant arrival cohort, and country of birth

This study contributes to a growing literature that documents the importance of arrival cohort and country of birth for differentiating the health of U.S. immigrants. We use nationally-representative data from nine years of the American Community Survey (2008-2016) to examine if an immigrant health advantage exists among Arab Americans ages 40+ (n = 49,867) and test if differences among the foreign-born vary by arrival cohort (pre-1991, 1991-2000, and 2001+). Results from multivariate logistic regression models find that foreign-born Arab Americans have higher odds of physical and self-care disability, and this varies by immigrant arrival cohort. The post-2001 cohort had the highest odds of both disabilities, while the earlier two cohorts did not differ from the native-born after adjustments for covariates. Compositional differences in birthplace, particularly the large influx of immigrants from Iraq in the most recent cohort, explained these differences. Political instabilities globally have contributed to a growing number of U.S. immigrants with vulnerabilities that might be overlooked when arrival cohorts are not considered.

A Comprehensive Analysis of Morbidity Life Expectancies Among Older Hispanic Subgroups in the United States: Variation by Nativity and Country of Origin

BACKGROUND AND OBJECTIVES

Although a clear advantage in mortality has been documented among older Hispanic subgroups, particularly the foreign-born, research examining health selectivity in morbidity life expectancies among older Hispanics are scarce. Differences in sociocultural characteristics among Hispanic subgroups may influence racial/ethnic and nativity disparities in morbidity. Research examining the heterogeneity among older Hispanic subgroups may further our understanding of why some Hispanics are able to preserve good health in old age, while others experience a health disadvantage. Thus, the primary goal of this analysis is to examine racial/ethnic, nativity, and country of origin differences in morbidity life expectancies among older adults in the United States.

RESEARCH DESIGN AND METHODS

We used individual-level data (1999-2015) from the National Health Interview Survey to estimate Sullivan-based life tables of life expectancies with morbidity and without morbidity by gender for U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, foreign-born Cubans, and whites in mid-life (age 50), and late-life (age 65).

RESULTS

Hispanics are heterogeneous in morbidity life expectancies. Among females, U.S.-born Mexicans, foreign-born Mexicans, and island-born Puerto Ricans spent more late-life years with morbidity than whites. For men, U.S.-born Puerto Ricans were the only Hispanic subgroup disadvantaged in the number of years lived with morbidity. Conversely, foreign-born Cubans exhibited the healthiest outcomes of all groups, regardless of gender.

DISCUSSION AND IMPLICATIONS

Reducing the risk for late-life morbidity must be informed by a comprehensive understanding of a wide range of factors that shape health among older adults. Research should avoid pan-ethnic groupings that overlook important differences in chronic disease risk profiles among Hispanic subgroups. Recognizing the various sociocultural and environmental processes that underlie Hispanic subpopulations is important for development and implementation of social and public health policies aimed at ameliorating negative health outcomes of late-life morbidity among minority and immigrant groups.

Sociocultural variability in the Latino population: Age patterns and differences in morbidity among older US adults

BACKGROUND

The US Latino population is rapidly aging and becoming increasingly diverse with respect to nativity and national origin. Increased longevity along with medical advancements in treatment have resulted in a higher number of older Latinos living with morbidity. Therefore, there is a need to understand variability in Latino health among older adults.

OBJECTIVES

This paper documents mid- and late-life health differences in morbidity by race/ethnicity, nativity, and country of origin among adults aged 50 and older.

METHODS

We use data from the 2000-2015 National Health Interview Survey to calculate age-and gender-specific proportions based on reports of five morbidity measures: hypertension, heart disease, stroke, cancer, and diabetes among non-Latino Whites and seven Latino subgroups.

RESULTS

The foreign-born from Mexico, Cuba, and Central/South America, regardless of gender, exhibit an immigrant advantage for heart disease and cancer in comparison to non-Latino Whites across all age categories. Conversely, island-born Puerto Ricans are generally characterized with higher levels of morbidity. Similarly, US-born Puerto Ricans and Mexicans exhibit morbidity patterns indicative of their minority status. Latinos, regardless of gender, were more likely to report diabetes than non-Latino Whites. Hypertension and stroke have significant variability in age patterns among US-and foreign-born Latinos.

CONCLUSION

Recognizing the importance of within-Latino heterogeneity in health is imperative if researchers are to implement social services and health policies aimed at ameliorating the risk of disease.

CONTRIBUTION

Considering intersectional ethnic, nativity, and country-of-origin characteristics among older Latinos is important to better understand the underlying causes of racial/ethnic disparities in morbidity across the life course.

Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans

BACKGROUND AND OBJECTIVES

To explore nativity and age of migration differentials in the incidence of cognitive impairment among older Mexican-Americans.

RESEARCH DESIGN AND METHODS

We employ maximum-likelihood discrete time hazard models to estimate risk ratios of cognitive impairment in a sample of 2,708 Mexican-Americans 65 and older who were cognitively healthy at baseline over a follow-up period of up to 20 years.

RESULTS

Late-life immigrant women have a 46% higher risk of cognitive impairment compared to U.S.-born Mexican-American women. Conversely, midlife immigrant men have a 29% lower risk of cognitive impairment compared to U.S.-born Mexican-American men. The incidence of cognitive impairment did not differ for early-life and midlife immigrant women relative to U.S.-born women or for early- and late-life immigrant men compared to U.S.-born men.

DISCUSSION AND IMPLICATIONS

Differences in cognitive impairment risk between U.S.-born and foreign-born Mexican-American subgroups may be partly due to health selectivity. Cognitive impairment is more prevalent among immigrant groups which may result in a higher burden on family members and/or high dependency on public resources. Programs are needed that can detect decline at earlier stages and reduce the risk for cognitive impairment among older immigrants entering their last decades of life.