Mortality of foreign-born and US-born Hispanic adults at younger ages: a reexamination of recent patterns

Mortality Advantage Reversed: The Causes of Death Driving All-Cause Mortality Differentials Between Immigrants, the Descendants of Immigrants and Ancestral Natives in Sweden, 1997-2016

A small but growing body of studies have documented the alarming mortality situation of adult descendants of migrants in a number of European countries. Nearly all of them have focused on all-cause mortality to reveal these important health inequalities. This paper takes advantage of the Swedish population registers to study all-cause and cause-specific mortality among men and women aged 15-44 in Sweden from 1997 to 2016 to a level of granularity unparalleled elsewhere. It adopts a multi-generation, multi-origin and multi-cause-of-death approach. Using extended, competing-risks survival models, it aims to show (1) how the all-cause mortality of immigrants arriving as adults (the G1), immigrants arriving as children (the G1.5) and children of immigrants born in Sweden to at least one immigrant parent (the G2) differs versus ancestral Swedes and (2) what causes-of-deaths drive these differentials. For all-cause mortality, most G1 (not Finns or Sub-Saharan Africans) have a mortality advantage. This contrasts with a near systematic reversal in the mortality of the G1.5 and G2 (notably among men), which is driven by excess accident and injury, suicide, substance use and other external cause mortality. Given that external causes-of-death are preventable and avoidable, the findings raise questions about integration processes, the levels of inequality immigrant populations are exposed to in Sweden and ultimately, whether the legacy of immigration has been positive. Strengths of the study include the use of quality data and advanced methods, the granularity of the estimates, and the provision of evidence that highlights the precarious mortality situation of the seldom-studied G1.5.

Diminished Advantage or Persistent Protection? A New Approach to Assess Immigrants' Mortality Advantages Over Time

Much research has debated whether immigrants' health advantages over natives decline with their duration at destination. Most such research has relied on (pooled) cross-sectional data and used years since immigration as a proxy for the duration of residence, leading to the challenge of distilling the duration effect from the confounding cohort-of-arrival and age-of-arrival effects. Because longitudinal studies tend to use self-rated health as the outcome, the changes they observed may reflect shifts in immigrants' awareness of health problems. We illuminate the debate by examining how immigrants' mortality risk-a relatively unambiguous measure tied to poor health-changes over time compared to natives' mortality risk. Our analysis uses the National Health Interview Survey (1992-2009) with linked mortality data through 2011 (n = 875,306). We find a survival advantage for U.S. immigrants over the native-born that persisted or amplified during the 20-year period. Moreover, this advantage persisted for all immigrants, regardless of their race/ethnicity and gender or when they began their U.S. residence. This study provides unequivocal evidence that immigrant status' health protection as reflected in mortality is stable and long-lasting.

Citizenship Status and Mortality Among Young Latino Adults in the U.S., 1998‒2015

INTRODUCTION

Although Latino immigrants, especially noncitizens, endure structural factors that may increase their risk of death at younger ages, little is known about their risk of death in young adulthood. This study evaluates mortality differences across citizenship status among young Latino adults (aged 18-44 years) in the U.S.

METHODS

This study used the National Health Interview Survey (1998-2014) with mortality follow-up through 2015. Cox regression models adjusted for age and sex were used to determine baseline differences in mortality. Models adjusted for socioeconomic factors (i.e., English proficiency, education, poverty, and health insurance) were used to determine whether socioeconomic conditions attenuate mortality differences.

RESULTS

Participants included noncitizens (n=48,388), naturalized citizens (n=16,241), and U.S.-born citizens (n=63,388). Noncitizens (hazard ratio [HR]=1.40, 95% CI=1.31, 1.51), but not naturalized citizens (HR=1.04, 95% CI=0.94, 1.16), were at greater risk of all-cause death than U.S.-born citizens. Both noncitizens (HR=2.46, 95% CI=2.07, 2.92) and naturalized citizens (HR=1.76, 95% CI=1.40, 2.21) were more likely to die of cancer. Noncitizens were also at a greater risk of death because of cardiometabolic diseases (HR=1.46, 95% CI=1.20, 1.78) and accidents (HR=1.33, 95% CI=1.14, 1.55). Socioeconomic factors attenuated differences in all-cause, cardiometabolic, and accidental deaths, but not differences in cancer mortality.

CONCLUSIONS

Contrary to the long-held notion of the healthy migrant, young Latino immigrants, especially noncitizens, are at increased risk of death than their U.S.-born counterparts. Efforts to reduce these disparities should focus on improving their socioeconomic conditions and healthcare access early in adulthood.

A Global Meta-analysis of the Immigrant Mortality Advantage

A large body of research on the “Healthy Immigrant Effect” (or “Paradox”) has reported an immigrant mortality advantage. However, other studies do not find such significant effects, and some even present contradictory evidence. This article is the first systematic meta-analysis that investigates the immigration-mortality relationship from a global perspective, examining 1,933 all-cause and cardiovascular mortality risk estimates from 103 publications. Our comprehensive analysis allows us to assess interactions between origin and destination regions and to reexamine, on a global scale, some of the most notable explanations for the immigrant mortality advantage, including suggestions that this paradox may be primarily the result of selection effects. We find evidence for the existence of a mild immigrant mortality advantage for working-age individuals. However, the relationship holds only for immigrants who moved between certain world regions, particularly those who immigrated from Northern Africa, Asia, and Southern Europe to richer countries. The results highlight the need in the broader migration literature for an increased focus on selection effects and on outcomes for people who chose not to migrate or who were denied entry into their planned destination country.

Quantifying Lifecourse Drivers of International Migration: A Cross-national Analysis of Mexico and the United States

BACKGROUND

Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.

METHODS

We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

RESULTS

Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

CONCLUSIONS

Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.

Cancer health disparities in racial/ethnic minorities in the United States

There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.

Comparison of Use of Health Care Services and Spending for Unauthorized Immigrants vs Authorized Immigrants or US Citizens Using a Machine Learning Model

IMPORTANCE

Knowledge about use of health care services (health care utilization) and expenditures among unauthorized immigrant populations is uncertain because of limitations in ascertaining legal status in population data.

OBJECTIVE

To examine health care utilization and expenditures that are attributable to unauthorized and authorized immigrants vs US-born individuals.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used the data on documentation status from the Los Angeles Family and Neighborhood Survey (LAFANS) to develop a random forest classifier machine learning model. K-fold cross-validation was used to test model performance. The LAFANS is a randomized, multilevel, in-person survey of households residing in Los Angeles County, California, consisting of 2 waves. Wave 1 began in April 2000 and ended in January 2002, and wave 2 began in August 2006 and ended in December 2008. The machine learning model was then applied to a nationally representative database, the 2016-2017 Medical Expenditure Panel Survey (MEPS), to predict health care expenditures and utilization among unauthorized and authorized immigrants and US-born individuals. A generalized linear model analyzed health care expenditures. Logistic regression modeling estimated dichotomous use of emergency department (ED), inpatient, outpatient, and office-based physician visits by immigrant groups with adjusting for confounding factors. Data were analyzed from May 1, 2019, to October 14, 2020.

EXPOSURES

Self-reported immigration status (US-born, authorized, and unauthorized status).

MAIN OUTCOMES AND MEASURES

Annual health care expenditures per capita and use of ED, outpatient, inpatient, and office-based physician care.

RESULTS

Of 47 199 MEPS respondents with nonmissing data, 35 079 (74.3%) were US born, 10 816 (22.9%) were authorized immigrants, and 1304 (2.8%) were unauthorized immigrants (51.7% female; mean age, 47.6 [95% CI, 47.4-47.8] years). Compared with authorized immigrants and US-born individuals, unauthorized immigrants were more likely to be aged 18 to 44 years (80.8%), Latino (96.3%), and Spanish speaking (95.2%) and to have less than 12 years of education (53.7%). Half of unauthorized immigrants (47.1%) were uninsured compared with 15.9% of authorized immigrants and 6.0% of US-born individuals. Mean annual health care expenditures per person were $1629 (95% CI, $1330-$1928) for unauthorized immigrants, $3795 (95% CI, $3555-$4035) for authorized immigrants, and $6088 (95% CI, $5935-$6242) for US-born individuals.

CONCLUSIONS AND RELEVANCE

Contrary to much political discourse in the US, this cross-sectional study found no evidence that unauthorized immigrants are a substantial economic burden on safety net facilities such as EDs. This study illustrates the value of machine learning in the study of unauthorized immigrants using large-scale, secondary databases.

The moderating role of race/ethnicity and nativity in the relationship between perceived discrimination and overweight and obesity: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity.

METHODS

We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors.

RESULTS

The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001].

CONCLUSION

Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.

Mental Strain of Immigrants in the Working Context

Inability to work due to reported mental strain and psychiatric disorders is rising in Germany these days. Meanwhile the country's net migration is positive. While there is empirical evidence for a healthy migrant effect regarding the physical health in the beginning (mostly accompanied by a subsequent convergence effect), the mental health of migrants remains partly understudied. In order to evaluate the migrant's share in the rise of reported mental strain in Germany, 4000 employees were surveyed by means of an online access panel. About 16 percent of them revealed a migration background. Their Copenhagen Burnout Inventory (CBI) score is slightly yet significantly above the German autochthonous' one both using bi- and multivariate analysis, indicating that there is a specific vulnerability rather than a healthy migrant effect regarding mental strain at work.

Patterns of Care and Survival in Stage III NSCLC Among Black and Latino Patients Compared With White Patients

BACKGROUND

Race and socioeconomic status have continued to affect the survival and patterns of care of patients with non-small-cell lung cancer (NSCLC). However, data evaluating these associations in patients with stage III disease remain limited. Therefore, we investigated the patterns of care and overall survival (OS) of black and Latino patients with locally advanced NSCLC compared with white patients, using the National Cancer Database.

MATERIALS AND METHODS

All patients with stage III NSCLC from 2004 to 2013 who had undergone external beam radiotherapy (RT) alone, RT with chemotherapy (bimodality), or RT with chemotherapy followed by surgery (trimodality) were analyzed within the National Cancer Database according to race (n = 113,945). Univariate associations among the demographic, disease, and treatment characteristics within the 3 cohorts were assessed using χ2 tests. The OS between cohorts were analyzed using the log-rank test and multivariate Cox proportional hazards regression.

RESULTS

The black and Latino patients were younger at diagnosis, had lower median household incomes, and were less likely to be insured than were the white patients. The black patients were more likely to receive RT alone (19.3% vs. 18%; P < .001) and less likely to have undergone concurrent chemo-RT (53.6% vs. 56.1%; P < .001) compared with the white patients. Black patients had improved OS (P < .001). In contrast, the Latino patients had survival equivalent to that of the white patients (P = .920).

CONCLUSIONS

Despite epidemiologic differences and a propensity for less aggressive treatment, black patients with locally advanced NSCLC had better OS than white patients and Latino patients had equivalent outcomes. Additional research is needed to elucidate this finding, perhaps focusing on biological differences among the cohorts.

Global patterns of mortality in international migrants: a systematic review and meta-analysis

BACKGROUND

258 million people reside outside their country of birth; however, to date no global systematic reviews or meta-analyses of mortality data for these international migrants have been done. We aimed to review and synthesise available mortality data on international migrants.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Library, and Google Scholar databases for observational studies, systematic reviews, and randomised controlled trials published between Jan 1, 2001, and March 31, 2017, without language restrictions. We included studies reporting mortality outcomes for international migrants of any age residing outside their country of birth. Studies that recruited participants exclusively from intensive care or high dependency hospital units, with an existing health condition or status, or a particular health exposure were excluded. We also excluded studies limited to maternal or perinatal outcomes. We screened studies using systematic review software and extracted data from published reports. The main outcomes were all-cause and International Classification of Diseases, tenth revision (ICD-10) cause-specific standardised mortality ratios (SMRs) and absolute mortality rates. We calculated summary estimates using random-effects models. This study is registered with PROSPERO, number CRD42017073608.

FINDINGS

Of the 12 480 articles identified by our search, 96 studies were eligible for inclusion. The studies were geographically diverse and included data from all global regions and for 92 countries. 5464 mortality estimates for more than 15·2 million migrants were included, of which 5327 (97%) were from high-income countries, 115 (2%) were from middle-income countries, and 22 (<1%) were from low-income countries. Few studies included mortality estimates for refugees (110 estimates), asylum seekers (144 estimates), or labour migrants (six estimates). The summary estimate of all-cause SMR for international migrants was lower than one when compared with the general population in destination countries (0·70 [95% CI 0·65-0·76]; I2=99·8%). All-cause SMR was lower in both male migrants (0·72 [0·63-0·81]; I2=99·8%) and female migrants (0·75 [0·67-0·84]; I2=99·8%) compared with the general population. A mortality advantage was evident for refugees (SMR 0·50 [0·46-0·54]; I2=89·8%), but not for asylum seekers (1·05 [0·89-1·24]; I2=54·4%), although limited data was available on these groups. SMRs for all causes of death were lower in migrants compared with the general populations in the destination country across all 13 ICD-10 categories analysed, with the exception of infectious diseases and external causes. Heterogeneity was high across the majority of analyses. Point estimates of all-cause age-standardised mortality in migrants ranged from 420 to 874 per 100 000 population.

INTERPRETATION

Our study showed that international migrants have a mortality advantage compared with general populations, and that this advantage persisted across the majority of ICD-10 disease categories. The mortality advantage identified will be representative of international migrants in high-income countries who are studying, working, or have joined family members in these countries. However, our results might not reflect the health outcomes of more marginalised groups in low-income and middle-income countries because little data were available for these groups, highlighting an important gap in existing research. Our results present an opportunity to reframe the public discourse on international migration and health in high-income countries.

FUNDING

Wellcome Trust, National Institute for Health Research, Medical Research Council, Alliance for Health Policy and Systems Research, Department for International Development, Fogarty International Center, Grand Challenges Canada, International Development Research Centre Canada, Inter-American Institute for Global Change Research, National Cancer Institute, National Heart, Lung and Blood Institute, National Institute of Mental Health, Swiss National Science Foundation, World Diabetes Foundation, UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, and European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group Research Funding for the ESCMID Study Group for Infections in Travellers and Migrants.

Differences in Heat-Related Mortality by Citizenship Status: United States, 2005-2014

OBJECTIVES

To determine whether non-US citizens have a higher mortality risk of heat-related deaths than do US citizens.

METHODS

We used place of residence reported in mortality data from the National Vital Statistics System from 2005 to 2014 as a proxy for citizenship to examine differences in heat-related deaths between non-US and US citizens. Estimates from the US Census Bureau American Community Survey of self-reported citizenship status and place of birth provided the numbers for the study population. We calculated the standardized mortality ratio and relative risk for heat-related deaths between non-US and US citizens nationally.

RESULTS

Heat-related deaths accounted for 2.23% (n = 999) of deaths among non-US citizens and 0.02% (n = 4196) of deaths among US citizens. The age-adjusted standardized mortality ratio for non-US citizens compared with US citizens was 3.4 (95% confidence ratio [CI] = 3.2, 3.6). This risk was higher for Hispanic non-US citizens (risk ratio [RR] = 3.6; 95% CI = 3.2, 3.9) and non-US citizens aged 18 to 24 years (RR = 20.6; 95% CI = 16.5, 25.7).

CONCLUSIONS

We found an increased mortality risk among non-US citizens compared with US citizens for heat-related deaths, especially those younger and of Hispanic ethnicity.

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

Although those identifying as "Hispanic or Latino" experience lower adult mortality than the more socioeconomically advantaged non-Hispanic white population, the ethnic category Hispanic conceals variation by country of origin, nativity, age, and immigration experience. The current analysis examines adult mortality differentials among 12 Hispanic subgroups by region of origin and nativity, and non-Hispanic whites, adjusting for socioeconomic and demographic characteristics. We use the National Health Interview Survey Linked Mortality Files pooled 1990-2009 to obtain sufficient sample of each subgroup to calculate mortality estimates by sex and age group (25-64, 65+). Among adults aged 65 and over, all foreign born subgroups have an advantage over non-Hispanic whites, and many USB subgroups exhibit an advantage in the adjusted model. Foreign-born Dominicans, Central/South Americans, and other Hispanics exhibit consistent advantages across models for both men and women, aged 25-64 and 65 and over, and both unadjusted and adjusted for socioeconomic covariates. Both US-born and foreign-born Mexicans between ages 25 and 64 have mortality disadvantaged relative to non-Hispanic whites, while older Mexicans exhibit clear advantages. Our results complicate the traditional formulation of the Hispanic Paradox and cast doubt on the singularity of the mortality experience of those of Hispanic origin.

High cancer mortality for US-born Latinos: evidence from California and Texas

Background

Latinos born in the US, 36 million, comprise 65% of all US Latinos. Yet their cancer experience is nearly always analyzed together with their foreign-born counterparts, 19 million, who constitute a steady influx of truly lower-risk populations from abroad. To highlight specific cancer vulnerabilities for US-born Latinos, we compare their cancer mortality to the majority non-Latino white (NLW) population, foreign-born Latinos, and non-Latino blacks.

Methods

We analyzed 465,751 cancer deaths from 2008 to 2012 occurring among residents of California and Texas, the two most populous states, accounting for 47% of US Latinos. This cross-sectional analysis, based on granular data obtained from death certificates on cause of death, age, race, ethnicity and birthplace, makes use of normal standardization techniques and negative binomial regression models.

Results

While Latinos overall have lower all-cancers-combined mortality rates than NLWs, these numbers were largely driven by low rates among the foreign born while mortality rates for US-born Latinos approach those of NLWs. Among Texas males, rates were 210 per 100,000 for NLWs and 166 for Latinos combined, but 201 per 100,000 for US-born Latinos and 125 for foreign-born Latinos. Compared to NLWs, US-born Latino males in California had mortality rate ratios of 2.83 (95% CI: 2.52–3.18) for liver cancer, 1.44 (95% CI: 1.30–1.61) for kidney cancer, and 1.25 (95% CI: 1.17–1.34) for colorectal cancer (CRC). Texas results showed a similar site-specific pattern.

Conclusions

Specific cancer patterns for US-born Latinos, who have relatively high cancer mortality, similar overall to NLWs, are masked by aggregation of all Latinos, US-born and foreign-born. While NLWs had high mortality for lung cancer, US-born Latinos had high mortality for liver, kidney and male colorectal cancers. HCV testing and reinforcement of the need for CRC screening should be a priority in this specific and understudied population. The unprecedented proximity of overall rates between NLWs and US-born Latino populations runs counter to the prevailing narrative of Latinos having significantly lower cancer risk and mortality. Birthplace data are critical in detecting meaningful differences among Latinos; these findings merit not only clinical but also public health attention.

Racial/Ethnic Differences in Early-Life Mortality in the United States

U.S. early-life (ages 1-24) deaths are tragic, far too common, and largely preventable. Yet demographers have focused scant attention on U.S. early-life mortality patterns, particularly as they vary across racial and ethnic groups. We employed the restricted-use 1999-2011 National Health Interview Survey-Linked Mortality Files and hazard models to examine racial/ethnic differences in early-life mortality. Our results reveal that these disparities are large, strongly related to differences in parental socioeconomic status, and expressed through different causes of death. Compared to non-Hispanic whites, non-Hispanic blacks experience 60 percent and Mexican Americans 32 percent higher risk of death over the follow-up period, with demographic controls. Our finding that Mexican Americans experience higher early-life mortality risk than non-Hispanic whites differs from much of the literature on adult mortality. We also show that these racial/ethnic differences attenuate with controls for family structure and especially with measures of socioeconomic status. For example, higher mortality risk among Mexican Americans than among non-Hispanic whites is no longer significant once we controlled for mother's education or family income. Our results strongly suggest that eliminating socioeconomic gaps across groups is the key to enhanced survival for children and adolescents in racial/ethnic minority groups.

Hispanic-White Differences in Lifespan Variability in the United States

This study is the first to investigate whether and, if so, why Hispanics and non-Hispanic whites in the United States differ in the variability of their lifespans. Although Hispanics enjoy higher life expectancy than whites, very little is known about how lifespan variability-and thus uncertainty about length of life-differs by race/ethnicity. We use 2010 U.S. National Vital Statistics System data to calculate lifespan variance at ages 10+ for Hispanics and whites, and then decompose the Hispanic-white variance difference into cause-specific spread, allocation, and timing effects. In addition to their higher life expectancy relative to whites, Hispanics also exhibit 7 % lower lifespan variability, with a larger gap among women than men. Differences in cause-specific incidence (allocation effects) explain nearly two-thirds of Hispanics' lower lifespan variability, mainly because of the higher mortality from suicide, accidental poisoning, and lung cancer among whites. Most of the remaining Hispanic-white variance difference is due to greater age dispersion (spread effects) in mortality from heart disease and residual causes among whites than Hispanics. Thus, the Hispanic paradox-that a socioeconomically disadvantaged population (Hispanics) enjoys a mortality advantage over a socioeconomically advantaged population (whites)-pertains to lifespan variability as well as to life expectancy. Efforts to reduce U.S. lifespan variability and simultaneously increase life expectancy, especially for whites, should target premature, young adult causes of death-in particular, suicide, accidental poisoning, and homicide. We conclude by discussing how the analysis of Hispanic-white differences in lifespan variability contributes to our understanding of the Hispanic paradox.

Disparities in visual impairment by immigrant status in the United States

PURPOSE

To examine differences in visual impairment between immigrants and natives in the United States (US).

DESIGN

This is a cross-sectional study of clinical vision examination data from the 2003-2008 National Health and Nutrition Examination Survey.

METHODS

Analyses compare myopia, hyperopia, astigmatism, and visual acuity between noncitizens, naturalized citizens, and US natives. Visual acuity variables included having 20/40 or better corrected vision. Differences in 20/20 vision and legal blindness (20/200 or worse) were also examined. Respondents born in the United States were defined as US natives. Foreign-born respondents were categorized as either naturalized US citizens or noncitizen residents. Multivariate logistic regression of outcomes adjusted for sex, age, race/ethnicity, poverty, insurance, diabetes, and surgical correction for eyesight.

RESULTS

A smaller percentage of noncitizens than US natives had myopia (18.8% vs 30.7%) or astigmatism (22.0% vs 30.9%). However, noncitizens using corrective lenses had an adjusted odds ratio (AOR) of 0.65 of having 20/20 vision compared to US natives (95% confidence interval [CI] 0.48-0.88). Differences in visual acuity for 20/40 and better vision were not statistically significant for corrective lens users. Among nonusers of corrective lenses, noncitizens were significantly less likely than US natives to have 20/40 or better vision (AOR = 0.54; 95% CI 0.39-0.74). Noncitizens also had up to 3.5 times the odds of being legally blind relative to US natives after adjusting for confounding factors (95% CI 1.52-7.83).

CONCLUSIONS

Significant differences in visual acuity exist between immigrants and US natives. More research is necessary to identify underlying factors that may explain these disparities in visual impairment.

Immigration factors and prostate cancer survival among Hispanic men in California: does neighborhood matter?

BACKGROUND

Hispanics are more likely than other racial/ethnic groups in the United States to be diagnosed with later stage of prostate cancer, yet they have lower prostate cancer mortality rates. The authors evaluated the impact of nativity and neighborhood-level Hispanic ethnic enclave on prostate cancer survival among Hispanics.

METHODS

A total of 35,427 Hispanic men diagnosed with invasive prostate cancer from 1995 through 2008 in the California Cancer Registry were studied; vital status data were available through 2010. Block group-level neighborhood measures were developed from US Census data. Stage-stratified Cox proportional hazards models were used to assess the effect of nativity and ethnic enclave on prostate cancer survival.

RESULTS

In models adjusted for neighborhood socioeconomic status and other individual factors, foreign-born Hispanics were found to have a significantly lower risk of prostate cancer survival (hazards ratio [HR], 0.81; 95% confidence interval [95% CI], 0.75-0.87). Living in an ethnic enclave appeared to modify this effect, with the survival advantage slightly more pronounced in the high ethnic enclave neighborhoods (HR, 0.78; 95% CI, 0.71-0.86) compared with low ethnic enclave neighborhoods (HR, 0.86; 95% CI, 0.76-0.98).

CONCLUSIONS

Despite lower socioeconomic status, Hispanic immigrants have better survival after prostate cancer than US-born Hispanics and this pattern was more striking among those living in ethnic enclaves. Identifying the modifiable individual and neighborhood-level factors that facilitate this survival advantage in Hispanic immigrants may help to inform specific interventions to improve survival among all patients.

Immigrant health, place effect and regional disparities in Canada

The paper addresses a critically important area in Canadian immigration and health from both a social and a spatial perspective. It employs multilevel and contextual approaches to examine the social determinants of immigrant health as well as the place effects on self-reported health at a regional and neighborhood scale. The data come from the raw microdata file of the 2005-10 Canadian Community Health Survey (a random national health survey) and the publicly available Canadian Marginalization index based on the 2006 Census. Three populations are compared: Canadian-born, overall foreign-born, and Chinese immigrants. The results suggest various degrees of association between self-reported health, individual and lifestyle behavioral characteristics, and neighborhood material deprivation and ethnic concentration in census tracts. These factors contribute differently to the reported health of Chinese immigrants, Canada's largest recent immigrant group. A healthy immigrant effect is partially evident in the overall foreign-born population, but appears to be relatively weak in Chinese immigrants. For all groups, neighborhood deprivation moderately increases the likelihood of reporting poor health. Ethnic concentration negatively affects self-rated health, with the exception of the slight protective effect of Chinese-specific ethnic density in census tracts. The multilevel models reveal significant area inequalities across Census Metropolitan Areas/Census Agglomerations in risk of reporting unhealthy status, with greater magnitude in the foreign-born population. The vast regional variations in health among Chinese immigrants should be interpreted carefully due to the group's heavy concentration in large cities. The study contributes to the literature on ethnicity and health by systematically incorporating neighborhood contextual effects in modeling the social determinants of immigrant health status. It fills a gap in the literature on neighborhoods and health by focusing on ethnically disparate groups rather than on the general population. By revealing regional disparities in health, the paper adds a spatial perspective to the work on immigrant health.

The Hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans: the san antonio longitudinal study of aging

OBJECTIVES

To examine predictors of mortality in aging Mexican Americans (MAs) and European Americans (EAs).

DESIGN

Longitudinal, observational cohort study.

SETTING

Socioeconomically diverse neighborhoods in San Antonio, Texas.

PARTICIPANTS

Community-dwelling adults aged 65 and older (394 MA; 355 EA) who completed the baseline examination (1992-96) of the San Antonio Longitudinal Study of Aging (SALSA) and for whom vital status was ascertained over an average 8.2 years of follow-up.

MEASUREMENTS

Ethnic group was classified using a validated algorithm. Hazard ratios (HRs) for mortality were estimated using Cox proportional hazards models with age, sex, ethnic group, education, income, frailty, diabetes mellitus with and without complications, comorbidity, cognition, depressive symptoms, and body mass index included as predictors in sequential models.

RESULTS

At baseline, MAs had a higher prevalence of diabetes mellitus and frailty and lower socioeconomic status (SES) than EAs. The age- and sex-adjusted ethnic HR (MA vs EA) for mortality was 1.54 (95% confidence interval (CI) = 1.17-2.03). After adjusting for SES, the ethnic HR was no longer significant (HR = 1.16, 95% CI = 0.83-1.61). In the final model, comorbidity, diabetes mellitus with complications, depressive symptoms, and cognitive impairment were significant independent risk factors for mortality.

CONCLUSION

Contrary to the Hispanic paradox, MAs were at greater risk of mortality than EAs. SES differences largely explained this ethnic disparity. Significant independent predictors of mortality, regardless of ethnic group, were diabetes mellitus with complications, comorbidity, depressive symptoms, and cognitive impairment. Mortality reduction in older MAs requires attention to socioeconomic disparities and disease factors.

Pregnancy as a risk factor for ambulatory limitation in later life

OBJECTIVES

We investigated the relationship between the number of times a woman has been pregnant and walking difficulty in later life.

METHODS

With data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a representative population-based cohort of Mexican Americans aged 65 years and older residing in 5 Southwestern states, we measured walking difficulty using 2 items from the performance-oriented mobility assessments: the timed walk and seated chair rise.

RESULTS

We observed significantly higher rates of ambulatory limitation among women with 6 or more pregnancies than among women with 4 or fewer pregnancies: 44.9% and 27.0%, respectively, were unable to perform or performed poorly in the seated chair rise and timed walk. Ordinal logistic regression models show that gravidity predicts level of performance in both mobility tasks and that higher gravidity is associated with worse performance, even after adjustment for both age and chronic disease.

CONCLUSIONS

Gravidity is a risk factor for ambulatory limitation in old age. A life course approach to reproduction in public health research and practice is warranted.

Understanding ethnic and nativity-related differences in low cardiovascular risk status among Mexican-Americans and non-Hispanic Whites

OBJECTIVE

Recent guidelines highlight the importance of improving cardiovascular health in the general population in addition to disease prevention among high risk individuals. We investigated factors associated with ethnic and nativity-related differences in the prevalence of low cardiovascular risk (optimal levels of all major cardiovascular risk factors).

METHODS

We used logistic regression to estimate differences in likelihood of being low risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure <120/<80; and body mass index <25 kg/m(2)) among 8693 foreign- and U.S.-born Mexican-American and non-Hispanic White 2003-2008 U.S. National Health and Nutrition Examination Survey participants before and after adjustment for socioeconomic, lifestyle, and acculturation-related factors.

RESULTS

Foreign-born Mexican-Americans were more likely to be low risk than non-Hispanic Whites after adjustment for all covariates (Odds Ratio [OR]: 1.53; 95% Confidence Interval [CI]: 1.00, 2.34). In contrast, U.S.-born Mexican-Americans were less likely to be low risk compared to Whites (OR: 0.60; 95% CI: 0.43, 0.84). Differences between foreign-born and U.S.-born Mexican-Americans were largely attenuated after adjustment for acculturation indicators.

CONCLUSIONS

Our findings support the healthy migrant hypothesis and suggest that acculturation-related factors may be important drivers of ethnic and nativity-related differences in low cardiovascular risk.

Problem drinking among Mexican-Americans: the influence of nativity and neighborhood context?

PURPOSE

We examined the influence of nativity and community context (Hispanic neighborhood concentration) on two measures of problem drinking among Mexican-Americans.

DESIGN

Cross-sectional study.

SETTING

Texas City Stress and Health Study conducted in Texas City, Texas during 2004-2006.

PARTICIPANTS

A total of 1435 Mexican-Americans aged 25 years and older.

MEASURES

Binge drinking (≥6 drinks per occasion by men and ≥4 drinks per occasion by women) and scoring positive on the CAGE (a four-item clinical measure of problem drinking) as dependent variables. Key independent variables included a measure of language acculturation, proportion of Hispanics in the participant's neighborhood according to 2000 U.S. Census data, and being foreign-born compared with being U.S.-born.

ANALYSIS

Logistic regression analysis was used to predict being a binge drinker and being positive on the CAGE. RESULTS . Foreign-born women were less likely to be binge drinkers than U.S.-born women. Nativity was not significant among men. Moreover women were less likely to be binge drinkers if they lived in heavily Hispanic neighborhoods. No such effect was found among men. Similar results were obtained with the CAGE.

CONCLUSIONS

We found a powerful influence of nativity (being U.S.-born compared with foreign born) and neighborhood Hispanic concentration on problem drinking among women but not among men. It is likely that cultural norms in heavily Hispanic environments discourage problem drinking among women but not among men.

Socioeconomic status and stress in Mexican-American women: a multi-method perspective

Stress is a hypothesized pathway in socioeconomic status (SES)-physical health associations, but the available empirical data are inconsistent. In part, this may reflect discrepancies in the approach to measuring stress across studies, and differences in the nature of SES-stress associations across demographic groups. We examined associations of SES (education, income) with general and domain-specific chronic stressors, stressful life events, perceived stress, and stressful daily experiences in 318 Mexican-American women (40-65 years old). Women with higher SES reported lower perceived stress and fewer low-control experiences in everyday life (ps < .05), but greater chronic stress (education only, p < .05). Domain-specific analyses showed negative associations of income with chronic housing and financial stress (ps < .05), but positive associations of SES with chronic work and caregiving stress (all ps < .05 except for income and caregiving stress, p < .10). Sensitivity analyses showed that most SES-stress associations were consistent across acculturation levels. Future research should adopt a multi-dimensional assessment approach to better understand links among SES, stress, and physical health, and should consider the sociodemographic context in conceptualizing the role of stress in SES-related health inequalities.

Differential record linkage by Hispanic ethnicity and age in linked mortality studies: implications for the epidemiologic paradox

OBJECTIVE

This study examines how the linkage of surveys to death records differs for Hispanics and non-Hispanic Whites and how such differences affect estimates of ethnic differences in U.S. adult mortality.

METHOD

I use data from the 1989-2000 National Health Interview Survey (NHIS) linked to the National Death Index (NDI) through 2002. Analyses assess how match score and match class vary by ethnicity, nativity, and age and whether mortality hazard ratios are sensitive to shifts in match criteria.

RESULTS

Linkage quality is lower for Hispanic and foreign-born adults than for non-Hispanic White and U.S.-born adults. Modification of the linkage criteria determine whether the Hispanic mortality advantage is observed among middle-aged adults.

DISCUSSION

The accuracy of adult mortality estimates depends on the quality of the linkage between surveys and death records.

Dietary folate protects against azoxymethane-induced aberrant crypt foci development and oxidative stress in rat colon

Azoxymethane (AOM) induces cancer and oxidative stress in rat colon. This study tested the hypothesis that dietary folate supplementation protects against AOM-induced oxidative stress and reduces aberrant crypt foci (ACF) development in rat colon. Fifty-four weanling male albino rats, with an average body weight of 50 ± 5 g, were randomly divided into three groups – A, B and C (18 rats per group) – and fed 2, 8 or 40 mg of folic acid per kg of supplemented diets, respectively, throughout the eight weeks' experimental period. The animals were supplied with diet and water ad libitum for four weeks and they reached an average body weight of 100 g. Thereafter each group was then further randomly subdivided into three subgroups (six rats per subgroup): control, vehicle and AOM-injected groups. The control group did not receive any treatment (neither AOM injection nor saline), the rats in the vehicle group were given 1 mL intraperitoneal injection of saline once a week for two weeks and the rats in the AOM-injected group were given two intraperitoneal injections of AOM dissolved in saline once a week for two weeks totaling 30 mg/kg body weight. After the last AOM injection, animals were continuously fed ad libitum their specified diet for two weeks of last AOM injection, all rats were sacrificed, and colon tissues were collected and used for ACF enumeration and measurements of glutathione (GSH) and total antioxidant capacity (TAC). The results revealed that AOM-injected rats showed lower levels of GSH and TAC as compared with control and vehicle groups. Folic acid-supplemented diets suppressed the AOM-induced ACF and GSH depletion in a dose-dependent manner and augmented the TAC. It was concluded that folic acid supplementation protects against the AOM-induced ACF formation by suppressing the AOM-induced GSH depletion in rat colon cells.

SEX DIFFERENCES IN LIFE EXPECTANCY IN CANADA: IMMIGRANT AND NATIVE-BORN POPULATIONS

A growing body of research often indicates that immigrant populations in Western countries enjoy a lower level of mortality in relation to their native-born host populations. In this literature, sex differences in mortality are often reported but substantive analyses of the differences are generally lacking. The present investigation looks at sex differences in life expectancy with specific reference to immigrant and Canadian-born populations in Canada during 1971 and 2001. For these two populations, sex differences in expectation of life at birth are decomposed into cause-of-death components. Immigrants in Canada have a higher life expectancy than their Canadian-born counterparts. In absolute terms, immigrant females enjoy the highest life expectancy. Inrelativeterms, however, immigrant men show a larger longevity advantage, as their expectation of life at birth exceeds that of Canadian-born men by a wider margin than do foreign-born females in relation to Canadian-born females. It is also found that immigrants have a smaller sex differential in life expectancy as compared with the Canadian born. Decomposition analysis shows this is a function of immigrants having smaller sex differences in death rates from heart disease and cancer. Factors thought to underlie these differentials between immigrants and the Canadian born are discussed and suggestions for further research are given.

Shorter stay, longer life: age at migration and mortality among the older Mexican-origin population

OBJECTIVE

In this article, we investigate the association between age at migration and mortality during a 13-year period in a sample of Mexican American immigrants 65 and older at baseline.

METHOD

We employ the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-PESE) to control for mortality-related health and social factors.

RESULTS

Our analyses show that the immigrant generation does not represent a homogeneous mortality risk category. Individuals who migrated to the United States in mature adulthood have a considerably lower risk of death than individuals who migrated in childhood or midlife. Chronic conditions or functional capacity do not account for these differences.

CONCLUSION

Our findings suggest that standard risk pools may differ significantly on the basis of genetic and unmeasured life-course factors. A better understanding of the late-life immigrant mortality advantage has important implications for more effective and targeted social and medical interventions.

Lower stroke mortality among Hispanics: an exploration of potential methodological confounders

OBJECTIVES

Stroke mortality rates are reported to be lower for Hispanics than non-Hispanic Whites. We investigate the degree to which this lower reported mortality is explained by inaccuracies introduced through omission of nativity, imprecise measurement of cause of death, and under-ascertainment of Hispanic ethnicity on death certificates. We used national vital registration data for the years 1989-1991 and 1999-2002, including foreign- and US-born Hispanics and non-Hispanic Whites. Hispanic deaths were adjusted for misclassification of ethnicity on the death certificate. Denominators for the rates were derived from census estimates.

RESULTS

Adjustment for nativity and death certificate misclassification removes the stroke mortality advantage for US-born Hispanic men, but not women. After adjustment, US-born Hispanic men and women have higher rates of mortality from subarachnoid hemorrhage than non-Hispanic Whites (RR: 1.23 and 1.23, respectively), but lower rates of mortality from Ischemic (RR: 0.76 and 0.73, respectively) and chronic effects of stroke (RR: 0.87 and 0.73, respectively).

CONCLUSIONS

When adjusted for misclassification the lower stroke mortality remains for Hispanic men and women at older ages. Part of the previously reported advantage is a combination of imprecise measurement and data quality.

Immigrants as crime victims: Experiences of personal nonfatal victimization

BACKGROUND

Immigrants to the United States are disproportionately victims of homicide mortality in and outside the workplace. Examining their experiences with nonfatal victimization may be helpful in understanding immigrant vulnerability to violence.

METHODS

We compared the annual prevalence of nonfatal personal victimization experienced by immigrant and US-born adults by sociodemographics, employment, occupation, industry, smoking, alcohol and drug use using data from Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS

The prevalence of victimization among immigrants was comparable to that among US-born adults [3.84% (95% CI: 3.18-4.63) vs. 4.10% (95% CI: 3.77-4.44)]. Lower percentages of victimization experienced by immigrants were seen among the unmarried, those age 30-44 years, and among residents of central city areas as compared to those groups among the US-born. For immigrants entering the US as youth, the victimization prevalence declines with greater years of residency in US. Multivariate logistic regression models suggest that, the odds of victimization was significantly associated with age, family income, marital status, central city residency, smoking, and drug use while employment status was not a significant factor. Immigrant workers with farming/forestry occupations might face a higher risk of being victims of violence than their US-born counterparts.

CONCLUSIONS

The prevalence of victimization among immigrants was comparable to that among US-born adults. Employment status and industry/occupation overall were not significant risk factors for becoming victims of violence.

Neighbourhood ethnic composition and diet among Mexican-Americans

OBJECTIVES

We explore the association between a neighbourhood's ethnic composition and the foods and nutrients consumed by Mexican-Americans.

DESIGN

Cross-sectional survey of a large national sample, from the Third National Health and Nutrition Examination Survey (1988-94), was linked to the 1990 Census. The outcomes were food frequencies and serum levels of micronutrients. The variable of interest was percentage of Mexican-Americans at the census tract level.

SETTING

United States.

SUBJECTS

A total of 5306 Mexican-American men and women aged 17-90 years.

RESULTS

Increased percentage of Mexican-Americans at the census tract level was associated with less consumption of fruits, carrots, spinach/greens and broccoli and with lower serum levels of Se, lycopene, alpha-carotene, vitamin C and folate. By contrast, increased percentage of Mexican-Americans at the census tract level was associated with more consumption of corn, tomatoes, hot red chilli peppers and legumes such as beans, lentils or chickpeas.

CONCLUSIONS

An increased percentage of Mexican-Americans at the census tract level was associated with less consumption of selective foods (e.g. some fruits, broccoli) and low levels of serum Se or vitamin C, but it was associated with more consumption of other foods (e.g. legumes, tomatoes, corn products) that may have positive effects on health in this population.

Allostatic load among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin: effects of ethnicity, nativity, and acculturation

OBJECTIVES

We investigated ethnic differences in allostatic load in a population-based sample of adults living in Texas City, TX, and assessed the effects of nativity and acculturation status on allostatic load among people of Mexican origin.

METHODS

We used logistic regression models to examine ethnic variations in allostatic load scores among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin. We also examined associations between measures of acculturation and allostatic load scores among people of Mexican origin only.

RESULTS

Foreign-born Mexicans were the least likely group to score in the higher allostatic load categories. Among individuals of Mexican origin, US-born Mexican Americans had higher allostatic load scores than foreign-born Mexicans, and acculturation measures did not account for the difference.

CONCLUSIONS

Our findings expand on recent research from the National Health and Nutrition Examination Survey with respect to ethnicity and allostatic load. Our results are consistent with the healthy immigrant hypothesis (i.e., newer immigrants are healthier) and the acculturation hypothesis, according to which the longer Mexican immigrants reside in the United States, the greater their likelihood of potentially losing culture-related health-protective effects.

Health disparities in the Latino population

In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and education are related to observed patterns of health and mortality. A key issue discussed is how to interpret the superior mortality indices of Latino immigrants and the subsequent declining health status of later generations. Explanations for differences in mortality include selection, reverse selection, death record inconsistencies, inequalities in health status, transnational migration, social marginality, and adaptation to environmental conditions in the United States. The utility of the public health social inequality framework and the status syndrome for explaining Latino disparities is discussed. The authors examine excess mortality from 8 causes: diabetes, stomach cancer, liver cancer, cervical cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, liver disease, homicide, and work-related injuries. The impact of intergenerational changes in health behavior within the Latino population and the contributory role of suboptimal health care are interpreted in the context of implications for future research, public health programs, and policies.

The health of older Mexican Americans in the long run

OBJECTIVES

We compared risk for several medical illnesses between immigrant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants.

METHODS

Cross-sectional, multistage probability sample data for 3050 Mexican Americans aged 65 years or older from 5 US southwestern states were analyzed. Self-rated health, medical illnesses, and functional measures were examined in multivariate regression models that included nativity and years of US residency as key predictors.

RESULTS

Self-rated health and medical illnesses of immigrant and US-born groups did not differ significantly. Immigrants with longer US residency had significantly higher cognitive functioning scores and fewer problems with functional activities after adjustment for predisposing and medical need factors.

CONCLUSIONS

Among older Mexican Americans, immigrant health advantages over their US-born counterparts were not apparent. Immigrants had better health functioning with longer US residency that may derive from greater socioeconomic resources. Our findings suggest that the negative acculturation-health relationship found among younger immigrant adults may become a positive relationship in later life.

Environmental hazards and stress: evidence from the Texas City Stress and Health Study

BACKGROUND

Substantial research has suggested that exposure to environmental health hazards, such as polluting industrial activity, has deleterious effects on psychological and physiological well-being. However, one gap in the existing literature is comparative analysis of objective and subjective exposure's relative association with various measurable outcomes of exposure.

METHODS

These relationships were explored within a community sample of 2604 respondents living near a large petrochemical complex in Texas City, Texas, USA. Objective exposure was investigated using distance of residence from a cluster of petrochemical plants and subjective exposure using residents' concern about potential health effects from those plants. Regression models were then used to examine how each type of exposure predicts perceived stress, physiological markers of stress and perceived health.

RESULTS

Results suggest that objective exposure was associated primarily with markers of physiological stress (interleukin-6 and viral reactivation), and subjective exposure (concern about petrochemical health risk) was associated with variables assessing perceived health.

CONCLUSIONS

From the analysis, it can be inferred that, in the context of an environmental hazard of this type, subjective exposure may be at least as important a predictor of poor health outcomes as objective exposure.

Differences in mortality among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States

BACKGROUND

The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States.

STUDY DESIGN

Prospective observational study.

SETTING & PARTICIPANTS

Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States.

PREDICTORS

Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values.

OUTCOMES

The major outcome of interest was mortality.

RESULTS

In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics.

LIMITATIONS

Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups.

CONCLUSION

Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.

Immigration and suicidal behavior among Mexicans and Mexican Americans

OBJECTIVES

We examined migration to the United States as a risk factor for suicidal behavior among people of Mexican origin.

METHODS

We pooled data from 2 nationally representative surveys in the United States (2001-2003; n = 1284) and Mexico (2001-2002; n = 5782). We used discrete time survival models to account for time-varying and time-invariant characteristics, including psychiatric disorders.

RESULTS

Risk for suicidal ideation was higher among Mexicans with a family member in the United States (odds ratio [OR] = 1.50; 95% confidence interval [CI] = 1.06, 2.11), Mexican-born immigrants who arrived in the United States at 12 years or younger (OR = 1.84; 95% CI = 1.09, 3.09), and US-born Mexican Americans (OR = 1.56; 95% CI = 1.03, 2.38) than among Mexicans with neither a history of migration to the United States nor a family member currently living there. Risk for suicide attempts was also higher among Mexicans with a family member in the United States (OR = 1.68; 95% CI = 1.13, 2.52) and US-born Mexican Americans (OR = 1.97; 95% CI = 1.06, 3.65). Selection bias caused by differential migration or differential return migration of persons at higher risk of suicidal ideation or attempt did not account for these findings.

CONCLUSIONS

Public health efforts should focus on the impact of Mexico-US migration on family members of migrants and on US-born Mexican Americans.

Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities

Addressing health disparities has been a national challenge for decades. The National Institutes of Health-sponsored Centers for Population Health and Health Disparities are the first federal initiative to support transdisciplinary multilevel research on the determinants of health disparities. Their novel research approach combines population, clinical, and basic science to elucidate the complex determinants of health disparities. The centers are partnering with community-based, public, and quasi-public organizations to disseminate scientific findings and guide clinical practice in communities. In turn, communities and public health agents are shaping the research. The relationships forged through these complex collaborations increase the likelihood that the centers' scientific findings will be relevant to communities and contribute to reductions in health disparities.

Health of foreign-born people in the United States: a review

This paper identifies the overarching patterns of immigrant health in the US. Most studies indicate that foreign-born individuals are in better health than native-born Americans, including individuals of the same race/ethnicity. They tend to have lower mortality rates and are less likely to suffer from circulatory diseases, overweight/obesity, and some cancers. However, many foreign-born groups have higher rates of diabetes, some infections, and occupational injuries. There is heterogeneity in health among immigrants, whose health increasingly resembles that of natives with duration of US residence. Prospective studies are needed to better understand migrant health and inform interventions for migrant health maintenance.