20th Century Puerto Rico and Later-Life Health: The Association Between Multigenerational Education and Chronic Conditions in Island-Dwelling Older Adults

Colón-López, Alejandra; García, Cézar

doi:10.1177/08982643221097532

Cited by 3 publications

(2 citation statements)

References 99 publications

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“…Researchers have argued that social, political, and economic inequalities in Puerto Rico derive from the impacts of US colonialism—a structural and social determinant of health ( 7 , 8 ). One significant impact of US colonialism was the transition of Puerto Rico from a rural agricultural society to an urban industrial society in the early twentieth century ( 9 ). This transition brought public health benefits, including improved sanitation practices and housing conditions, the creation of local health boards and hospitals, and increased access to primary education.…”

Section: Introductionmentioning

confidence: 99%

The neighborhood context and all-cause mortality among older adults in Puerto Rico

García

McEniry

et al. 2023

Front. Public Health

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BackgroundRecent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality.MethodsWe linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution.ResultsA five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates.ConclusionsConsidering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

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Section: Introductionmentioning

confidence: 99%

The neighborhood context and all-cause mortality among older adults in Puerto Rico

García

McEniry

et al. 2023

Front. Public Health

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“…Puerto Rico, an unincorporated U.S. territory with the most advanced aging within the LAC region [3], has a high prevalence of cardiometabolic diseases, with hypertension and diabetes being more prevalent among Puerto Rican older adults than older adults on the U.S. mainland [4]. Emerging research among older adults in Puerto Rico suggests that socioeconomic conditions are important determinants of later-life cardiometabolic risks [5,6]. Despite growing evidence that social environments, including neighborhood and household contexts, are also critical social determinants of later-life cardiometabolic health [7][8][9], these factors have not been examined among older adults in Puerto Rico.…”

Section: Introductionmentioning

confidence: 99%

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002–2007

Quashie,

García,

Meltzer

et al. 2023

PLoS ONE

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Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

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LifeCourse Socioeconomic Position and Ideal Cardiovascular Health in Hispanic/Latino Adults of the Hispanic Community Health Study/Study of Latinos

Filigrana,

Moon,

Gallo

et al. 2024

JAHA

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Background The Hispanic/Latino population experiences socioeconomic disadvantages across the lifespan. Yet, little is known about the role of these disadvantages in cardiovascular health (CVH). We assessed the association of lifecourse socioeconomic position (SEP) with ideal CVH and change in Hispanic/Latino adults. Methods and Results We used longitudinal data from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos). Childhood SEP was determined using parental educational attainment. Adult SEP was determined through an index combining participants' education, occupation, income, and assets at baseline. We classified participants into 4 socioeconomic mobility categories (eg, stable low or high SEP, upward or downward mobility). Using the 4 health factors of the American Heart Association “Life's Essential 8,” we built a score of ideal CVH at baseline and the 6‐year follow‐up. Linear mixed‐effects models using inverse probability weighting were fitted to assess the main associations. Higher childhood SEP was associated with higher ideal CVH at baseline (β for high school versus <high school, 3.57 [95% CI, 1.76–5.57]) and (>high school versus <high school, 3.76 [95% CI, 1.99–5.52]). Middle (β for middle versus low SEP, 3.57 [95% CI, 1.65–5.49]) and high adult SEP (β for high versus low SEP, 5.05 [95% CI, 2.55–7.55]) were also associated with higher ideal CVH. Socioeconomic mobility was also associated with higher ideal CVH. No life‐course SEP exposure was associated with the change in ideal CVH over a 6‐year period. Conclusions Although high childhood and adult SEP and socioeconomic mobility were associated with higher levels of ideal CVH, they were not associated with change in ideal‐CVH.

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20th Century Puerto Rico and Later-Life Health: The Association Between Multigenerational Education and Chronic Conditions in Island-Dwelling Older Adults

Cited by 3 publications

References 99 publications

The neighborhood context and all-cause mortality among older adults in Puerto Rico

The neighborhood context and all-cause mortality among older adults in Puerto Rico

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002–2007

LifeCourse Socioeconomic Position and Ideal Cardiovascular Health in Hispanic/Latino Adults of the Hispanic Community Health Study/Study of Latinos

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