The Hispanic Paradox in Cardiovascular Disease and Total Mortality

Medina‐Inojosa, José R.; Jean, Nathalie; Cortés-Bergoderi, Mery; López-Jiménez, Francisco

doi:10.1016/j.pcad.2014.09.001

Cited by 99 publications

(71 citation statements)

References 44 publications

(38 reference statements)

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“…The Hispanic epidemiologic paradox is an observation that Hispanic Americans compared with NHW have similar or lower mortality rates despite having a lower socioeconomic status (46,47) and a higher prevalence of cardiometabolic risk factors (48). It has been proposed that population-specific genetic factors and gene-environmental interactions may partly account for this phenomenon (49,50), although sociobehavioral factors (e.g., salmon bias [some sick immigrants may return to their country of origin before death]) (51) and healthy-immigrant bias (immigrants may be generally healthy or have more healthful behaviors) (51) are relevant considerations. In this study, adjusting for educational attainment and insurance coverage did not impact effect estimates.…”

Section: Discussionmentioning

confidence: 99%

Type 2 Diabetes Genetic Predisposition, Obesity, and All-Cause Mortality Risk in the U.S.: A Multiethnic Analysis

et al. 2016

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OBJECTIVEType 2 diabetes (T2D) is associated with increased mortality in ethnically diverse populations, although the extent to which this association is genetically determined is unknown. We sought to determine whether T2D-related genetic variants predicted all-cause mortality, even after accounting for BMI, in the Third National Health and Nutrition Examination Survey.RESEARCH DESIGN AND METHODSWe modeled mortality risk using a genetic risk score (GRS) from a weighted sum of risk alleles at 38 T2D-related single nucleotide polymorphisms. In age-, sex-, and BMI-adjusted logistic regression models, accounting for the complex survey design, we tested the association with mortality in 6,501 participants. We repeated the analysis within ethnicities (2,528 non-Hispanic white [NHW], 1,979 non-Hispanic black [NHB], and 1,994 Mexican American [MA]) and within BMI categories (<25, 25–30, and ≥30 kg/m2). Significance was set at P < 0.05.RESULTSOver 17 years, 1,556 participants died. GRS was associated with mortality risk (OR 1.04 [95% CI 1.00–1.07] per T2D-associated risk allele, P = 0.05). Within ethnicities, GRS was positively associated with mortality risk in NHW and NHB, but not in MA (0.95 [0.90–1.01], P = 0.07). The negative trend in MA was largely driven by those with BMI <25 kg/m2 (0.91 [0.82–1.00]). In NHW, the positive association was strongest among those with BMI ≥30 kg/m2 (1.07 [1.02–1.12]).CONCLUSIONSIn the U.S., a higher T2D genetic risk was associated with increased mortality risk, especially among obese NHW. The underlying genetic basis for mortality likely involves complex interactions with factors related to ethnicity, T2D, and body weight.

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Section: Discussionmentioning

confidence: 99%

Type 2 Diabetes Genetic Predisposition, Obesity, and All-Cause Mortality Risk in the U.S.: A Multiethnic Analysis

et al. 2016

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“…Hispanics, despite an increased burden of CHD risk factors and greater socioeconomic disadvantage, are less likely to have CHD and less likely to die from heart disease compared to non-Hispanic whites [8, 19–21]. This discordance comprises the “Hispanic paradox” [22, 23]. This paradox is an important incongruity that remains unresolved.…”

Section: Cardiovascular Health and Chd Risk Factorsmentioning

confidence: 99%

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Leigh

Alvarez

Rodríguez

2016

Curr Atheroscler Rep

123

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Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recent literature which examines CHD in ethnic minorities and future directions in research and care.

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“…Although cardiovascular disease (CVD) is the leading cause of death for this group, when studied in aggregate, Hispanic persons experience lower age‐adjusted CVD mortality rates than non‐Hispanic white (NHW) persons 10. This lower than expected mortality, despite greater adverse CVD risk profiles and lower levels of income and education than NHWs, has been coined the “Hispanic paradox.”11, 12, 13, 14 It has been speculated that Hispanic cultural orientation results in healthier behaviors (eg, lower smoking rates) that result in better health outcomes, protecting Hispanic patients against the effects of lower socioeconomic status compared with other race/ethnic groups in the United States 15. The “healthy immigrant effect,” whereby there is selective migration among healthier immigrants to a host country, has also been cited as a possible explanation for the Hispanic mortality advantage 16…”

mentioning

confidence: 99%

Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults

Rodríguez

Hastings

et al. 2017

JAHA

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BackgroundHispanic persons represent a heterogeneous and growing population of any race with origins in Mexico, the Caribbean, Central America, South America, or other Spanish‐speaking countries. Previous studies have documented variation in cardiovascular risk and outcomes among Hispanic subgroups. Few studies have investigated whether these patterns vary by nativity status among Hispanic subgroups.Methods and ResultsWe used the National Center for Health Statistics mortality file to compare deaths of Hispanic (n=1 258 229) and non‐Hispanic white (n=18 149 774) adults (aged ≥25 years) from 2003 to 2012. We identified all deaths related to cardiovascular disease (CVD) and categorized them by subtype (all CVD, ischemic, or cerebrovascular) using the underlying cause of death (International Classification of Diseases, 10th Revision codes I00–I78, I20–I25, and I60–I69, respectively). Population estimates were calculated using linear interpolation from the 2000 and 2010 US censuses. CVD accounted for 31% of all deaths among Hispanic adults. Race/ethnicity and nativity status were recorded on death certificates by the funeral director using state guidelines. Nativity status was defined as foreign versus US born; 58% of Hispanic decedents were foreign born. Overall, Hispanic adults had lower age‐adjusted CVD mortality rates than non‐Hispanic white adults (296 versus 385 per 100 000). Foreign‐born Cubans, Mexicans, and Puerto Ricans had higher CVD mortality than their US‐born counterparts (rate ratio: 2.64 [95% confidence interval, 2.46–2.81], 1.17 [95% confidence interval, 1.15–1.21], and 1.91 [95% confidence interval, 1.83–1.99], respectively).ConclusionsMortality rates for total cardiovascular, ischemic, and cerebrovascular disease are higher among foreign‐ than US‐born Hispanic adults. These findings suggest the importance of disaggregating CVD mortality by disease subtype, Hispanic subgroup, and nativity status.

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The Hispanic Paradox in Cardiovascular Disease and Total Mortality

Cited by 99 publications

References 44 publications

Type 2 Diabetes Genetic Predisposition, Obesity, and All-Cause Mortality Risk in the U.S.: A Multiethnic Analysis

Type 2 Diabetes Genetic Predisposition, Obesity, and All-Cause Mortality Risk in the U.S.: A Multiethnic Analysis

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults

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