The Hispanic Paradox: Race/Ethnicity and Nativity, Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults

Abstract

Hispanics, and particularly foreign-born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the “Hispanic Paradox”. Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally-representative sample of US adults leaving unanswered questions about potentially “paradoxical” advantages of Mexican ethnic-origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US-born non-Hispanic whites (US-NHW), US-born non-Hispanic blacks (US-NHB), US-born Mexican Americans (US-MA), and foreign-born Mexican Americans (FB-MA). Data come from a nationally-representative sample of community-dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10 years (N= 8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US-born non-Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB-MA odds of prevalent CI were about half those of US-NHW and hazards of incident CI were about half those of US-MA. Residence in an immigrant enclave was protective of prevalent CI among FB-MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population.

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

“…This prevented us from being able to compare our findings on the risk for cognitive impairment among the U.S.-born and foreign-born Mexican-Americans to other racial and ethnic groups, as well as other Hispanic groups (such as Cuban, Central and South American, and Caribbean origins). Recent research has found a foreign-born Mexican-American advantage in the risk of cognitive impairment compared to non-Hispanic whites and blacks in a nationally representative sample of older adults in the United States ( Weden et al, 2017 ). However, this analysis did not consider potential differences in the risk for cognitive impairment among foreign-born by gender or age of migration.…”

“…Research has only recently begun to examine how cognitive functioning for older Hispanics may differ by nativity status ( Downer, Garcia, Saenz, Markides, & Wong, 2017 ; Garcia, Downer, et al, 2017 ; Garcia, Saenz, et al, 2017 ; Garcia et al, 2018 ; Hill, Angel, & Balistreri, 2012 ; Hill, Angel, Balistreri, & Herrera, 2012 ; Weden et al, 2017 ). An analysis of the Health and Retirement Study revealed that foreign-born Mexican-Americans had a 36% lower risk for incident cognitive impairment than non-Hispanic whites independent of age, gender, and socioeconomic characteristics.…”

“…An analysis of the Health and Retirement Study revealed that foreign-born Mexican-Americans had a 36% lower risk for incident cognitive impairment than non-Hispanic whites independent of age, gender, and socioeconomic characteristics. However, U.S.-born Mexican-Americans had a 27% higher risk for incident cognitive impairment compared to non-Hispanic whites ( Weden et al, 2017 ). In addition, research using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) found that foreign-born Mexican-American men, but not women, who migrate to the United States in middle age (20–49 years old) exhibit higher cognitive function and less cognitive decline as older adults compared to U.S.-born Mexican-American men ( Hill, Angel, & Balistreri, 2012 ; Hill, Angel, Balistreri, et al, 2012 ).…”

Activity Engagement and Cognitive Function: Findings From a Community-Dwelling U.S. Chinese Aging Population Study

“…Second, although it is a population-based sample of Chinese older adults in the United States, the generalizability of study findings may not go beyond the greater Chicago area, where the PINE study participants were recruited. Third, other factors, that are not included in this study, such as geographic locations, neighborhood conditions, may also affect activity engagement and cognitive function, or serve as the mechanisms through which activities affect cognition ( Weden et al, 2017 ). Finally, our measures might not be inclusive; for example, the cognitive tests did not capture the full range of cognitive abilities, and clinical evaluations of cognitive impairment were missing.…”

Acculturation and Activity Engagement Among Older Chinese Americans

“…Acculturation is associated with healthy behaviors, such as greater exercise and leisure physical activity; yet, high levels of acculturation are also associated with increased rates of cancer, infant mortality, and poor physical and mental health among Latinos (see Abraído-Lanza et al, 2006 ). The literature inconsistence implies that the immigrant health paradox may be explained by health selection, sociocultural protection, and other mechanisms ( Jasso, Massey, Rosenzweig, & Smith, 2004 ; Weden et al, 2017 ).…”