AHA News: The 'Hispanic Paradox': Does a Decades-Old Finding Still Hold Up?

WEDNESDAY, May 10, 2023 (American Heart Association News) -- Many Hispanic people in the United States face socioeconomic disadvantages and lower access to affordable health care. Despite these and other challenges to their health, they generally tend to live longer than other racial or ethnic communities – a health phenomenon that's been studied for decades.

The "Hispanic paradox" has been widely recognized since 1986, when University of Texas researchers Kyriakos Markides and Jeannine Coreil published their analysis of two decades' worth of studies. Their review noted that Hispanic people in the Southwest fared better in key health indicators, including death due to cardiovascular diseases and some types of cancer.

"The idea was that despite the fact that Hispanics as a group have lower education, lower income and less access to health care, their health outcomes are much better or similar to the white population," said Luisa N. Borrell, a distinguished professor in the department of epidemiology and biostatistics at the Graduate School of Public Health and Health Policy at City University of New York.

The assumption was that if you had more education, income and access to health care, you had better health, she said. "But we have learned over time that having income and having education is not like vitamins."

Almost 40 years later, the Hispanic paradox has yet to be fully explained. Researchers have suggested that factors such as diet, lower rates of smoking, and strong family and social support may give Hispanic people an edge.

A 2015 Centers for Disease Control and Prevention report on the health and causes of death among Hispanic people supported the paradox. The CDC analysis found that Hispanic people ages 18 to 64 had a lower risk of mortality from any cause and a decreased risk for cancer and heart disease compared to white people. However, the report also found that Hispanic people had higher death rates from other conditions, including diabetes and liver disease, and a higher prevalence of obesity and uncontrolled high blood pressure.

The COVID-19 pandemic cut life expectancy at birth across all races and ethnicities, but Hispanic people may still live longer than most racial and ethnic groups, according to data published by the CDC's National Center for Health Statistics last August. Hispanic people have a life expectancy of 77.7 years compared with the overall expectancy of 76.1 and behind only Asian people (83.5 years). Between 2015 and 2019, Hispanic people had a life expectancy of just under 82 years, while the overall life expectancy in the U.S. was just under 79 years.

The Hispanic paradox has not been without its challengers.

In a 2022 study published in the Journal of General Internal Medicine, researchers intended "to take a quick look" at the paradox and found their "study did not support it," said lead author Dr. Olveen Carrasquillo, a professor of medicine and public health sciences at the University of Miami's Miller School of Medicine.

The researchers focused on heart disease, the leading cause of death in the U.S.

Carrasquillo and his colleagues used medical record data from the All of Us national research program, which has health information on about 40,000 Latinos among more than 200,000 participants.

The researchers found that 6.1% of Latino women had developed heart disease compared with 7.7% for Black women and 3.9% for white women. Latino men had a rate of 9.2%, while Black men were at 8.1% and white men at 7.6%.

"That's what we found, which is what I guess you'd expect, knowing what the rates of obesity are, the rates of diabetes, poorly controlled cholesterol, poorly controlled blood pressure, and limited access to care," he said.

Still, Carrasquillo didn't outright reject the paradox. "I don't want to say it's not a real thing because it's just one study. And I can't say, 'Hey, after 30 years of data, it turns out we were wrong.'"

Recent research suggests the Hispanic paradox may be fading to a degree. In April 2022, a study published in the Journal of the American Heart Association found Hispanic adults had a lower overall death rate from cardiovascular disease compared to white adults, but their rate of stroke-related deaths had been increasing since 2011 as the rate for white adults had flattened. The research also showed a bigger rise in death rates for heart failure among Hispanic adults under 65.

Carrasquillo said his team intends to do more research, including on how health outcomes may differ between the various Latino nationalities, which many studies typically don't do.

Studies have focused primarily on Mexican Americans likely because "they are very young relative to the other groups," Borrell said. Given the diversity of the Hispanic population and recent waves of immigrants, the paradox may need a deeper look to "examine health pattern trends" for those with roots in other Latin American and Caribbean countries, she said. "We are not homogenous. We have groups that are doing very well, health-wise, and groups that are doing poorly."

John Ruiz, a psychology professor at the University of Arizona in Tucson, said data suggest the paradox is "actually growing stronger."

In a review of published literature between 2000 and 2018, Ruiz and his colleagues found that the paradox may extend to lung cancer. Hispanic people had better survival rates than non-Hispanic white people, according to the research published in JNCI Cancer Spectrum in 2021.

Ruiz said much of the work that he and his colleagues are doing now in relation to the paradox focuses on the possible influence of social connections. Newer research on the paradox, he said, includes a focus on sociocultural resilience, which suggests "cultural values may drive Hispanics into tighter social connections which have a myriad of health benefits, ranging from prevention to stress buffering to caregiving."

"I always think of the movie 'Coco,' which is all about family and super-tight bonds and relationships," Ruiz said. "We know in general that having more friends, having a tighter social network is related to better health outcomes. And it just might be that Latinos are a good example of that."

Ultimately, Carrasquillo said, the takeaway message should be that Latino people, like everyone else, must strive to eat healthy foods and exercise. "We still need to work hard to lead a healthier lifestyle," he said.

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved.

By Lourdes Medrano, American Heart Association News