Health Disparities Between Central and South Americans and other Latinos Living in the United States

This literature review provides an overview of the Latino epidemiological paradox and health disparities between Central/South Americans and other Hispanics living in the United States. Prior research has demonstrated that foreign-born Latinos have better overall health compared to those who aren’t foreign-born. Latinos also have a lower mortality rate compared to non-Hispanic Whites and African Americans. While it is unknown why these disparities exist, various hypotheses centered on the causes of the Latino paradox exist. These hypotheses will be addressed in the literature review and potential health protective factors that Hispanics/Latinos exhibit will be evaluated. In addition, health disparities exist between Latino groups, and this will be addressed as well. Due to the large size and growth of the Latino population in the U.S., understanding their health is a nationwide priority. HEALTH DISPARITIES BETWEEN CENTRAL AND SOUTH AMERICANS AND OTHER LATINOS LIVING IN THE UNITED STATES 3 Introduction: The Latino population in the United States has augmented about nine-fold since 1960, in which only 6.3 million Latinos were living in the U.S., to 55.3 million in 2014 (Brown & Stapler, 2016). Foreign-born Latinos living in the United States has increased by more than 20 times in the past half century, and the population of U.S.-born Latinos has also increased about six-fold (Brown & Stapler, 2016). According to the U.S. Census Bureau (2014), the Latino population is projected to be about 119 million by 2060. The largest population of Latinos living in the United States are Mexicans. Mexicans comprise of 66% of the Latino population, followed by Central and South Americans (13%), Puerto Ricans (9.4%), Cubans (3.9%), and people of other Hispanic origins (7.5%) (Centers for Disease Control and Prevention, 2011). Latinos and Mexican Americans have substantial socio-demographic risks including low incomes, education, access to healthcare, and high rates of obesity and undiagnosed diseases. However, Latinos experience lower infant mortality, adult all-cause mortality, and lower incidence of heart disease and several cancers compared to non-Hispanic Whites (Ruiz et al., 2014). Lower socioeconomic status is attributed to poor health in the context of morbidity and mortality because individuals may lack access to healthcare. Nonetheless, while both Latinos and African Americans may have a lower SES profile compared to non-Hispanic Whites, African Americans surprisingly have a higher mortality rate, thus demonstrating that the Latino epidemiological paradox exists (Abraido-Lanza et al., 1999). Nonetheless, limited research exists on the Latino epidemiological paradox, and the explicit causes are unknown. However, it is essential to understand the contributing factors to the Latino mortality paradox in order to understand why health disparities are present between HEALTH DISPARITIES BETWEEN CENTRAL AND SOUTH AMERICANS AND OTHER LATINOS LIVING IN THE UNITED STATES 4 Latino groups. For instance, Mexicans tend to have better overall health, followed by Central and South Americans, then Puerto Ricans and Cubans. The goal of this literature review is to bridge the gaps in research and provide different health protective factors that Latinos may exhibit. Methods: The methods utilized to complete this literature review were to study prior research on the Latino mortality paradox to understand potential health protective factors and explore other health protective factors not notable in research. The subjects in all studies reviewed included Cubans, Puerto Ricans, Mexicans and Central and South Americans. They were relatively compared to non-Hispanic Whites and African Americans. Literature Review: While limited research exists on the Latino health paradox, different hypotheses have been tested. Two competing arguments that Abraido-Lanza et al. (1999) highlight in their article, The Latino mortality paradox: a test of the" salmon bias" and healthy migrant hypotheses, are that lower mortality is “real” in the Latino community due to favorable health behaviors and greater family support among Latinos, or lower mortality is non-existent because it is caused by migratory factors. In order to investigate whether migratory factors play a role in the epidemiologic paradox among the Latino population in the United States, Abraido-Lanza et al. (1999) tested the “Salmon Bias” hypothesis and the healthy migrant hypothesis. The salmon bias hypothesis proposes that Latinos often return to pass away in their country of birth, therefore, causing them to be “statistically immoral”. The healthy migrant hypothesis claims that the epidemiologic paradox among Latinos is caused by the selection of healthy Latino immigrants HEALTH DISPARITIES BETWEEN CENTRAL AND SOUTH AMERICANS AND OTHER LATINOS LIVING IN THE UNITED STATES 5 into the United States. Often, Latinos choose to come to the United States illegally in search of better opportunities for themselves and their families, and they must endure a physically coarse journey. In order to have the ability to tolerate the harsh journey, these Latino immigrants need to be healthy to survive. The overall purpose of the study conducted by Abraido-Lanza et al. (1999) was to test the salmon bias and healthy migrant hypotheses. If these two hypotheses could be rejected, then it would demonstrate that lower mortality among Latinos exists and other factors contributing to the paradox could be considered and evaluated. The groups evaluated were non-Latino Whites, Mexicans, Puerto Ricans, Cubans, Central/South Americans and other Latinos. Cubans and Puerto Ricans were not necessarily subject to the salmon bias because Cubans are unable to easily return to Cuba, and Puerto Ricans are accounted for in the U.S. mortality statistics since Puerto Rico is a U.S. territory. Abraido-Lanza et al. (1999) utilized the National Longitudinal Mortality Study data, a nationwide personal interview household survey conducted annually by the National Center for Health Statistics, to analyze mortality rates for the groups in which the salmon hypothesis was not applicable. These groups were Cubans, who encounter barriers against return migration; Puerto Ricans, whose deaths in Puerto Rico are recorded in U.S. national statistics; and U.S.-born individuals, who are not impacted by the salmon or healthy migrant effects. The sample of their study were 301,718 non-Latino Whites and 17,375 Latino Whites, who were 25 years or older. Abraido-Lanza et al. (1999) discovered that Cubans and Puerto Ricans had lower mortality rates than non-Latino Whites, and foreignborn Latinos had lower mortality rates than U.S.-born Latino Whites. This demonstrated that the salmon and healthy migrant hypotheses could not serve as explanations for the lower mortality rate among Latinos, and other factors are causing the lower mortality. One of the limitations in this study to consider is not all surveys requested respondents to provide their birthplace, which HEALTH DISPARITIES BETWEEN CENTRAL AND SOUTH AMERICANS AND OTHER LATINOS LIVING IN THE UNITED STATES 6 made sample sizes much smaller to compare. Although the salmon bias hypothesis and healthy migrant hypothesis were ruled out by the Abraido et al. (1999) study, controversy persists around the Latino mortality paradox. This is because lower socioeconomic is linked to poorer overall health, and even though Latinos may have lower socioeconomic status, they tend to have lower all-cause mortality rate. Therefore, Abraido-Lanza et al. (2005) conducted a second data analysis of the 1991 National Health Interview Survey to evaluate the health behavior and acculturation hypotheses, which are potential explanations for the Latino mortality paradox. The health behavior hypothesis claims that the Latino mortality paradox is caused by Latinos having favorable health behaviors and risk factor profiles than do non-Latino Whites. These health behaviors may be correlated to cultural values and practices found in the Latino population, such as dietary intake and adverse perceptions of smoking and drinking, which may decline due to acculturation. On the other hand, the acculturation hypothesis suggests that Health behaviors and risk factors become more hostile with greater acculturation. In this particular study, acculturation was defined as the “process by which immigrants adopt the attitudes, values, customs, beliefs and behaviors of a new culture” (Abraido-Lanza et al., 2005). Quantitatively, it was defined as the amount of time Latinos have lived in the United States. Greater acculturation is associated with an increase in alcohol consumption, smoking, and several other risky health behaviors as well as rates of overall cancer, infant mortality and other illnesses. Nonetheless, acculturation may also lead to some healthy behaviors like an increase in leisure-time physical activity. Abraido-Lanza et al. (2005) studied specific health behaviors including smoking, alcohol use, leisure-time exercise activity and body mass index (BMI). These health behaviors were selected because they were responsible for more than half of the premature deaths in the United HEALTH DISPARITIES BETWEEN CENTRAL AND SOUTH AMERICANS AND OTHER LATINOS LIVING IN THE UNITED STATES 7 States, especially smoking, alcohol use and lack of physical activity. While controlling for sociodemographic factors, Abraido-Lanza et al. (2005) found mixed evidence to prove the plausibility of the health behaviors hypothesis since Latinos were less likely to smoke and drink alcohol compared to non-Latino Whites. However, Latinos were less likely to engage in physical activity, and they were more likely to have a higher BMI as opposed to non-Latino Whites, after controlling for age and SES. While the health behaviors hypothesis was similar to their findings, the acculturation hypothesis was only found to be partially true. After age and SES were adjusted, greater a