NEARLY 50 YEARS AFTER RESEARCH BEGAN, MORE QUESTIONS THAN ANSWERS ABOUT LATINO HEART HEALTH
By Laura Williamson, American Heart Association News There are more than 65 million Hispanic and Latino people living in the U.S. – the second-largest racial or ethnic minority population in the country. Yet when it comes to heart and brain health, less may be understood about this population than any other. Researchers say the reasons for this are complex, but two stand out: While often lumped together, people of Hispanic origin are not actually one group, but many. And for decades, nobody studied them. In fact, until the 1980s, nobody even counted them – or collected comprehensive data about their health. Half a century later, many questions remain unanswered. “For years, all we had was anecdotal evidence about health trends,” said Dr. Lindsay Fernández-Rhodes, an associate professor of biobehavioral health at Penn State College of Health and Human Development in University Park, Pennsylvania. “Before you have the data to measure something, it may appear that it doesn’t exist.” Defining the population: Hispanic or Latino? Many people and entities, including the federal government, lump people of Hispanic and Latino origin together, but the two terms have different meanings. Hispanic refers to people with ancestry from a country where Spanish is the primary language spoken, including Spain or any of the countries it colonized. Latino refers to people with origins anywhere in Latin America and the Caribbean. The Census Bureau uses the two terms to cover anyone whose family has origins in Cuba, Mexico, Puerto Rico, South or Central America or places from any “other Spanish culture or origin.” People of Hispanic and Latino origins may be of any race. This covers a broad range of cultures, geographic origins, languages, nutritional preferences and socioeconomic statuses, with differences in how people access the health care system. And all these factors can affect a person’s health, said Dr. Fátima Rodríguez, an associate professor of cardiovascular medicine at Stanford University School of Medicine in California. “Studying all of these people together does not make sense,” she said. “We’re starting to recognize this is a highly diverse group of people, and the heterogeneity and diversity within the Hispanic population make it impossible to generalize to all of these groups. We need to consider how social determinants of health affect each group individually.” Early focus largely on people with Mexican heritage: Hispanic and Latino people have been part of the U.S. since before the nation’s beginning, especially in Texas, California, Nevada, Utah, New Mexico and Arizona, which once belonged to Mexico. Because of the large numbers of Mexican American people living there, early studies of Hispanic cardiovascular health focused on this population. Some of the first studies looked at people of Mexican descent living in and around San Antonio, Texas. During the 1970s, researchers were seeking clues about what was causing a decline in heart disease mortality rates in the U.S. They thought they’d find them by comparing health trends for people of differing cultural and economic backgrounds, so they compared death rates for white men and women to those for people with Spanish surnames. They theorized that because Hispanic people had lower socioeconomic status, they would have higher death rates than their more affluent white peers. They did not. Mexican American women, in particular, were seeing declines in heart disease death rates that puzzled researchers. This was the first indication that Hispanic and Latino populations might have differences that merit investigation, but “it was not a representative sample of Hispanics and Latinos across the U.S.,” said Dr. Larissa Avilés-Santa, director of clinical and health services research at the National Institutes of Minority Health and Health Disparities. Nonetheless, “we began to recognize that something was happening here.” Opening the door to research: Researchers couldn’t look at national data for health trends among Hispanic people because there wasn’t any. It wasn’t until 1980 that a question regarding Hispanic or Latino heritage was included on U.S. census forms. Once this demographic data was collected, it allowed researchers to construct studies such as the Hispanic Health and Nutrition Examination Survey, or HHANES. It collected comprehensive data about the health and nutritional status and needs for three Hispanic subgroups: Mexican Americans in five Southwestern states; Cuban Americans in Dade County, Florida; and Puerto Ricans in New York City and the surrounding area. The 1982 to 1984 survey was the first time the National Center for Health Statistics looked at a specific population. However, it covered only 76% of the Hispanic population living in the U.S. at the time. Researchers collected socioeconomic, health and demographic data and conducted physical and dental exams and a series of lab tests, creating what was then the largest and most comprehensive health database for this population in the U.S. The medical data collected included the presence of chronic conditions such as diabetes, high blood pressure, heart disease and depression, along with information on insurance coverage, use of the health care system and exposure to environmental toxins such as lead. “Really, what it took was recognizing from the census data that there was a growing demographic group that warranted study,” Fernández-Rhodes said. “And that’s when a fuller picture began to emerge.” The Hispanic paradox: As data began to surface, some puzzling questions arose. In 1986, an analysis of two decades of studies on the health status of Hispanic people in the Southwest, most of whom were of Mexican origin, found an anomaly in health trend data between Hispanic and non-Hispanic populations that quickly became known as the “Hispanic paradox.” The researchers noted that Hispanic people, who faced socioeconomic disadvantages similar to Black people, nonetheless experienced better health, more in line with their white, non-Hispanic peers. Compared to non-Hispanic white people, Hispanic participants had similar infant mortality rates, life expectancy and death rates for cardiovascular disease and cancer. Subsequent studies found even lower heart disease mortality rates for Hispanic populations than their non-Hispanic white peers. In contrast, studies consistently found Hispanic people in the U.S. had higher rates of diabetes and other cardiovascular risk factors, such
