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      Longer—but Harder—Lives?: The Hispanic Health Paradox and the Social Determinants of Racial, Ethnic, and Immigrant-Native Health Disparities from Mid- through Late-Life

      research-article
      ,
      Journal of health and social behavior
      aging, health disparities, Hispanic paradox

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          Abstract

          Though Hispanics live long lives, whether a “Hispanic paradox” extends to older-age health remains unclear, as do the social processes underlying racial-ethnic and immigrant-native health disparities. Using data from the Health and Retirement Study (2004–2012) (N=6,581), we assess the health of US- and foreign-born Hispanics, relative to US-born Whites and Blacks, and examine the socioeconomic, stress, and behavioral pathways contributing to health disparities. Findings indicate higher disability, depressive, metabolic, and inflammatory risk for Hispanics relative to Whites and similar health profiles among Hispanics and Blacks. We find limited evidence of a healthy immigrant pattern among foreign-born Hispanics. While socioeconomic factors account for Hispanic-White gaps in inflammation, disparities in other outcomes persist after adjustment for SES, due in part to group differences in stress exposure. Hispanics may live long lives, but their lives are characterized by more socioeconomic hardship, stress, and health risk than Whites and similar health risks as Blacks.

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          Most cited references26

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          Racial Differences in Physical and Mental Health: Socio-economic Status, Stress and Discrimination.

          This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.
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            Is Racism a Fundamental Cause of Inequalities in Health?

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              Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk.

              We propose a model wherein chronic stress results in glucocorticoid receptor resistance (GCR) that, in turn, results in failure to down-regulate inflammatory response. Here we test the model in two viral-challenge studies. In study 1, we assessed stressful life events, GCR, and control variables including baseline antibody to the challenge virus, age, body mass index (BMI), season, race, sex, education, and virus type in 276 healthy adult volunteers. The volunteers were subsequently quarantined, exposed to one of two rhinoviruses, and followed for 5 d with nasal washes for viral isolation and assessment of signs/symptoms of a common cold. In study 2, we assessed the same control variables and GCR in 79 subjects who were subsequently exposed to a rhinovirus and monitored at baseline and for 5 d after viral challenge for the production of local (in nasal secretions) proinflammatory cytokines (IL-1β, TNF-α, and IL-6). Study 1: After covarying the control variables, those with recent exposure to a long-term threatening stressful experience demonstrated GCR; and those with GCR were at higher risk of subsequently developing a cold. Study 2: With the same controls used in study 1, greater GCR predicted the production of more local proinflammatory cytokines among infected subjects. These data provide support for a model suggesting that prolonged stressors result in GCR, which, in turn, interferes with appropriate regulation of inflammation. Because inflammation plays an important role in the onset and progression of a wide range of diseases, this model may have broad implications for understanding the role of stress in health.
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                Author and article information

                Contributors
                Journal
                0103130
                4780
                J Health Soc Behav
                J Health Soc Behav
                Journal of health and social behavior
                0022-1465
                2150-6000
                16 April 2020
                26 November 2019
                December 2019
                01 December 2020
                : 60
                : 4
                : 434-452
                Affiliations
                University of Pennsylvania
                University of North Carolina at Chapel Hill
                Author notes
                Corresponding Author, Courtney Boen, 232 McNeil Building, 3718 Locus Walk, Philadelphia, PA 19104-6299, cboen@ 123456upenn.edu
                Article
                PMC7245019 PMC7245019 7245019 nihpa1581804
                10.1177/0022146519884538
                7245019
                31771347
                605ef73b-81fd-4b0a-b3d4-3cb79ee05987
                History
                Categories
                Article

                Hispanic paradox,health disparities,aging
                Hispanic paradox, health disparities, aging

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