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Glenn D. Braunstein, M.D.

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Unraveling the Latino Paradox

Posted: 10/04/10 11:33 AM ET

By the bottom-line measure, Los Angeles is the healthiest it's been since the late 1990s. The county's death rate dropped 22 percent from 1998 to 2007, according to a recent report from the Department of Public Health.

The number of people who died from heart disease, stroke, lung cancer and pneumonia dropped over that period. We're living longer lives, too. The average life expectancy of a Los Angeles County resident is 80.3 years, up from 75.8 years in 1991 - the first year the county started tracking it.

While the mortality rates dropped for all ethnicities, there are some dramatic differences.
Asians maintained the lowest death rates, and blacks - black men especially - had the highest. At the extremes, the gap in life expectancy is wide: There is a nearly 18-year difference in life expectancy between black men and Asian/Pacific Islander women (69.4 vs. 86.9 years). Differences in death rates and life expectancy from city to city and ethnic group to ethnic group are frequently attributed to economic conditions and access to health care.

But there is one group that seems to buck these trends. As a group, Latinos had fewer deaths than blacks - despite comparable levels of income and access to health insurance. They also enjoyed lower mortality rates than non-Hispanic whites. Statistics show they are living longer lives, too. Life expectancy among Latinos is 84.4 years - four years longer than the county average. This phenomenon - Latino health thriving despite disadvantages in income, education and access to health care - was dubbed the "Latino Epidemiological Paradox" in 1986.

For example, in 2007 - the most recent year for which data are available - coronary heart disease accounted for 24 percent of the premature deaths of blacks, 26 percent of the premature deaths of whites but only 18 percent of the premature deaths of Latinos. Premature deaths are deaths that occur before age 75. They Latinos also have the lowest rates of infant mortality - despite frequently not having access to healthcare until later in pregnancy. They also have lower incidences of stroke, heart attacks and cancer.

Using epidemiological risk factor models, as a lower-income, lower-education population that uses fewer services, Latinos should have higher mortality rates. Instead, they defy expectations. But why?

The answers have been elusive, and researchers can't agree on a single answer to explain the phenomenon.

Some have chalked up the difference to immigration, the reasoning being that those who choose to immigrate are likely to be the healthy and hardy in a population. Others have posited that immigrants are likely to return to their country of origin when they become ill.

However, the explanation may be far more complex. Researchers, including Dr. David Hayes-Bautista, executive director of UCLA's Center for the Study of Latino Health, have been studying data for decades trying to see if clues will emerge to reveal what lifestyle choices might hold the key to Latinos' longer, healthier lives. If there were a way to extend the good health statistics of Latinos to everyone in the nation, there would be about half a million fewer deaths each year.

There are a few of the key traits that may be crucial to longer life: The diet of recent immigrants tends to be traditional and healthy - with markedly lower consumption of processed and fast foods. Historically, studies have shown that Latinos tend to drink and smoke less than other ethnicities. Strong family connections and, strong social support networks, such as belonging to a church, have also been pointed to as supporting better health.

However, the protections of the Latino Paradox are not without their limits. Statistics indicate that over time, the lower risk seems to dwindle. Acculturation is often cited as a likely cause. As Latinos over time adopt a lifestyle that more closely mirrors the rest of the population, their mortality statistics also move closer to those of the rest of the population. While Latinos enjoy a lower risk of cardiovascular disease, cancer and stroke over all, they are at greater risk than other populations for diabetes and obesity. A study in the September issue of the Journal of Studies on Alcohol and Drugs reports that Hispanic adolescents were more likely than their peers to have ever used alcohol, cigarettes or marijuana. The study included 5,500 seventh- and eighth-graders at 16 California schools.

The one thing all the research seems to agree upon is that the Latino Paradox is worthy of further study. Determining and embracing the lifestyle factors that lead to longer, healthier lives will benefit us all. Salud!