Journal Article

All-Cause and Cardiovascular Mortality among Mexican-American and Non-Hispanic White Older Participants in the San Antonio Heart Study— Evidence against the “Hispanic Paradox”

Kelly J. Hunt, Roy G. Resendez, Ken Williams, Steve M. Haffner, Michael P. Stern and Helen P. Hazuda

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 158, issue 11, pages 1048-1057
Published in print December 2003 | ISSN: 0002-9262
Published online December 2003 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwg249
All-Cause and Cardiovascular Mortality among Mexican-American and  Non-Hispanic White Older Participants in the San Antonio Heart Study— Evidence against the “Hispanic Paradox”

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The observation that Hispanics have lower all-cause and cardiovascular mortality rates despite increased rates of diabetes and obesity and lower socioeconomic status has been termed the “Hispanic paradox.” The authors therefore examined the relation between ethnicity and mortality in 1,438 Mexican-American and 921 non-Hispanic White San Antonio Heart Study participants, aged 45–64 years when they enrolled between 1979 and 1988. Over an average of 14.5 years, 466 deaths occurred: 238 attributed to cardiovascular disease (death certificate International Classification of Diseases, Ninth Revision, codes 401–414 or codes 420–447 with the exception of code 427.5) and 117 attributed to coronary heart disease (codes 410–414). Age- and gender-adjusted hazard ratios for all-cause, cardiovascular, and coronary heart disease mortality comparing Mexican Americans with non-Hispanic Whites were 1.50 (95% confidence interval (CI): 1.23, 1.81), 1.70 (95% CI: 1.30, 2.24), and 1.60 (95% CI: 1.09, 2.36), respectively. After adjusting for possible confounders, among diabetic individuals not using insulin, the authors found excess risk of all-cause, cardiovascular, and coronary heart disease mortality associated with being Mexican American; however, in nondiabetic individuals and insulin-using diabetic individuals, Mexican Americans and non-Hispanic Whites appeared to be at similar risk of mortality. Contrary to the prediction of the “Hispanic paradox,” in the San Antonio Heart Study, Mexican Americans were at greater risk of all-cause, cardiovascular, and coronary heart disease mortality than were non-Hispanic Whites.

Keywords: cardiovascular diseases; cohort studies; coronary disease; diabetes mellitus, non-insulin-dependent; Mexican Americans; mortality; risk factors; Abbreviations: CI, confidence interval; HR, hazard ratio; ICD-9, International Classification of Diseases, Ninth Revision.

Journal Article.  6335 words.  Illustrated.

Subjects: Public Health and Epidemiology

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