Ethnic variation in health and the determinants of health among Latinos

Abstract

The purpose of this research is to document and explain ethnic variation in health among Latino adults in the United States. Results of analyses of data pooled from the 1997–2001 National Health Interview surveys reveal that health patterns are clearly different among Latino ethnic groups. Mexicans have health advantages, whereas Puerto Ricans experience health disparities. Cubans and Dominicans reveal a mix of health disparities and advantages, depending on the health outcome. The effects of social determinants of health are also contingent upon ethnicity. For example, worse health is associated with higher levels of socioeconomic status (SES) and acculturation among Mexicans, but with lower levels of SES and acculturation among Latinos whose origins are from Caribbean islands. We conclude that racial/ethnic comparative health research should avoid pan-ethnic groupings, and explicitly acknowledge ethnic group distinctiveness.

Introduction

The extent and nature of Latino health disparities in the US is inconclusive, with an especially thin knowledge of the health of Puerto Ricans, Cubans, and other non-Mexican-origin Latinos. Latinos, as a group, face sociocultural and economic barriers to health care, yet paradoxically they have lower levels of infant and adult mortality (Abraido-Lanza, Dohrenwend, Ng-Mak, & Turner, 1999; Cobas, Balcazar, Benin, Keith, & Chong, 1996; Falcon & Tucker, 2000; Hummer, Rogers, Amir, Forbes, & Frisbie, 2000; Idler & Angel, 1990; Landale, Oropesa, & Gorman, 2000; Padilla, Boardman, Hummer, & Espitia, 2002; Sorlie, Backlund, Johnson, & Hogat, 1993). We know much less about the major health statuses and processes that characterize the epidemiological reality of contemporary US adulthood, and are the focus of current social and behavioral science health research. The scanty evidence available suggests relatively good health among Latinos, given their fewer economic resources (Hayes-Bautista, 1992; Markides & Coreil, 1986). A more recent analysis, however, describes significant ethnic heterogeneity among Latinos, finding better health among Cubans and Mexicans, and a discernible health disparity among Puerto Ricans (Hajat, Lucas, & Kington, 2000).

The purpose of this research is to document and explain ethnic variation in health among Latino adults. National-level data permit us to distinguish among the three largest Latino groups in the US, Mexicans, Puerto Ricans, and Cubans, as well as among Dominicans, a rapidly growing ethnic group. We describe Latino ethnic variation evident in different levels of health, yielding health disparities or health advantages, relative to non-Latino whites. We explore ethnic variation that may also appear in how social determinants of health shape health outcomes and differentials. In the next section, we delineate the sets of health determinants prevalent in social science research on health disparities. As we discuss each set of determinants, we evaluate the extent to which they differ among the Latino ethnic groups, and thus pose mechanisms that yield ethnic differentials in health.