The Metabolic Health and Mortality Patterns of the US Hispanic Population: Exploring Causes and Consequences

Abstract

Hispanics in the United States (US) generally live longer and experience better health than non-Hispanic whites despite their lower socioeconomic status; a phenomenon commonly termed the Hispanic paradox. Yet over the past few decades, rising obesity levels in the US and Mexico have all disproportionately affected the US Hispanic population, and it remains unclear if and how these trends could reshape future health and mortality patterns. Centering different demographic processes and key segments of a growing US Hispanic population, each paper of the dissertation approaches the question of how obesity and related metabolic conditions may impact the Hispanic paradox through a distinct lens informed by methods and perspectives from social demography, population health, and medical sociology.

Using a nationally representative sample of adults from the National Health and Nutrition Examination Study (NHANES), Paper 1 assesses and seeks to explain differences in metabolic syndrome (MetS) risk by race-ethnicity, country of origin, and duration of residence in the US to evaluate whether recent Mexican immigrants continue to exhibit a health advantage in this area. Recent Mexican immigrants were found to hold a metabolic health advantage over US-born whites due to their younger age structure. However, a decomposition analysis further reveals that recent Mexican immigrants would retain a MetS advantage, even after adjusting for age differences, if they were to achieve parity with US-born whites on education, income, and food security. This highlights these as key areas of social policy intervention to protect and preserve the health of newly-arriving Mexican immigrants with increasing time spent in the US.

Looking to the future, Paper 2 again leverages data from NHANES and brings in supplemental sources to project the impact of observed, historical patterns in obesity prevalence among non-Hispanic whites and US-born and foreign-born Hispanics on age-40 life expectancy (e40) over three decades, from 2015 to 2045. Somewhat counter to expectations set by historical trends and the few existing studies on this topic, I find that obesity is expected to have a large and comparable effect on mortality for all groups, and thus is unlikely to significantly reshape the existing Hispanic advantage in life expectancy within the foreseeable future.

Finally, expanding the focus of the dissertation in terms of life course and geography, Paper 3 combines cross-national data from the US Health and Retirement Study (HRS) and Mexican Health and Aging Study (MHAS) to explore disparities in metabolic health conditions and attributable mortality risks across first- and later-generation Mexican-origin populations in the US and Mexico as compared to US-born whites. Despite considerable focus on obesity as an emergent threat to Hispanic health and longevity, my findings reveal significant disparities primarily in the distribution of physiological metabolic conditions—particularly, elevated blood glucose levels (i.e., prediabetes/diabetes)—and attributable mortality risks burdening older Mexican-origin populations on both sides of the border relative to US-born whites. Future research should focus on managing diabetes as a key area of preventable mortality that is currently driving disparities between aging foreign-born and US-born Mexican populations relative to US-born whites.

Taken together, these studies update current understandings about the Hispanic paradox and highlight emergent areas of vulnerability to guide future interventions as part of a comprehensive strategy to protect and promote the health and longevity of Hispanics living in the US, while also seeking to reduce health inequities across the entire US population.