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Stanford Report, May 12, 1999

New studies suggest United States falls short on Mexican-American health

BY MITCH LESLIE

Warning to Mexican-Americans: the United States can be hazardous to your
children's health.

That's not the latest government health warning but the ironic conclusion from two recent Stanford studies of Mexican-Americans, who represent the largest population of immigrants to the United States.

One study found that Mexican-Americans born in the United States face a much higher risk of dying from cardiovascular disease than do Mexican-Americans born in Mexico.

The second study showed that Mexican-born children who immigrate to the United States are nine times more likely to grow up without health insurance than American-born Caucasian children (of non-Hispanic descent).

Both studies were based on an analysis of data collected during the third National Health and Nutrition Examination Survey, a six-year assessment of the health and nutritional status of the U.S. population, conducted by the National Center for Health Statistics. This survey combined interviews, medical examinations and laboratory tests on some 40,000 Americans to produce the most comprehensive evaluation of the state of American health to date.

For their examination of cardiovascular risk in Mexican-Americans, Jan Sundquist and Marilyn Winkleby focused on five factors that affect the odds of developing cardiovascular disease: blood pressure, body mass index (weight scaled by height), cigarette smoking, cholesterol levels, and prevalence of Type II diabetes. Sundquist, MD, PhD, is a visiting scholar at the Stanford Center for Research in Disease Prevention, where Winkleby, PhD, is as senior research scientist.

Sundquist and Winkleby wanted to find out how these risk factors vary with birthplace and degree of assimilation into American society. So they divided their sample of 2,800 Mexican-American men and women into three groups: those born in Mexico; those born in the United States who speak primarily Spanish at home; and those born in the United States who speak English at home.

Despite having the least education and the highest poverty rate, Mexican-Americans born in Mexico had the healthiest cardiovascular profile across the board. They had the lowest blood pressure and cholesterol levels. They were leaner, as evidenced by a lower body mass index. And they were less likely to smoke.

By contrast, the Spanish-speaking, American-born group had the least healthy profile, while the English speakers born in the United States fell in the middle.

Using a standard formula, Sundquist and Winkleby also calculated the risk of dying from cardiovascular disease for each group. For men, the Spanish-speakers were almost 38 percent more likely to die within the next 10 years than those born in Mexico. For women, the disparity was even greater, with the Spanish-speaking group showing a 73 percent greater chance of death over the next decade. Again, the values for American-born English speakers were intermediate. Sundquist and Winkleby reported their conclusions in the May issue of the American Journal of Public Health.

The results of the study may deflate some of the public's rosy notions about immigrants finding a healthier life in America, but they aren't surprising to epidemiologists, Sundquist said. This same pattern appears among vastly different immigrant groups, such as Japanese immigrants in Hawaii and Eastern Europeans in Sweden. The common factor seems be a change in diet and lifestyle.

The study is important because it reveals a more heterogeneous health profile of the nation's 29 million Mexican-Americans, which are often considered by public health officials to be uniform, Winkleby noted. "Our findings identify a new group at substantial risk for cardiovascular disease and in need of effective heart disease prevention programs," she said.

Sundquist and Winkleby said their work did not identify why Spanish-speakers are at especially high risk for cardiovascular disease.

The second study, conducted by Anthony Burgos, MD, a Stanford University postdoctoral fellow in general pediatrics, is among the first to look at the generational differences in health care access that exist among Mexican-Americans. From the same database, Burgos and his colleagues analyzed the health access of more than 12,000 children, age 2 months to 16 years.

Burgos' work discloses a much larger discrepancy for first-generation Hispanics than previously thought, since earlier data has shown improvements in health care access among Hispanic children as a group.

Burgos said it was not surprising that immigrant children from Mexico are poorer and receive less health care than others, "but we were surprised at the extent of the problem and how it is masked by somewhat better status for later generations."

The study found that 75.4 percent of first generation Hispanic children live in households with income below the poverty line, compared to 14.9 percent of non-Hispanic whites and 46.9 percent of African-Americans. Moreover, 63.9 percent of the first generation youths were uninsured, compared with only 7.6 percent of non-Hispanic whites, 9.9 percent of African-Americans, 26.1 percent of second generation Mexican-Americans and 16.4 percent of third generation Mexican-Americans. All whites and African-Americans surveyed were U.S. born and not divided by generation.

"Surveys reported in recent years have shown that about 40 percent of Hispanics live in poverty and are uninsured," said Burgos. "Our project shows that the most recent immigrants have a more serious problem finding access to health care, which tends to put them in an underserved category all their own."

Without insurance and without health care access, they will have less opportunity for preventive care, including well-child visits, immunizations and developmental screening, and "eventually may be more likely to require [expensive] treatment and hospitalization," he said.

The study did not delve into the reasons for the lack of access, but Burgos suggested a combination of likely factors, including poverty, language barriers, lack of transportation and parental fear of deportation.

Burgos and his colleagues presented the results of their study on May 2 at the annual meeting of the Pediatric Academic Societies in San Francisco.

Other researchers involved in the study included Loribeth Dixon, a consulting nutritionist and statistician, and Fernando Mendoza, MD, MPH, associate professor and Chief of Stanford's Division of General Pediatrics. SR