摘要：Objectives. We examined 3 cardiovascular disease risk factors by nativity and gender, evaluating evidence for education and health behaviors in explaining the “Hispanic Health Paradox.” Methods. We analyzed 2001–2008 National Health and Nutrition Examination Survey data for adults (n = 6032) to compare hypertension, high waist circumference, and diabetes for US- and foreign-born Mexican men and women. We controlled for age, depression, and health insurance. Results. Cardiovascular disease risk factors differed by education, nativity, and gender. Higher education was associated with higher odds of hypertension and high waist circumference for men and women regardless of nativity. As education increased, the odds of diabetes increased for US-born women, showing a gradient for this population. Finally, foreign-born Mexican women with 5 to 19 years in the United States conferred the highest odds of having diabetes, whereas foreign-born men with less than 5 years in the United States had the lowest odds for high waist circumference and presence of diabetes. Conclusions. Results contest assumptions of the Hispanic Health Paradox and suggest new approaches. New research can yield accurate information to ensure the development of appropriate interventions, decreasing health disparities endemic to a subgroup of Latinos. Considerable interest in the cardiovascular health of Latinos has emerged during the past decade. Although cardiovascular disease (CVD) is the second leading cause of death behind cancer, the Latino mortality rate for CVD is lower than that of non-Hispanic Whites. 1,2 Of the 4 major racial/ethnic groups, Latinos have the second highest morbidity-related CVD rate (26% for men and 32% for women). 3 Relatively well established is that Mexican American groups have substantial risk factors, such as diabetes, obesity, and hypertension, which contribute to the development of CVD at some point during the life course, making them an important population in which to examine the association between risk factors and future cardiac events. Much of the work on Latino health has focused on Mexicans, traditionally framing it as either a “Hispanic Health Paradox” (given their lower than expected socioeconomic status [SES], Latinos exhibit better health outcomes than non-Hispanic Whites) 4 or a “Hispanic Healthy Immigrant Hypothesis” (foreign-born Latinos, primarily Mexicans, have a health advantage over US-born Mexicans). 5,6 In this study, we move beyond the Hispanic Health Paradox to explore differences in CVD risk factors by examining educational gradients and the intersections of nativity and gender. An intersectional lens acknowledges coconstitutive dimensions of social inequality such as ethnic identity, gender, and SES to better understand how these social categories are associated with health. 7–9 A paucity of empirical research exists on gender inequalities by nativity for Latinos. Most studies have been descriptive, finding gender inequalities across 3 domains: migration, acculturation processes, and health. 10–12 CVD risk factors, such as hypertension, high waist circumference or high body mass index, and diabetes are most prevalent in Mexican American women. 13–15 Prevalence rates for hypertension have indicated that Mexican American women have higher rates than men regardless of nativity, 16 and foreign-born Mexican men (9.8%) and women (16.1%) have lower prevalence rates than US-born Mexican men (17.1%) and women (20.1%). 17 Estimates using 1999–2008 National Health and Nutrition Examination Survey data have shown prevalence rates for obesity at 45.1% for Mexican American women and 35.9% for Mexican American men. 18 Moreover, Mexican Americans are twice as likely as non-Hispanic Whites to have been diagnosed with diabetes by a physician. 19 Evidence on the social determinants of health has shown that SES measured by education, income, and occupation is strongly associated with lower mortality and better health outcomes at higher levels of the SES gradient. 20–24 However, investigations of the SES gradient for Latinos have been inconclusive, showing either weak or nonexistent associations with educational attainment. 25,26 Data are even more puzzling for foreign-born Latinos because reports have shown more modest associations between education and health compared with those for US-born Latinos, Mexicans, and Central and South Americans. 27–29 To contribute to the scant literature on the Hispanic Health Paradox and CVD risks, we used 3 traditional risk factors (hypertension, high waist circumference [HWC], and diabetes) to investigate whether health advantages exist for foreign-born Mexican populations. We (1) empirically investigated the relationship between education, nativity, gender, time in the United States, and CVD risk factors and (2) assessed the extent to which the education gradient matters for Mexican Americans by gender and nativity in predicting high risk for future CVD events. Our major contributions with this article are examining and describing variations in health risk and extending current intersectional thinking on the health of Mexican-origin populations by moving beyond the generalized Hispanic Health Paradox to produce meaningful information and to ensure the development of appropriate CVD interventions to decrease health disparities that are endemic to a subgroup of the Latino population.
