Sociocultural variability in the Latino population: Age patterns and differences in morbidity among older US adults

BACKGROUND—The US Latino population is rapidly aging and becoming increasingly diverse with respect to nativity and national origin. Increased longevity along with medical advancements in treatment have resulted in a higher number of older Latinos living with morbidity. Therefore, there is a need to understand variability in Latino health among older adults. OBJECTIVES—This paper documents mid- and late-life health differences in morbidity by race/ethnicity, nativity, and country of origin among adults aged 50 and older. METHODS—We use data from the 2000–2015 National Health Interview Survey to calculate age-and gender-specific proportions based on reports of five morbidity measures: hypertension, heart disease, stroke, cancer, and diabetes among non-Latino Whites and seven Latino subgroups. RESULTS—The foreign-born from Mexico, Cuba, and Central/South America, regardless of gender, exhibit an immigrant advantage for heart disease and cancer in comparison to non-Latino Whites across all age categories. Conversely, island-born Puerto Ricans are generally characterized with higher levels of morbidity. Similarly, US-born Puerto Ricans and Mexicans exhibit morbidity patterns indicative of their minority status. Latinos, regardless of gender, were more likely to report diabetes than non-Latino Whites. Hypertension and stroke have significant variability in age patterns among US-and foreign-born Latinos. CONCLUSION—Recognizing the importance of within-Latino heterogeneity in health is imperative if researchers are to implement social services and health policies aimed at ameliorating the risk of disease. CONTRIBUTION—Considering intersectional ethnic, nativity, and country-of-origin characteristics among older Latinos is important to better understand the underlying causes of racial/ethnic disparities in morbidity across the life course

The Disproportionate Impact of COVID-19 on Older Latino Mortality: The Rapidly Diminishing Latino Paradox

Objectives: This brief report aims to highlight stark mortality disparities among older Latinos that result from the novel coronavirus disease (COVID-19) pandemic. Methods: We use recent data from the Centers for Disease Control and Prevention to compute age-specific death rates (ASDRs) for three causes of death: deaths from COVID-19, residual deaths, and total deaths for four age-groups (55-64, 65-74, 75-84, and 85 and older) to assess the impact of COVID-19 on older Latino mortality relative to non-Latino Whites and non-Latino Blacks and also in comparison to residual deaths. Additionally, we obtain ASDRs for all causes of deaths from 1999 to 2018 to provide a pre-pandemic context and assess the extent to which the consistently observed mortality advantage of Latinos persists during the pandemic. Results: Consistent with previous research, our findings show that Latinos have lower ASDRs for non-COVID-19 causes of death across all age groups compared to non-Latino Whites. However, our findings indicate that Latinos have significantly higher ASDRs for COVID-19 deaths than non-Latino Whites. Furthermore, although the Latino advantage for total deaths persists during the pandemic, it has diminished significantly compared to the 1999-2018 period. Discussion: Our findings indicate that as a result of the pandemic, the time-tested Latino paradox has rapidly diminished due to higher COVID-19 mortality among older Latino adults compared to non-Latino Whites. Future research should continue to monitor the impact of COVID-19 to assess the disparate impact of the pandemic on older Black, Latino and non-Latino White adults as additional data become available

The Color of COVID-19: Structural Racism and the Pandemic’s Disproportionate Impact on Older Racial and Ethnic Minorities

Objectives: The aim of this evidence-based theoretically informed essay is to provide an overview of how and why the COVID-19 outbreak is particularly detrimental for the health of older Black and Latinx adults. Methods: We draw upon current events, academic literature, and numerous data sources to illustrate how biopsychosocial factors place older adults at higher risk for COVID-19 relative to younger adults, and how structural racism magnifies these risks for older Black and Latinx adults. Results: We identify three proximate mechanisms through which structural racism operates as a fundamental cause of racial/ethnic inequalities in COVID-19 burden among older adults: (1) Risk of exposure; (2) Weathering processes; and (3) Health care access and quality. Discussion: While the ongoing COVID-19 pandemic is an unprecedented crisis, the racial/ethnic health inequalities among older adults it has exposed are long-standing and deeply rooted in structural racism within American society. This knowledge presents both challenges and opportunities for researchers and policymakers as they seek to address the needs of older adults. It is imperative that federal, state, and local governments collect and release comprehensive data on the number of confirmed COVID-19 cases and deaths by race/ethnicity and age to better gauge the impact of outbreak across minority communities. We conclude with a discussion of incremental steps to be taken to lessen the disproportionate burden of COVID-19 among older Black and Latinx adults, as well as the need for transformative actions that address structural racism in order to achieve population health equity

Gender and Age of Migration Differences in Mortality among Older Mexican Americans

Objectives: Using a gendered life course perspective, we examine whether the relationship between age of migration and mortality is moderated by gender among a cohort of older Mexican-Americans. Methods: Data from the Hispanic Established Populations for the Epidemiological Study of the Elderly and recently matched mortality data are used to estimate Cox proportional hazard models. Results: Our findings indicate the relationship between age of migration and mortality is moderated by gender suggesting a more nuanced perspective of the immigrant mortality paradox. Among men, midlife migrants exhibit an 18 percent lower risk of mortality compared to their U.S.-born co-ethnics, possibly due to immigrant selectivity at the time of migration. Conversely, late-life migrant women exhibit a 17 percent lower risk of mortality relative to U.S.-born women, attributed in part to socio-cultural characteristics that influence lifestyle risk factors across the life course. Discussion: Selection mechanisms and acculturation processes associated with the immigrant experience are contingent on both age and gender suggesting the utility of an integrated life course approach to contextualize the mortality profiles of older immigrants. These findings demonstrate the heterogeneity among immigrants and highlight the need to understand gender differences in the migration process when assessing the immigrant mortality paradox

Prevalence and Trends in Morbidity and Disability Among Older Mexican Americans in the Southwestern United States, 1993–2013

This study examines the prevalence of morbidity and disability among older Mexican Americans using 5-year age groups. Twenty-year panel data from the Hispanic Established Populations for the Epidemiological Study of the Elderly are used to make detailed comparisons by nativity and gender. Results show that prevalence rates for most chronic conditions for both males and females do not vary by nativity. For disabilities, nativity is a significant predictor of increased instrumental activity of daily living disability for foreign-born females and reduced activity of daily living disability for U.S.-born males. Additionally, results show significant interactions between nativity and age cohorts, with the gap increasing with age for males and decreasing with age for females. These results have important implications for health services and health policy. Given the rapid aging of the Mexican American population, the prevention and treatment of medical conditions, particularly among the foreign-born, should be a major public health priority to reduce dependence from disabilities

Age at migration and disability-free life expectancy among the elder Mexican-origin population

BACKGROUND—Migration selectivity is thought to shape the health profiles of Mexican immigrants. OBJECTIVE—This study examines how the experience of Mexican migration to the United States affects the health process and the quality of life in old age by age at migration, specific to sex. METHODS—We use 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent disability-free prior to death across eight subgroups by sex, nativity, and age at migration among Mexican-origin elderly in the United States. RESULTS—Female migrants are at a significant disadvantage in terms of IADL disability-free life expectancy relative to US-born women, particularly late-life migrants. Conversely, mid- and late-life male migrants exhibit an advantage in ADL disability-free life expectancy compared to their US-born counterparts. CONCLUSIONS—Foreign-born Mexican elders are not a homogeneous group. This issue merits special attention in the development of community-based long-term care programs in order to appropriately target the specific needs of different subgroups of older Mexican individuals entering their last decades of life. CONTRIBUTION—This study contributes to immigrant health literature by providing a more comprehensive documentation of nativity differentials, by distinguishing subgroups of Mexican elderly by sex, nativity, and age at migration

Challenging the Utility of a Racial Microaggressions Framework Through A Systematic Review of Racially Biased Incidents on Campus

Despite claims of being in a “postracial” era, racially biased incidents pervade college and university campuses across the U.S., as evidenced in the continual media coverage of such incidents. In recognizing the complexities of these incidents, we sought to offer a contemporary review of racially biased incidents on college and university campuses and to explore the extent to which they represent covert forms of racial microaggressions versus more overt forms of racism. We conducted a content analysis of all news-making racially biased incidents that occurred on college and university campuses between August 1, 2005 and May 1, 2010, identifying 205 incidents. We classified these incidents by mode of delivery, racial content/symbolism, and type of racial (micro)aggression. While a number of these incidents can be best understood through a microaggressions framework, many are blatantly racist and do not fit the theory. Higher education and student affairs researchers and practitioners must understand these incidents for their complexities, recognizing that both overt and covert forms of racism are prevalent on campus

Diverse Sources of Social Support and Cognitive Functioning by Race, Ethnicity, and Nativity

This study examines the relationship between social support profiles and cognitive functioning by race, ethnicity and nativity in older adults using cross-sectional data drawn from the Health and Retirement Study (2010 and 2012). We employed a hierarchical clustering routine to generate nine support profiles that differentiated three sources of support: children, wider family relationships and friendships. Cognitive functioning was measured as the score on the Telephone Interview for Cognitive Status (TICS-m), a 27 point scale of cognitive function. Our approach explicitly acknowledges the ambivalence and multidimensionality of close relationships and the resources embedded within them. Descriptive analyses revealed significant differences in access to support across demographic groups. White respondents are over-represented in profiles that are characterized by support from friends, and under-represented in family support profiles. The reverse is found among Foreign-born Hispanic respondents who are over-represented in the profiles characterized by high family support and under-represented in those with high friend support. Native-born Hispanic respondents and Black respondents have less clear support patterns, although both are more likely to receive support from family and children compared to friends. Findings from the Poisson regression suggest that the relationship between familial support and cognitive decline is stronger among Hispanic respondents, particularly those who are foreign born. These findings are supported even with the inclusion of other relationship quality indicators including negative support and frequency of contact

Late Life Depressive Symptoms and Cognitive Function among Older Mexican Adults: The Past and the Present

Objective: To evaluate associations between depression and individual cognitive domains and how changes in depressive symptoms relate to cognition three years later in the context of Mexico, a developing country experiencing rapid aging. Method: Data comes from waves 3 (2012) and 4 (2015) of the Mexican Health and Aging Study (n=12,898, age 50+). Depression is ascertained using a modified Center for Epidemiologic Studies – Depression Scale. Cognition is assessed using verbal learning, verbal memory, visual scanning, verbal fluency, visuospatial ability, visual memory, and orientation tasks. Depressive symptoms and cognitive functioning were both measured in 2012 and 2015. Scores across cognitive domains are modeled using ordinary least squares regression, adjusting for demographic, health, and economic covariates. Results: When depression and cognition were measured concurrently in 2015, depression exhibited associations with all cognitive domains. When considering a respondent’s history of depression, individuals who had elevated depressive symptoms in 2012 and recovered by 2015 continued to exhibit poorer cognitive function in 2015 in verbal learning, verbal memory, visual scanning, and verbal fluency tasks compared to individuals who were neither depressed in 2012 nor 2015. Conclusions: Depression was associated with cognition across cognitive domains among older Mexican adults. Despite improvements in depressive symptomatology, formerly depressed respondents continued to perform worse than their counterparts without a history of depression on several cognitive tasks. In addition to current mental health status, researchers should consider an individual’s history of depression when assessing the cognitive functioning of older adults

Contextualizing the Relationship between Culture and Puerto Rican Health: Towards a Place-Based Framework of Minority Health Disparities

In both the culture of poverty literature and the acculturation literature, Puerto Ricans are portrayed in negative terms. The culture of poverty framework attributes Puerto Rican poverty to the mental, behavioral, and moral pathology of Puerto Rican individuals and to Puerto Rican culture. Similarly, outdated acculturation frameworks also trace the poor health of immigrants and racialized minorities, such as Puerto Ricans, to equivalent perceived deficiencies. In this paper, we argue that both the culture of poverty and acculturation frameworks are two pillars of the White Racial Frame (Feagin 2009) that sustains racial inequality in the United States. To build our case, we provide an overview of Puerto Rican physical health disparities and highlight key findings. Then, we analyze this literature using natural language processing (NLP) tools to examine the lexicon of words that scholars use to understand such disparities. Our literature review shows that Puerto Ricans are generally doing worse than other groups across a range of health indicators. Results from the NLP analyses reveal that the lexicon of the culture of poverty and outdated notions of acculturation are rhetorical tools that scholars still use to make sense of these conditions. We conclude by arguing that moving away from a White Racial Frame of Puerto Rican health requires a theoretical model that puts race, place, and culture within a multilevel framework that we call the Racialized Place Inequality Framework