Despite poverty, poor access to medical care and a lack of health insurance, Latinos are surprisingly less likely than Anglos to die of most of the major chronic illnesses, including nearly all forms of cancer, heart disease and pulmonary disorders, a new nationwide study has found.
The study, conducted by federal researchers and published today in the Journal of the American Medical Assn., is the first to give a comprehensive picture of causes of death for Latinos. It found that with certain notable exceptions--including diabetes, liver disease and homicide--the overall health outlook for Latinos is significantly better than for Anglos.
"This is perhaps the best news we have had in a long time," said former Surgeon General Antonia C. Novello, a Latina who was the first woman to serve in that post. "It's a light of hope in the presence of a negative stereotype and negative ways of survival--low income, low education, low health insurance."
The reasons for the disparity, however, remain a mystery.
Many health experts, including Novello, theorize that Latino culture--which frowns on drinking and smoking and promotes strong family values--helps keep that population healthy in spite of socioeconomic disadvantages. But the researchers who conducted the study say cultural differences do not appear to explain their findings.
"It remains a paradox," said Paul Sorlie, an epidemiologist with the National Heart, Lung and Blood Institute and the lead author of the study. "Whatever (Latinos) have got good going for them, they should keep it up. Unfortunately, we don't know what that is."
Latinos face difficult odds in health care, a fact that troubles many policy-makers. Although they have one of the highest employment rates of any ethnic group, Latinos are severely underinsured, in part because they are often self-employed or work for small businesses. One recent study found that 39% of all Latinos lack health insurance, a rate three times that of Anglos and nearly twice that of blacks.
Other research has shown that Latinos tend to delay visits to the doctor because of this lack of insurance, and because of suspicion of the U.S. medical profession and a fatalistic attitude toward disease. As a result, life-threatening illnesses among Latinos are often detected much later than among Anglos.
But over the past several years, medical research has shown that Latinos are defying these odds, particularly with regard to cancer. Small studies in New Mexico, California, Texas and other states with large Latino populations show that Latinos have lower rates of breast cancer, colon cancer and lung cancer than Anglos.
One Texas study showed that even though cervical cancer in Latinas was diagnosed later than in Anglo women, the two groups die at about the same rates. The researcher who conducted it, Amelie Ramirez of the University of Texas, said the findings defy explanation. "These are questions that science just hasn't answered yet," she said.
The study published today broadens those findings considerably. It looks at how Latinos across the United States fare against all the leading causes of death: six forms of cancer, diabetes, heart disease, respiratory illnesses, liver disease, accidents, suicide and homicide.
Sorlie and his co-authors compared death records of 40,000 Latino adults, 25 and older, to those of 660,000 Anglos--the researchers refer to them as "non-Hispanic whites"--in the same age group. Their study spanned eight years, from 1979 to 1987.
Even though Latinos fared worse than Anglos in certain categories, their overall death rates were still lower--meaning, in general, that when people of the same age were compared over a set period of time, more Anglos died than did Latinos. When all causes of death were lumped together, Latino men were 74% as likely to die as Anglos in a given time period, while Latino women were 82% as likely.
Homicide was the most stark exception to this finding. Latino men are more than 3 1/2 times as likely to be murdered as Anglos, and Latinas twice as likely to be murdered as Anglo women. Yet Latinos were less likely to kill themselves, and less likely to die in accidents.
There were other exceptions as well. Latino men were 1.8 times as likely as non-Latino whites to die of diabetes, and Latinas were 2.3 times as likely. Medical researchers have long known that Latinos report high rates of diabetes, and some have conjectured that they are genetically prone to the disease.
Latinos were also more than 1 1/2 times as likely as Anglos to die of pneumonia and influenza. Novello said she suspects this statistic actually reflects deaths from AIDS, which are rising among Latinos. She said Latino deaths from AIDS--which were not examined in the federal study--may falsely be reported as pneumonia cases to avoid cultural stigma.
Nevertheless, Latinos who suffer from the chronic illnesses that are the country's major killers--heart disease and cancer--fared much better than Anglos. Latinos were about two-thirds as likely to die of heart disease as Anglos, and also two-thirds as likely to die of cancer. They were half as likely as Anglos to die of colon cancer. And Latino women were only half as likely as Anglo women to die of breast cancer and lung cancer.
Some researchers attribute these differences to culture. They say strong family bonds in the Latino community provide nurturing that somehow protects people against the devastating effects of disease.
They also say Latino culture discourages smoking, drinking and other unhealthful habits. Research has shown that Latino immigrants shun these behaviors when they first arrive, but adopt them as they "acculturate"--become integrated into American society.
This may help explain why the federal researchers found that Latinos are considerably more likely than Anglos to die of cirrhosis of the liver--a disease that is linked to alcohol consumption. And the authors noted that some studies show smoking is in fact more prevalent among Latinos than Anglos, although Latinos who do smoke tend to smoke fewer cigarettes than Anglo smokers.
"The lower rates of heart disease, cancer and pulmonary disease do not seem to be explained by the major known risk factors for these diseases," the study concluded.
In trying to explain the disparities, the researchers also considered age and what is known as the "healthy migrant effect"--the theory that new immigrants are bound to be healthier because only healthy people move from one country to another. But both were discounted, Sorlie said.
Although Latinos are younger than the general population, Latino death rates remained lower even when age was taken into account. But the study showed that Latinos who were immigrants still had lower death rates than Anglos who were immigrants. And the same was true for those who were born in this country.
Latinos are less likely than Anglos to die of the major chronic diseases.
The following chart lists, by percentage, the likelihood of death for Latinos as compared to Anglos.
For instance, Latino men are 69% as likely as Anglo men to die of all forms of cancer. But they are 360%--or more than 3.5 times--as likely to be murdered.
Likelihood of death for Latinos as compared to Anglos:
Causes Men Women CANCER * All 69% 61% * Colon 47% 40% * Pancreatic 72% 75% * Lung 62% 45% * Prostate 97% NA * Breast NA 53% * Ovarian NA 80% DIABETES 186% 238% CARDIOVASCULAR DISEASE 65% 60% PULMONARY DISEASE 46% 65% PNEUMONIA/INFLUENZA 121% 167% LIVER DISEASE/CIRRHOSIS 196% 167% ACCIDENT * Motor vehicle 95% 68% * Other 82% 43% SUICIDE 62% 67% HOMICIDE 360% 200%
NOTE: NA indicates not applicable.
Source: Journal of the American Medical Assn.