The hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans: The san antonio longitudinal study of aging

Sara E Espinoza, Inkyung Jung, Helen P Hazuda

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15 Citations (Scopus)

Abstract

Objectives To examine predictors of mortality in aging Mexican Americans (MAs) and European Americans (EAs). Design Longitudinal, observational cohort study. Setting Socioeconomically diverse neighborhoods in San Antonio, Texas. Participants Community-dwelling adults aged 65 and older (394 MA; 355 EA) who completed the baseline examination (1992-96) of the San Antonio Longitudinal Study of Aging (SALSA) and for whom vital status was ascertained over an average 8.2 years of follow-up. Measurements Ethnic group was classified using a validated algorithm. Hazard ratios (HRs) for mortality were estimated using Cox proportional hazards models with age, sex, ethnic group, education, income, frailty, diabetes mellitus with and without complications, comorbidity, cognition, depressive symptoms, and body mass index included as predictors in sequential models. Results At baseline, MAs had a higher prevalence of diabetes mellitus and frailty and lower socioeconomic status (SES) than EAs. The age- and sex-adjusted ethnic HR (MA vs EA) for mortality was 1.54 (95% confidence interval (CI) = 1.17-2.03). After adjusting for SES, the ethnic HR was no longer significant (HR = 1.16, 95% CI = 0.83-1.61). In the final model, comorbidity, diabetes mellitus with complications, depressive symptoms, and cognitive impairment were significant independent risk factors for mortality. Conclusion Contrary to the Hispanic paradox, MAs were at greater risk of mortality than EAs. SES differences largely explained this ethnic disparity. Significant independent predictors of mortality, regardless of ethnic group, were diabetes mellitus with complications, comorbidity, depressive symptoms, and cognitive impairment. Mortality reduction in older MAs requires attention to socioeconomic disparities and disease factors.

Original languageEnglish (US)
Pages (from-to)1522-1529
Number of pages8
JournalJournal of the American Geriatrics Society
Volume61
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Hispanic Americans
Longitudinal Studies
Mortality
Ethnic Groups
Social Class
Comorbidity
Diabetes Complications
Depression
Diabetes Mellitus
Confidence Intervals
Independent Living
Proportional Hazards Models
Cognition
Observational Studies
Body Mass Index
Cohort Studies
Education

Keywords

  • frailty
  • Hispanic paradox
  • mortality

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{16f6b1b6b45f43cbb441eb2527a36493,
title = "The hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans: The san antonio longitudinal study of aging",
abstract = "Objectives To examine predictors of mortality in aging Mexican Americans (MAs) and European Americans (EAs). Design Longitudinal, observational cohort study. Setting Socioeconomically diverse neighborhoods in San Antonio, Texas. Participants Community-dwelling adults aged 65 and older (394 MA; 355 EA) who completed the baseline examination (1992-96) of the San Antonio Longitudinal Study of Aging (SALSA) and for whom vital status was ascertained over an average 8.2 years of follow-up. Measurements Ethnic group was classified using a validated algorithm. Hazard ratios (HRs) for mortality were estimated using Cox proportional hazards models with age, sex, ethnic group, education, income, frailty, diabetes mellitus with and without complications, comorbidity, cognition, depressive symptoms, and body mass index included as predictors in sequential models. Results At baseline, MAs had a higher prevalence of diabetes mellitus and frailty and lower socioeconomic status (SES) than EAs. The age- and sex-adjusted ethnic HR (MA vs EA) for mortality was 1.54 (95{\%} confidence interval (CI) = 1.17-2.03). After adjusting for SES, the ethnic HR was no longer significant (HR = 1.16, 95{\%} CI = 0.83-1.61). In the final model, comorbidity, diabetes mellitus with complications, depressive symptoms, and cognitive impairment were significant independent risk factors for mortality. Conclusion Contrary to the Hispanic paradox, MAs were at greater risk of mortality than EAs. SES differences largely explained this ethnic disparity. Significant independent predictors of mortality, regardless of ethnic group, were diabetes mellitus with complications, comorbidity, depressive symptoms, and cognitive impairment. Mortality reduction in older MAs requires attention to socioeconomic disparities and disease factors.",
keywords = "frailty, Hispanic paradox, mortality",
author = "Espinoza, {Sara E} and Inkyung Jung and Hazuda, {Helen P}",
year = "2013",
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T1 - The hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans

T2 - The san antonio longitudinal study of aging

AU - Espinoza, Sara E

AU - Jung, Inkyung

AU - Hazuda, Helen P

PY - 2013/9

Y1 - 2013/9

N2 - Objectives To examine predictors of mortality in aging Mexican Americans (MAs) and European Americans (EAs). Design Longitudinal, observational cohort study. Setting Socioeconomically diverse neighborhoods in San Antonio, Texas. Participants Community-dwelling adults aged 65 and older (394 MA; 355 EA) who completed the baseline examination (1992-96) of the San Antonio Longitudinal Study of Aging (SALSA) and for whom vital status was ascertained over an average 8.2 years of follow-up. Measurements Ethnic group was classified using a validated algorithm. Hazard ratios (HRs) for mortality were estimated using Cox proportional hazards models with age, sex, ethnic group, education, income, frailty, diabetes mellitus with and without complications, comorbidity, cognition, depressive symptoms, and body mass index included as predictors in sequential models. Results At baseline, MAs had a higher prevalence of diabetes mellitus and frailty and lower socioeconomic status (SES) than EAs. The age- and sex-adjusted ethnic HR (MA vs EA) for mortality was 1.54 (95% confidence interval (CI) = 1.17-2.03). After adjusting for SES, the ethnic HR was no longer significant (HR = 1.16, 95% CI = 0.83-1.61). In the final model, comorbidity, diabetes mellitus with complications, depressive symptoms, and cognitive impairment were significant independent risk factors for mortality. Conclusion Contrary to the Hispanic paradox, MAs were at greater risk of mortality than EAs. SES differences largely explained this ethnic disparity. Significant independent predictors of mortality, regardless of ethnic group, were diabetes mellitus with complications, comorbidity, depressive symptoms, and cognitive impairment. Mortality reduction in older MAs requires attention to socioeconomic disparities and disease factors.

AB - Objectives To examine predictors of mortality in aging Mexican Americans (MAs) and European Americans (EAs). Design Longitudinal, observational cohort study. Setting Socioeconomically diverse neighborhoods in San Antonio, Texas. Participants Community-dwelling adults aged 65 and older (394 MA; 355 EA) who completed the baseline examination (1992-96) of the San Antonio Longitudinal Study of Aging (SALSA) and for whom vital status was ascertained over an average 8.2 years of follow-up. Measurements Ethnic group was classified using a validated algorithm. Hazard ratios (HRs) for mortality were estimated using Cox proportional hazards models with age, sex, ethnic group, education, income, frailty, diabetes mellitus with and without complications, comorbidity, cognition, depressive symptoms, and body mass index included as predictors in sequential models. Results At baseline, MAs had a higher prevalence of diabetes mellitus and frailty and lower socioeconomic status (SES) than EAs. The age- and sex-adjusted ethnic HR (MA vs EA) for mortality was 1.54 (95% confidence interval (CI) = 1.17-2.03). After adjusting for SES, the ethnic HR was no longer significant (HR = 1.16, 95% CI = 0.83-1.61). In the final model, comorbidity, diabetes mellitus with complications, depressive symptoms, and cognitive impairment were significant independent risk factors for mortality. Conclusion Contrary to the Hispanic paradox, MAs were at greater risk of mortality than EAs. SES differences largely explained this ethnic disparity. Significant independent predictors of mortality, regardless of ethnic group, were diabetes mellitus with complications, comorbidity, depressive symptoms, and cognitive impairment. Mortality reduction in older MAs requires attention to socioeconomic disparities and disease factors.

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