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The H ispanic P aradox and Predictors of Mortality in an Aging B iethnic C ohort of M exican A mericans and E uropean A mericans: The S an A ntonio Longitudinal Study of Aging
Author(s) -
Espinoza Sara E.,
Jung Inkyung,
Hazuda Helen
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12421
Subject(s) - medicine , gerontology , cohort , cohort study , mexican americans , longitudinal study , demography , ethnic group , pathology , sociology , anthropology
Objectives To examine predictors of mortality in aging M exican A mericans ( MA s) and E uropean A mericans ( EA s). Design Longitudinal, observational cohort study. Setting Socioeconomically diverse neighborhoods in S an A ntonio, T exas. Participants Community‐dwelling adults aged 65 and older (394 MA ; 355 EA ) who completed the baseline examination (1992–96) of the S an A ntonio L ongitudinal S tudy of A ging ( 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. H azard ratios ( HR s) for mortality were estimated using C ox 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, MA s had a higher prevalence of diabetes mellitus and frailty and lower socioeconomic status ( SES ) than EA s. 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 H ispanic paradox, MA s were at greater risk of mortality than EA s. 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 MA s requires attention to socioeconomic disparities and disease factors.