Hunt Kelly J, Resendez Roy G, Williams Ken, Haffner Steve M, Stern Michael P, Hazuda Helen P
Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
Am J Epidemiol. 2003 Dec 1;158(11):1048-57. doi: 10.1093/aje/kwg249.
The observation that Hispanics have lower all-cause and cardiovascular mortality rates despite increased rates of diabetes and obesity and lower socioeconomic status has been termed the "Hispanic paradox." The authors therefore examined the relation between ethnicity and mortality in 1,438 Mexican-American and 921 non-Hispanic White San Antonio Heart Study participants, aged 45-64 years when they enrolled between 1979 and 1988. Over an average of 14.5 years, 466 deaths occurred: 238 attributed to cardiovascular disease (death certificate International Classification of Diseases, Ninth Revision, codes 401-414 or codes 420-447 with the exception of code 427.5) and 117 attributed to coronary heart disease (codes 410-414). Age- and gender-adjusted hazard ratios for all-cause, cardiovascular, and coronary heart disease mortality comparing Mexican Americans with non-Hispanic Whites were 1.50 (95% confidence interval (CI): 1.23, 1.81), 1.70 (95% CI: 1.30, 2.24), and 1.60 (95% CI: 1.09, 2.36), respectively. After adjusting for possible confounders, among diabetic individuals not using insulin, the authors found excess risk of all-cause, cardiovascular, and coronary heart disease mortality associated with being Mexican American; however, in nondiabetic individuals and insulin-using diabetic individuals, Mexican Americans and non-Hispanic Whites appeared to be at similar risk of mortality. Contrary to the prediction of the "Hispanic paradox," in the San Antonio Heart Study, Mexican Americans were at greater risk of all-cause, cardiovascular, and coronary heart disease mortality than were non-Hispanic Whites.
尽管西班牙裔人群糖尿病和肥胖发生率较高且社会经济地位较低，但他们的全因死亡率和心血管死亡率却较低，这一现象被称为“西班牙裔悖论”。因此，作者对1438名墨西哥裔美国人和921名非西班牙裔白人圣安东尼奥心脏研究参与者的种族与死亡率之间的关系进行了研究，这些参与者在1979年至1988年入组时年龄为45 - 64岁。在平均14.5年的时间里，共发生了466例死亡：238例归因于心血管疾病（死亡证明国际疾病分类第九版，编码401 - 414或编码420 - 447，但不包括编码427.5），117例归因于冠心病（编码410 - 414）。将墨西哥裔美国人与非西班牙裔白人相比，全因、心血管和冠心病死亡率的年龄和性别调整风险比分别为1.50（95%置信区间（CI）：1.23，1.81）、1.70（95%CI：1.30，2.24）和1.60（95%CI：1.09，2.36）。在对可能的混杂因素进行调整后，作者发现，在未使用胰岛素的糖尿病个体中，墨西哥裔美国人存在全因、心血管和冠心病死亡的额外风险；然而，在非糖尿病个体以及使用胰岛素的糖尿病个体中，墨西哥裔美国人和非西班牙裔白人的死亡风险似乎相似。与“西班牙裔悖论”的预测相反，在圣安东尼奥心脏研究中，墨西哥裔美国人的全因、心血管和冠心病死亡风险高于非西班牙裔白人。
