Salinas Jennifer J, Su Dejun, Al Snih Soham
University of Texas Health Science Center at Houston, Houston, TX, USA,
J Cross Cult Gerontol. 2013 Sep;28(3):251-66. doi: 10.1007/s10823-013-9202-9.
Mexican Americans have demonstrated lower than what would be expected mortality rates and disease prevalence, given their overrepresentation among those living in poverty. However, Mexican Americans living along the US-Mexico border have been documented as carrying a higher burden of disease and disability that seems to contradict or at least challenge evidence in support of a "Hispanic Paradox". The purpose of this paper is to evaluate the concept of border health as it relates to the conceptualization and measurement of health outcomes in older Mexican Americans living in the Southwest United States. Data for this study comes from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (Hispanic EPESE) wave 1 and mortality files up to wave 5. Border residence was determined using La Paz Agreement county and distance from a port of entry classifications. Statistical analysis was conducted to assess border versus non-border differences in cause of death, disability, disease prevalence and premature mortality. Adjusted regression models were used to predict cause of death, disability and disease-free life expectancy and premature mortality (i.e. occurring before life expectancy). Interaction models between border/non-border and median income were also performed. Finally, distance from the US-Mexico border was used to determine the effect of distance to the US-Mexico border in border-residing participants. The findings from this study indicate that participants in the HEPESE were more likely to be alive at Wave 5 if they resided in a border county, however more likely to transition into ADL disability status. These findings were not explained by behaviors, duration in the US or sociocultural characteristics of where they lived. Additionally, Hispanic EPESE subjects that lived in the border region were more likely to have died from old age and were less likely to be lost to follow up. Interaction models revealed significant effects for diabetes as a cause of death. Moreover, distance from a US-Mexico port of entry was significant for being alive at wave 5 for border-residing participants. Relative to non-border residing participants, border residing Mexican Americans in the Hispanic EPESE did not carry a uniformly higher burden of disease, however had a significantly greater odds of 10 year survival. These findings bring up issues of measurement and the importance of geographic location when it comes to evaluating disease burden and mortality in Mexican Americans.
鉴于墨西哥裔美国人在贫困人口中占比过高，但其死亡率和疾病患病率却低于预期水平。然而，有记录显示，生活在美国与墨西哥边境地区的墨西哥裔美国人承受着更高的疾病和残疾负担，这似乎与支持“西班牙裔悖论”的证据相矛盾，或者至少对其构成了挑战。本文旨在评估边境健康这一概念，及其与居住在美国西南部的老年墨西哥裔美国人健康结果的概念化和测量之间的关系。本研究的数据来自西班牙裔老年人流行病学研究既定人群（Hispanic EPESE）的第1波，以及截至第5波的死亡率档案。边境居住情况是根据《拉巴斯协定》县以及与入境口岸的距离分类来确定的。进行了统计分析，以评估边境地区与非边境地区在死因、残疾、疾病患病率和过早死亡率方面的差异。使用调整后的回归模型来预测死因、残疾情况、无病预期寿命和过早死亡率（即在预期寿命之前发生）。还进行了边境/非边境与中位数收入之间的交互模型分析。最后，利用与美墨边境的距离来确定边境地区参与者中距离美墨边境的远近所产生的影响。本研究的结果表明，Hispanic EPESE研究中的参与者如果居住在边境县，在第5波时存活的可能性更大，但更有可能转变为日常生活活动（ADL）残疾状态。这些结果无法通过行为、在美国居住的时长或他们居住地点的社会文化特征来解释。此外，居住在边境地区的Hispanic EPESE研究对象更有可能死于老年，且失访的可能性较小。交互模型显示糖尿病作为死因具有显著影响。此外，对于边境地区的参与者来说，与美墨入境口岸的距离对于在第5波时存活具有显著意义。相对于非边境地区的参与者，Hispanic EPESE研究中居住在边境地区的墨西哥裔美国人并非普遍承受更高的疾病负担，但10年生存率的几率显著更高。这些发现提出了测量问题以及地理位置在评估墨西哥裔美国人疾病负担和死亡率时的重要性。
