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Foreign-born less likely to receive treatment, manage conditions, CU Boulder researchers find听

Almost everywhere in the world, lower socioeconomic status is a reliable indicator of higher mortality rates and worse population health.

Almost.

For decades, surveys have shown that Hispanics living in the United States have relatively better health and lower mortality rates than other racial groups with similar, or even higher, socioeconomic status, including non-Hispanic whites. The effect鈥攌nown as the 鈥淗ispanic health paradox鈥濃�攊s especially pronounced in foreign-born Hispanics.

Recent research, however, is casting new light on this phenomenon鈥攑articularly for foreign-born Hispanics and African Americans, whose health outcomes fall below those of non-Hispanic whites and U.S.-born Hispanics.

The research, led by University of Colorado Boulder researchers and published in the journal Biodemography and Social Biology, found that foreign-born Hispanics were less likely to get treated for hypertension, and more than twice as likely to manage their condition, due to one important cause: a lack of access to affordable health care.

鈥淚t鈥檚 very disheartening,鈥� Emily Bacon, lead author of the study, says. 鈥淭here is a dire situation for migrants in U.S. when it comes to accessing health care. Despite their pretty good health patterns overall, it鈥檚 completely reversed when looking at management. 鈥� That鈥檚 how much health care matters.鈥�

Researchers have sought to identify various drivers of the 鈥淗ispanic health paradox鈥� for years, including the 鈥渟almon effect鈥濃�攊mmigrants may return to their own countries if they become sick鈥攁nd the fact that less-healthy people are less likely to immigrate in the first place.听 听

But Bacon, a PhD candidate in sociology at CU Boulder, wanted to know more about what happens to those who do live with illness.

We know there鈥檚 a paradox,鈥� she says, 鈥渂ut does that extend to actually managing illness once Hispanics get sick?鈥�

To find out, Bacon and her co-investigators at CU Boulder鈥檚 Institute for Behavioral Studies, Richard Rogers, professor of sociology, and Fernando Riosmena, associate professor of geography, analyzed a large data set from the bi-annual National Health and Nutrition Examination Survey.

鈥淣ot only does the (NHANES) questionnaire survey thousands of people every other year, but they do clinical exams鈥� that document blood pressure, height, weight, heart rate, cholesterol levels and other factors, Bacon says.

鈥淭his means we could look at people who say they are diagnosed with hypertension and their blood-pressure readings. If the readings are high, we can say they haven鈥檛 successfully managed the condition; if it鈥檚 pretty low, you can say, 鈥極K, they have.鈥欌��

The research found that foreign-born Hispanics, when compared to non-Hispanic whites, were 38 percent less likely to receive treatment for hypertension, and if they did, were 60 percent less likely to actually stick to the regiment.

鈥淚t鈥檚 actually the opposite of the Hispanic health paradox,鈥� Bacon says. 鈥淚t鈥檚 not good.鈥�

However, when adjusting the statistics for access to health-care, the disparities in hypertension control was drastically reduced between foreign-born Hispanics and non-white Hispanics.

The reason for that isn鈥檛 surprising, Bacon says.

鈥淲e know this group in particular faces a lot of challenges, especially with health care, and most did not benefit from the ACA (Affordable Care Act),鈥� she says. 鈥淭here are many barriers to access, unless they pay out of pocket. Most don鈥檛 have access to Medicaid or Medicare.鈥�

In short, lack of access is the primary reason foreign-born Hispanics don鈥檛 manage hypertension well鈥攁nd potentially, by extension, any other condition.

But there is an upside, too: 鈥淚t provides a direct point of targeted intervention. We have to develop better systems of getting people access to care,鈥� she says.

Bacon recognizes that immigration has been a political flash point for some Americans since the 2016 presidential election. But, she says, political forces on both right and left recognize the critical role immigrant labor plays in the economy, and an immigration-free future is not in the cards.

鈥淲e are paying for people鈥檚 health care one way or another anyway, so we have to decide: Do we want to keep people healthy to begin with, before they get sick, or spend much more money when they get very sick later?鈥� she says.

And where the federal government may fall short in supporting immigrant health care, many local communities are stepping up. Boulder County鈥檚 Clinica Family Health and Denver鈥檚 Inner City Health Center, for example, serve immigrant populations at no charge.

鈥淏y investing in organizations that provide care to everybody, we are seeing more negative health patterns among most disadvantaged reversed, or good ones continued, despite the relatively dire national scene,鈥� Bacon says.