ABSTRACT

Hispanics in the United States (and foreign-born Hispanics in particular) have relatively favorable health given their lower socioeconomic status compared to, for example, non-Hispanic whites. This phenomenon is often called the Hispanic health paradox (HHP). This study examines whether the previously documented HHP in hypertension prevalence extends to its management using clinical and self-reported measures from the 2007–2012 National Health and Nutrition Examination Surveys. Multivariate models adjusting for demographic, socioeconomic, and sociobehavioral characteristics show an advantage among foreign-born Mexicans in hypertension prevalence relative to non-Hispanic whites (adjusted OR = 0.85). However, compared to non-Hispanic whites, foreign-born Mexicans were 38% less likely to receive treatment recommendations and, when advised to undergo treatment, were 60% less likely to adhere to treatment. Adjusting for health care access and utilization dramatically reduces disparities in hypertension control between foreign-born Mexicans and non-Hispanic whites, suggesting that insufficient systematic access to and use of quality health care erodes the HHP and contributes to the deterioration of health throughout the immigrant experience. Without appropriate interventions, particularly in health care access and utilization, poorer hypertension management among foreign-born Mexicans may negatively affect the Hispanic health profile, increase risk of cardiovascular disease-related mortality, and erode the Hispanic health advantage in the future.

 抽象的

美国的西班牙裔（尤其是外国出生的西班牙裔）由于其社会经济地位低于非西班牙裔白人等，因此健康状况相对较好。这种现象通常被称为西班牙裔健康悖论（HHP）。本研究利用 2007-2012 年国家健康和营养检查调查中的临床和自我报告措施，检验了先前记录的高血压患病率中的 HHP 是否延伸到其管理。调整人口、社会经济和社会行为特征的多变量模型显示，相对于非西班牙裔白人，外国出生的墨西哥人在高血压患病率方面具有优势（调整后 OR = 0.85）。然而，与非西班牙裔白人相比，外国出生的墨西哥人接受治疗建议的可能性要低 38%，而在建议接受治疗时，坚持治疗的可能性要低 60%。对医疗保健的获取和利用进行调整，可以大大减少外国出生的墨西哥人和非西班牙裔白人之间在高血压控制方面的差异，这表明，高质量医疗保健的系统获取和使用不足会侵蚀 HHP，并导致整个移民经历中健康状况恶化。如果没有适当的干预措施，特别是在医疗保健的获取和利用方面，外国出生的墨西哥人的高血压管理较差可能会对西班牙裔的健康状况产生负面影响，增加心血管疾病相关死亡率的风险，并削弱西班牙裔未来的健康优势。