The Hispanic paradox unraveled?
The Hispanic paradox unraveled?
复制标题
西班牙裔悖论解开了吗？
DOI：
10.1164/rccm.201109-1684ed
复制
发表时间：
2011
影响因子：
24.7
通讯作者：
Drummond,MBradley
中科院分区：
文献类型：
--
作者：
Drummond,MBradley
Chronic obstructive pulmonary disease (COPD) has recently risen to the third leading cause of death in the United States (1). While a wealth of important studies work to identify populations at risk for the development and progression of COPD, current research falls short in evaluating a group that is potentially protected from development of COPD: the US Hispanic population. Hispanics, the fastest growing minority in the United States (2), have a heterogeneous ethnic ancestry comprised of American Indian, European, and African origin. Despite being the largest US minority, Hispanics have traditionally fallen outside the scope of COPD clinical trials because of the relatively low prevalence of COPD and challenges of recruitment in this population. Ironically, it is these exclusions that may have delayed the understanding of genetic factors associated with protection against COPD development and progression, a key step in our understanding of the underlying susceptibility to COPD. As early as 1969, it was recognized that US Hispanics were using psychiatric resources at rates much lower than other minority groups (3). After reviewing additional clinical outcomes, including infant mortality and cardiovascular disease, Markides and Coreil codified the term “Hispanic paradox” to characterize the observation that health outcomes in US Hispanics were more comparable to non-Hispanic whites than to African Americans, despite lower socioeconomic indices (4). The Hispanic paradox has been shown to apply to COPD. Samet and colleagues demonstrated that New Mexico Hispanics have reduced risk of physician-diagnosed COPD and chronic airflow obstruction compared with non-Hispanic whites (5). In addition, while the ageadjusted mortality for COPD increased in Hispanics from 1958 to 1982, the annual rates of death were lower than those for non-Hispanic whites for each year studied (6). Recently, the PLATINO study evaluated the prevalence of COPD in five Latin cities, finding the lowest prevalence in Mexico City, consistent with the Hispanic paradox (7). Theories explaining the better clinical outcomes in Hispanics include differential smoking habits (5), the effects of altitude on lung growth (7), a healthy immigrant effect (disproportionate migration of individuals with good health), and the “salmon bias”(less healthy Hispanics may return home where they die)(8). Although the etiology and validity of the Hispanic paradox remains unclear, the epidemiological literature suggests that Hispanics have improved COPD outcomes. In this issue of the Journal, Bruse and colleagues (pp. 1254–1260) expand our understanding of the ethnic and genetic factors related to COPD prevalence and disease progression in Hispanic smokers (9). They accomplish this by examining nearly 2,000 participants of the Lovelace Smokers’ Cohort, a communitybased longitudinal cohort of former and current smokers in Albuquerque, New Mexico. With these data, the risk of spirometry-defined COPD and risk of rapid decline in the forced expiratory volume in one second (FEV1) is compared between Hispanic and non-Hispanic white smokers. Importantly, the authors use ancestry informative markers in addition to selfreported ethnicity to determine the relative effect of Native American ancestry on spirometric outcomes. At baseline, Hispanics were slightly younger and less likely to have a high school education than non-Hispanic whites. Smoking habits also differed between the ethnic groups, with Hispanics having more current smokers (77 versus 54%; P, 0.001), lower cumulative pack-years (34 versus 41; P, 0.001), and fewer packs smoked per day (1.10 versus 1.24; P, 0.001). After …
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