All-cause and cardiovascular mortality among Mexican-American and non-Hispanic white older participants in the San Antonio Heart Study - Evidence against the "Hispanic paradox"
All-cause and cardiovascular mortality among Mexican-American and non-Hispanic white older participants in the San Antonio Heart Study - Evidence against the "Hispanic paradox"
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DOI：
10.1093/aje/kwg249
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发表时间：
2003-12-01
影响因子：
5
通讯作者：
Hazuda, HP
中科院分区：
文献类型：
--
作者：
Hunt, KJ;Resendez, RG;Hazuda, HP
尽管西班牙裔的糖尿病和肥胖率增加，社会经济地位降低，但西班牙裔的全因死亡率和心血管死亡率较低，这一观察结果被称为“西班牙裔悖论”。因此，作者研究了1,438名墨西哥裔美国人和921名非西班牙裔白色圣安东尼奥心脏研究参与者的种族与死亡率之间的关系，他们在1979年至1988年期间登记时年龄在45-64岁之间。在平均14.5年的时间里，发生了466例死亡：238例死于心血管疾病（死亡证明《国际疾病分类》第九次修订版，代码401-414或代码420-447，代码427.5除外），117例死于冠心病（代码410-414）。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校正风险比分别为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）。在调整了可能的混杂因素后，在不使用胰岛素的糖尿病患者中，作者发现墨西哥裔美国人的全因、心血管和冠心病死亡率风险过高;然而，在非糖尿病患者和使用胰岛素的糖尿病患者中，墨西哥裔美国人和非西班牙裔白人的死亡率风险相似。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率高于非西班牙裔白人。
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 (Cl): 1.23, 1.81), 1.70 (95% Cl: 1.30, 2.24), and 1.60 (95% Cl: 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.