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

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—known as the “Hispanic health paradox”—is especially pronounced in foreign-born Hispanics.

Recent research, however, is casting new light on this phenomenon—particularly 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.

“It’s very disheartening,” Emily Bacon, lead author of the study, says. “There is a dire situation for migrants in U.S. when it comes to accessing health care. Despite their pretty good health patterns overall, it’s completely reversed when looking at management. … That’s how much health care matters.”

Researchers have sought to identify various drivers of the “Hispanic health paradox” for years, including the “salmon effect”—immigrants may return to their own countries if they become sick—and the fact that less-healthy people are less likely to immigrate in the first place.   

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’s a paradox,” she says, “but does that extend to actually managing illness once Hispanics get sick?”

To find out, Bacon and her co-investigators at CU Boulder’s 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.

“Not only does the (NHANES) questionnaire survey thousands of people every other year, but they do clinical exams” that document blood pressure, height, weight, heart rate, cholesterol levels and other factors, Bacon says.

“This 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’t successfully managed the condition; if it’s pretty low, you can say, ‘OK, they have.’”

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.

“It’s actually the opposite of the Hispanic health paradox,” Bacon says. “It’s not good.”

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’t surprising, Bacon says.

“We 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),” she says. “There are many barriers to access, unless they pay out of pocket. Most don’t have access to Medicaid or Medicare.”

In short, lack of access is the primary reason foreign-born Hispanics don’t manage hypertension well—and potentially, by extension, any other condition.

But there is an upside, too: “It provides a direct point of targeted intervention. We have to develop better systems of getting people access to care,” 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.

“We are paying for people’s 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?” she says.

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

“By 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,” Bacon says.