Dylan H. Roby

Summary: The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and U.S.-born Latinos and non-Latino whites. This study examined whether the paradox holds after accounting for health care access and utilization.

Researchers used 2019–2020 National Health Interview Survey data. The main predictors included population groups of foreign-born and U.S.-born Latinos (Mexican or non-Mexican) versus U.S.-born non-Latino whites. 

Findings: After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than U.S.-born non-Latino whites, except overweight/obesity and diabetes. U.S.-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than U.S.-born non-Latino whites.

In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

Read the Publications:

• Journal Article: Health Care Access and Utilization and the Latino Health Paradox
   

Summary: Although socioeconomic disparities in outcomes of peripheral artery disease (PAD) have been well studied, little is known about relationship between severity of PAD and socioeconomic status. The objective of this study was to examine this relationship.

Patients who had operations for severe PAD (rest pain or tissue loss) were identified in the National Inpatient Sample, 2005–2014. They were stratified by the median household income (MHI) quartiles of their residential ZIP codes. Other characteristics such as race/ethnicity and insurance type were extracted. Factors associated with more severe disease (tissue loss) were evaluated using multivariable regression analyses.

Findings: There were 765,175 patients identified; 34% in the first MHI quartile and 18% in the fourth MHI quartile. Compared to patients in the first quartile, those in the fourth quartile were more likely white (69% vs. 42%), more likely ≥65 years old, and were less likely to undergo amputations. After adjusting for patient characteristics, the fourth quartile was associated with more severe disease compared to the first quartile.

While higher MHI was associated with higher PAD severity, patients with high MHI were less likely to undergo amputations indicating a disparity in the choice of treatment for PAD. Increased efforts are necessary to reduce socioeconomic disparities in the treatment of severe PAD.

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• Journal Article: The Relationship Between Peripheral Arterial Disease Severity and Socioeconomic Status (Annals of Vascular Surgery)

​Summary: Researchers study the impact of Medicaid funding structures before and after the implementation of the Affordable Care Act (ACA) on health care access for Latinos in New York (Medicaid expansion), Florida (Medicaid non-expansion), and Puerto Rico (Medicaid block grant). Pooled state-level data for New York, Florida, and Puerto Rico from the 2011–2019 Behavioral Risk Factor Surveillance System and data from the 2011–2019 American Community Survey and Puerto Rico Community Survey were used for this study.

This cross-sectional study used probit with predicted margins to separately compare four health care access measures (having health insurance coverage, having a personal doctor, delayed care due to cost, and having a routine checkup) among Latinos in New York, Florida, and Puerto Rico. Authors also used difference-in-differences to measure the probability percent change of having any health insurance and any public health insurance before (2011–2013) and after (2014–2019) the ACA implementation among citizen Latinos in low-income households.

The sample consisted of Latinos aged 18–64 residing in New York, Florida, and Puerto Rico from 2011 to 2019.

Findings: Latinos in Florida had the lowest probability of having health care access across all four measures and all time periods compared with those in New York and Puerto Rico. While Latinos in Puerto Rico had greater overall health care access compared with Latinos in both states, health care access in Puerto Rico did not change over time. Among citizen Latinos in low-income households, New York had the greatest post-ACA probability of having any health insurance and any public health insurance, with a growing disparity with Puerto Rico.

Limited Medicaid eligibility (non-expansion of Florida's Medicaid program) and capped Medicaid funds (Puerto Rico's Medicaid block grant) contributed to reduced health care access over time, particularly for citizen Latinos in low-income households.
 

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• Journal Article: The Impact of Medicaid Funding Structures on Inequities in Health Care Access for Latinos in New York, Florida, and Puerto Rico

​Summary: Partisan differences in attitudes toward the COVID-19 pandemic and toward the appropriateness of local policies requiring masks, social distancing, and vaccines are apparent in the United States. Previous research suggests that areas with a higher Republican vote share may experience more COVID-19 mortality, potentially as a consequence of these differences. In this observational study that captured data from a majority of U.S. counties, researchers compared the number of COVID-19 deaths through October 31, 2021, among counties with differing levels of Republican vote share, using 2020 presidential election returns to characterize county political affiliation. Authors’ analyses controlled for demographic characteristics and social determinants likely to influence COVID-19 transmission and outcomes using state fixed effects.

Findings: Authors found a positive dose-response relationship between county-level Republican vote share and county-level COVID-19 mortality. Majority Republican counties experienced 72.9 additional deaths per 100,000 people relative to majority Democratic counties during the study period, and COVID-19 vaccine uptake explains approximately 10 percent of the difference. Findings suggest that county-level voting behavior may act as a proxy for compliance with and support of public health measures that would protect residents from COVID-19.
 

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• Journal Article: The Association Between COVID-19 Mortality and the County-Level Partisan Divide in The United States