title: Birthplace and mortality among insured Latinos: the paradox revisited.
abstract: OBJECTIVE
  We investigated the Latino paradox in a managed care setting and examined the role of birthplace.
  
  
  METHODS
  We evaluated 133,155 non-Latino Whites and 5,237 Latinos (36% born in the United States, 34% in Central and South America, 21% in Mexico, and 8% in the Caribbean Islands) who were enrolled in an integrated healthcare delivery system in northern California. Baseline data were from 1964-1973, and the median followup was 34 years. Main outcome measures were cause-specific and all-cause mortality.
  
  
  RESULTS
  In fully-adjusted analyses, and compared with non-Latino Whites, the risk of death from circulatory causes was significantly lower among US-born Latinos (hazard ratio [HR] .79, 95% confidence interval [CI] .66-.93), among Central and South America-born Latinos (HR .76, 95% CI .63-.91), and Caribbean-born Latinos (HR .66, 95% CI .47-0.93). Risk of death by malignant neoplasms was significantly lower among US-born Latinos (HR .68, 95% CI .56-.83). Risk of respiratory death was significantly lower among Central and South America-born Latinos (HR .50, 95% CI .32-.80). All-cause mortality risk was significantly decreased in US-born Latinos (HR .79, 95% CI .71-.87), Central and South America-born Latinos (HR .81, 95% CI .73-.90), and Caribbean-born Latinos (HR .76, 95% CI .63-.93) but not in Mexico-born Latinos.
  
  
  CONCLUSIONS
  In our managed care setting, the Latino paradox phenomenon varied by birthplace; it was more evident among US-born Latinos. This subgroup experienced lower circulatory, cancer, and all-cause mortality than did non-Latino Whites, despite higher prevalences of current smoking, obesity, and asymptomatic hyperglycemia.
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA 94612, USA. cgi@dor.kaiser.org
authors.forename: Carlos
authors.initials: C
authors.lastname: Iribarren
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Darbinian
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Fireman
authors.forename: Esteban González
authors.initials: EG
authors.lastname: Burchard
mesh_terms: D000328:Adult; D002140:California; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality*; D002489:Central America / Q000208:ethnology; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013020:South America / Q000208:ethnology; D014900:West Indies / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*