Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes

J Health Care Poor Underserved. 2002 Nov;13(4):477-503. doi: 10.1177/104920802237532.


Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher porverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adult
  • Bias
  • Cause of Death
  • Cultural Characteristics*
  • Databases as Topic
  • Emigration and Immigration
  • Female
  • Health Behavior / ethnology*
  • Health Knowledge, Attitudes, Practice*
  • Health Services Accessibility / standards
  • Health Status Indicators*
  • Health Surveys
  • Hispanic Americans / education
  • Hispanic Americans / psychology*
  • Humans
  • Life Expectancy
  • Logistic Models
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / organization & administration*
  • Population Surveillance
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / ethnology
  • Socioeconomic Factors
  • United States / epidemiology