A comprehensive study of Puerto Rican health

The Puerto Rican pop­u­la­tion is the largest Latino group in the north­eastern United States, but data about health dis­par­i­ties is largely focused on Mex­ican Amer­i­cans, according to Katherine Tucker, whose Puerto Rican Health Study is the longest, most com­pre­hen­sive study of its kind for the Puerto Rican population.

This is impor­tant, because all His­panics are not alike. The Cubans have rel­a­tively low dia­betes preva­lence, but the Puerto Ricans have much higher,” she said. The so-​​called His­panic paradox — which claims that His­panic people have lower rates of heart dis­ease than non-​​Hispanic whites, despite higher risk fac­tors — is really a Mex­ican Amer­ican paradox, said Tucker, because that’s who the data is on.

In 2004, Tucker and her group began knocking on doors in the city’s Puerto Rican neigh­bor­hoods. After a sig­nif­i­cant effort of under a dozen people, they man­aged to round up 1500 par­tic­i­pants, with an average age of 58. The par­tic­i­pants signed on for a long term study, where inter­viewers come to their home to take blood and urine sam­ples, answer long ques­tion­naires about every­thing from their income to their diets to their med­ica­tion use.

Our hypoth­esis was that since Puerto Ricans are often low income and living with lan­guage iso­la­tion in an urban envi­ron­ment, they would have high stress which trans­lates into phys­i­o­log­ical burn out of home­o­static reg­u­la­tion,” said Tucker. Stress, she said, has a direct impact on waist cir­cum­fer­ence and can cause chron­i­cally high blood pressure.

The Puerto Rican pop­u­la­tion is known to have a twice as high preva­lence of dia­betes and higher rates of chronic obstruc­tive pul­monary dis­ease than non-​​hispanic whites and hyper­ten­sion rates second only to African Amer­i­cans. Puerto Rican chil­dren have the highest rates of asthma in the country, said Tucker.

In addi­tion to the like­li­hood that high chronic stress may play an impor­tant role, they also expected to find an increase preva­lence of these con­di­tions in people with poor diets and shaky social sup­port net­works. By exten­sion, this would mean “that even in the face of stress, good nutri­tion and social sup­port would mod­erate these out­comes,” said Tucker, offering a poten­tial inter­ven­tion point.

Through a series of data analysis studies, Tucker’s group is showing that across sev­eral mea­sures, diet does indeed have a sig­nif­i­cant impact on the health dis­par­i­ties seen in the Puerto Rican pop­u­la­tion. For example, low levels of vit­amin B6, high sugar intake and low nutri­tional variety were all asso­ci­ated with lower levels of cog­ni­tive func­tion, she said.

While these out­comes are likely true for all pop­u­la­tions, Tucker said it was par­tic­u­larly impor­tant in iden­ti­fying sources of health dis­par­i­ties in low-​​income pop­u­la­tions. “I think it’s more dra­matic in this pop­u­la­tion because the diet tends to be inad­e­quate in sev­eral nutrients.”

Tucker has a series of arti­cles out and coming out that high­light the numerous results they’ve amassed by ana­lyzing the data from sev­eral dif­ferent angles. In the coming months, I hope you’ll stay tuned for more blog posts on the indi­vidual papers.