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.