“I think the future is continuing to define — perhaps with genetic markers — these populations better, from the point of view of risk-to-disease rather the ability to speak a [common] language,” said Leira, an associate professor of neurology and epidemiology at the University of Iowa who was not involved in the study.
Nevertheless, language inevitably plays a role, said Rodriguez, who suggests doctors who treat patients born abroad be more aware of potential communication obstacles.
The disparities among Hispanic subgroups aren’t limited to death rates from cardiovascular diseases, other research shows. Studies over the past decade have revealed differences in the rate of risk factors such as high blood pressure, diabetes and obesity among Mexican-Americans, Puerto Ricans, Cuban-Americans and Dominican-Americans.
In the new study, researchers didn’t analyze the impact of educational attainment, income or access to health care. They also don’t know whether some of the Hispanic participants classified as U.S.-born were in fact naturalized citizens.
Having that information would give researchers a better grasp of how cultural and societal factors impact cardiovascular disease in Hispanic subgroups, Leira said. For example, knowing how long foreign-born Hispanics lived in their home countries may provide a clearer picture about how living conditions in the United States affected their health, said Leira, co-author of the American Heart Association’s 2014 report on the state of cardiovascular disease in Hispanic-Americans.
“We’re going in the right direction, by subclassifying Hispanics by country of origin — or like this study, by place of birth,” he said. “But these are very general classifications, and we know that Hispanics are a very diverse population.”