Healthier Than You Might Expect

The older ones go to the family practice with arthritis and hypertension, the younger ones with diabetes and asthma.

What surprises Flores, however, is not how sick they are, it is how sick they are not.

Overall, Flores said, his patients are much healthier than one would expect given their low levels of income and education, factors epidemiologists long have known are linked to poor health.

"You can predict in the African American population, for example, a high infant mortality rate," he said recently, "so we would think a [similarly] poor minority would have the same health outcomes.

"But they don't. They're not there," he said, referring to outcomes among Latinos.

Why Latinos aren't sicker -- a phenomenon known to health experts as the Latino paradox -- is puzzling to public health experts, given the link between disadvantage and high disease and mortality rates.

In overall mortality rates and infant mortality rates, two standard measures of a population's health, Latinos' numbers approach and sometimes surpass those of whites.

In Los Angeles County in 2003, the age-adjusted mortality rate for Latinos was 535 per 100,000, 33% less than for non-Hispanic whites and 52% less than for blacks, according to the most recent data from the county's Department of Public Health.

Nationally that year, Latinos' mortality rate was 621, 25% less than whites' and 43% less than blacks', according to National Vital Statistics Reports, published by the Centers for Disease Control and Prevention.

Latinos' infant mortality rates reflect a similar pattern. Locally, the rate was 5.2 per 100,000 in 2003, 16% higher than whites' and 57% less than blacks'. The national rate was 5.7, about the same as whites' and 58% less than blacks'.

"It violates one of the most predictable patterns we see in most areas of the world and for most diseases," said Dr. Paul Simon, chief epidemiologist for the county's Public Health Department.

"The question is, 'What is the Latino population doing right?' "

The reasons for the paradox are a matter of some debate. Some scholars attribute it to immigration, which may draw selectively from the ranks of the hale and hardy.

Another possibility is that many immigrants return to their home countries when seriously ill, skewing mortality statistics in this country.