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December 06, 2012 9:34 AM Another Excuse Bites the Dust: Health Costs and American Lifestyles

By Aaron Carroll

Whenever I present data showing that we under-perform other health care systems. or that our health in general is worse than other countries’, someone tries to blame it on our lifestyle. They claim that other countries’ people are healthier when they live over there, but when they move here, they start to eat terribly, etc., and then they get diabetes or some other disease. In other words, it’s not the health care system’s fault – it’s the fault of our lifestyles.

Here’s Health Affairs, “Undiagnosed Disease, Especially Diabetes, Casts Doubt On Some Of Reported Health ‘Advantage’ Of Recent Mexican Immigrants“:

Newly arrived Mexican immigrants in the United States generally report better health than do native-born Americans, but this health advantage erodes over time. At issue is whether the advantage is illusory—a product of disease that goes undiagnosed in Mexico but is discovered after immigration. Using results from the National Health and Nutrition Examination Survey, we compared clinical to self-reported diagnosed disease prevalence and found that Mexican immigrants are not as healthy as previously thought when undiagnosed disease is taken into account, particularly with respect to diabetes. About half of recent immigrants with diabetes were unaware that they had the disease—an undiagnosed prevalence that was 2.3 times higher than that among Mexican Americans with similar characteristics. Diagnosed prevalence was 47 percent lower among recent Mexican immigrants than among native-born Americans for both diabetes and hypertension, but undiagnosed disease explained one-third of this recent immigrant advantage for diabetes and one-fifth for hypertension. The remaining health advantage might be explained in part by immigrant selectivity—the notion that healthier people might be more likely to come to the United States. Lack of disease awareness is clearly a serious problem among recent Mexican immigrants. Since undiagnosed disease can have adverse health consequences, medical practice should emphasize disease detection among new arrivals as part of routine visits. Although we found little evidence that health insurance plays much of a role in preventing these diseases, we did find that having health insurance was an important factor in promoting awareness of both hypertension and diabetes.

I have heard on any number of occasions the argument that newly arrived Mexican immigrants are healthier than their American-born counterparts. This study basically showed that this was largely in part due to undiagnosed, not an absence of, disease.

So it’s not just that the people moving here were healthier before they got here. Living in the US doesn’t give all of them diabetes. Let’s put this one to bed.

*I’m going to add (in response to some twitter critique), that I’m not claiming that we don’t have an unhealthy lifestyle. Nor am I claiming that getting obese doesn’t increase your chance of getting diabetes. I’m claiming that the pat answer of saying that people are healthier in other countries and sicker here and that completely drives our bad outcomes is a bad argument.

[Cross-posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.
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Comments

  • emjayay on December 06, 2012 11:49 PM:

    I don't see the relevance of the facts presented to any conclusions about American lifestyle vs. that of other countries. Mexican immigrants are no doubt from the low class of a bordering but third world country. Only based on observation, most Mexican immigrants are very short and many are overweight, from children to adults.

    Height is much more dependent on nutrition through one's growing years - 0 to 18 or so, and probably prenatal as well - than heredity. I'm not sure that anyone has figured out exactly what factors of nutrition - protein, vitamins, whatever - are most responsible for height differences. Maybe a lot of factors. Anyway generally very short stature indicates serious nutritional deficiency. Mexican immigrants are not western Europeans, a relevant comparable group to Americans.