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Atmos Environ (1994). 2015 Oct 1;119:314-321.

Is there a Hispanic Health Paradox in Sensitivity to Air Pollution? Hospital Admissions for Asthma, Chronic Obstructive Pulmonary Disease and Congestive Heart Failure Associated with NO2 and PM2.5 in El Paso, TX, 2005-2010.

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University of Texas at El Paso, 500 West University Avenue, El Paso, TX, USA 79902, , 915-747-8471 (tele), 915-747-5505 (fax).
Center for Institutional Evaluation, Research and Planning, University of Texas at El Paso, El Paso, TX, USA.
Department of Statistical Science, Southern Methodist University, Dallas, TX, USA.
University of Texas at El Paso, El Paso, TX, USA.



Linkages between pollution and morbidity have been observed in numerous studies. But race/ethnicity has been underemphasized as a modifier of that association, and few studies have tested for a Hispanic Health Paradox in sensitivity to air pollution.


Daily asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) hospital admissions in El Paso, Texas were studied in age groups and insurance groups. Daily PM2.5 and NO2 were calculated from pollution monitors and all models adjusted for apparent temperature and wind speed. Conditional logistic regression for the case-crossover design was used for a between-group comparison and for a within-group comparison for Hispanics.


Hispanics were at lower risk than non-Hispanic whites and non-Hispanics of other races for NO2-associated admissions, but at greater risk for PM2.5-associated admissions. While Hispanics were generally protected with regards to NO2, Hispanic children (vs. elderly) faced increased risk for asthma and uninsured Hispanics (vs. Private) faced increased risk for COPD admissions. While Hispanics were at increased risk of PM2.5-associated admissions, certain characteristics heightened their risks: being a Hispanic child (vs. Elderly) for asthma; being a Hispanic with Medicare (vs. Private) for asthma; and being a Hispanic with private insurance (vs. all other insurance types) for CHF. The main effect of pollution on admissions was more significant for asthma and CHF than for COPD, which had the fewest cases.


There was heterogeneity in sensitivity to air pollution based on social characteristics and moderate evidence for a Hispanic Health Paradox in sensitivity to NO2.


Air pollution; Case-crossover; Effect Modification; Hispanic Health Paradox

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