International Journal of Behavioral Medicine

, Volume 26, Issue 4, pp 331–342 | Cite as

Perceived Discrimination and Cardiometabolic Risk Among US Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study

  • Rina S. Fox
  • Mercedes R. Carnethon
  • Linda C. Gallo
  • Joshua F. Wiley
  • Carmen R. Isasi
  • Martha L. Daviglus
  • Jianwen Cai
  • Sonia M. Davis
  • Aida L. Giachello
  • Patricia Gonzalez
  • Jessica L. McCurley
  • Neil Schneiderman
  • Frank J. PenedoEmail author



Metabolic syndrome (MetS) is a group of cardiovascular risk factors including elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein cholesterol, impaired fasting glucose, and abdominal obesity, which disproportionately affects Hispanics/Latinos. The present study examined associations between perceived discrimination and MetS in Hispanic/Latino adults from various background groups (i.e., Dominican, Central American, Cuban, Mexican, Puerto Rican, South American).


Data were obtained from 5174 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. MetS components and covariates were measured at a baseline examination, and perceived discrimination was assessed within 9 months of baseline. Path analysis modeled associations of perceived discrimination with MetS prevalence and each of the six components of MetS, controlling for age, sex, income, acculturation, physical activity, diet, smoking, and alcohol use.


Among the full cohort, perceived discrimination was not associated with MetS prevalence in any of the models evaluated. Higher perceived discrimination at work/school was associated with larger waist circumference. When examining background groups separately, higher perceived ethnicity-associated threat was related to increased MetS prevalence only among individuals of Central American background. Differential patterns of association between perceived discrimination and MetS components were found for different background groups.


Overall results suggested that perceived discrimination was not strongly or consistently associated with MetS among Hispanics/Latinos.


Hispanic/Latino Perceived discrimination Metabolic syndrome Cardiometabolic risk Path analysis Background groups 



The authors would like to thank Katy Wortman for her assistance with data management and analysis. The authors thank the staff and participants of the HCHS/SOL and the HCHS/SOL Sociocultural Ancillary Study for their important contributions.

Funding Information

The Hispanic Community Health Study/Study of Latinos is a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01-HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), N01-HC-65236 Northwestern University (N01-HC65236), and San Diego State University (N01-HC65237). The following institutes/centers/offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, and NIH Institution-Office of Dietary Supplements. The HCHS/SOL Sociocultural Ancillary Study was supported by grant 1 RC2 HL101649 from the NHLBI/NIH. Rina S. Fox was supported through a National Cancer Institute Training Grant (5T32CA193193).

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA. 2015;313:1973–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Heiss G, Snyder ML, Teng Y, Schneiderman N, Llabre MM, Cowie C, et al. Prevalence of metabolic syndrome among Hispanics/Latinos of diverse background: the Hispanic Community Health Study/Study of Latinos. Diabetes Care. 2014;37:2391–12999.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Frank AT, Zhao B, Jose PO, Azar KM, Fortmann SP, Palaniappan LP. Racial/ethnic differences in dyslipidemia patterns. Circulation. 2014;129:570–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Colby SL, Otman JM. Projections of the size and composition of the U.S. population: 2014 to 2060, current population reports, P25–1143. Washington, DC: 2014.Google Scholar
  6. 6.
    Goldbacher EM, Matthews KA. Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature. Ann Behav Med. 2007;34:240–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Pascoe EA, Richman LS. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135:531–54.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gallo LC, Matthews KA. Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull. 2003;129:10–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Gallo LC, de los Monteros KE, Ferent V, Urbina J, Talavera G. Education, psychosocial resources, and metabolic syndrome variables in Latinas. Ann Behav Med. 2007;34:14–25.CrossRefPubMedGoogle Scholar
  10. 10.
    McCurley JL, Penedo F, Roesch SC, et al. Psychosocial factors in the relationship between socioeconomic status and cardiometabolic risk: the HCHS/SOL Sociocultural Ancillary Study. Ann Behav Med. 2017;51:477–88.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wagner JA, Tennen H, Feinn R, Osborn CY. Self-reported discrimination, diabetes distress, and continuous blood glucose in women with type 2 diabetes. J Immigr Minor Health. 2015;17:566–73.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Dolezsar CM, McGrath JJ, Herzig AJ, Miller SB. Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol. 2014;33:20–34.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ryan AM, Gee GC, Laflamme DF. The association between self-reported discrimination, physical health and blood pressure: findings from African Americans, black immigrants, and Latino immigrants in New Hampshire. J Health Care Poor Underserved. 2006;17:116–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Everson-Rose SA, Lutsey PL, Roetker NS, Lewis TT, Kershaw KN, Alonso A, et al. Perceived discrimination and incident cardiovascular events: the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2015;182:225–34.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Daviglus ML, Talavera GA, Aviles-Santa ML, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308:1775–84.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Escobedo J, Schargrodsky H, Champagne B, Silva H, Boissonnet CP, Vinueza R, et al. Prevalence of the metabolic syndrome in Latin America and its association with sub-clinical carotid atherosclerosis: the CARMELA cross sectional study. Cardiovasc Diabetol. 2009;8:52.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wong-McClure RA, Gregg EW, Barcelo A, et al. Prevalence of metabolic syndrome in Central America: a cross-sectional population-based study. Rev Panam Salud Publica. 2015;38:202–8.PubMedGoogle Scholar
  18. 18.
    Ai AL, Appel HB, Huang B, Lee K. Overall health and healthcare utilization among Latino American women in the United States. J Women's Health. 2012;21:878–85.CrossRefGoogle Scholar
  19. 19.
    Ai AL, Noël LT, Appel HB, Huang B, Hefley WE. Overall health and health care utilization among Latino American men in the United States. Am J Mens Health. 2012;7:6–17.CrossRefPubMedGoogle Scholar
  20. 20.
    Neighbors CJ, Marquez DX, Marcus BH. Leisure-time physical activity disparities among Hispanic subgroups in the United States. Am J Public Health. 2008;98:1460–4.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Siega-Riz AM, Sotres-Alvarez D, Ayala GX, Ginsberg M, Himes JH, Liu K, et al. Food-group and nutrient-density intakes by Hispanic and Latino backgrounds in the Hispanic Community Health Study/Study of Latinos. Am J Clin Nutr. 2014;99:1487–98.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kaplan RC, Bangdiwala SI, Barnhart JM, Castañeda SF, Gellman MD, Lee DJ, et al. Smoking among U.S. Hispanic/Latino adults The Hispanic Community Health Study/Study of Latinos. Am J Prev Med. 2014;46:496–506.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Blendon RJ, Benson JM, Gorski MT, Weldon KJ, Pérez DJ, Mann F, et al. The perspectives of six Latino heritage groups about their health care. J Immigr Minor Health. 2015;17:1347–54.CrossRefPubMedGoogle Scholar
  24. 24.
    Arellano-Morales L, Roesch SC, Gallo LC, Emory KT, Molina KM, Gonzalez P, et al. Prevalence and correlates of perceived ethnic discrimination in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. J Lat Psychol. 2015;3:160–76.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Caetano R, Ramisetty-Mikler S, Rodriguez LA. The Hispanic Americans Baseline Alcohol Survey (HABLAS): the association between birthplace, acculturation and alcohol abuse and dependence across Hispanic national groups. Drug Alcohol Depend. 2009;99:215–21.CrossRefPubMedGoogle Scholar
  26. 26.
    Vaeth PA, Caetano R, Rodriguez LA. The Hispanic Americans Baseline Alcohol Survey (HABLAS): the association between acculturation, birthplace and alcohol consumption across Hispanic national groups. Addict Behav. 2012;37:1029–37.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Sorlie PD, Avilés-Santa LM, Wassertheil-Smoller S, Kaplan RC, Daviglus ML, Giachello AL, et al. Design and implementation of the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol. 2010;20:629–41.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Gallo LC, Penedo FJ, Carnethon M, Isasi CR, Sotres-Alvarez D, Malcarne VL, et al. The Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: sample, design, and procedures. Ethn Dis. 2014;24:77–83.PubMedPubMedCentralGoogle Scholar
  29. 29.
    LaVange LM, Kalsbeek WD, Sorlie PD, et al. Sample design and cohort selection in the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol. 2010;20:642–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Brondolo E, Kelly KP, Coakley V, Gordon T, Thompson S, Levy E, et al. The perceived ethnic discrimination questionnaire: development and preliminary validation of a community version. J Appl Soc Psychol. 2005;35:335–65.CrossRefGoogle Scholar
  32. 32.
    Atkins R. Instruments measuring perceived racism/racial discrimination: review and critique of factor analytic techniques. Int J Health Serv. 2014;44:711–34.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci. 1987;9:183–205.CrossRefGoogle Scholar
  34. 34.
    Armstrong T, Bull F. Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health. 2006;14:66–70.CrossRefGoogle Scholar
  35. 35.
    Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012;142:1009–18.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    US Department of Health and Human Services. National Institute on Alcohol Abuse and Alcoholism: helping patients who drink too much: a Clinician’s guide. 2005 edition. 2007.Google Scholar
  37. 37.
    Klem LG, Grimm G, Yarnould PR. Path analysis: reading and understanding multivariate statistics. Washington: American Psychological Association; 1995.Google Scholar
  38. 38.
    R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2015. Available from: Scholar
  39. 39.
    Muthén LK, Muthén BO. Mplus user's guide. 6th ed. Los Angeles, CA: Muthén & Muthén; 1998-2011.Google Scholar
  40. 40.
    Hallquist MN, Wiley JF. MplusAutomation: an R package for facilitating large-scale latent variable analyses in Mplus. Struct Equ Model. 2018;25:621–38.CrossRefGoogle Scholar
  41. 41.
    Asparouhov T. Sampling weights in latent variable modeling. Struct Equ Model. 2005;12:411–34.CrossRefGoogle Scholar
  42. 42.
    Enders CK. Applied missing data analysis. New York: Guilford Press; 2010.Google Scholar
  43. 43.
    Lewis TT, Barnes LL, Bienias JL, Lackland DT, Evans DA, Mendes de Leon CF. Perceived discrimination and blood pressure in older African American and white adults. J Gerontol A Biol Sci Med Sci. 2009;64:1002–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Thomas KS, Nelesen RA, Malcarne VL, Ziegler MG, Dimsdale JE. Ethnicity, perceived discrimination, and vascular reactivity to phenylephrine. Psychosom Med. 2006;68:692–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Pérez DJ, Fortuna L, Alegria M. Prevalence and correlates of everyday discrimination among US Latinos. J Commun Psychol. 2008;36:421–33.CrossRefGoogle Scholar
  46. 46.
    Lee DL, Ahn S. Discrimination against Latina/os: a meta-analysis of individual-level resources and outcomes. Couns Psychol. 2012;40:28–65.CrossRefGoogle Scholar
  47. 47.
    Castañeda SF, Buelna C, Giacinto RE, Gallo LC, Sotres-Alvarez D, Gonzalez P, et al. Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med. 2016;87:144–50.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Lewis TT, Williams DR, Tamene M, Clark CR. Self-reported experiences of discrimination and cardiovascular disease. Curr Cardiovasc Risk Rep. 2014;8:365.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Pew Research Center. Mexican lawful immigrants among the least likely to become U.S. citizens; 2017. Available from: Accessed January 2019

Copyright information

© International Society of Behavioral Medicine 2019

Authors and Affiliations

  • Rina S. Fox
    • 1
  • Mercedes R. Carnethon
    • 2
  • Linda C. Gallo
    • 3
    • 4
  • Joshua F. Wiley
    • 5
  • Carmen R. Isasi
    • 6
  • Martha L. Daviglus
    • 7
  • Jianwen Cai
    • 8
  • Sonia M. Davis
    • 8
  • Aida L. Giachello
    • 2
  • Patricia Gonzalez
    • 9
  • Jessica L. McCurley
    • 4
  • Neil Schneiderman
    • 10
  • Frank J. Penedo
    • 10
    Email author
  1. 1.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of PsychologySan Diego State UniversitySan DiegoUSA
  4. 4.SDSU/UC San Diego Joint Doctoral Program in Clinical PsychologySan DiegoUSA
  5. 5.Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological SciencesMonash UniversityMelbourneAustralia
  6. 6.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineNew YorkUSA
  7. 7.Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoUSA
  8. 8.Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  9. 9.Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  10. 10.Department of PsychologyUniversity of MiamiMiamiUSA

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