Factors Influencing Self-Reported Health in Puerto Rican Populations: A Systematic Review.

BACKGROUND AND AIMS: Puerto Ricans experience disproportionate chronic disease burden, structural barriers to care, and disparities in health outcomes. Self-reported health is a validated indicator of morbidity, mortality, and healthcare utilization, yet its determinants in Puerto Rican populations remain insufficiently synthesized. This review examined factors associated with self-reported health among Puerto Rican populations in mainland United States and island settings. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine databases were searched for English-language studies published from January 1, 1996, through January 31, 2026, using Puerto Rican population terms combined with self-reported health, self-rated health, subjective health, general health status, health perception, and health-related quality-of-life terms. Eligible studies reported original empirical data on self-reported health or health-related quality of life as a primary or secondary outcome in Puerto Rican samples. Study quality was appraised using Joanna Briggs Institute checklists. The Health Belief Model was applied post hoc to organize extracted findings. RESULTS: Of 2059 records identified, 1271 remained after deduplication; 38 reports underwent full-text review, and 33 studies were included in qualitative synthesis. Most studies were cross-sectional or quasi-experimental, with four cohort designs. Chronic disease burden, functional limitation, depressive symptoms, and allostatic load were consistently associated with poorer self-reported health. Socioeconomic disadvantage, language barriers, discrimination, psychosocial stress, and provider knowledge gaps further shaped outcomes. Acculturation influenced health perceptions and introduced measurement bias, with less acculturated individuals tending to underreport poor health. Nativity effects persisted across study designs, with island birth associated with durable health disadvantages independent of current residence. Aggregating Puerto Ricans into pan-Hispanic categories obscured population-specific patterns. CONCLUSION: Poor self-reported health among Puerto Rican populations reflects intersecting chronic disease, socioeconomic disadvantage, acculturation-related measurement bias, and nativity. Disaggregated data, culturally validated measures, longitudinal designs, and provider education on Puerto Rican health contexts are needed to improve research accuracy and quality of care.