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The Hispanic Paradox

Econ Focus
Third/Fourth Quarter 2016

Hispanics in the United States tend to have longer life expectancy and lower mortality rates than whites (that is, non-Hispanic whites) or blacks (non-Hispanic blacks). In 2014, the most recent year for which the CDC has published life tables by race and ethnicity, life expectancy at birth for Hispanics was about three years longer than for whites and about seven years longer than for blacks. (See chart below.) At the same time, Hispanics on average have lower incomes, less education, and are much less likely to have health insurance than whites. Given the strong link between socioeconomic status and health, one would expect Hispanic mortality to resemble black mortality — and to be worse than whites', not better. What explains this so-called "Hispanic paradox"?

In part, it could be a statistical illusion. Mortality rates are derived from two sources: The numerator — mortality — comes from the National Vital Statistics System, which collects information from local death certificates, and the denominator — population — comes from the decennial Census and the American Community Survey. But information about Hispanic origin was not included on death certificates in every state until 1997, and there is debate about the extent to which death certificates still understate Hispanic origin. In addition, the wording of the Census questions has changed over time, potentially leading more people to identify as Hispanic. If the denominator has become larger over time, while the numerator is underreported, the mortality rate for Hispanics could have decreased without any actual change.

But measurement issues can't explain all of the paradox. Another possibility is that there are self-selection effects, such as a tendency for healthier people to migrate in the first place, or for less-healthy immigrants to return to their country of origin before they die. Numerous studies have attempted to quantify the impact of these tendencies, with mixed results. Even in those studies that do find evidence of selection effects, selection explains a relatively small portion of the Hispanic paradox.

There also are social and behavioral differences. For example, some researchers have proposed that strong family and social ties among Hispanics contribute to better health and lower mortality. And perhaps the greatest factor is differences in smoking rates: Hispanics are significantly less likely to smoke than whites or blacks, and research suggests this could account for at least half, and perhaps as much as 90 percent, of differences in life expectancy between Hispanics and whites, depending on gender and country of origin. Hispanics also have lower death rates from heart disease, chronic respiratory diseases, accidents (including drug overdoses), perinatal conditions, suicide, stroke, and diabetes.

Whatever explains the Hispanic paradox, Hispanic mortality might be less paradoxical in the future. Second-generation Hispanics tend to be less healthy than those who were born outside the United States; if Hispanic immigration rates continue to slow, the health of the population overall could decline. In addition, rates of obesity and Type 2 diabetes have increased among Mexican Americans, which could eventually counteract the advantage of lower smoking rates.


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