Mortality from All Causes and Life Expectancy

The Hispanic mortality paradox has received growing attention since the proposed epidemiological paradox for Mexican Americans in the Southwest proposed over twenty years ago by Markides and Coreil (1986). The Hispanic paradox can be defined as the health and mortality advantage that the Hispanic population has relative to the non-Hispanic White population and seems to be more salient in old age (Turra & Goldman, 2007; Markides & Eschbach, 2005; Franzini, Ribble, and Keddie, 2001).

The evidence is based on various National and regional data sets including the National Death Index, Mortality, Medicare and Social Security files (Markides et al., 2005). Despite the evidence in the literature research shows that self-reports indicate that this population reports poorer health and greater disability which are inconsistent with the health advantage findings. New findings regarding the Hispanic paradox show a mortality advantage with foreign born Hispanics compared to U.S. born with middle and older ages, occurs more with other Hispanics rather than Puerto Rican, and relevant to those who are of lower socioeconomic status (Turra & Goldman, 2007). Based on the H-EPESE study examining widowhood among older Mexican Americans and risk for mortality, findings revealed that the risk of dying is extended to 33 months for Mexican Americans compared to previous findings of 24 months (Stimpson, Kuo, Ray, Raji, Peek, 2007).

Table 6 shows the mortality rates comparing Hispanic/Latinos to non-Hispanic whites in the United States by gender and age group (65-74, 75-84, 85 + years) (Kramarow, Lentzer, Rooks, Weeks, & Saydah ,1999). For these three age groups, the all-cause mortality rates are about one-third lower in Hispanics. National surveys conducted by the U.S. Bureau of Census (Current Population Surveys) were matched to the National Death Index over a 9-year follow-up period; 40,000 Hispanics were included in the 700,000 respondents, age 25 years and older.  Hispanics were shown to have a lower mortality from all causes than NHW (standardized rate ratio or SSR = 0.74 for men, and 0.82 for women (Sorlie, Backlund, Johnson, & Rogot, 1993).

These findings are consistent with observations reported from the National Health Interview Study (1986-1990) with 27,000 Hispanics and nearly 300,000 NHW interviewed. Deaths were determined by matching names to the National Death Index for a 5-year period through 1991. Age-adjusted total mortality rates per 100,000 person years were 2,466 for Hispanic men, 3,089 for NHW men, 1,581 for Hispanic women, and 1,897 for NHW women (Liao, et al., 1998).

The Hispanic/ non-Hispanic white mortality ratios for men were 1.33, 0.92, and 0.76 for men age 18–44, 45–65, and 65 +, respectively. The mortality ratios for women were 1.22, 0.75, and 0.70, respectively. These findings again suggest all-cause mortality is lower in Hispanics than NHW, especially in those over age 65 years.

Table 6 presents the mortality rates for 5 major causes of death comparing Hispanics to non-Hispanic whites in the United States by gender and age group (age 65–74,75–84, 85+ years) (Kramarow, et al., 1999). Each of the disease-specific mortality rates is lower in Hispanics than NHW.

Table 7 shows the top five causes of death for older Hispanics explain 70% of all causes of death, suggesting that these diseases are critical for health prevention efforts.  The other five diseases that are causes of death  among Hispanics include influenza, pneumonia, Alzheimer’s Disease, nephritis, accidents (or unintentional injuries), and chronic liver disease (Heron & Smith, 2007).