Race/Ethnicity and All-Cause Mortality in US Adults: Revisiting the Hispanic Paradox

Objectives. We examined the association between race/ethnicity and all-cause mortality risk in US adults and whether this association differs by nativity status. Methods. We used Cox proportional hazards regression to estimate all-cause mortality rates in 1997 through 2004 National Health Interview Survey respondents, relating the risk for Hispanic subgroup, non-Hispanic Black, and other non-Hispanic to non-Hispanic White adults before and after controlling for selected characteristics stratified by age and gender. Results. We observed a Hispanic mortality advantage over non-Hispanic Whites among women that depended on nativity status: US-born Mexican Americans aged 25 to 44 years had a 90% (95% confidence interval [CI]=0.03, 0.31) lower death rate; island- or foreign-born Cubans and other Hispanics aged 45 to 64 years were more than two times less likely to die than were their non-Hispanic White counterparts. Island- or foreign-born Puerto Rican and US-born Mexican American women aged 65 years and older exhibited at least a 25% lower rate of dying than did their non-Hispanics White counterparts. Conclusions: The Hispanic paradox may not be a static process and may change with this population growth and its increasing diversity over time. (Am J Public Health. 2012;102:836-843. doi:10.2105/AJPH.2011.300345)