Hispanics

By 2002, the Hispanic population was estimated at more than 37.4 million, representing 13.3% of the U.S. population and becoming the largest ethnic minority population (with African Americans a close second). By far the largest segment of the Hispanic population were of Mexican origin (67%), followed by Central and South Americans (14.3%), mainland Puerto Ricans (8.6%), other Hispanics (6.5%), and Cuban Americans (3.7%). The Hispanic population is growing rapidly and is expected to reach more than 103 million by 2050. Although only 5.6% of the total Hispanic population is age 65 years and older, the numbers and proportions of this segment of the Hispanic population are expected to increase dramatically during the next several decades.

Although Hispanics are generally disadvantaged socioeconomically, they appear to have favorable mortality and health profiles, a phenomenon often referred to in the literature as theHispanic paradox. With respect to mortality, there appears to be an advantage at all ages and Hispanic origins. It is greatest among persons of Cuban origin and lowest among Puerto Ricans. The advantage is evident in major causes of death, such as cardiovascular disease and cancer, and is typically attributed to a “healthy migrant” effect. Hispanic immigrants, like all immigrants to the United States, appear to be selected for good health. Any mortality advantage appears to disappear by the second generation as the children of immigrants adopt the American lifestyle.

There is some suggestion in the literature that mortality rates based on census and vital statistics data may underestimate mortality among the various Hispanic groups. A problem with the data (also found in Asian American and Native American populations) is misclassification of ethnicity. However, corrections for such biases indicate that mortality rates among [Page 273]Hispanics remain relatively low. Longitudinal survey studies that establish ethnicity by self-report do not have the problem of misclassification of ethnicity on death certificates. Such studies also show a Hispanic advantage in mortality. If indeed there is substantial return migration to their country of origin by Hispanic immigrants after being included in the survey, their mortality rates could be biased downward, especially at older ages. Although this is not a concern with the Cuban American population, it is one with the Mexican-origin population. However, such biases do not appear to explain away the mortality advantages in the Mexican American population. One recent study of mortality of Medicare recipients found a lower overall mortality advantage among older Hispanics than that found in studies using other sources. Nevertheless, there was still an advantage, giving further support to the Hispanic paradox.

The favorable mortality rates of Hispanics in major causes of death (e.g., cardiovascular, cancer) cannot be explained fully by traditional risk factors. For example, there is no evidence that rates of hypertension are lower among Hispanics than among non-Hispanic Whites. Data from the Hispanic Established Population for Epidemiologic Studies of the Elderly (EPESE) that included 3,050 Mexican Americans age 65 years and older showed rates of measured hypertension comparable to those of older non-Hispanic Whites.

Another factor that might be associated with low cardiovascular and cancer mortality in Mexican Americans is their traditionally lower smoking rates. However, smoking rates of Mexican American men have been comparable to rates for the general population during the past two decades. Smoking rates are also high among Puerto Rican and Cuban American men. Men in most Hispanic populations, especially Puerto Ricans and Mexican Americans, exhibit heavy alcohol consumption patterns that may explain high mortality from cirrhosis of the liver and is also probably related to high rates of Hepatitis C.

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