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Title: Education and the Hispanic Mortality Advantage: the Role of Smoking

Citation Type: Working Paper

Publication Year: 2012

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Abstract: Nearly three decades of research into the so-called Hispanic/Latino Paradox has failed to generate a convincing explanation for this ervasive epidemiological phenomenon (Markides and Eschbach 2005). Despite having lower levels of material wealth and fewer years of education than non-Hispanic whites in the United States, most Hispanic groups exhibit lower death rates at most adult ages (Markides and Coreil 1986; Sorlie et al. 1993; Hummer et al. 2000; Abraido-Lanza et al. 1999; Elo, Turra, et al. 2004). The National Center for Health Statistics released the first ever Hispanic life tables in 2010, showing a substantial survival advantage relative to non-Hispanic whites (Arias 2010). While a mortality advantage has been observed among many different Hispanic subgroups (Hummer et al. 1999, 2000), the specific reasons for the advantage remain unclear in the literature. Some recent research suggests that health behaviors are essential to understanding the overperformance of Hispanics with respect to health and longevity. Singh and Siahpush (2002) show that Hispanics have substantially lower mortality than non-Hispanic whites from cancers and respiratory diseases, which are commonly associated with smoking. They also find lower reported smoking prevalence among Hispanics. Abraido-Lanza et al. (2005) likewise find that Hispanics have a generally better behavioral profile than non-Hispanic whites. Blue and Fenelon (2011) directly calculate the burden of cigarette smoking among Hispanics and non-Hispanics whites using three indirect estimation techniques, they find that a majority of the longevity advantage of Hispanics compared with non-Hispanic whites can be attributed to lower mortality from smoking among Hispanics.However, the Hispanic mortality advantage is not a characteristic of all Hispanics. First, foreign-born Hispanics exhibit a large advantage, while US-born Hispanics show a health and mortality profile more similar to non-Hispanic whites (Palloni and Arias 2004). Second, Hispanics have the largest advantage at the lowest levels of education (Turra and Goldman 2007). College educated Hispanics and non-Hispanic whites have very similar health performance. Ostensibly this is because whites have a rather steep educational gradient in mortality while Hispanics, especially immigrants have a relatively flat gradient (Goldman et al. 2006). The proximate reasons for this ethnic difference in gradient steepness are not yet identified. Since the size of the Hispanic mortality advantage varies widely by education, any explanation should be able to account for this educational pattern. In this paper, I examine the contribution of smoking to the educational pattern in Hispanic and non-Hispanic white mortality. I use a large, nationally-representative survey to calculate smoking attributable-risk for three population subgroups in the United States: non-Hispanic whites, Mexican-Americans, and all other Hispanics.

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Authors: Fenelon, Andrew

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Institution: University of Pennsylvania

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Publisher Location: Philadelphia, PA

Data Collections: IPUMS Health Surveys - NHIS

Topics: Education, Fertility and Mortality, Health, Race and Ethnicity

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