Could something as obvious as smoking explain immigrants’ and Hispanics’ life expectancy advantage in the U.S.? This is the theory that Fenelon and I set out to test. In 2009 and 2010 we conducted two analyses of National Vital Statistics System and Census Bureau data from 2000: one to compare Hispanics with non-Hispanic whites (with no regard to birthplace) and a second to compare immigrants with native-born Americans (with no regard to ethnicity). Regrettably, we could not specifically compare immigrant and native Hispanics; there are not enough data about older U.S.-born Hispanics to generate statistically valid estimates of total life expectancy for the purposes of comparison. In each analysis, we estimated the number of deaths attributable to smoking for each group we were comparing and then checked how much of the difference in total death rates could be explained by smoking. We used death from lung cancer as a marker for smoking-related death because lung cancer is the condition most strongly tied to smoking. We then used death from lung cancer to extrapolate death from all smoking-related conditions.
The strength of the results, published this year in the International Journal of Epidemiology, surprised even us. We found that smoking is the single best explanation of the Hispanic paradox and the general immigrant advantage, at least among adults. Our results show that in 2000 smoking explained more than 75 percent of the difference in life expectancy at age 50 between Hispanic and non-Hispanic white men and roughly 75 percent among women. It also accounted for more than 50 percent of the difference in life expectancy at age 50 between foreign- and native-born men and more than 70 percent of the difference among women. We cannot know from these estimates whether less smoking means that foreign-born Hispanics live longer than their U.S.-born Hispanic counterparts, because we did not estimate death rates separately for these groups. But recent data are not inconsistent with that idea: Fenelon has found that foreign-born Hispanics do smoke substantially less than U.S.-born Hispanics do.
People ask me how it is that no one noticed the role of smoking before. Of course, people did know that smoking is bad for health. But the extent of its role in health disparities between ethnic groups was not much recognized, perhaps because most studies of health habits in different populations have been based on large-scale surveys, which typically do not include tremendous detail about smoking and thus do not reveal differences in smoking habits between groups.
Consider, for example, a typical health survey, which somewhat resembles the health history form you often fill out when you visit a new doctor. The form will probably ask whether you smoke now and whether you used to smoke. But smokers and former smokers are rarely asked precisely how long they smoked and how many cigarettes a day they consumed at every point in their lives. Even if the questions were asked, people might misremember exactly how much they smoked several decades ago.
Nevertheless, a number of studies based on survey data have picked up some ethnic differences in smoking prevalence (whether or not people smoke)—and this was exactly the kind of information that inspired Fenelon and me to determine whether smoking was the key factor in the Hispanic paradox. But those surveys have generally failed to notice ethnic differences in smoking intensity and duration or how much smokers are smoking. At least one set of data, however, does address such details. The National Health Interview Survey, an annual questionnaire that asks fairly detailed questions about tobacco use, has shown that Hispanics are not only less likely to be smokers or former smokers but that the smokers among them are also less likely to smoke heavily. In 2009, for instance, only 9 percent of Hispanic women were current smokers, compared with 21 percent of non-Hispanic white women; 18 percent of Hispanic men smoked, compared with 25 percent of non-Hispanic white men. Among smokers, Hispanics also consumed far fewer cigarettes on average.
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22 Comments
Add CommentExcellent perspective but flawed interpretation.
Reply | Report Abuse | Link to thisIt is flawed to extrapolate lung cancer deaths to other smoking related deaths because the chance of a smoker dying from smoking depends on many factors, some of which may be very different between immigrants and natives.
Even if a lower smoking related death rate really explains the immigrants' longevity, it may not be solely caused by less smoking. It is quite possible that immigrants who are smokers are less likely to die from smoking than natives who smoke the same amount. I wonder if the author has compared the lung cancer rates of immigrants and natives who smoke the same amount.
Let me propose an explanation for the immigrant advantage - stress. It is well established that wealth is correlated with longevity, but it is not absolute wealth but comparative wealth that matters. It is because being happy or stressed depends very much on how one compares oneself with others around. Immigrants may be less well off from a demographer's point of view, but they FEEL very well off when they compare themselves with people they are connected - fellow immigrants and people still living in their homelands.
The same psychological factor can also explain the difference in smoking habits - people and animals are more prone to addiction when they are stressed.
I expect the immigrant advantage will still be very significant even when smoking is banned.
Another explanation for the immigrant advantage is immigrants' successful second generation. It is well documented that the children of immigrants are more successful in their pursuit of studies and careers. Thus during the later stage of their lives, the immigrants afford to lead richer lifestyles than their own wealth suggests, thanks to support from their richer children who also tend to have stronger ties with their parents.
Reply | Report Abuse | Link to thisThe headline of this article mentions "two populations" but does not state what the second population is. From what I have read the Japanese people in this country (and also in their homeland) have the best mortality statistics. This suggests that a combination of life style and genetics are paramount for a healthy life, not money spent on health care.
Reply | Report Abuse | Link to thisIt also implies that excessive spending on medical care will not improve significantly the quality of life if there is no accompanying significant change in life style.
Immigrants avoid doctors because the don't trust them. They likely were not vaccinated when they were born. That means they were mentally damaged and their immune system was not damaged.
Reply | Report Abuse | Link to thisSomething to check. Just a guess
What do you mean by mentally damaged?
Reply | Report Abuse | Link to thisi should have said ....not mentally damaged
Reply | Report Abuse | Link to thisSeems pretty reasonable analysis and makes sense. Smoking is quite bad for long-term health. If a certain population smokes alot more than another, then the smoking population won't live as long.
Reply | Report Abuse | Link to thisThe key seems to be stress, with large variations on how well particular individual's bodies handle or don't handle stress. Various things like lifestyle, eating habits and family/friends support all help to lower stress. Stuff like smoking raises stress on the body (various amounts based on the individuals personalized reactions to smoke+contaminants).
Laura, you have too many extrapolations and asumptions to reach a valid conclusion. If you over dose on anything, it can kill. I see nothing on the well documented health benifits of low dose nicotene. I was a commercial floorcovering installer for 40 years. The apprentices had an 85%drop out rate and about the same for the young journymen. The one who made it to retirement were much healthier than average as are our children. Immigrants would follow the same selection. Ask your self why the Food and Drug Administration has not followed their mandate with Tobacco and where did all the TV commercials go all of a sudden? Does someone need to go to jail for biasing your education for fun and profit?
Reply | Report Abuse | Link to thisIt isn't as simple as that. No ethnic group outlives the Japanese who are among the heaviest smokers on the plant. Last time I looked Japan ranked #1 or #2 in cigarette consumption per capita. In Europe, the Greeks excel in life expectancy but they also rank at or near the top in cigarette consumption.
Reply | Report Abuse | Link to thisPersonally I think anyone who smokes is a damn fool. Yet the link between smoking and lung cancer isn't nearly as clear cut as it's made out to be.
As an ex-patriot I have found that people that move to a new country tend to be healthier, both physically and mentally, than the general population and therefore live longer. People that are sick or depressed don't pick up and move to a new country.
Reply | Report Abuse | Link to thisI think people from poorer countries where people die of diseases that are routinely cured in Canada and the US, Have undergone genetic changes making them healthier than us. I also think the reason why blacks are superior athletes is because they were picked in Africa as good specimens, survived the boat trip and the tough life as slaves and impoverished people. The survivors have got to be tougher than the average person.
Reply | Report Abuse | Link to thisWayne Jones
Ottawa
You have proven my husband's comments over the last 30 years - that having taking statistics, he came away with the conclusion that Statistics can be used to prove any per-conceived concept. Having lived my life in an area originally settled by the Spanish in the 1500's, I can absolutely tell you that the locals tend to die before the age of 30. Which makes me wonder from where your demographics originate. Consulting with a denizen of a local barrio, we came up with an alternate scenario: that Hispanics and recent immigrants tend to take those jobs which are labor-intensive. And that if you look at the origins of humanity, humans are designed to 'work' - designed to be physical in their daily activities. Ergo - sitting behind a desk is counter-productive to longevity. Could this be an alternate result of these statistical data?
Reply | Report Abuse | Link to thisThis article proves what my husband has told me for 30 years. Having studied Statistics, he has always said that statistics could be used to prove any preconceived concept.
Reply | Report Abuse | Link to thisLooking at this premise in another way, from the viewpoint of having lived 6 decades in the part of the country settled by the Conquistadors: in reality, young Hispanic males partake of risk-taking lifestyles, and are often dead by the age of 20. Or they join gangs - and gang members Always smoke as a sign of being 'macho'. It looks like your data have been taken from some flawed source.
So, let's look at your premise another way. Homo sapiens were designed to be active daily, millions of years ago. Take that premise to current times - and what do Hispanic populations have in common with immigrant populations? They tend to take on the labor-intensive jobs that lazy Americans will not perform. Jobs which, ultimately, keep them healthy throughout their lives. Could that be they reason they live longer?
Really, "white men can't jump". There are genetic advantages to being Black which come down to a deeper heel bone around which the tendons wrap enabling more ability to 'jump'. Political correctness be damned - there are physical differences that need to be recognized - if my child were missing, please let me know that a skeleton found does or does not match my ethnic heritage!
Reply | Report Abuse | Link to thisThank you. This article proves what I've heard for 35 years from someone who studied Statistics in college. That statistics can be used to 'prove' any pre-conceived thesis.
Reply | Report Abuse | Link to thisHow about this one: new immigrants and the Hispanic population tend to take on labor-intensive jobs, and the human body was designed to work daily. Which means that desk jobs are not healthy. Having lived in the Southwest all my life, I can tell you that young Hispanics ALL smoke, and large numbers of them are dead by the age of 25. Most join gangs. So I would also question your data collection.
Thank you! Your article proves what my husband has said for 35 years - that Statistics can be used to prove any pre-conceived concept. Having lived all my life in the Southwest, among descendants of the Spanish Conquistadors, I would like to point out that young Hispanic males ALL smoke. How about this concept: Hispanics and Immigrants tend to take the manual-labor jobs in this country. Those jobs Gringos won't stoop to taking. And - surprise! - Homo sapiens were designed to work - not to sit at a desk job. Ergo, physical labor equals a healthy life style. Just a thought.
Reply | Report Abuse | Link to this"Immigrants avoid doctors because the don't trust them."
Reply | Report Abuse | Link to thisIt is called "The Hispanic Paradox" (not the "immigrant paradox"). Hispanics have been in the US since about 200 years before the Mayflower was built. YOU are the immigrant.
BTW: Immigrants do not trust *politicians*, but they trust doctors.
"Immigrants avoid doctors because the don't trust them."
Reply | Report Abuse | Link to thisIt is called "The Hispanic Paradox" (not the "immigrant paradox"). Hispanics have been in the US since about 200 years before the Mayflower was built. YOU are the immigrant.
BTW: Immigrants do not trust *politicians*, but they trust doctors.
This is what the doctor says:
Reply | Report Abuse | Link to this"Let me give my opinion now on why Hispanics have better health in the USA than non-Hispanic whites. It has to do with the support they give one another and their strong family lives that counter the adverse effects of the gap and their poverty. Much has been written about this so-called Hispanic Paradox. I came to understand the reasons by reflecting on Hispanic patients I see in the ER. I never see a single Hispanic patient. There is always a group of people huddled together. I have to go and figure out who the patient is, for everyone comes to offer support. By contrast, I'm much more likely to see a white person lying there writhing in pain alone. So we can conclude that it is the nature of psychosocial relationships, the support people have and give in a society, that is more responsible for their health as communities, than any other factor. "
"The headline of this article mentions "two populations" but does not state what the second population is."
Reply | Report Abuse | Link to thisYes, it does:
(1) Immigrants
(2) Hispanics
In this day and age, it is easy to confuse the two groups, but they are different. :-)
(I happen to be both)
This article is VERY related:
Reply | Report Abuse | Link to thishttp://www.washingtonpost.com/wp-dyn/content/article/2006/04/10/AR2006041001385.html
http://tinyurl.com/l9opd
"Yet the link between smoking and lung cancer isn't nearly as clear cut as it's made out to be."
Reply | Report Abuse | Link to thisThe link in one direction is almost perfect: If you get lung cancer, you are a smoker. A remote exception is people who work with and breath asbestos all day (who are zero these days). Some people can smoke all they want and don't get cancer, like some people who eat lots of salt and don't get high blood pressure.