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See Inside October 2011

The Ethnic Health Advantage

Two populations in the U.S. tend to outlive their often richer neighbors. Why?

When I say that the answer to the immigrant and Hispanic paradoxes may have been “hiding in plain sight all along,” I am referring to the kind of information in the national health survey. In the case of Hispanics in the U.S., scholars recognized that smoking prevalence was unusually low among that group, and the data were there to check whether smoking intensity was low as well. But no one took the next step of calculating whether differences in total cigarette consumption could be so large as to drive the overall life expectancy advantage among Hispanics. My research with Fenelon has done that.

We estimated smoking-attributable deaths not from survey data but instead from aggregate national death data: records of every single death in the U.S. in 2000. These data have plenty of their own drawbacks, to be sure. Crucially, our methods depend on the assumption that records of deaths from lung cancer are equally reliable in all subpopulations. To limit the impact of our assumptions on our final results, Fenelon and I used a few different methods to estimate smoking-attributable deaths, and the methods all yielded similar answers. We also took into account the possibility that immigrants may return to their home countries to die. We still found that, yes, smoking makes the difference in longevity.

I cannot say why Hispanics historically have smoked less than non-Hispanic whites. What is clear, however, is that millions of Americans have turned away from smoking since its health effects became obvious in the second half of the 20th century. Meanwhile cigarette consumption is on the rise in much of the developing world, thanks in no small part to strong marketing from tobacco companies. Together these two trends suggest that, over time, immigrants’ life expectancy advantage in the U.S. may erode. I expect that both the immigrant advantage and the Hispanic paradox may disappear within the next few decades.

No one who reads this article will be surprised to learn that smoking kills. But sometimes we forget how profound its effects on health can be. In the case of Hispanics in the U.S., low cigarette consumption seems powerful enough to counteract a slew of socioeconomic disadvantages that often result in poor health and early death. That is a finding worth remembering for everyone.

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