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Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability?

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Abstract

Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics’ low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born.

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Notes

  1. Palloni and Arias (2004) suggest that “salmon bias” may largely explain the mortality advantage of foreign-born Mexican Americans.

  2. We replicated all of our results specifically for Hispanics of Mexican Origin: foreign-born Mexicans and U.S.-born Mexican Americans. These supplemental results (available upon request from the authors) show that the mortality, disability, and disabled life expectancy patterns for the foreign-born and U.S.-born Mexican Origin subgroups closely mirror those of all foreign-born and U.S.-born Hispanics, respectively. This is not surprising given that Mexican Origin Hispanics comprise over 60 % of the U.S. Hispanic population. Future work on Hispanic mortality, disability, and disabled life expectancy patterns should attempt to disaggregate Hispanics based on national origin, given the overall heterogeneity of the group. At present, unfortunately, such disaggregation is impossible given the limited sample sizes of most Hispanic origin subgroups in the HRS.

  3. We turned to the NHIS to validate the race/ethnic/nativity disability differences shown in the Table 2 (results available upon request). Although the items used to measure ADLs in the NHIS differed from the HRS, our patterns of results were almost identical for males and females. The NHIS ADL questions are based on “needing help” carrying out key activities of self-care, while the HRS measures reference difficulty in self-care activities. This difference in wording usually results in significantly lower levels of disability using the “needing help” criterion (Jette 1994).

  4. Arias (2010) did not produce separate life expectancies for U.S.- and foreign-born Hispanics. Her estimates for all Hispanics aged 50 years were 34.9 years for women and 31.2 years for men. We combined the two Hispanic groups to derive an overall estimate for Hispanics. These expectancies (shown in Table 3) were 34.4 years for women and 30.7 years for men, slightly lower than the expectancies produced by Arias using vital statistics data. This makes perfect sense given that our mortality data are centered on the year 1999, while Arias based her life tables on vital statistics data from 2006.

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Acknowledgments

Funding for this research was provided by the MacArthur Foundation Research Network on an Aging Society: John W. Rowe, Columbia University (Chair). Additional support was provided by the Eunice Shriver National Institute of Child Health and Human Development (5 R24 HD042849, PI is Mark D. Hayward).

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Authors and Affiliations

  1. Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA

    Mark D. Hayward & Robert A. Hummer

  2. Duke-NUS Graduate Medical School, Singapore, Singapore

    Chi-Tsun Chiu

  3. National Institute of Geriatrics, Mexico, Mexico

    César González-González

  4. University of Texas Medical Branch, Galveston, TX, USA

    Rebeca Wong

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  1. Mark D. Hayward
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Correspondence to Mark D. Hayward.

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Hayward, M.D., Hummer, R.A., Chiu, CT. et al. Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability?. Popul Res Policy Rev 33, 81–96 (2014). https://doi.org/10.1007/s11113-013-9312-7

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