Abstract 15825: County-Level Factors Explaining the Reversal of the Hispanic Mortality Paradox

Abstract

Introduction: The Hispanic population in the United States (US) has lower-than-expected mortality rates when compared with the non-Hispanic White population; this is known as the “Hispanic Paradox.” After the coronavirus 2019 pandemic, many US counties had an unprecedented reversal in this Hispanic mortality advantage. Methods: With age-adjusted mortality rates (AAMRs) and county health rankings, we used univariable and multivariable linear regressions to measure the association between the decrease in Hispanic mortality advantage (between 2019 and 2020) and county-level factors, including demographic, socioeconomic, cardiovascular disease (CVD) risk, healthcare, and structural factors. Results: Five hundred sixteen counties had reliable all-cause mortality rates and 201 had reliable CVD-specific mortality rates for the Hispanic population. 76% of studied counties had a decrease in the Hispanic mortality advantage for all-cause deaths; the mean differences in AAMRs between non-Hispanic White and Hispanic populations were 236.7 (95% CI 219.4; 253.9) in 2019 and 89.0 (95% CI 68.3; 109.7) in 2020. 58% of studied counties had a decrease in the Hispanic mortality advantage for CVD-specific deaths; the mean differences in CVD-specific AAMRs between non-Hispanic White and Hispanic populations were 63.7 (95% CI 56.1; 71.3) in 2019 and 40.5 (95% CI 32.4; 48.6) in 2020. In adjusted analyses, all factors explained 34% of the all-cause and 33% of the CVD-specific variation in Hispanic mortality advantage. Demographic factors explained the greatest variation for both; followed by structural factors (16%) for all-cause, and CVD risk factors (7.4%) for the CVD-specific Hispanic mortality advantage ( Table ). Conclusions: Demographic factors played an important role in explaining the recent decline in the Hispanic mortality advantage for all-cause and CVD-specific deaths. Further research is needed to analyze which factors may contribute to reduced disparities.