Abstract
Hispanics' paradoxical life expectancy advantage over whites has largely been attributed to Hispanics' lower smoking prevalence. Yet across birth cohorts, smoking prevalence has declined for whites and Hispanics, and Hispanics' obesity prevalence has increased substantially. Our analysis uses data from the 1989 to 2014 National Health Interview Survey and Linked Mortality files to investigate whether these trends could lead Hispanics to lose their comparative mortality advantage. Simulations suggest that foreign-born Hispanics' life expectancy advantage over whites is likely to persist because cohort trends in smoking and obesity largely offset each other. However, U.S.-born Hispanics' life expectancy advantage over whites is likely to diminish or disappear entirely as the 1970s and 1980s birth cohorts age due to increases in obesity prevalence and the relatively high mortality risks of those who are obese. Results have important implications for understanding the future of immigrants' health advantages and ethnic disparities in health.
Highlights
Trends in smoking and obesity have changed significantly over the last 50 years
Prior literature led us to hypothesize that mortality risks would be weaker among Hispanics than whites in the case of smoking, but stronger for Hispanics in the case of obesity
This study sought to build on the small, emerging body of research asking whether the Hispanic paradox can and will endure in the wake of countervailing trends in smoking and obesity
Summary
Trends in smoking and obesity have changed significantly over the last 50 years. In 1965, nearly half of all U.S adults smoked, but by 2016, this percentage had fallen to 15.5 percent (Centers for Disease Control and Prevention 2016a, 2016b). Smoking tends to start and become an established habit early in life. Changes in U.S smoking behaviors have occurred largely through cohort replacement. Men born in the early 20th century through the 1950s, and women born in the 1920s through the 1950s, had a high smoking prevalence and smoking-related morbidity and mortality, but later-born cohorts are much less likely to have ever smoked and have been much less likely to suffer from smoking-related diseases such as lung cancer (Preston and Wang 2006)
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