CDC report confirms “Hispanic paradox”BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2467 (Published 07 May 2015) Cite this as: BMJ 2015;350:h2467
Despite having lower incomes and less access to health services, Hispanic people in the United States have lower overall mortality rates and a longer life expectancy than white people, a new report by the US Centers for Disease Control and Prevention has found.
The term “Hispanic paradox” is used to describe the projected longer life expectancy (by an estimated two years) and lower overall mortality rate of this ethnic group, “despite potential barriers to good health such as higher rates of being uninsured and worse profiles for some social determinants of health,” the report said.1
The Hispanic population is currently the largest ethnic group in the US, totalling almost 57 million people (or about one in six of the US population). By 2033 the Hispanic population is projected to grow to more than 85 million, at which time one in four people living in the country will be of Hispanic origin.
The study compared the leading causes of death, prevalence of diseases and associated risk factors, and the use of health services by Hispanic people and non-Hispanic white people. The researchers said that they focused on adults aged 18 to 64 because people in this age range would receive the most benefit from early intervention.
The study found that on average Hispanic people in the US were nearly 15 years younger, four times as likely not to have completed high school, 20 times as likely not to speak English proficiently, and twice as likely to live below the poverty line, compared with white people. In all, 41.5% of Hispanic people lacked health insurance, compared with 15.1% of white people, and 15.5% of Hispanic people reported delay or non-receipt of needed medical care because of cost concerns, compared with 13.6% of white people. Nevertheless, the all cause mortality rate was 24% lower for Hispanic people, the cancer mortality rate was 28% lower, and the heart disease mortality rate was 25% lower.
Hispanic people and non-Hispanic white people shared 13 of the 15 leading causes of death. Homicide and conditions originating in the perinatal period were the two leading causes of death among Hispanic people but not among white people, and pneumonitis due to inhalation of solids or liquids and Parkinson’s disease were the two leading causes of death among white people but not Hispanic people. Mortality rates were substantially higher for the Hispanic population for a number of conditions, including diabetes (51% higher), chronic liver disease and cirrhosis (48%), and homicide (96%).
Hispanic people had a 49% lower prevalence of self reported cancer, a 35% lower prevalence of self reported heart disease, but a 133% higher prevalence of diabetes, compared with white people. Prevalence of smoking was 43% lower for Hispanic people than white people, but prevalence of obesity was 23% higher. There were no significant differences in the prevalence of hypertension or elevated cholesterol.
Hispanic people born in the US had a higher prevalence of risk factors and worse health outcomes with a greater prevalence of obesity, hypertension, smoking, heart disease, and cancer than Hispanic people born abroad. There were also differences associated with national or regional origins. For example, smoking prevalence was 66% higher among Puerto Ricans than among Mexicans, and the prevalence of self reported cancer and heart disease was nearly twice as high in Puerto Ricans.
To tackle the health needs of the growing Hispanic population in the US, the researchers called for the establishment of public health programmes and health services that are culturally and linguistically appropriate, the increased use of community health workers to help patients obtain care, the establishment of “medical homes” to provide coordinated services, and an increase in the number of Spanish speaking healthcare providers. Currently, they noted, only 5.8% of US physicians and 7.5% of graduates from schools of public health are Hispanic.
Cite this as: BMJ 2015;350:h2467