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标题：Rethinking the Hispanic Paradox: Death Rates and Life Expectancy for US Non-Hispanic White and Hispanic Populations
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作者：David P. Smith ; Benjamin S. Bradshaw
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：9
页码：1686-1692
DOI：10.2105/AJPH.2003.035378
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the “Hispanic paradox,” whereby persons of Hispanic origin seemed to experience lower mortality than the non-Hispanic White population. This paradox coincided with a change from the classification of deaths and population by Spanish surname to the use of Hispanic-origin questions in the census and vital statistics. Methods. To estimate US Hispanic and non-Hispanic White mortality, we applied a familiar relation between death rates for population subgroups to Hispanic and non-Hispanic White population death rates. We calculated age-specific death rates for the Hispanic population and the non-Hispanic White population and computed life tables for each. Result. For Texas between 1980 (surname) and 1990 (origin), the change in Hispanic deaths in persons aged 65 years or older was only half as great as the change in population size, implying a relative omission of 15% to 20% of deaths. By a different approach, the life tables for the US Hispanic and non-Hispanic White populations pointed to a similar omission. Conclusions. There is no “Hispanic paradox.” The Hispanic paradox described in past research derives from inconsistencies in counts of Hispanic-origin deaths and populations. Since at least 1930, the US Census Bureau has tried different methods for identifying the Hispanic population in the United States. Some of these methods have been reasonably successful, although only 1 (classification by Spanish or non-Spanish surname) has so far been capable of replication in classifying vital records and persons enumerated in the census. The problems of consistency between census data and vital statistics for the Hispanic population of the southwestern states under different ascertainment conventions have been reviewed rather extensively. 1 ^– 3 After the 1980 census, as had been done after each census beginning in 1950, the Census Bureau coded the surnames of respondents in 5 southwestern states (Arizona, California, Colorado, New Mexico, Texas) according to whether the names were of Spanish or non-Spanish origin, using a surname list developed over a number of years. 4 ^, 5 Several of the states, including Texas, used the list, or a linguistically based computer program that gave comparable results, to classify surnames of infants and decedents. Vital statistics for these states were thus defined consistently with census data for the Hispanic and non-Hispanic populations. Several researchers 6 ^– 8 used these data to create life tables for the Spanish-surname and White non-Spanish-surname populations between 1950 and 1980. The Texas Department of Health also published Spanish-surname life tables in some years, and a number of life tables have been prepared for local populations, such as San Antonio 9 ^, 10 and Houston. 11 Starting in 1980, life tables for both Hispanic- and non-Hispanic-origin populations have been calculated from self- or informant-identified Hispanic origin in censuses, and from the origin questions on death certificates. The latter, however, use different wording from that of censuses and are typically filled in by medical or funeral home personnel. These individuals may have no close ties to the families of the deceased and no means of confirming that their designation of ethnicity on the death certificate agrees with the designation likely to have been given for the decedent in the previous census. It is also relevant that death certificates are legal documents that are used in ways the census is not, placing explicit responsibility on physicians and funeral directors to use informed judgment. The census places no such burden on respondents, who answer the origin question according to their self-perception or preference. In an investigation of the consistency of death data and census data, Sullivan et al. 8 found 1980 life expectancies of 69.6 years at birth for White Spanish-surnamed males and 77.1 years for White Spanish-surnamed females, but 71.0 years for Spanish-origin males and 78.7 years for Spanish-origin females when origin questions in death certificates and the census were used. The former are less than, and the latter greater than, the life expectancies they derived for White non–Spanish-surnamed males (70.2 years) and females (78.1 years). Their results imply a remarkably high life expectancy for the population that is of Spanish origin but not Spanish surnamed, or else a serious discrepancy between the 2 sets of identifiers as applied to populations and to deaths. The higher life expectancies and lower Hispanic death rates that are observed when data from Hispanic-origin questions are used to classify people have given rise to the claim of a “Hispanic paradox.” That is, despite lower average incomes and educational levels, the Hispanic population appears to have higher life expectancies than the more advantaged non-Hispanic White population. In a review of the literature, Franzini et al. 12 found the balance of the evidence for the paradox convincing, but such evidence is harder to find in studies with complete death records 13 ^, 14 than in studies in which it is less evident that all deaths have been identified. 1 ^, 15 ^, 16 Problems also arise because the term Hispanic is not itself clearly or consistently defined, or definable, 17 requiring at least some substitution of faith for evidence in its usage. We developed new estimates of US Hispanic death rates and life expectancies for 1990 and 2000 that are adjusted for the evident omission of deaths relative to the population as suggested by Sullivan et al. 8 Our results are inconsistent with the existence of a Hispanic paradox. We do not assert that our own estimates are accurate, but we believe them to be better than measures based on presently available Hispanic-origin death and population data.