certificate misclassification among racial/ethnic groups found that vital statistics underestimate
Hispanic mortality rates, but that the rates for Hispanics are only increased by 1.6 percent by
adjustment and that they remain about 20 percent below those of the white population.96
Similar studies of Hispanic subgroup mortality rates have not been conducted.
Various studies have investigated the comparability of Hispanic and white mortality rates. In
a recent study using data from the National Health Interview Survey and the National Death
Index, overall mortality among Hispanics was found to be lower than among whites,
particularly among adults age 65 years and older.66 In the same study, mortality among
younger Hispanics was higher than that of similarly aged whites, and risk of death among
foreign-born Hispanics was lower than among whites. In a different study using data from the
National Health Interview Survey, Mexican Americans and whites were found to have similar
mortality rates.97 Areport from the San Antonio Heart Study used information from next of
kin to ascertain vital status for 98.1 percent of the cohort.67 The eight-year mortality rates for
U.S.-born Mexican Americans and whites were similar, although the total number of deaths
in the study was small (N = 136). In an earlier study based on the National Longitudinal
Mortality Study, relative to whites, Hispanics were found to have lower overall mortality, lower
morality due to cancer, and lower mortality due to cardiovascular disease, but higher mortality
due to diabetes mellitus and to homicide.98
Relatively few studies have examined mortality among Hispanic subgroups. Those that have,
though, suggest that the positive side of the health paradox does not appear to hold for all
subgroups. Specifically, mortality is higher among Puerto Ricans relative to Mexican and
Cuban migrants living in the United States.99
The reasons for the health paradox among Hispanics are not entirely clear. The healthy migrant
effect is one explanation mentioned in the literature. It posits that healthier persons are more
likely to emigrate than their relatively less healthy compatriots, which results in a greater
longevity in the emigrant population. This theory is of interest because more than one-third of
Hispanics are foreign-born, making migrants an important segment of the Hispanic population.
Although relatively few studies have examined the health of immigrants, those we reviewed
suggest that foreign-born Hispanics have a mortality advantage over U.S.-born Hispanics, but
that the health of the foreign-born may decline with the duration of residence in the United
States.
A second hypothesis, the moribund migrant effect, posits that older and/or dying Hispanics
return to their country of origin to die and therefore are unlikely to be counted among U.S.
decedents (or, following their departure, in the census). This emigration effect would cause
estimates of Hispanic mortality to be understated and would inflate life expectancy estimates.
Little research has been conducted to examine the rate of return migration among Hispanics.
In one study of emigration among the foreign-born population enumerated in the 1980 and
1990 censuses, only 7 percent of Hispanic immigrants were found to have left the United States.
100 In comparison, non-Hispanic white and Asian/Pacific Islander emigration rates were 10
percent to 11 percent. The authors suggested that the emigration rate for Hispanics was
probably low for the same reasons that the Hispanic immigration rate is so high (e.g., the relative
difference in economic and social conditions between the origin and destination countries).
Other studies corroborate the low rates of emigration before death among Hispanics.101
The acculturation hypothesis is related to the healthy-migrant effect theory because, on
average, immigrants are presumably less acculturated than U.S.-born Hispanics. The
acculturation hypothesis posits that Hispanic cultural orientation (i.e., traditional Mexican
culture) results in health-related behaviors that protect Hispanics from the adverse health
outcomes associated with low socioeconomic status in the United States. Furthermore, the