摘要：Objectives. We sought to determine whether mortality rates among immigrant and US-born Hispanic young adults were higher or lower compared with non-Hispanic Whites. We also sought to identify which causes of death accounted for the differences in mortality rates between groups. Measures. We used Texas and California vital registration data from 1999 to 2001 linked to 2000 census denominators. We calculated cause-specific, indirectly standardized rates and ratios and determined excess/deficit calculations comparing mortality rates among US- and foreign-born Hispanic men and women with rates among non-Hispanic White men and women. Results. Mortality rates were substantially lower among Hispanic immigrant men (standardized mortality ratio [SMR]=0.79) and women (SMR=0.59) than among non-Hispanic White men and women. Most social and behavioral and chronic disease causes in Texas and California other than homicide were noteworthy contributors to this pattern. Mortality rates among US-born Hispanics were similar to or exceeded those among non-Hispanic Whites (male SMR=1.17, female SMR=0.91). Conclusions. Mortality rates among younger Hispanic immigrants in Texas and California were lower than rates among non-Hispanic Whites. This pattern was not observed among US-born Hispanics, however. Recent studies using Social Security and Medicare records, 1 vital statistics, 1 , 2 and survey cases linked to the National Death Index (NDI) 3 , 4 confirm that, among individuals at older ages, rates of all-cause mortality are lower in certain US Hispanic populations than among non-Hispanic Whites. This pattern is clearer for Hispanic immigrants, in particular Mexicans and Central and South Americans, than for US-born Hispanics. 1 – 5 The low mortality among some Hispanic populations is sometimes described as paradoxical because of those populations’ lower average socioeconomic status, limited health care access, and higher risk of certain diseases. 6 – 9 Selective immigration of healthy populations, selective emigration of ill populations, sociocultural and behavioral differences, 3 , 4 , 7 , 8 and genetic differences 10 have been proposed as explanations. There has been less evidence that mortality rates among younger Hispanic adults (i.e., those aged 18 to 44 years) are also lower than those among younger non-Hispanic White adults. Studies involving the use of survey records linked to the NDI have reported a mortality crossover at approximately 45 years of age, with mortality rates among younger Hispanic adults being higher than those among younger non-Hispanic Whites and rates among older Hispanic adults (i.e., those aged 45 years or older) being lower than those among older non-Hispanic Whites. 5 Reduced mortality among older Hispanics is driven by lower death rates from leading chronic causes of death, including heart disease and cancers of most major sites. 5 , 11 At younger ages, causes such as homicide, suicide, substance abuse, and motor vehicle accidents account for a larger share of all deaths. There is evidence that death rates associated with many of these causes are higher among younger Hispanic adults than among younger non-Hispanic White adults. 5 , 12 – 16 We believe that mortality patterns among younger Hispanics require reexamination. Most of what is known about these patterns is derived from studies, now somewhat dated, using vital statistics linked to the 1980 US census, 13 , 15 – 18 National Health Interview Survey (NHIS) data from the late 1980s and early 1990s linked to the NDI through 1997, 3 , 5 , 12 , 14 and Current Population Survey data linked to the NDI through 1987. 11 Mortality rates may have changed since these studies were conducted because of changes in cause-specific rates and because of cohort differences in the attributes of immigrants (e.g., educational attainment and economic performance relative to US natives). 19 In most previous studies, stratified analyses of mortality among younger individuals were not conducted or were conducted with data sets involving limited sample sizes. We investigated recent cause-specific mortality rates and patterns among younger foreign-born Hispanic adults and US-born Hispanic adults as compared with non-Hispanic Whites in California and Texas. In addition, we assessed differences from previously reported patterns and sought to identify the factors producing the lower mortality rates observed for certain Hispanic groups.
