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AJPH First Look, published online ahead of print Jan 31, 2007
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March 2007, Vol 97, No. 3 | American Journal of Public Health 392
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.105320

LETTER

HISPANIC PARADOX

Alex Ho, MPH, Margaret Shih, MD, PhD and Paul Simon, MD, MPH

The authors are with the Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, Calif.

Correspondence: Requests for reprints should be sent to Alex Ho, 313 N Figueroa Street, Suite 127, Los Angeles, CA 90275 (e-mail: aho{at}ladhs.org).

Although Smith and Bradshaw’s effort to improve the way in which Hispanic mortality rates and life expectancies are estimated is commendable, their conclusion that "there is no Hispanic paradox"1(p1686) is not justified.

They attribute the observed paradox to error introduced through differential ascertainment of Hispanic ethnicity on death certificates compared with the census. This is a reasonable hypothesis given the documented underreporting of Hispanic ethnicity on death certificates.2 However, they fail to acknowledge 2 large nationally representative studies that used linked data files, in which the problem of incongruous classification of ethnic origin in numerator and denominator data was eliminated, and yet still found a Hispanic mortality advantage.3,4 Further, in both studies, mortality rates were found to vary significantly across Hispanic subgroups, suggesting that the paradox is more complex than simply Hispanic versus non-Hispanic.

The methods used by Smith and Bradshaw depend on the assumption that Hispanic mortality in Texas is similar to that seen nationally, a dubious assumption given the variation in mortality across Hispanic subgroups. In light of this limitation and the findings of the earlier studies we cite, we believe considerably more caution is warranted in their stated conclusions.

References

1. Smith DP, Bradshaw BS. Rethinking the Hispanic paradox: death rates and life expectancy for US non-Hispanic white and Hispanic populations. Am J Public Health. 2006;96:1686–1692.[Abstract/Free Full Text]

2. Rosenberg HM, Maurer JD, Sorlie PD, et al. Quality of death rates by race and Hispanic origin: a summary of current research, 1999. Vital Health Stat 2. 1999;128:1–13.

3. Sorlie PD, Backlund E, Johnson NJ, Rogot E. Mortality by Hispanic status in the United States. JAMA. 1993;270:2464–2468.[Abstract/Free Full Text]

4. Palloni A, Arias E. Paradox lost: explaining the Hispanic adult mortality advantage. Demography 2004; 41:385–415.[CrossRef][Web of Science][Medline]





This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
AJPH.2006.105320v1
97/3/392    most recent
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Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ho, A.
Right arrow Articles by Simon, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ho, A.
Right arrow Articles by Simon, P.
Related Collections
Right arrow Hispanics/Latinos
Right arrow Mortality

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