All-cause mortality among Hispanics in the United States: exploring heterogeneity by nativity status, country of origin, and race in the National Health Interview Survey-linked Mortality Files

Luisa N Borrell, Natalie D Crawford
Annals of Epidemiology 2009, 19 (5): 336-43

PURPOSE: To investigate the association of nativity status, country of origin, and race with all-cause mortality in Hispanic adults relative to non-Hispanic adults in the United States, we used 565,352 records of participants 25 years and older from years 1990 to 2000 of the National Health Interview Survey linked to the National Death Index.

METHODS: All-cause mortality was coded for underlying cause of death according to the Ninth and Tenth Revision of the International Statistical Classification of Diseases, Injuries, and Causes of Deaths. Time to death was considered from each survey year through December 31, 2002. Cox proportional hazard models were used to estimate all-cause mortality death rates for Hispanics and non-Hispanic blacks relative to non-Hispanic whites.

RESULTS: In the adjusted analysis, we found that Hispanics ages 25-44 had greater death rates than non-Hispanic-white adults regardless of sex and nativity. However, it appears that this finding is driven by island/foreign-born men and women. Compared with non-Hispanic white adults, younger Puerto Rican women and Mexican American men and women had a 61% (95% confidence interval [CI], 1.15-2.24), 44% (95% CI, 1.22-1.26), and 36% (95% CI, 1.17-1.59) greater all-cause death rate, respectively. Hispanics who identify as white, regardless of sex, had greater death rates than non-Hispanic white adults.

CONCLUSIONS: These findings highlight important differences in Hispanics by nativity status, country of origin and race. Studies assessing disparities in health among Hispanics should closely examine the heterogeneity of this population usually lost under a homogeneous classification. This examination would lead to a better understanding of health outcomes within Hispanics.

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