Signs of the End of the Paradox? Cohort Shifts in Smoking and Obesity and the Hispanic Life Expectancy Advantage

Abstract

Hispanics' paradoxical life expectancy advantage over whites has largely been attributed to Hispanics' lower smoking prevalence. Yet across birth cohorts, smoking prevalence has declined for whites and Hispanics, and Hispanics' obesity prevalence has increased substantially. Our analysis uses data from the 1989 to 2014 National Health Interview Survey and Linked Mortality files to investigate whether these trends could lead Hispanics to lose their comparative mortality advantage. Simulations suggest that foreign-born Hispanics' life expectancy advantage over whites is likely to persist because cohort trends in smoking and obesity largely offset each other. However, U.S.-born Hispanics' life expectancy advantage over whites is likely to diminish or disappear entirely as the 1970s and 1980s birth cohorts age due to increases in obesity prevalence and the relatively high mortality risks of those who are obese. Results have important implications for understanding the future of immigrants' health advantages and ethnic disparities in health.