Explaining low mortality among US immigrants relative to native-born Americans: the role of smoking

Int J Epidemiol. 2011 Jun;40(3):786-93. doi: 10.1093/ije/dyr011. Epub 2011 Feb 15.


Background: In many developed countries, immigrants live longer-that is, have lower death rates at most or all ages-than native-born residents. This article tests whether different levels of smoking-related mortality can explain part of the 'healthy immigrant effect' in the USA, as well as part of the related 'Hispanic paradox': the tendency for US Hispanics to outlive non-Hispanic Whites.

Methods: With data from vital statistics and the national census, we calculate lung cancer death rates in 2000 for four US subpopulations: foreign-born, native-born, Hispanic and non-Hispanic White. We then use three different methods-the Peto-Lopez method, the Preston-Glei-Wilmoth method and a novel method developed in this article-to generate three alternative estimates of smoking-related mortality for each of the four subpopulations, extrapolating from lung cancer death rates. We then measure the contribution of smoking-related mortality to disparities in all-cause mortality.

Results: Taking estimates from any of the three methods, we find that smoking explains >50% of the difference in life expectancy at 50 years between foreign- and native-born men, and >70% of the difference between foreign- and native-born women; smoking explains >75% of the difference in life expectancy at 50 years between US Hispanic and non-Hispanic White men, and close to 75% of the Hispanic advantage among women.

Conclusions: Low smoking-related mortality was the main reason for immigrants' and Hispanics' longevity advantage in the USA in 2000.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cross-Sectional Studies
  • Databases, Factual
  • Emigrants and Immigrants / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Status Disparities*
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Life Expectancy / ethnology*
  • Lung Neoplasms / ethnology
  • Lung Neoplasms / etiology
  • Lung Neoplasms / mortality
  • Male
  • Middle Aged
  • Population Groups / statistics & numerical data
  • Risk Assessment
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / ethnology
  • Smoking / mortality*
  • Survival Analysis
  • United States