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

Laura Blue, Andrew Fenelon

Research output: Contribution to journalArticle

95 Scopus citations


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 smokingrelated 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 450% of the difference in life expectancy at 50 years between foreign- and native-born men, and 470% of the difference between foreign- and native-born women; smoking explains475% 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. Published by Oxford University Press on behalf of the International Epidemiological Association.

Original languageEnglish (US)
Article numberdyr011
Pages (from-to)786-793
Number of pages8
JournalInternational journal of epidemiology
Issue number3
StatePublished - Jun 1 2011


All Science Journal Classification (ASJC) codes

  • Epidemiology

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