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Spatial Variation in the Hispanic Paradox: Mortality Rates in New and Established Hispanic US Destinations Noli Brazil* Yale University, New Haven, CT USA

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Spatial Variation in the Hispanic Paradox: Mortality Rates in New and Established Hispanic US Destinations Noli Brazil* Yale University, New Haven, CT USA POPULATION, SPACE AND PLACE Popul. Space Place (2015) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/psp.1968 Spatial Variation in the Hispanic Paradox: Mortality Rates in New and Established Hispanic US Destinations Noli Brazil* Yale University, New Haven, CT USA ABSTRACT mortality outcomes given the expanding dis- persion of Hispanics into areas that until re- A long line of research has shown that despite cently attracted few Latinos. Copyright © 2015 their lower socioeconomic standing, Hispanics John Wiley & Sons, Ltd. have lower mortality rates relative to Whites. In a separate literature, scholars have shown that Accepted 8 May 2015 Hispanics are increasingly relocating and shifting their destination choices within the US. Keywords: Hispanic paradox; epidemiological Using 1999–2010 county-level national vital sta- paradox; spatial regime; immigrant destination; tistics data, this paper combines these two re- Hispanic migration; mortality search domains by comparing Hispanic and White all-cause mortality rates and their differ- entials in new and established Hispanic desti- INTRODUCTION nations. The results reveal that the Hispanic mortality advantage in established destinations esearch has consistently shown that low is much smaller relative to the rest of the nation socioeconomic status is strongly associ- owing to significantly higher Hispanic mortal- R ated with poor health and mortality out- ity rates. Utilising spatial regression techniques, comes in the US (Kawachi and Berkman, 2000). the study also compares the ecological corre- Studies have also found a consistent relationship lates of White and Hispanic mortality rates and between socioeconomic status and race, where their gaps across Hispanic destinations. The re- non-Hispanic Whites (hereafter called Whites) sults show that the structural factors associated are generally more economically advantaged with mortality gaps vary by destination type than their Black and Hispanic counterparts. except for the percent of Hispanics that are re- Given these associations, it is not surprising to cent immigrants, which is associated with a find that Whites have better health outcomes greater Hispanic mortality advantage in all than Blacks for both genders across all age groups areas. In addition to providing support for a (Williams and Collins, 2001). However, a long healthy migrant effect, the results also reveal line of research has found the opposite when the importance of internal Hispanic migration, comparing Whites with Hispanics: Whites in the which is associated with larger gaps in US experience higher mortality rates than do established areas. Lastly, factors associated with Hispanics (Palloni and Arias, 2004; Turra and White mortality, particularly local Goldman, 2007). This finding, known as the socioeconomic conditions, are associated with Hispanic or Latino health paradox, has perplexed larger mortality gaps, specifically in new researchers since it was first discovered nearly destinations. The study highlights the 30 years ago (Markides and Coreil, 1986). increasing need to consider geographic In order to shed light on the potential factors heterogeneity in White and Hispanic health and driving these counterintuitive results, researchers have examined the Hispanic paradox across a number of dimensions including gender (Palloni *Correspondence to: Noli Brazil, Yale University, PO Box, 208265, New Haven, CT 06520-8265, USA. and Arias, 2004), data source (Arias et al., 2010), E-mail: [email protected] biological risk factor (Crimmins et al., 2007), Copyright © 2015 John Wiley & Sons, Ltd. N. Brazil immigration status (Eschbach et al., 2004), self- country that have largely been unexamined de- reported health (Browning et al., 2003), and spite their growing Hispanic populations. potential cause, such as neighbourhood charac- teristics (Eschbach et al., 2004), return migration THE HISPANIC MORTALITY ADVANTAGE (Abraido-Lanza et al., 1999), and selective migra- OVER SPACE tion (Rubalcava et al., 2008). However, there are no studies to the author’s knowledge that has Most studies examining the mortality and health examined geographic variation in the Hispanic advantages of the Hispanic population rely on paradox, which we might expect considering that individual-level data drawn from either vital mortality rates and their structural determinants registrations or surveys (Markides and Eschbach, are not randomly distributed across space (Sparks 2011). Many of these data sources provide and Sparks, 2010; Yang et al., 2015). If the Hispanic nationally representative samples that do not paradox varies spatially, a demographic compari- allow researchers to generalise results at lower son of areas where the White-Hispanic mortality geographic levels. Therefore, most of these stud- gap is smaller, larger, or non-existent may help ies do not attempt to account for spatial variation, validate or uncover new explanations. with the exception of controls for urbanicity, met- Spatial variation in the Hispanic paradox has ropolitan status, or regional affiliation (Markides become increasingly likely given the growing and Eschbach, 2011). variability in the destination choices of the Researchers have not been completely oblivi- Hispanic population. Historically, Hispanics in ous to the possible presence of spatial variation the US have resided in large metropolitan areas in the Hispanic mortality advantage. In fact, in a in the Southwest and Northeast (Leach and Bean, critical review of the literature, Palloni and 2008). In recent years, owing to factors such as Morenoff (2001) discuss the important role that economic restructuring and hostile political envi- geography plays in influencing Hispanic mortal- ronments, Hispanics have increasingly dispersed, ity levels and trends. In their review, they note resettling in small towns and rural areas in the that earlier South and Midwest (Durand et al., 2000; Kandel and Parrado, 2005; Lichter and Johnson, 2006). Given their rapidly growing Hispanic popula- results vary, not just depending on the defini- tions and socioeconomic differences with tradi- tion of the target population, but also as a func- tional gateways, new destinations merit more tion of the geographic location of such groups. attention from the health and mortality literature. This is not surprising. If, as we argue later, However, studies examining the Hispanic health there are powerful selection effects accounting paradox have largely been conducted at the na- for some of the unexpected findings, it stands tional level or in regions with large, established to reason that the outcomes of interest will vary Hispanic populations (Markides and Eschbach, sharply by region of residence. As a conse- 2011). Surprisingly, little attention has been paid quence, one should expect and not be surprised to the health and mortality outcomes in new by the fact that contrasts between target and destinations. standard population include important geo- In this paper, I address this research gap by graphic heterogeneity (Palloni and Morenoff, comparing age-adjusted all-cause mortality rates 2001:158). for Hispanics and Whites in traditional versus new Hispanic destinations using county-level Subsequent research has not completely ignored national vital statistics data. I then use spatial the authors’ arguments; however, the integration regression techniques to determine whether the of geography in the examination of the Hispanic effects of ecological characteristics on Hispanic paradox has been narrow. and White mortality rates and their gaps also vary The few studies that have examined Hispanic by destination type. This paper combines two health and mortality at sub-national levels do so prominent literatures in Hispanic research – desti- for regions with large Hispanic populations. The nation choices and health advantages – to shed most utilised regional dataset is from the new light on the Hispanic paradox by focusing at- Hispanic Established Population for the Epidemi- tention on the mortality outcomes in areas of the ological Study of the Elderly, a survey of a Copyright © 2015 John Wiley & Sons, Ltd. Popul. Space Place (2015) DOI: 10.1002/psp Spatial Variation in the Hispanic Paradox representative sample of Mexican-Americans in Since the 1990s, US Hispanics have increas- five Southwestern states (Arizona, California, ingly dispersed, moving to new destinations in Colorado, New Mexico, and Texas). Researchers the South and Midwest that are typically small, relying on this data have examined a range of rural or suburban, and less dense (Lichter and Mexican-American health outcomes, including Johnson, 2006; Liaw and Frey, 2007). Between mortality and morbidity levels of diabetic people, 1990 and 2000, the Midwest registered the depression, health conditions of the oldest old, highest rate of Hispanic growth (81%), followed and mortality from cardiovascular diseases (Kuo by the South (Vasquez et al., 2008). During the et al., 2003; Ostir et al., 2003). In general, these same period, the Northeast’s share of the overall studies have found that Mexican-Americans national Hispanic population went down from exhibit better health depending on medication 16.8% to 14.9%, whereas in the West, it declined use, neighbourhood characteristics, and meta- from 45.2% to 43.5% (Guzman and McConnell, bolic syndrome. 2002). Although the majority of the Hispanic pop- Other studies examining narrower geographic ulation in the US still resides in traditional desti- regions suggest
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