Racial and ethnic inequality in adult survival in the United States
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While all racial/ethnic groups in the U.S. exhibited an increase in longevity during the twentieth century, inequalities in survival remain. Hispanics have the highest life expectancy at birth in the United States, non-Hispanic blacks have the lowest, and non-Hispanic whites exhibit life expectancy between the two minority groups. An overarching objective of Healthy People 2020 is to "achieve health equity, eliminate disparities, and improve the health of all groups." Yet, a similar objective based on the Healthy People 2010 campaign regarding reduction of health inequalities was clearly not met. As the population of the United States becomes increasingly diverse as a result of immigration, intermarriage, and evolving notions regarding race and ethnicity, health demographers must monitor adult survival outcomes and inequalities across racial and ethnic subpopulations. This dissertation examines current inequalities in survival among Hispanic, non-Hispanic black, and non-Hispanic white adults in the United States. Using the 1989-2006 National Health Interview Survey Linked Mortality Files and 2010 U.S. National Vital Statistics System, I contribute to the understanding of racial/ethnic survival disparities through three empirical studies: The first chapter affirms that Hispanic mortality rate and life expectancy estimates are favorable relative to blacks and whites, particularly for foreign-born Hispanics and from smoking-related causes. The second chapter shows that, in addition to their higher mean age at death, Hispanics exhibit less variability around that mean relative to non-Hispanic whites. Non-Hispanic blacks, on the other hand, have greater variability and lower life expectancy than the other two racial/ethnic groups. The lower variability among Hispanics relative to whites is largely attributable to lower incidence in cancer, suicide, and other external cause mortality, whereas the greater variability among blacks relative to whites is mainly due to greater dispersion in age at death from heart disease and the residual cause grouping. The third chapter finds that smoking initiation in childhood or adolescence contributes additional mortality risk for current heavy and light smokers relative to never smokers. Lower smoking prevalence and later initiation among foreign-born and U.S-born Hispanics account for much of their lower mortality risk relative to whites.