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

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.