â€å“paradox Found Again Infant Mortality Among the Mexicanorigin Population in the United States

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Census. Author manuscript; available in PMC 2007 Oct xvi.

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PMCID: PMC2031221

NIHMSID: NIHMS25162

PARADOX Constitute (AGAIN): Babe Mortality Amid THE MEXICAN-ORIGIN POPULATION IN THE U.s.

Abstract

Recent research suggests that the favorable mortality outcomes for the Mexican immigrant population in the Us may largely be attributable to selective out-migration among Mexican immigrants, resulting in artificially low recorded death rates for the Mexican-origin population. In this paper we calculate detailed age-specific infant bloodshed rates by maternal race/ethnicity and birth for 2 important reasons: (one) it is extremely unlikely that women of Mexican origin would migrate to Mexico with newborn babies, peculiarly if the infants were simply a few hours or a few days erstwhile; and (2) more than 50% of all babe deaths in the The states occur during the first calendar week of life, when the chances of out-migration are very small. We employ concatenated information from the U. S. linked birth and infant death cohort files from 1995 to 2000, which provides us with over 20 million births and more than 150,000 babe deaths to clarify. Our results clearly show that kickoff-hr, first-day, and first-week mortality rates among infants born in the United states to Mexican immigrant women are virtually x% lower than those experienced by infants of non-Hispanic, white U.S.-born women. It is extremely unlikely that such favorable rates are artificially acquired by the out-migration of Mexican-origin women and infants, as nosotros demonstrate with a simulation exercise. Further, infants born to U.S.-born Mexican American women showroom rates of bloodshed that are statistically equal to those of non-Hispanic white women during the first weeks of life and fare considerably improve than infants born to non-Hispanic black women, with whom they share similar socioeconomic profiles. These patterns are all consistent with the definition of the epidemiologic paradox equally originally proposed past Markides and Coreil (1986).

A big and growing literature exists on the epidemiologic paradox for wellness and mortality outcomes amidst Hispanics in the United states (Franzini, Ribble, and Keddie 2001; Guendelman 2000; Landale, Oropesa, and Gorman 2000; Markides and Coreil 1986; Markides and Eschbach 2005; Palloni and Morenoff 2001; Smith and Bradshaw 2006). In particular, the relatively low levels of education, income, and wellness insurance coverage among Hispanics compared with non-Hispanic whites is thought to identify the former at college run a risk for negative health outcomes. However, it is well documented that some Hispanic groups exhibit like observed death rates compared with the non-Hispanic white population and much lower death rates than the non-Hispanic black population, whom they closely resemble with respect to socioeconomic characteristics. The greatest enigma is exhibited by the Mexican-origin population of the United states. This Hispanic subgroup is characterized by low educational attainment; low health insurance coverage rates; mortality rates similar to non-Hispanic whites; and much more favorable bloodshed rates than those of not-Hispanic blacks beyond most of the life grade (Elo et al. 2004; Frisbie and Vocal 2003; Hummer, Benjamins, and Rogers 2004; Liao et al. 1998; Rogers, Hummer, and Nam 2000; Singh and Siahpush 2001, 2002). Contempo studies bespeak that the similarity in decease rates betwixt the Mexican-origin and non-Hispanic white populations is attributable in part to the specially depression mortality of the Mexican-origin immigrant population, with the Mexican-origin U.S.-born population experiencing modestly higher death rates than non-Hispanic whites but experiencing much lower death rates than not-Hispanic blacks (Elo and Preston 1997; Hummer, Biegler, et al. 1999; Hummer, Rogers et al. 1999; Palloni and Arias 2004).

Despite the big volume of literature on this topic, a cracking deal of debate continues regarding the definition of the epidemiologic paradox itself as well every bit the health and mortality outcomes to which information technology pertains. In the instance of mortality, there is also the basic question of whether a paradox exists at all, given the data and methodological problems surrounding the estimates of mortality rates among the Hispanic population. Palloni and Arias (2004), for example, recently suggested that out-migration of Mexican-origin elders from the United States to Mexico may result in a serious underreporting of adult deaths in the United states, leading to an artificially low mortality rate among Mexican immigrant adults. Thus, they argue that much of the credible Mexican immigrant mortality reward, in relation to non-Hispanic whites in the Usa, may exist attributable to render migration to United mexican states by unhealthy immigrants. This miracle has been referred to every bit a "salmon bias" (Abraido-Lanza et al. 1999).

The key issue in this paper is to decide, to the greatest caste possible, whether the epidemiologic paradox exists for the Mexican-origin population of the The states with regard to one very well-measured upshot: infant mortality. We consider infants of U.S.-born (Mexican American) women every bit well as infants who are born to foreign-born (Mexican immigrant) women. Nosotros compare babe bloodshed rates for these two population groups with those of non-Hispanic whites, not-Hispanic blacks, Cuban Americans, Puerto Ricans, and other Hispanics, while also separating infants of strange-built-in and native-born women in each of those racial/ethnic groups. Perhaps most chiefly—and, nosotros believe, unique for this study—we clarify finely grained, age-specific infant deaths rates (less than 1 hour, 1 hr to less than 1 day, one–six days, 7–27 days, 28–90 days, 91–180 days, and 181–364 days). This allows us to take reward of (one) the farthermost unlikelihood that women with the very youngest infants born in the U.s. will take out-migrated to Mexico or elsewhere; (2) the large proportion of infant deaths that occur very early on during the first year of life; (three) the virtually 100% registration of births and infant deaths that occur in the U.s.; and (4) the extremely high match rate between baby expiry certificates and their corresponding birth certificates that is characteristic of the vital statistics–based information set up that nosotros use. Nosotros also behave a like assay for large metropolitan counties virtually the U.South.-Mexico border, where possible out-migration to Mexico may have the greatest impact on the reported infant mortality rates in the United States. Finally, we estimate the extent to which out-migration of Mexican-origin women to United mexican states would need to occur for the epidemiologic paradox, as observed in the data nosotros use, to be an artifact of the underregistration of infant deaths in the United States.

Background

Evidence for an epidemiologic paradox for the U.S. Hispanic population was peradventure first clearly uncovered by Teller and Clyburn (1974), who, using data from the State of Texas, reported that the infant mortality rate for the Spanish-surname population was slightly lower than that of non-Hispanic whites in the mid-1960s. In a seminal review on the topic about a decade later, Markides and Coreil (1986:253) coined the concept "epidemiologic paradox," summarizing it as follows:

Despite methodological limitations of much of the research, information technology can be concluded with some certainty that the health status of Hispanics in the Southwest is much more like to the wellness status of other whites than that of blacks although socioeconomically, the condition of Hispanics is closer to that of blacks. This observation is supported past evidence on such central health indicators as baby mortality, life-expectancy, bloodshed from cardiovascular diseases, mortality from major types of cancer, and measures of functional health. On other wellness indicators, such every bit diabetes and infectious and parasitic diseases, Hispanics appear to be clearly disadvantaged relative to other whites.

Note that Markides and Coreil (1986; too encounter Markides and Eschbach 2005) did non define the paradox as amend health or mortality for Hispanics compared with non-Hispanic whites, nor did they argue that the paradox applied to all health and mortality outcomes. Instead, they defined the paradox with regard to Hispanics exhibiting some primal wellness and bloodshed outcomes that are much more than like to whites than to blacks fifty-fifty though the overall socioeconomic status of Hispanics is much closer to that of blacks than to that of whites.

Three explanations have been offered for the paradox. The first is immigration selectivity. Here, the argument is that immigration is positively selective on skillful health (Franzini et al. 2001; Markides and Eschbach 2005). Thus, for example, selectively good for you immigrant women of childbearing historic period are more likely to give birth to healthy infants in the United States in comparison with their native-born counterparts who are not selectively healthy in the same way.

Second, some have suggested that cultural factors tend to encourage healthy behaviors and strong family ties among Hispanics in the U.s.a., particularly in the immigrant generation, helping to explain the relatively favorable observed wellness and bloodshed patterns that define the paradox (Franzini et al. 2001; Scribner 1996). Some have suggested that a negative acculturation process may work to help deteriorate the largely positive health and bloodshed outcomes among immigrant Hispanics over time and across generations, although data limitations have prevented a rigorous test of this hypothesis (Cho et al. 2004; Jasso et al. 2004).

Near recent demographic work in this area of study has focused on the third explanation for the paradox, which is also the master focus of the current report: namely, data quality issues. Indeed, contempo demographic work in this expanse, mostly focusing on developed mortality, has attempted to account for the event of out-migration on Hispanic mortality estimates in the Us, fabricated corrections for questionable data, and dealt with the issue of disparate race/ethnicity reporting across dissimilar data sources and beyond time (Abraido-Lanza et al. 1999; Elo et al. 2004; Hummer et al. 2004; Liao et al. 1998; Palloni and Arias 2004; Rosenberg et al. 1999; Smith and Bradshaw 2006; Swallen and Guend 2003; Turra and Elo forthcoming). Although these studies concur that U.South. regime-reported Hispanic adult mortality rates (e.thousand., Kochanek et al. 2004) are too depression because of data quality issues, there is not all the same consensus with regard to whether Hispanic adult mortality rates are actually slightly lower than, equivalent to, or higher than bloodshed rates for not-Hispanic whites. The answer to that question surely depends on the Hispanic subgroup in question, whether immigrant Hispanics are distinguished from native-born Hispanics, and the specific age groups that are examined.

Most primal to the issues in the electric current paper is recent work by Turra and Elo (forthcoming), who examined the impact of out-migration from the U.s. (to Mexico and elsewhere) on reported bloodshed rates amid main beneficiaries of social security (those aged 65 and older) in the United States. They found evidence that both Hispanic and non-Hispanic white out-migrants from the United states of america do indeed exhibit higher mortality than persons in their same racial/ethnic group who do non out-migrate. However, even when such out-migration is taken into account, Hispanic mortality in the Us for social security beneficiaries anile 65 and older remains between eleven% and xviii% lower than that of non-Hispanic whites, depending on the specific age/sex group in question. This happens primarily considering the volume of out-migration is simply non large enough to significantly influence adult mortality rates in the United States. Thus, although they show evidence that is consistent with what some refer to as a "salmon bias" (Abraido-Lanza et al. 1999) in terms of Hispanic mortality in the United States, the overall magnitude of its consequence on Hispanic versus non-Hispanic white mortality patterns was constitute to be very slight.

Turning to infant bloodshed, historical demographic work has found that baby mortality rates for the Spanish-surname population of the U.s. were not ever like to, or lower than, those for non-Hispanic whites. In fact, they were much higher than those of whites throughout the first one-half of the twentieth century (Forbes and Frisbie 1991; Gutmann et al. 2000). By 1980, however, information sets from Texas and California showed parity or near-parity between the infant mortality rates of the Hispanic and non-Hispanic white populations (Forbes and Frisbie 1991; Williams, Binkin, and Clingman 1986). These findings were later echoed in national-level data on infant mortality (Becerra et al. 1991; Hummer, Biegler et al. 1999; Singh and Yu 1996). Nonetheless, there was (and continues to be) some skepticism that the relatively low infant mortality charge per unit among Hispanics was (and is), at least in role, owing to the underreporting of Hispanic infant deaths in the United States, particularly within the Mexican-origin population (Palloni and Morenoff 2001; Williams et al. 1986). The near relevant reason for underreporting, at least during the past few decades, is consequent with that discussed earlier from the developed mortality literature: namely, that out-migration of women and their U.S.-born infants to Mexico or elsewhere results in an underregistration of baby deaths in the Usa. Such out-migration of women and infants is not necessarily health based, as divers past the concept of the salmon bias amongst older adults. Nonetheless, the general phenomenon of out-migration of women and infants from the United States for wellness or other reasons would consequence in an underregistration of babe deaths in the Us.

Recently, for example, Palloni and Morenoff (2001:152−53) reviewed and critiqued the literature on the epidemiologic paradox. Specifically writing about possible explanations for the epidemiologic paradox with regard to baby mortality, they highlighted the event of underregistration:

The get-go explanation (the under-registration of infant deaths in the target population) has been dismissed outright, but probably too quickly and hastily. We are not enlightened of whatsoever big-scale effort to actually test this hypothesis, at least not in a way that is comparable to what has been done for the case of white-black differentials in developed mortality in the U.S. (Preston et al. 1996). Instead, we find assessments of some data sets (e.thousand., Bexar County) where the authors affirm that errors of under-registration could non reasonably be large enough to account for the observed patterns of infant mortality differences (Forbes and Frisbie 1991). Admittedly the claim for that particular data gear up may be compelling but equally a full general explanation does non take the power to close the example once and for all. The important indicate is that this alternative explanation has non yet been excluded and may, together with other problems, undermine the instance for a paradox.

Clearly, it is plausible that Mexican-origin women who give birth in the United States render to Mexico. Such a miracle would consequence in a birth being registered in the United States, which increases the denominator of the Mexican-origin infant-mortality rate in the Us. Even so, if U.S.-born out-migrating infants die in the first twelvemonth of life in Mexico, such deaths are not recorded in the United states of america. Thus, the resulting count of deaths in the numerator of the U.S. babe mortality rate is artificially low. No data system is in place for linking babe deaths that may occur in Mexico back to the corresponding birth certificate records in the United states.

This newspaper makes no claim that such a process cannot, or does not, occur. Rather, this newspaper sheds calorie-free on the magnitude of this issue and its relevance for the epidemiologic paradox by advisedly calculating detailed, age-specific babe-mortality rates for the cardinal ethnicity/nativity groups in question. Given the complete registration of births and infant deaths in the The states (Bryan and Heuser 2004:61), the extremely high match rate betwixt infant deaths that occur in the U.s.a. with their corresponding birth certificates in the vital statistics data set we use (National Centre for Wellness Statistics 2000), and the strong unlikelihood that mothers with newborn infants (less than 1 hour, 1 twenty-four hour period, 1 week, or even 1 month old) would leave a country that has extremely advanced medical technology (particularly if their babe was born early and/or modest, or was otherwise at risk of decease), we are very confident that the detailed mortality rates in the neonatal period that we calculate are quite authentic and take little chance of beingness influenced past the underregistration of babe deaths. Because out-migration becomes a more than logical possibility afterward in infancy, the rates that we calculate for the postneonatal period are more than bailiwick to possible underregistration of infant deaths in the United States. Nosotros complete the assay by providing approximations of the number of women and infants who would need to out-drift from the United States for the observed rates of infant mortality among the Mexican immigrant population to be seriously biased. Nosotros conclude that the epidemiologic paradox, at least in terms of infant mortality among the Mexican-origin population in the United States in relation to not-Hispanic whites and non-Hispanic blacks, is not a data antiquity.

Information, MEASURES, AND METHODS

Data

For this assay, nosotros use the National Centre for Health Statistics (NCHS) linked birth and infant death cohort files, concatenated beyond the years of 1995–2000. The information ready includes all infants born alive in the United States during those years, including over 20 one thousand thousand cases. The recorded infant deaths in the United States are matched to their nascence certificates at an exceptional rate, which was betwixt 98% and 99% in the 1995–2000 period that we clarify (National Center for Health Statistics 1995, 1996, 1997, 1998, 1999, 2000). Important for present purposes, three additional characteristics about this data ready stand out. Start, the linked cohort files that we selected include just births to mothers who were identified as residents of the United States; nonresident mothers are not included. This results in the exclusion of well-nigh 5,000 births to nonresident mothers per year, over 80% of whom were identified as beingness of Mexican origin on the birth certificate (National Center for Wellness Statistics 2000: table B, technical appendix).

Second, race and ethnicity information are almost complete in this file, with simply 1.1% of women not reporting whether they were of Hispanic origin (National Center for Health Statistics 2000 : table B, technical appendix). As is customary in this literature, we use maternal identification reported on the birth certificate to measure race/ethnicity (Rogers 1989) and exclude cases with missing identification information.

3rd, the information are weighted to account for infant deaths that are not linked to a matching nativity record. Although the incidence of unlinked death records is very small nationally—for instance, in 2000, but 358 infant deaths (one.3%) were non linked to their original birth certificate—the use of weights is still a safeguard against error. Weights were calculated by the NCHS separately for each state of residence and by historic period category of death because each state is responsible for collecting and matching nascency and babe death data (National Center for Health Statistics 2000). By far, the everyman successful record linkage was in Oklahoma (92.eight% in 2000); in contrast, 17 states successfully matched 100% of their infant deaths to a nascence record. The two states where the bulk of the Mexican-origin population lives, California and Texas, matched their babe deaths at the rates of 98.1 % and 97.0%, respectively, in 2000 (National Centre for Wellness Statistics 2000: tabular array A, technical appendix). In all, the assigned weights for babe deaths in our file ranged from 1.01 to ane.04 (not shown), depending on the land of residence of the female parent and age of death of the infant. Because Mexican-origin women in our data tend to live in states where the successful linkage percent was slightly lower than in other states, case weights for Mexican-origin infant deaths are slightly higher on average than among other racial/ethnic groups. Thus, this weighting adjustment results in higher Mexican-origin infant bloodshed rates than would be generated without using the weights. This weighting technique best reflects the modest but important adjustment that needs to be made for slightly differing linkage success rates across the U.Southward. states.

Measures and Methods

The racial/ethnic categories that we specify include Mexican-origin, not-Hispanic white, non-Hispanic blackness, Puerto Rican, Cuban, and other Hispanic. Infants built-in to women from other racial/ethnic groups are excluded. In improver to race/ethnicity, nosotros also consider maternal nativity, dividing each racial/ethnic group into U.South.-born and strange-built-in subpopulations.ⁱEvery bit mentioned earlier, the epidemiologic paradox for babe mortality among the Mexican-origin population is idea to be largely owing to the relatively low mortality rates amongst Mexican immigrants. We include infants born to Cuban-origin women in our analysis because unlike Mexican immigrant women, Cuban immigrant women are extremely unlikely to return to their land of origin. Thus, a comparison between Mexican immigrant women and Cuban immigrant women is potentially instructive. Nosotros include Puerto Ricans be cause even though they practice not share a mortality advantage compared with not-Hispanic whites with Mexicans and Cubans, Puerto Rican women living on the U.S. mainland tin can easily return to Puerto Rico. Other Hispanics, consisting mainly of immigrant women from diverse countries in Central and South America—just also including U.S.-born Hispanic women of unknown national origin—are also included.

A main objective of this paper is to calculate detailed, age-specific baby mortality rates by race/ethnicity, subdivided past maternal nativity. The historic period groups used for this analysis are less than 1 hour, 1 to 23 hours, 1–half-dozen days, vii–27 days, 28–90 days, 91–180 days, and 181–364 days. Nosotros specify these very detailed age categories considering of the extreme unlikelihood of out-migration among women and their infants in the first hours and days of life as well as the high proportion of baby deaths that occur in the first hours and days of life. Indeed, about 50% of all infant deaths in the United states of america occur during the first calendar week of life (calculation non shown). The denominator that we use for each historic period-specific rate is the number of births that occurred to that racial/ethnic/nativity group of women; thus, the historic period-specific rates add up to the overall infant mortality rate (IMR) for each grouping. The age-specific rates used in this paper may be more appropriately viewed as partial IMRs insofar every bit they are age interval-specific contributions to the total IMR. They are defined as the number of deaths for a particular racial/indigenous/nativity grouping in a given age interval, divided past the number of live births recorded in that group. Formally, let D_jk denote the number of deaths in the jthursday age interval for the kth racial/ethnic/nascency group, with N_k denoting the number of live births in that population. The empirical rates, or partial IMRs, are defined equally p ^ jk = D jk / N k .

The adding of rates is followed by a calculation of charge per unit ratios, with rates for each racial/ethnic/nativity group explicitly compared with infants of native-born, non-Hispanic white women. Standard errors of functions of the partial IMRs can be derived based on the sampling distribution of deaths. We assume that for the N_grand births occurring in group k, the number of deaths is distributed as multinomial with probability p_jk of expiry in the jth age interval. The maximum likelihood estimator of the charge per unit in group k and age interval j is the empirical rate p ^ j 2 = D jk / N m , which matches the definition of the partial IMR used earlier. This assumes an age interval J, extending from mean solar day 365 onward, where deaths somewhen occur to all those who survive the first year. In this mode, the multinomial probabilities sum to 1.0.

Inferences almost relative mortality risks involve rate ratios of the class θ _j =p_{j 2} / p_{j 1}, which are estimated as ratios of the maximum likelihood estimators p ^ j i and p ^ j 2 and where group I (infants born to not-Hispanic white, U.S.-born women) is the reference group. Although the rates have large sample normal distributions, the sampling distribution of the estimated charge per unit ratio, θ ^ j , converges to normality at a much slower rate than does the sampling distribution of log θ ^ j (Agresti 2002). For this reason, information technology is customary carry out significance tests on the logarithm of the rate ratios. The logarithm of the rate ratio can be expressed as the difference in log rates,

log θ ^ j = log ( p ^ j ane / p ^ j two ) = log p ^ j 1 − log p ^ j ii .

(ane)

The variance of log θ ^ j requires expressions for the asymptotic variances of the log rates, which can exist found by using the delta method (Rao 1973) as follows:

var ( log p ^ j k ) = var ( p ^ j k ) [ ∂ log p ^ j k ∂ p ^ j k ] 2 = var ( p ^ j g ) ( i p ^ j 1000 ) two .

(ii)

Assuming independent groups, the variance of a difference is the sum of the group-specific variances in the log rates, or

var ( log θ ^ j ) = var ( log p ^ j one − log p ^ j 2 ) = var ( log p ^ j 1 ) + var ( log p ^ j 2 ) .

(3)

Using the formula for the variance of a multinomial proportion, applying the delta method in (ii), and simplifying, the variance of log p ^ j k can be expressed every bit

var ( log p ^ j k ) = N yard − D j k North thousand D j k .

(4)

This leads to a convenient expression for the variance of log θ ^ j :

var ( log θ ^ j ) = N i − D j ane N 1 D j one + Northward ii − D j two N ii D j two .

(5)

The standard error of log θ ^ j is the square root of this quantity. Statistical tests are carried out in the usual way by dividing the log rate ratio by its standard error, which results in a standard normal test statistic that is used to direct test the hypothesis that logθ _j = 0 or that θ _j = 1.²

Later in the paper, we separately consider only those births that occurred in large metropolitan counties virtually the U.S. -Mexico border because of the greater possibility that Mexican-origin women and infants in such areas would have a higher likelihood of out-migrating to Mexico. Finally, nosotros employ our data to specify several hypothetical scenarios to appraise the possible number of out-migrant women and infants to Mexico that there would need to be for the epidemiologic paradox—equally observed in the data set nosotros use—to exist an antiquity of underreporting due to out-migration. The methods that nosotros use for these latter two analyses are explained in the following sections.

RESULTS

Findings From the The states every bit a Whole

Panel A of Table 1 shows the historic period-specific rates of death (per 1,000 births) for U.South. infants born to resident mothers, by maternal race/ethnicity and birth. The overall babe mortality rates for each racial/ethnic/nascence grouping are shown at the bottom of this console. They reflect what is widely known about infant mortality patterns in the United States: the highest rate is exhibited amongst infants of U.S.-born, non-Hispanic black women, and the lowest overall rates are exhibited by infants of foreign-built-in Hispanic women, especially Cuban immigrant women, other Hispanic immigrant women, and Mexican immigrant women. Indeed, infants of immigrant women in each racial/ethnic group except Puerto Ricans, for whom this stardom may exist less meaningful, take lower infant mortality than infants of native-born women (Hummer, Biegler et al. 1999; Singh and Yu 1996).

Table 1

Infant Bloodshed Rates (IMRs) and Charge per unit Ratios for Births to Mexican-Origin and Other Racial/Ethnic Groups of Women in the United States, 1995–2000

	Mexican-Origin		Puerto Rican		Cuban-Origin		Other Hispanic		Not-Hispanic Black		Non-Hispanic White
	Immigrant	U.S.-born	Island-born	U.S.-built-in	Immigrant	U.Due south.-built-in	Immigrant	U.S.-born	Immigrant	U.Due south.-built-in	Immigrant	U.S.-born
Panel A. Historic period-Specific IMR (per 1,000 Births)
Less than i hour	0.74	0.84	i.38	0.98	0.63	0.70	0.75	0.88	1.55	1.93	0.69	0.81
1–23 hours	1.23	1.41	2.22	2.11	i.16	0.97	1.24	i.49	3.10	3.95	one.21	1.38
1–half-dozen days	0.77	0.88	1.12	one.21	0.79	0.60	0.74	1.02	one.54	1.58	0.80	0.87
7–27 days	0.74	0.96	1.15	ane.13	0.94	i.06	0.73	0.85	1.46	1.73	0.72	0.82
28–90 days	0.73	1.05	one.07	i.34	0.58	0.86	0.70	1.13	1.14	2.31	0.67	0.95
91–180 days	0.47	0.79	0.69	0.76	0.36	0.36	0.45	0.77	0.75	1.46	0.46	0.67
181–364 days	0.43	0.54	0.63	0.59	0.26	0.40	0.38	0.53	0.67	1.01	0.35	0.43
Total IMR	5.11	6.47	8.26	8.13	4.71	4.95	five.00	6.66	10.21	13.98	iv.xc	5.93
Linked deaths	9,711	vii,716	ane,025	1,731	222	151	3,095	1,793	three,487	44,698	3,586	80,942
Resident births	1,899,926	1,192,690	124,111	212,783	47,227	thirty,456	619,388	269,127	341,407	3,198,271	732,232	13,659,178
Panel B. Charge per unit Ratios of Babe Death
Less than 1 hour	0.91a	ane.04	1.70a	one.22a	0.77	0.86	0.93	1.09	1.92a	2.38a	0.85a	1.00
1–23 hours	0.90a	1.02	1.61a	1.54a	0.84	0.70	0.90a	i.08	2.25a	2.87a	0.88a	one.00
i–6 days	0.89a	i.02	1.thirtya	1.40a	0.91	0.69	0.85a	1.18a	1.78a	1.83a	0.93	1.00
seven–27 days	0.90a	1.18a	i.41a	ane.39a	1.15	1.xxx	0.89	1.04	1.79a	2.12a	0.88a	1.00
28–90 days	0.77a	1.11a	1.13	1.41a	0.61	0.90	0.74a	1.19a	1.xxa	2.43a	0.70a	1.00
91–180 days	0.70a	i.xviiia	1.02	1.12	0.54	0.54	0.67	i.14	ane.x	2.17a	0.68a	1.00
181–364 days	0.99	1.24a	1.45a	1.36a	0.59	0.92	0.88	1.21	i.55a	2.34a	0.82a	1.00
Total rate ratio	0.86a	1.09a	ane.39a	i.37a	0.79a	0.84	0.84a	1.12a	1.72a	two.36a	0.83a	1.00

Of greater involvement in the present paper are the detailed age-specific death rates by race/ ethnicity and nativity. The rates for infants built-in to Mexican immigrant women, compared with U.South.-born, non-Hispanic white women, are conspicuously favorable during the start hours and days of life. Indeed, the charge per unit ratios in Panel B of Table 1 show that infants of Mexican immigrant women take historic period-specific death rates that are 9% to 11% lower than those of infants of U.S.-built-in white women during the first month of life, a time menses during which out-migration to United mexican states is highly unlikely (and perhaps fifty-fifty more so if the infants are built-in early or minor, or are otherwise in poor health and at a heightened adventure of expiry). Similar patterns are exhibited amongst infants of other Hispanic immigrant women. Moreover, the detailed age-specific rates during the offset calendar month of life for infants of Mexican immigrant women are far lower than infants of non-Hispanic black women, with whom they tend to share socioeconomic and health care characteristics. These patterns provide potent evidence in support of the epidemiologic paradox, every bit defined past Markides and Coreil (1986), amid infants of both Mexican immigrant women and infants of other Hispanic immigrant women.

The historic period-specific death rates amongst infants of both Mexican immigrant women and other Hispanic immigrant women become even more favorable compared with infants of not-Hispanic white women during the 28–90 day time period and the 91–180 twenty-four hours fourth dimension period. For example, the charge per unit ratios of 0.77 and 0.70 for infants of Mexican immigrant women, respectively, are fifty-fifty lower than the 0.89 to 0.91 ratios exhibited for this group during the specific commencement calendar month of life time periods. These lower rate ratios are consequent with the idea that women and infants may be more probable to out-migrate to Mexico as the infants become older, with some postmigration infant deaths going unrecorded in the U.s.. A parallel design is evident among infants of other Hispanic immigrant women. However, a similar blueprint is also axiomatic when looking at the rate ratios for Puerto Rican, black, white, and Cuban immigrant women compared with not-Hispanic, white U.Southward.-born women. That is, all rate ratios for infants of immigrant women are lower in the 28–90 day and 91–180 twenty-four hours periods than during the before periods. One possibility is that this is consequent with a greater likelihood of woman-infant out-migration during these periods and, thus, an underreporting of U.Southward. infant mortality amid infants of immigrant women. However, the fact that this pattern is also seen for both Puerto Rican and Cuban immigrant women casts at least some doubt on the out-migration hypothesis. Indeed, Cuban immigrant women are non at all probable to out-migrate to Cuba, given the political human relationship between Cuba and the U.s.a.. Second, deaths to infants of island-built-in Puerto Rican women, fifty-fifty if the deaths occur in Puerto Rico, are linked to birth certificates in the data that we are using (National Center for Wellness Statistics 2000). Thus, although some of the observed patterns at ages 28–ninety days and 91–180 days are consistent with an out-migration hypothesis, there is clearly not unambiguous evidence in support of such patterns.

The concept of the epidemiologic paradox is not limited to Hispanic immigrants (Markides and Coreil 1986). Thus, it is instructive to too examine patterns of infant bloodshed amidst U.S.-born Hispanic women relative to non-Hispanic whites and not-Hispanic blacks. Infants of U.Due south.-built-in Mexican-origin women display death rates that are statistically equal to those of non-Hispanic white, U.Due south.-built-in women during the early neonatal period; the similarity in death rates between these 2 groups is perfectly consistent with the concept of the epidemiologic paradox. During the after stages of the first year of life, rates of bloodshed among infants of U.S.-built-in, Mexican-origin women are statistically higher than those of U.S.-built-in, non-Hispanic white women, with the rate ratios varying from ane.11 to one.24 (Tabular array 1, Panel B). This divergence from the equality observed during the early neonatal period is troubling, given the socioeconomic disadvantages that second- and third-generation Mexican Americans in the United States face up relative to non-Hispanic whites (National Research Quango 2006). Nonetheless, infant mortality rates amongst U.S.-born, Mexican-origin women are however far closer to those of non-Hispanic whites than to those of non-Hispanic blacks across the entire get-go twelvemonth of life, which is again fully consistent with the concept of the epidemiologic paradox.

Findings From Metropolitan Counties in the Southwest Region of the United States

Table two reports infant bloodshed rate ratios for the two Mexican-origin groups (that is, foreign-built-in and U.S.-born women, respectively) compared with U.S.-built-in, non-Hispanic whites among women residing in large counties (> 250,000 population) close to the U.S.-Mexico border. These include counties in the southern portions of California, Arizona, and Texas (meet Map 1). Unfortunately, county of residence for women living in less-populated counties are not identified in the linked nascency–infant death data. The comparison of age-specific infant mortality rates in these counties is instructive because of their proximity to the U.S.-Mexico edge. In such locations, the possibility of Mexican immigrants in the The states returning to Mexico shortly later the birth of a child may exist greater because of the shorter distance. Thus, if out-migration of mothers and their infants is more pronounced in this geographic area, i might expect to see especially favorable infant bloodshed outcomes—particularly for Mexican immigrant women compared with non-Hispanic whites—in this portion of the analysis.

Map of the Southwestern States Depicting the Big Metropolitan Counties (population > 250,000) About the U.South.-Mexico Border

Table two

Infant Bloodshed Rate (IMR) Ratios for Births to Mexican -Origin Women (compared with U.Southward.-born, non-Hispanic white women) Residing in Large Metropolitan Counties Near the U. Due south.-Mexico Border, 1995–2000

	Mexican-Origin		Non-Hispanic White, U.S.-born
	Immigrant	U.S.-born
Historic period
Less than 1 hour	0.88	i.ten	i.00
1–23 hours	0.97	1.16	1.00
1–6 days	0.90	1.03	one.00
7–27 days	ane.04	1.25	1.00
28–90 days	0.87	1.ten	1.00
91–180 days	0.74	1.08	1.00
181–364 days	1.02	1.44	1.00
Full Rate Ratio	0.92	1.14a	1.00
Total IMR	iv.98	vi.21	5.42
Linked Deaths	four,002	2,905	3,858
Resident Births	803,145	468,050	711,345

Tabular array 2 shows that the overall infant mortality charge per unit for both Mexican immigrant women and for U.S.-built-in Mexican-origin women are slightly less favorable for this geographic area than for the country as a whole (compared with the parallel findings from Table i). Because of much smaller jail cell sizes for deaths by historic period, no statistically significant age-specific differences be between either of the Mexican-origin groups and non-Hispanic whites. Nevertheless, the findings from Tabular array 2 continue to demonstrate an overall pattern of favorable historic period-specific infant mortality rates for Mexican immigrant women in the start hours and days of life as well as about-parity between U.S.-born, Mexican-origin women and native-built-in, non-Hispanic whites in the early on historic period periods. Concurrent with the findings from the nation as a whole, no prove exists here that the favorable infant mortality rates for the Mexican-origin population are strongly influenced by out-migration. Simply put, the depression mortality rates for infants of Mexican immigrant women and the relatively low bloodshed rates for infants of U.S.-born Mexican-origin women in the earliest age periods are firmly consistent with the concept of an epidemiologic paradox. And in that location are no exceedingly depression age-specific rates for infants built-in to Mexican immigrant women throughout the outset year that suggest out-migration as an influential factor.

Findings From an Exercise Simulating Out-Migration

Table iii reports on our calculations that address the question of how many Mexican immigrant women and infants would demand to out-migrate from the United States to Mexico—under dissimilar assumptions regarding the level of infant mortality for out-migrants—to equalize the infant mortality rates between infants of Mexican immigrant women and infants of U.S.-born, non-Hispanic white women in the United States. We focus on Mexican immigrant women, rather than Mexican American women, in this do because it is highly unlikely that more than a tiny fraction of U.S.-born, Mexican American women would out-migrate to United mexican states with their infants. The left side of Panel A begins by reporting that an boosted 1,548 infant deaths of Mexican immigrant women would accept needed to be recorded in the United States over the 1995–2000 period for their overall rate (IMR = five.xi; meet Table 1) to exist equivalent to that of not-Hispanic white, native-built-in women (IMR = 5.93; encounter Table 1). The correct side of Panel A simply reports this figure as an almanac boilerplate over the 6 years. That is, the overall lower infant mortality of Mexican immigrant women compared with non-Hispanic white native-built-in women resulted in 258 fewer infant deaths per year, on average, amongst the former group.

Table 3

Simulations of Infant Out-Migration Needed to Account for the Mexican Immigrant Infant Mortality Advantage Compared With Non-Hispanic Whites in the The states, 1995–2000

	1995–2000		Annual Boilerplate
Infants Born in U.s.a. to Mexican Immigrant Women Versus U.Southward.-born, Non-Hispanic White Women	Additional Deaths Needed to Lucifer IMR for Not-Hispanic Whites	Out- Migrants Required	Additional Deaths Needed to Match IMR for Non-Hispanic Whites	Out- Migrants Required
Panel A
Hypothetical out-migrant deaths: Infants who died at ages 0–364 Days	one,548		258
If out-migrant infants died
At their observed U.South. IMR of 5.eleven (IMR for U.South.-born Mexican immigrant)		302,935		50,489
At an IMR of 16.0 (in between estimates for U.Due south. and Mexico)		96,750		sixteen,125
At an estimated Mexican IMR of 27.0 (Pan American Wellness Systemaestimate for Mexico 1997–1998)		57,333		ix,556
Panel B
Hypothetical out-migrant deaths: Infants who emigrated afterward half dozen days and died at ages 7–364 days	1,548		258
Exposure to an IMR of 5.xi for days seven–364		605,871		100,978
Exposure to an IMR of xvi.0 for days 7–364		193,500		32,250
Exposure to an IMR of 27.0 for days 7–364		114,667		nineteen,111

Panel A of Table 3 specifies three different levels of infant mortality amongst hypothetical out-migrants: (1) Mexican out-migrant infants die at a hypothetical charge per unit equivalent to that experienced by Mexican immigrant infants in the United States between 1995 and 2000 (IMR = five.11); (two) Mexican out-migrant infants dice at a hypothetical rate roughly halfway between that experienced by Mexican immigrants in the United States and Mexicans in United mexican states (IMR = 16.0); and (3) Mexican out-migrant infants die at a hypothetical rate equivalent to that estimated for infants in Mexico in 1997–1998 (IMR = 27.0).

An IMR of 5.eleven for the hypothetical out-migrants requires over 300,000 out-migrating women and infants over the six-year menses (or over 50,000 per year), with all of their resulting baby deaths occurring in Mexico and going unrecorded in the United States, for the Mexican immigrant infant mortality rate in the United States to be equivalent to the rate of U.S.-built-in, non-Hispanic white women. Under conditions of college baby mortality, the resulting out-migration numbers are lower but however very loftier. For example, under the assumption of an infant mortality rate of 16.0 for the hypothetical out-migrants, information technology would take nearly 100,000 women and infants out-migrating from the United states of america over the six-year period—over 16,000 per twelvemonth—for the Mexican immigrant women in the Us to experience the same infant mortality rate as not-Hispanic white, native-born women. These numbers tin exist compared with recent information from Mexico that estimated that 139,661 Mexican-origin females aged v and older migrated from the Us and other countries back to Mexico between January 1995 and Feb 2000 (INEGI 2003). It is highly implausible that such a large fraction of Mexican-origin women migrating from the United States to Mexico are not only of childbearing historic period but likewise out-migrate with a newborn infant.

Panel B of Table 3 reports results from like calculations equally Console A but does and so past merely because babe mortality that occurs between ages 7 and 364 days. This console makes the assumption that there is no return migration of Mexican immigrant women to Mexico with infants who are less than one week old (which seems plausible, and particularly so if infants are premature, of low nativity weight, or in otherwise poor wellness). Thus, in that location are no unrecorded deaths in the beginning week of life amidst Mexican-origin infants born in the Usa. As a event, the hypothetical number of out-migrants in Panel B for those scenarios is much higher than the number in Console A because approximately half of all infant deaths in the United states occur during the outset week of life (authors' adding; not shown in the table). The results show that huge numbers of Mexican immigrant women and their infants would need to out-migrate on a yearly basis for the infant bloodshed rates between Mexican immigrant women and U.S.-born, non-Hispanic white women to exist equivalent. Under any of the three mortality scenarios presented, the overall conclusion remains unchanged: information technology would take an implausibly large number of Mexican immigrant women and their infants out-migrating from the United States to Mexico, with subsequent infant deaths going unrecorded in the Us, for the rates between the two groups to be equivalent. Fifty-fifty then, the equivalency of rates between Mexican immigrant and U.S.-born, non-Hispanic white women would all the same qualify as an epidemiologic paradox under the definition by Markides and Coreil (1986).

CONCLUSION

Although a dandy deal of research has documented the relatively favorable wellness and bloodshed outcomes among both the Mexican American and Mexican immigrant populations, recent work has suggested that the favorable mortality outcomes for the Mexican immigrant population may largely be attributable to selective out-migration among Mexican immigrants, resulting in artificially low recorded death rates for the Mexican-origin population in the U.s.. In this paper, nosotros specified and examined detailed age-specific babe bloodshed for 2 important reasons: (one) women of Mexican origin are extremely unlikely to migrate to Mexico with newborn babies who were born in the Usa, especially if the infants are only a few hours or a few days old; and (two) more than than 50% of all infant deaths in the The states occur in the outset week of life, when the chances of out-migration are small. We used concatenated data from the U.S. linked birth and babe death files from 1995 through 2000, which provided us with over 20 million births and more than 150,000 infant deaths to analyze. Our results clearly show that first hour, get-go mean solar day, and kickoff week mortality amidst infants born to Mexican immigrant women in the United states are about x% lower than that experienced past infants of non-Hispanic white, U.S.-born women. It is implausible that such favorable rates are artificially caused by the out-migration of Mexican-origin women and their newborn infants. Although the rates for infants of Mexican immigrant women become even more favorable than rates for infants of non-Hispanic white women during the postneonatal period—which would be consistent with an out-migration interpretation—the same pattern arises for Cuban immigrant women, who are almost surely not returning to Republic of cuba, too every bit for several other groups of immigrant women. Further, infants born to Mexican American women, fifty-fifty though exhibiting rates of bloodshed that are slightly higher than those of not-Hispanic white women during the starting time weeks of life, as well fare considerably better than infants born to non-Hispanic black women, with whom the former share similar socioeconomic profiles. All these patterns are completely consequent with the concept of the epidemiologic paradox.

Our analysis of specific metropolitan counties forth the U.Due south.-Mexico edge and our additional simulation calculations using different out-migration scenarios and infant mortality assumptions further bolstered this decision. Fifty-fifty with a higher likelihood of out-migration in counties along the border, our analysis of these areas resulted in findings that are similar to those for the United States as a whole. Our boosted simulation calculations based on different mortality rates for hypothetical out-migrant women demonstrated that even though out-migration of Mexican immigrant women and their infants surely can and does occur, with some subsequent deaths of U.S.-born infants going unrecorded in U.South. data, the extent to which this would demand to happen to influence observed U.S. expiry rates even moderately is very substantial. Thus, nosotros conclude that the epidemiologic paradox for U.S. infant mortality amidst the Mexican-origin population—both among immigrant women and among U.Due south.-born women—is existent and not a information artifact. Such a determination is fully consistent with that of Turra and Elo (forthcoming) with regard to old-historic period mortality amidst the Hispanic population of the United States. Our findings should, at least for at present, "shut the case" (Palloni and Morenoff 2001:152–53) regarding the underreporting explanation for the epidemiologic paradox of infant bloodshed. Instead, future research should focus on understanding why the Mexican immigrant population exhibits the low mortality rates that information technology does. Ane of import intent of such research should be to use the lessons learned from this health-achieving population to other population groups in the United States. Indeed, one area of focus should be on the uncommonly good for you behaviors (eastward.m., very depression rates of smoking, alcohol use, and drug use) exhibited by immigrants to the U.s.a., particularly women (Lopez-Gonzalez, Aravena, and Hummer 2005). Such salubrious behaviors by immigrant women may exist especially of import in helping to account for the positive health outcomes of Mexican-origin infants.

In closing, we would exist remiss in not commenting on another very important pattern observed in our data. Among the Mexican-origin population, as well as for most of the other racial/ethnic groups considered here, baby mortality is higher among U.Due south.-born women than amidst immigrant women. Further, among Mexican American (U.Due south.-built-in) women, the statistical parity in infant mortality with non-Hispanic whites observed in the commencement week later on birth disappeared in the later periods of infancy, when the Mexican American women exhibited a moderate disadvantage compared with U.S.-born, not-Hispanic white women. Such patterns of less-favorable Mexican American wellness over time and across generations in comparison with non-Hispanic whites are consistent with a negative acculturation interpretation of Hispanic wellness (National Research Council 2006), or longer exposure to a less-salubrious social environment for the Mexican-origin population compared with non-Hispanic whites. Thus, the most important result in moving forward in this area of inquiry is non whether an epidemiologic paradox of Mexican-origin infant bloodshed exists in the Usa; information technology does, at least for now. Rather, the more than important issue is whether Mexican-origin health and bloodshed outcomes will continue to be characterized past parity or well-nigh-parity with non-Hispanic whites in a context of standing social disadvantage in the United States among the Mexican-origin population. Forth these lines, it volition be vitally of import in the coming decades to continue to monitor the health and health behavior of 2nd- and third-generation Mexican-origin individuals throughout the land while pursuing an aggressive social policy calendar that attempts to close the educational, income, and health insurance gaps between minority groups in the The states and the majority white population.

Acknowledgments

We gratefully acknowledge the financial support for this analysis provided by the National Plant of Child Wellness and Human Development (Grants R01 HD49754 and RO1 HD043371). Nosotros also thank Andres Villareal, Emilio Parrado, and population brownbag seminar attendees at Duke University, the University of North Carolina at Chapel Colina, and the University of Texas at Austin for helpful comments and suggestions.

Footnotes

¹Of class, Puerto Ricans from the island of Puerto Rico are U.S. citizens at birth and are not immigrants to the U.s.. It is common in inquiry such as this to compare isle-born Puerto Ricans with mainlandborn Puerto Ricans. For simplicity's sake just, we employ the terms foreign-born (or immigrant) and U.S.-born, respectively, for all the racial/ethnic populations but fully realize that these concepts do not accurately depict the nativity distinction for Puerto Ricans.

²The results presented here are robust to alternative specifications of the underlying probability model. For example, a classical life tabular array approach uses the observed bloodshed to decrement the survivors in order to reverberate the effective number at risk at the starting time of each age interval. The usual assumption in this case is that deaths in each age interval follow a binomial distribution. Standard errors calculated based on assuming a binomial distribution testify differences at the seventh decimal place from our estimates. This is attributable to the very large sample sizes used in this analysis. Considering we do not know the actual number of infant deaths in Mexico for infants built-in in the Usa to resident mothers who after returned to Mexico, we practice not decrement the number at risk in each historic period interval.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2031221/

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