Racial/Ethnic Differences in Mortality in Late Midlife: Have They Narrowed in Recent Years?

Objectives: To examine whether racial/ethnic differences in mortality rates have changed in recent years among adults in late midlife, and if so, how. Methods: We analyze Health and Retirement Study data on non-Hispanic Whites (Whites), non-hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics (Hispanic-English and Hispanic-Spanish), aged 50-64 from 2 periods: 1998-2004 (Period 1, n = 8,920) and 2004-2010 (Period 2, n = 7,224). Using survey-generalized linear regression techniques, we model death-by-end-of-period as a function of race/ethnicity and sequentially adjust for a series of period-specific baseline risk factors including demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition techniques are used to assess the contribution of these factors to observed racial/ethnic differences in mortality rates. Results: The odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in Period 1 but was 33% higher in Period 2 (OR = 1.33; 95% confidence interval [CI] = 1.05-1.69). The adjusted ORD among Hispanic-English (vs. Whites) was not statistically different in both periods. The adjusted ORD among Hispanic-Spanish (vs. Whites) was lower (ORD = 0.36; 95% CI = 0.22-0.59) in Period 1 but indistinguishable in Period 2. In Period 1, 50.1% of the disparity in mortality rates among Blacks was explained by baseline health status, 53.1% was explained by financial factors. In Period 2, 55.8% of the disparity in mortality rates was explained by health status, 40.0% by financial factors, and 16.2% by health insurance status. Discussion: Mortality rates among Blacks and Hispanic-Spanish have risen since the mid-1990s. Hispanic-Spanish may be losing their advantageous lower risk of mortality, long known as the "Hispanic Paradox."