Except at the very oldest ages, black Americans have the highest death rates of any of America's racial and ethnic groups. In large part, this can be attributed to inequalities in economic status, education, and occupation, all of which are related to the risk of mortality. But the racial differences in mortality persist even in studies that compare individuals with similar levels of income and education. The disadvantage for blacks appears for all the major causes of death: heart disease, strokes, and cancer. The disadvantage is greatest in deaths from HIV infection, for which the risk to blacks is seven times the risk to white Americans.

Death rates for American Indians are similar to those of whites for most causes, but are substantially higher for cirrhosis of the liver and for injuries, suicide, and homicide. Asian and Pacific Islanders and Hispanics, by contrast, have much lower mortality rates than would be expected from their social and economic status in the United States. Their advantage is especially apparent in the leading causes of death — heart disease and cancers. One factor contributing to the good health of both Asians and Hispanics in the United States is the "immigrant advantage." Several studies have shown that international migrants tend to be particularly healthy and optimistic individuals, with better diets and more positive health-related behaviors than nonimmigrants. And both Asian and Hispanic populations include a higher proportion of recent immigrants than do either the white non-Hispanic or the black non-Hispanic populations. But the immigrant advantage itself does not explain entirely the paradox of Hispanic and Asian-American good health.

• citations
• National Center for Health Statistics
  at www.cdc.gov/nchs/

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