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The U.S. Hispanic population has tended to defy the odds. Before the COVID-19 pandemic, they outlived non-Hispanic white Americans by three years on average, despite having lower income, education, and health insurance levels. Although the U.S. Hispanic population died from COVID-19 at disproportionately higher rates than the non-Hispanic white population, the advantage in life expectancy, though smaller, persists.

Pre-pandemic, life expectancy at birth for the Hispanic Americans was 81.8 years in 2019, compared with 78.8 years (3 years lower) for non-Hispanic white Americans and 75.9 years (6 years lower) for non-Hispanic Black Americans.

For three decades, demographers have probed why socioeconomic disadvantages have not shortened life expectancy for Hispanic Americans, as they have for other racial and ethnic groups in the country, a paradox they’ve dubbed the “Hispanic health advantage.” New research shows how disaggregating the Hispanic population by factors like ancestry, citizenship, age, and health care access can help us understand this phenomenon.¹

Before COVID-19, Immigration Dynamics Drove Hispanic Health Advantage

Mounting evidence suggests that immigration dynamics play a role. Hispanic immigrants to the United States tend to be healthier than the average Hispanic American, while those who return to their countries of birth are often older and less healthy. Low smoking rates, healthier diets, and strong family and community ties may buffer the health effects of other stressors for Hispanic Americans—and the effects are especially for pronounced for immigrants versus those born in the United States.

It’s also possible that measurement difficulties distort these findings. For example, undocumented immigrants are less likely to answer surveys, and second- and later-generation Americans of Hispanic origin often fail to self-identify as Hispanic, researchers report. In addition, immigrants, Hispanic people, and people with a medical condition are often miscounted by surveys, censuses, and other tools used to measure population health.

But it’s impossible to pinpoint a single cause of the Hispanic health advantage, report study authors José Fernandez of the University of Louisville, Mónica García-Pérez of Duke University, and Sandra Orozco-Aleman of Mississippi State University. “Instead, these pieces of the puzzle may affect Hispanic subgroups differently according to their birthplace, place of ancestry, status as documented or undocumented immigrants, length of time residing in the country,” and other factors, the authors said.

U.S. Hispanic Population Is Less Likely to Have Health Insurance, Especially Among Noncitizens

Among Hispanic U.S. citizens, the health insurance rate is close but not equal to that of non-Hispanic white citizens (88% and 94%, respectively). But only 57% of Hispanic people who live in the United States as noncitizens have health insurance, compared to 88% of white noncitizens, Fernandez and team found.

The team focused on health insurance trends by citizenship and ancestry, using American Community Survey data for 2008 to 2020. The researchers called the differences “stark” when they explored health insurance rates among Hispanic noncitizens by ancestry, with a high of 73% to a low of 49% for those of Central American ancestry.

During this period, the share of the U.S. population with insurance increased because of the 2010 Affordable Care Act, also known as Obamacare. Among the total Hispanic population as a whole, health coverage jumped from 69.1% to 82.6%, they found, and the coverage gap between the non-Hispanic white and Hispanic populations shrank by nearly half, from 20.6 percentage points in 2008 to 11.2 percentage points in 2020.

Figure. Health Insurance Coverage Rates Vary Widely Among Noncitizen Groups

Percent of Population With Any Health Insurance Coverage, by Ancestral Background and Citizenship Status, 2020

Source: José Fernandez, Mónica García-Pérez, and Sandra Orozco-Aleman, “Unraveling the Hispanic Health Paradox,” Journal of Economic Perspectives, 37, no. 1 (2023): 145-68.

These patterns may affect the Hispanic health advantage in two ways, according to the researchers. First, people with health insurance may be more aware of their health and therefore more likely to report specific health conditions in a survey, they said. Second, people who use less health care may underreport certain health conditions, leading some to believe that people of Hispanic origin are simply healthier. (Another caveat? Spanish-speaking Hispanics may not reveal as much if their provider does not speak Spanish.)

In other words, if the U.S. Hispanic population had the same rates of health insurance coverage and health care use as the white population, the Hispanic health advantage could be even larger—or a larger portion of the paradox could be explained.

U.S. Hispanic Population Less Likely to See a Doctor, More Likely to Use an Emergency Room for Care

Health insurance often drives health care use, the research team noted; in a separate anaylsis, they found that more than half (56%) of the U.S. Hispanic population lacks a usual place of health care, which is 7 percentage points less than the non-Hispanic white population.

Fernandez and colleagues used data from the National Health Interview Survey from 2006 to 2019 to examine various measures of health care use by citizenship and ancestry, adjusting for age, gender, and variations by year. These findings imply that a large share of the Hispanic population may be “missing preventive care, either because of limited access to quality health care or overall barriers to access to care,” they suggested.

In addition, the U.S. Hispanic population is more likely than the U.S. non-Hispanic white population to report that emergency rooms are their usual place of health care, 6% versus 4%. (Rates are 8% for foreign- and island-born U.S. Hispanics.) “The inefficient use of emergency services relative to a traditional doctor’s office are well known, including higher medical expense in health care and higher out of pocket expense for patients, and the possibility that ailments may worsen before treatment,” the researchers point out.

All U.S. Hispanic groups were less likely to visit a doctor in the previous two years than their non-Hispanic U.S. counterparts. The gap is widest for those born in Mexico (8 percentage points), Cuba (3 percentage points), and other countries in South and Central America (4 percentage points).

Treating the U.S. Hispanic population “as a monolithic group hides variations in health outcomes by subgroup ancestry,” the research team writes. In addition, the composition of the U.S. Hispanic population has changed in recent decades from an “immigrant-dominated group” to a “citizen-dominated group,” with different patterns of health care access and use, they noted.

Understanding these differences can help researchers develop better models to address barriers to health care and measurement errors that affect Hispanic health data—and, in turn, health outcomes.