Smith and Bradshaw Respond

Between 1980 and 1990, the Hispanic population aged 65 years and older in Texas increased by 75% with the change from surname classification to origin classification. With the same change in classification, deaths in the Hispanic population aged 65 years and older increased 43%. In that decade, the “Hispanic paradox” was born. Using US national data in the only way we are aware it could be used, we found a similar discrepancy between populations and deaths in both 1990 and 2000 from origin classifications in the census and death certificates. The discrepancy persisted when California was excluded from the analysis and when the relatively small Cuban- and Puerto Rican–origin populations were excluded. If we are to understand Hispanic mortality in the United States, the data must be national. If the data are national, the analysis of those data cannot rest simply on the assertion that our assumptions are dubious. We are dealing with the questions of who thinks of themselves as Hispanic when they fill in census forms and who funeral providers think is Hispanic when they prepare death certificates. Texas provides direct evidence that the 2 sources are so inconsistent as to be unusable together in Texas. To find that the problem is not national would require far stronger assumptions than we required. To develop workable Hispanic mortality estimates, any estimates from origin questions must be checked for consistency against estimates from surname classifications. That is not a difficult step. It can still be done for the 2000 US population and deaths and should be an essential part of the analysis of the census and vital statistics for 2010. We need not comment here on Hispanic mortality estimates from sample surveys. Until the national mortality data are better handled, we will not have the benchmark we require to appraise them fairly. That is another cost of the muddle beneath the paradox

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• Health Disparities in the Latino Population

  William A Vega, Michael Rodríguez et al.•Epidemiologic Reviews•2009

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