Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 23.
doi: 10.1007/s11606-025-09705-1. Online ahead of print.

County-Level Determinants of the Loss of the Hispanic Mortality Advantage in the United States

Bongeka Z Zuma  1 , Zahra Azizi  2   3   4 , Sara King  3 , Ashish Sarraju  5 , Summer Ngo  6 , David Scheinker  7   8 , Fatima Rodriguez  9   10
Affiliations

County-Level Determinants of the Loss of the Hispanic Mortality Advantage in the United States

Bongeka Z Zuma et al. J Gen Intern Med. .

Abstract

Background: The COVID-19 pandemic disproportionately impacted the Hispanic population in the United States, leading to an unprecedented decline in the longstanding Hispanic mortality advantage (HMA) and highlighting the need to better understand the sociodemographic and structural factors driving these trends.

Objective: To evaluate the association between county-level determinants (including demographic, socioeconomic, behavioral, healthcare, and structural factors) and declines in the HMA during COVID-19 pandemic.

Participants: Data on non-Hispanic White (NHW) and Hispanic individuals were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation County Health Rankings databases.

Exposures: County-level sociodemographic and structural factors.

Main measures: In this cross-sectional analysis of national county-level mortality data from 2019 to 2020, the primary outcome was the change in the HMA between 2019 and 2020. All-cause age-adjusted mortality rates (AAMRs) at the county level were used to calculate the HMA (NHW AAMR - Hispanic AAMR). Coronavirus disease 2019 (COVID-19)-specific AAMRs and county-level factors were identified.

Key results: We analyzed 619 US counties with complete and reliable mortality and sociodemographic data from a total of 3193 counties. From 2019 to 2020, the mean AAMR per 100,000 persons increased by 12.5% for NHW, from 765.4 to 861.0, and by 30.3% for Hispanic populations, from 554.5 to 722.3. On average, the HMA per 100,000 persons decreased by 34.2%, from 210.9 to 138.7, with 71.5% counties experiencing a decline in the HMA. County-level factors that were associated with a decline in the HMA included the percentage of Hispanic individuals aged > 65 years, segregation index, percentage of uninsured individuals, and COVID-19 AAMRs for 2020.

Conclusions: From 2019 to 2020, there was a significant decline in the HMA across a large sample of US counties. Addressing the related county-level factors may mitigate the impact of future health crises on Hispanic populations.

Keywords: COVID-19; county-level analyses; hispanic mortality advantage; social determinants of health.

PubMed Disclaimer

Conflict of interest statement

Declarations:. Conflict of Interest:: Dr. Rodriguez consulting fees from Novartis, NovoNordisk, Movano Health, Kento Health, Inclusive Health, Edwards, Arrowhead Pharmaceuticals, HeartFlow, iRhythm, Amgen, and Cleerly Health outside the submitted work. The remaining authors report no relevant disclosures or competing interests.

References

    1. Graham G. Disparities in cardiovascular disease risk in the United States. Curr Cardiol Rev. 2015;11(3):238-45.
    1. Valencia A, Zuma BZ, Spencer-Bonilla G, López L, Scheinker D, Rodriguez F. The Hispanic paradox in the prevalence of obesity at the county-level. Obes Sci Pract. 2021;7(1):14-24.
    1. Zuma BZ, Parizo JT, Valencia A, et al. County-level factors associated with cardiovascular mortality by race/ethnicity. J Am Heart Assoc. 2021;10(6):e018835.
    1. Ruiz JM, Steffen P, Smith TB. Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature. Am J Public Health. 2013;103(3):e52-60.
    1. Medina-Inojosa J, Jean N, Cortes-Bergoderi M, Lopez-Jimenez F. The Hispanic paradox in cardiovascular disease and total mortality. Prog Cardiovasc Dis. 2014;57(3):286–92.

LinkOut - more resources