American Diversity: A Demographic Challenge for the Twenty-first Century

5. Mortality Differentials in a Diverse Society

Chapter 5 Mortality Differentials in a Diverse Society Richard G. Rogers 129 Introduction This chapter explores ethnic differences in mortality. It begins by providing a general framework from which to examine mortality. It then reveals mortality variations both among and within ethnic groups. Finally, it uncovers some of the factors that lead to these differences. The Significance of Mortality Understanding mortality trends is important from demographic, public policy , public health, and social perspectives. Measures of mortality, especially of infant mortality and of life expectancy, are gauges of the population’s general health. Differences in mortality by age, sex, race, and ethnicity suggest dissimilar access to education, employment, and health care; differential exposure to hazardous substances; and diverse lifestyle patterns. Mortality and fertility are the driving forces behind natural increase, or the growth of the population. These factors, along with migration, affect population size and composition, including sex ratios, racial composition, age structure, cohort effects, and family formation and composition. In fact, high mortality can create higher rates of widowhood, or single-parent families, and more households arranged around extended families. Therefore, information on the current and future mortality of racial and ethnic groups is crucial to understanding the dynamics of our society. Conceptual Considerations Most mortality research has focused on how demographic characteristics —age, sex, race, and ethnicity—affect overall and cause-specific mortality. Although demographic factors are important, so too are social relations, cultural factors, health behaviors, and biological influences (Rogers, Hummer, and Nam, 2000). For example, Blacks may exhibit higher rates of cancer because of greater genetic predispositions, risky health behaviors such as cigarette smoking, or lower likelihoods of seeking medical care. American Indians may suffer more fatal accidents because they live in more dangerous environments , or because, in general, lower socioeconomic status increases a person’s risk of accidents. Contextual effects—which include social support and stress, social order and disorder, and environmental amenities and insults—affect life chances (LeClere, Rogers, and Peters 1997; 1998). The protection against mortality that cohesive family and community relations can bestow on individuals is called the “Roseto Effect,” after a small community in Pennsylvania, which had been settled by Italian immigrants in 1882 (Egolf et al., 1992). In the mid-1950s, Roseto exhibited remarkably low mortality from myocardial infarction relative to other like towns in the area. Several studies attributed Roseto’s low rates of heart attack and relatively great individual longevity to its stable social structure , close family ties, ethnic and social homogeneity, and community support (Egolf et al., 1992). In the 1960s, as Roseto youth abandoned many of the traditions —family-centered life, absence of ostentation, patronage of local business , and ethnic intramarriages—for more contemporary behavior—looser family and community ties, more materialist orientation, greater rates of ethnic intermarriage—myocardial infarction morbidity and mortality rates climbed. Contextual effects can contribute to mortality: areas with high rates of crime, poverty, drug and alcohol abuse, marital disruption, sub-standard housing , overcrowding, illiteracy, unemployment, and air and water pollution may predispose residents to unusually high mortality due to cancer, accidents, such infectious diseases as AIDS and tuberculosis, respiratory disease, cirrhosis of the liver, and homicide (see Feingold, 1994; Haan, Kaplan, and Camacho, 1987; Jenkins et al., 1977; McCord and Freeman, 1990; Wilson, 1987). Moreover, these social strains may produce individual stress and hostility—a distrust of and antagonistic behavior toward others—which contributes to heart disease and premature mortality (Adler et al., 1994). As early as 1971, Nesser, Tyroler, and Cassel found that familial and social disorganization and poverty at the county level increased the risk of stroke mortality among Blacks. Compositional effects, including nativity, can contribute to ethnic differences in mortality. International migration selects motivated, healthy individuals who engage in healthy behaviors—low rates of cigarette smoking, moderate to low rates of alcohol consumption, increased seat belt use in automobiles, and dietary practices that lead to less obesity (Hummer, Rogers, Nam, and LeClere, 1999). Compared to native-born individuals, foreign-born individuals experience about 20% lower mortality. This lower mortality is witnessed for Richard G. Rogers 130 most all ethnic groups, including foreign-born Blacks and Whites. Because foreign-born persons generally experience lower mortality than native-born persons, those ethnic groups with the highest percentages of foreign-born individuals experience lower mortality than groups with high proportions of native-born individuals (Hummer, Rogers, Nam, and LeClere, 1999). Race and ethnicity have both social and genetic components. Although...