AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Unraveling the Hispanic Paradox in the United States: The Role of Nativity and Length of Residence on Mortality, Insights from NHANES 1999-2018
By Gomez Aviles LP, Ortega Aviles LM, Esmaeili Z et al.
Background: Hispanic individuals in the United States (US) experience lower mortality rates than non-Hispanic adults despite higher burden of some cardiovascular (CV) risk factors and more adverse social determinants of health (SDoH), a phenomenon known as the Hispanic Paradox. Whether this survival advantage differs by nativity or duration of US residence remains poorly understood. Methods: We included adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 linked to mortality files. Participants were categorized as non-Hispanic (non-Hispanic white [NHW], non-Hispanic Black [NHB], and other non-Hispanic adults). Hispanic participants were divided into US born and foreign-born (FB) residing in the US for ≥10 years or <10 years. Survey-weighted Cox proportional hazards models estimated hazard ratios (HRs) for all-cause and CV mortality after sequential adjustment for demographics, CV risk factors, and SDoH. Results: Final sample included 32,698 subjects, mean age 49.3±0.3 years among NHW, 45.1±0.3 NHB, and 40.8±0.7, 43.3±0.5, and 37.2±0.8 years among Hispanic US-born, FB ≥10 years, and FB <10 years, respectively. During a median follow-up of 8.2 (IQR 4.4-15.4) years, 4,452 all-cause deaths and 1,342 CV deaths occurred. After adjustment for age, sex, CV risk factors and SDoH, Hispanic population exhibited 25% lower risk of all-cause mortality and 47% lower risk of CV mortality (Table 1). Hispanics residing in the US for <10 years had the lowest risk of all-cause (HR 0.40; 95% CI 0.22-0.73; p=0.003) and CV mortality (HR 0.29; 95% CI 0.09-1.01; p=0.05) (Fig 1). Sex-stratified analyses showed similar patterns (Fig 2) . Conclusion: FB Hispanics residing in the US for <10 years demonstrate the lowest all-cause and CV mortality. However, this is attenuated with increased duration of residence, perhaps due to environmental and behavioral factors related to acculturalization. This finding also supports the healthy migrant hypothesis that may explain the Hispanic Paradox.