Through the lens of the Hispanic Paradox, this thesis examines healthy and unhealthy life expectancy changes occurring from 1997 to 2015 among Hispanics, non-Hispanic blacks, and non-Hispanic whites in the United States. The goal is to determine how Hispanics –disaggregated by nativity status– fare relative to other racial-ethnic groups in regard to changes in the percentage of total life expectancy that is lived in a healthy state (i.e. compression and expansion of morbidity). Using the Sullivan method, multi-state life tables were created with functional limitation prevalence data from the National Health Interview Survey. Results indicate that most subpopulation groups experienced periods of both morbidity compression and expansion from 1997 to 2015, though patterns of change varied by race-ethnicity and gender. Partial support was found for the Hispanic paradox given that similar trends in the percentage of total life expectancy lived disabilityree existed between non-Hispanic whites and foreign-born Hispanics.

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INTRODUCTION: Racial disparities exist in both healthcare access and outcomes. Despite high poverty rates, less education, and worse access to healthcare, the Hispanic population as a whole experiences equal, if not better outcomes compared to their non- Hispanic White counterparts. We sought to determine if race was significantly associated with the development of serious post-operative complications (POC) among patients undergoing intra-abdominal general surgical procedures. METHODS: We performed a retrospective cohort study of patients undergoing appendectomy, cholecystectomy, or colectomy at a single healthcare system over a 12 month period. Medical records were reviewed for patient demographics, co-morbidities, operative variables, and the occurrence of selected post-operative complications. Variables found to be significantly associated with the development of a POC on univariate analysis were entered into a multivariate logistic regression model to determine the effect of Hispanic race on POC. Additionally, we constructed a propensity score adjusted logistic regression model as a confirmation of our findings. RESULTS: Among 456 patients, 48 (10.5%) developed a POC. Hispanic race, age, tobacco use, selected co-morbidities, surgical procedure and surgical approach were all associated with POC on univariate analysis. On multivariate logistic regression analysis, after adjusting for confounders, Hispanic race, age, tobacco use, and surgical approach were all significantly associated with POC. Hispanic race was the strongest independent predictor, and was found to be protective against the development of a POC (adjusted OR= 0.22, p-value=0.048). The propensity score adjusted regression model provided a similar estimate of the effect of Hispanic race on POC (adjusted OR= 0.20, p-value=0.03). CONCLUSIONS: We have demonstrated that Hispanic patients undergoing common intra-abdominal surgical procedures have lower rates of serious post-operative complications, even after adjusting for patient demographics, co-morbidities, and operative variables. This, and other existing data, suggests that Hispanic patients may incur some type of overall health advantage despite the socioeconomic hardships they often face. / Clinical Research and Translational Medicine

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