Background and Objectives In the US, Hispanic mothers have rates of infant mortality and low birthweight that are comparable to non-Hispanic White mothers despite being more likely to live in socio-economically deprived areas. This well known phenomenon is termed the Hispanic paradox. Recent research suggests that this phenomenon may be partly explained by the areas in which Hispanic people live. Hispanic mothers living in counties with a high proportion of Hispanic people (Hispanic density) have lower rates of infant mortality and smoking during pregnancy. In this paper, we investigate whether or not Hispanic density is associated with better birth outcomes for mothers of other ethnicities.

Design Multilevel analysis of the US Linked Birth and Infant Death Dataset 2000 and US census data at county level.

Setting USA.

Participants 2 274 247 White and 581 151 Black non-Hispanic mothers of singleton births.

Main outcome measures Infant mortality, low birthweight, preterm delivery and maternal smoking during pregnancy.

Results Living in counties with a higher percentage of Hispanic residents was associated with reduced risk of all outcomes for non-Hispanic White and Black mothers and infants in analyses adjusting for individual and area level socio-demographic characteristics. The reduction in odds was greatest for maternal smoking during pregnancy. White mothers living in counties where more than half the residents were Hispanic had their odds of smoking during pregnancy reduced by approximately 80% (OR 0.19 95% CI 0.11 to 0.33), relative to comparable mothers living at Hispanic densities of 0 to 1%. Similar reductions in risk of maternal smoking during pregnancy were found for Black mothers (OR 0.14 95% CI 0.14 to 0.51). Infant mortality was reduced by approximately a third for both Black and White mothers living in counties with a high proportion of Hispanic residents. In addition, higher Hispanic density was associated with modest but significant reductions in the risks of preterm delivery and low birthweight.

Conclusions Living in Hispanic communities appears to have health benefits for those of non-Hispanic origin.