Puerto Ricans living in the United States die from asthma at higher rates than their counterparts on the island, and education plays a critical role in those disparities. A new study in The Journal of Allergy and Clinical Immunology: In Practice shows that Puerto Ricans with lower educational attainment face particularly steep risks, challenging long-held assumptions about Hispanic health advantages.
Researchers found that Puerto Rican individuals in the U.S. with less than a high school degree had an asthma mortality rate of 38.86 per 100,000, compared with 22.37 per 100,000 among Puerto Ricans in Puerto Rico. Even with a high school diploma, mortality was far higher stateside—46.3 per 100,000 compared with 15.45 per 100,000 on the island. By contrast, non-Hispanic white individuals with the same education levels had mortality rates less than one-third as high.
The findings undermine the so-called Hispanic Mortality Paradox, which has suggested that Hispanic immigrants often live longer than non-Hispanic whites despite socioeconomic disadvantages. “Education contributes to reducing [asthma mortality] but impacts inconsistently [Puerto Rican] populations, suggesting that other factors are at play,” said lead author Sylvette Nazario, MD, of the University of Puerto Rico Medical Sciences Campus.
Socioeconomic context appeared to influence these outcomes. Puerto Ricans on the island had lower incomes, higher poverty rates, and greater dependence on public insurance, but higher educational achievement did not translate into the same health gains as it did for Puerto Ricans in the U.S. or for other groups. The study highlights how location, education, and community resources intersect to shape asthma-related mortality, placing Puerto Ricans alongside non-Hispanic Black individuals as the populations at highest risk.
See: “Asthma mortality in Puerto Rican individuals differs by U.S. vs. Puerto Rico residence” (August 1, 2025)
