Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california

Abstract

Background Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors. Methods This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0–9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest. Results Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05). Conclusions Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.

Beyond “Chilling Effects”

“…Immigration enforcement policies are associated with reduced health care access and utilization among immigrant populations, particularly Latinx immigrants 4,5. The relationship between enforcement policies and health care access has been largely explained as the result of anti-immigrant social climates that result from restrictive immigration policies 6.…”

“…There is limited population data, however, about the extent to which immigrants encounter the surveillance, policing, or deportation of this “crimmigration” system 5,15,24. Recent studies have found that Latinx immigrants who experienced a home raid or knew someone deported experienced poor physical and mental health outcomes 25,26.…”

“…Immigration enforcement policies are associated with reduced health care access and utilization among immigrant populations, particularly Latinx immigrants. 4,5 The relationship between enforcement policies and health care access has been largely explained as the result of anti-immigrant social climates that result from restrictive immigration policies. 6 For example, the Illegal Immigration Reform and Immigration Responsibility Act (IIRIRA) of 1996 expanded federal enforcement and authorized state and local law enforcement collaboration with immigration authorities.…”

“…There is limited population data, however, about the extent to which immigrants encounter the surveillance, policing, or deportation of this "crimmigration" system. 5,15,24 Recent studies have found that Latinx immigrants who experienced a home raid or knew someone deported experienced poor physical and mental health outcomes. 25,26 Evidence from the policing literature shows that people of color experience numerous law enforcement actions in their daily lives, 27 and experiences of police brutality are associated with mistrust of health care institutions.…”

La migración internacional en Latinoamérica y el Caribe desde la perspectiva de la salud pública

“…La pandemia por sars-CoV-2 que aún enfrentamos nos enseñó la ineficiencia de cerrar fronteras y los efectos nocivos en materia migratoria y humana que deja [16], así como que los migrantes en situación migratoria irregular y en desventaja o vulnerabilidad socioeconómica (pobreza por ingresos, hacinamiento, informalidad laboral, entre otros) son quienes más pueden arriesgar y sufrir en salud en contextos de desastre [17]. Esto se suma a las barreras administrativas, financieras, culturales y de información que los migrantes suelen encontrar cuando necesitan acercarse al sistema de salud en el país de acogida [18]. De acuerdo con algunos estudios de nuestro equipo de investigación, en América Latina y el Caribe también se han reportado las necesidades sociales y de salud de personas migrantes durante la pandemia, así como su resiliencia, al desarrollar y fortalecer sus capacidades y recursos cuando cuentan con redes sociales de apoyo y respaldo institucional [17,[19][20][21].…”