Disentangling contributions of demographic, family, and socioeconomic factors on associations of immigration status and health in the United States

Abstract

BackgroundIn the United States, immigration policy is entwined with health policy, and immigrants’ legal statuses determine their access to care. Yet, policy debates rarely take into account the health needs of immigrants and potential health consequences of linking legal status to healthcare. Confounding from social and demographic differences and lack of individual-level data with sensitive immigration variables present challenges in this area of research.MethodsThis article used the restricted California Health Interview Survey (CHIS) to assess differences in self-rated health, obesity, and severe psychological distress. Between US-born citizens, naturalised citizens, lawful permanent residents (LPR), undocumented immigrants, and temporary visa holders living in California.ResultsResults show that while immigrant groups appear to have poorer health on the surface, these differences were explained predominantly by older age among naturalised citizens and by lower-income and education among LPRs and undocumented immigrants. Favourable family characteristics acted as protective factors for immigrants’ health, especially among disadvantaged immigrants.ConclusionImmigration policy that limits access to healthcare and family support may further widen the health disadvantage among immigrants with less legal protection.

Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California

“…This could be due to data constraints-particularly in the ability to sample undocumented immigrant populations and measure immigrant legal status in secondary data sources. Yet, studies using a range of methods and data sources arrive at similar conclusions-of few legal status disparities in health (Bacong & Sohn, 2020;Flores et al, 2012;Hamilton et al, 2019;Iten et al, 2014;Kelaher & Jessop, 2002;Marshall et al, 2005;Ro & Hook, 2021;Swartz et al, 2017;Wen & Maloney, 2014).…”

“…The large majority of this group is likely undocumented; in prior years, studies estimated that 88-93% of Latinx non-citizen-non-LPRs in California were undocumented (Vargas Bustamante et al, 2012). 4 Many studies have used the CHIS to examine the health status and access to health care of undocumented immigrants (e.g., Bacong & Sohn, 2020;Oropesa et al, 2015;Patler et al, 2019;Pourat et al, 2014;Vargas Bustamante et al, 2012).…”

“…Yet, while research finds that changes to immigration policy impact immigrant health (Novak et al, 2017;Patler & Laster Pirtle, 2018;Ro et al, 2020;Torche & Sirois, 2019), research on health disparities among immigrants in various legal statuses have found inconsistent results (Bacong & Sohn, 2020;Hamilton et al, 2019;Ro & Van Hook, 2021).…”

Selection, experience, and disadvantage: Examining sources of health inequalities among naturalized US citizens

“…Unlike other decomposition analyses that are restricted to linear regressions, the KHB method can be used for non-linear models, including logistic regressions. Previous studies have successfully used KHB decomposition on binary health outcomes ( Bacong & Sohn, 2020 ; Harnois & Bastos, 2018 ). We report Average Partial Effects (APE), which corresponds to the direct contribution of mediators (demographic, naturalization, and socioeconomic factors) on each health outcome.…”

“…While about 700,000 immigrants are naturalized each year, about 25 million, including the 11 million undocumented, live in the US as non-citizens ( DHS, 2020 ; Passel & Cohn, 2018 ). In general, naturalized immigrants tend to be older, more likely to be female and married, and have more education and income than non-citizen immigrants ( Bacong & Sohn, 2020 ). The naturalization rate among eligible permanent-resident immigrants is particularly low among people from Mexico ( Gonzalez-Barrera, 2017 ).…”