Migration selection, protection, and acculturation in health: a binational perspective on older adults

A longitudinal perspective to migrant health: Unpacking the immigrant health paradox in Germany

Previous research finds that recent immigrants are healthier than the native-born, while more established immigrants exhibit worse health, suggesting a process of unhealthy assimilation. However, previous literature is mostly based on cross-sectional data or on longitudinal analyses similarly failing to disentangle individual-level variation from between-individual confounding. Moreover, previous longitudinal studies are often limited in their study of different health outcomes (few and mostly subjective health), populations (sometimes only elderly individuals), time periods (short panels) and geographical contexts (mostly Australia, Canada and USA). We address these limitations by comparing the health trajectories of adult immigrants and natives in Germany over extended periods, using data from years 2002-2021 of the German Socio-Economic Panel (SOEP), and investigating a wide range of health outcomes, including self-assessed physical and mental health measures, diagnosed illnesses, and health behaviors. We employ a longitudinal approach that stratifies immigrants by age at arrival, and compares them to natives of the same age. This allows us to estimate both Hierarchical Linear Models and more rigorous Fixed Effects models to further address confounding. Cross-sectionally, we confirm previous literature's findings: recent immigrants are healthier than natives and established immigrants. Longitudinally, we find support for the unhealthy assimilation hypothesis concerning subjective health and mental health, but not for the others health indicators or behaviors. We interpret these findings as possible evidence of immigrants' reduced access to timely health care and emphasize the need for greater longitudinal research investigating migrant gaps in various health outcomes.

Does the immigrant health advantage extend to incarcerated immigrants?

•Existing immigrant health research does not include institutionalized populations.•The immigrant health advantage does not extend to all incarcerated immigrant groups.•Differences in health exist by race/ethnicity, U.S. citizenship, and health outcome.•The incarcerated immigrant population has unique health profiles and needs.

Revisiting the Immigrant Health Advantage: Self-Reported Health and Smoking Among Sexual Minority Immigrants

This study aims to examine how the immigrant health advantage (IHA) may differ by sexual orientation. Using data from the 2015-2019 National Health Interview Survey, we examined general health status (n = 131,635) and smoking behavior (n = 131, 658) for US-born and foreign-born heterosexual and sexual minority adults, as well as how the duration of stay in the U.S. may influence sexual minority immigrants' health. Logistic regression models were adopted to examine the health outcomes of immigration in different immigrant groups divided by sexual orientation. Findings show a weaker immigrant health advantage among sexual minorities than heterosexual persons, which disappears or turns into a disadvantage for several subpopulations (i.e., foreign-born homosexual individuals who stayed for 10-15 or 15 + years in the U.S.). Foreign-born homosexual individuals having stayed in the U.S. for a decade or more have substantially higher odds of reporting poor/fair health and smoking currently than their US-born counterparts. Although immigrants' health advantage overall attenuates over time, sexual minority immigrants' health erodes more with time spent in the U.S. The disparities in immigrants' health advantages suggest a segmented health acculturation (or even marginalization) process and entail higher sexual orientation-based health disparities among immigrants than among US-born individuals, likely reinforcing the preexisting health disparities in the country. The findings call for policies to address the multifaceted barriers to health equity at the intersection of social disadvantages.

Impact of migration on diabetes burden: audit in the metropolitan area of Bologna, Italy

PURPOSE

To investigate the impact of diabetes in immigrants on the Italian healthcare system, as well as their compliance with standard protocols of control and treatment.

METHODS

The prevalence of immigrants with diabetes living in the metropolitan area of Bologna (about 1 million inhabitants) in 2019 was investigated using a database containing all subjects in active follow-up for diabetes, based on antidiabetic drug use, disease-specific copayment exemption, ICD-9 codes, continuous care in diabetes units. Country of origin was derived from fiscal code.

RESULTS

The overall prevalence of diabetes (n = 53,941; 51.8% males, median age 64) was 6.1% in both Italy-born and immigrant cohorts. Immigrant prevalence was 12.4%, moderately higher than that observed in the total population (12.2%). Diabetes risk was increased in the whole immigrant cohort (odds ratio (OR) 1.74; 95% Confidence Interval (CI) 1.69-1.79). Among cases with incident diabetes, the proportion of immigrants (median age, 49 vs. 65 in Italy-born individuals) increased progressively from 11.7% to 26.5% from 2011 to 2019 (males, 8.9-21.0%; females, 14.9-32.8%) in all age groups, particularly in young adults, but also in older subjects. Metabolic control was lower in immigrants, as was adherence to shared diagnostic and therapeutic protocols, without systematic differences in antidiabetic drug use, but much lower use of drugs for comorbid conditions.

CONCLUSIONS

The population with diabetes in the metropolitan area of Bologna is rapidly changing. Quality improvement initiatives are needed to reduce the burden for the universalistic Italian health care system generated by the rapidly-growing high-risk immigrant population.

Does the population size of a city matter to its older adults' self-rated health? Results of China data analysis

Clarifying the association between city population size and older adults' health is vital in understanding the health disparity across different cities in China. Using a nationally representative dataset, this study employed Multilevel Mixed-effects Probit regression models and Sorting Analysis to elucidate this association, taking into account the sorting decisions made by older adults. The main results of the study include: (1) The association between city population size and the self-rated health of older adults shifts from a positive linear to an inverted U-shaped relationship once individual socioeconomic status is controlled for; the socioeconomic development of cities, intertwined with the growth of their populations, plays a pivotal role in yielding health benefits. (2) There is a sorting effect in older adults' residential decisions; compared to cities with over 5 million residents, unobserved factors result in smaller cities hosting more less-healthy older adults, which may cause overestimation of health benefits in cities with greater population size. (3) The evolving socioeconomic and human-made environment resulting from urban population growth introduces health risks for migratory older adults but yields benefits for those with local resident status who are male, aged over 70, and have lower living standards and socioeconomic status. And (4) The sorting effects are more pronounced among older adults with greater resources supporting their mobility or those without permanent local resident status. Thus, policymakers should adapt planning and development strategies to consider the intricate relationship between city population size and the health of older adults.

The Big (Genetic) Sort? A Research Note on Migration Patterns and Their Genetic Imprint in the United Kingdom

This research note reinvestigates Abdellaoui et al.'s (2019) findings that genetically selective migration may lead to persistent and accumulating socioeconomic and health inequalities between types (coal mining or non-coal mining) of places in the United Kingdom. Their migration measure classified migrants who moved to the same type of place (coal mining to coal mining or non-coal mining to non-coal mining) into "stay" categories, preventing them from distinguishing migrants from nonmigrants. We reinvestigate the question of genetically selective migration by examining migration patterns between places rather than place types and find genetic selectivity in whether people migrate and where. For example, we find evidence of positive selection: people with genetic variants correlated with better education moved from non-coal mining to coal mining places with our measure of migration. Such findings were obscured in earlier work that could not distinguish nonmigrants from migrants.

Understanding Internal Migration: A Research Note Providing an Assessment of Migration Selection With Genetic Data

Migration is selective, resulting in inequalities between migrants and nonmigrants. However, investigating migration selection is empirically challenging because combined pre- and post-migration data are rarely available. We propose an alternative approach to assessing internal migration selection by integrating genetic data, enabling an investigation of migration selection with cross-sectional data collected post-migration. Using data from the UK Biobank, we utilized standard tools from statistical genetics to conduct a genome-wide association study (GWAS) for migration distance. We then calculated genetic correlations to compare GWAS results for migration with those for other characteristics. Given that individual genetics are determined at conception, these analyses allow a unique exploration of the association between pre-migration characteristics and migration. Results are generally consistent with the healthy migrant literature: genetics correlated with longer migration distance are associated with higher socioeconomic status and better health. We also extended the analysis to 53 traits and found novel correlations between migration and several physical health, mental health, personality, and sociodemographic traits.

Examining sociocultural factors in widowhood and cognitive function among older Chinese immigrants: findings from the PINE study

Objectives: Although there is growing evidence on widowhood and cognitive function, existing studies have shown mixed results. Little is known about protective factors that may contribute to resilience, thereby ameliorate the adverse effect of widowhood on cognition among older Asian immigrants. This study explored potential moderators (i.e. social support, acculturation, leisure activities) in the association between widowhood and cognitive function among older Chinese immigrants.Method: The study sample included 2,515 adults aged 60 or older who completed two waves (2011-2013 and 2013-2015) of the Population Study of Chinese Elderly in Chicago. Cognitive function was indexed by global cognitive function and episodic memory. Linear regression analyses were conducted with interaction terms.Results: Our results show that social support moderated the relationship between widowhood and global cognitive function, and acculturation moderated the relationship between widowhood and episodic memory. The adverse effect of widowhood on cognitive function was more pronounced at lower levels of social support and acculturation.Conclusion: Our findings indicate buffering roles of social support and acculturation in cognitive health among older Chinese immigrants who experience widowhood. Providing supportive programs and interventions to increase social support and acculturation is suggested to promote cognitive function in this population.

Return Migration Selection and Its Impact on the Migrant Mortality Advantage: New Evidence Using French Pension Data

The migrant mortality advantage (MMA) has been observed in many immigrant-receiving countries, but its underlying factors remain poorly understood. This article examines the role of return migration selection effects in explaining the MMA among males aged 65+ using a rich, unique dataset from France. This dataset contains information on native-born and foreign-born pensioners who are tracked worldwide until they die, providing a rare opportunity to assess return migration selection effects and their impact on the MMA. Results provide evidence of substantial and systematic negative return migration selection among foreign-born males in France. Old-age returns, in particular, appear particularly affected by such selection; however, they are not frequent enough to explain the MMA at ages 65+. By contrast, returns at younger ages are much more frequent, and the MMA at ages 65+ essentially disappears once these earlier returns are considered. This study extends the literature on negative selection at return and its impact on the MMA by providing evidence that such negative selection may operate not only at older ages but throughout the life course, with impacts on the MMA that are larger than previously suggested.

Race/Ethnicity, Nativity, and Gender Disparities in Mental Health Trajectories from Mid- to Later-Life: A Life Course-Intersectional Approach

BACKGROUND

Numerous studies have highlighted mental health disparities based on race/ethnicity, nativity, and gender across different life stages. However, few have investigated how the intersectionality of these factors influences mental health trajectories during midlife to late life. This study fills this gap by adopting a life course-intersectional approach, viewing mental health trajectories as dynamic processes shaped by the combined influences of race/ethnicity, nativity, and gender. It explores social, psychological, and physiological pathways contributing to these disparities.

DESIGN

Using data from the Health and Retirement Study (2006-2018; N = 38,049 observations) and growth curve models, this study examines how intra-individual trends in depressive symptoms (measured as CES-D scale, 07) are influenced by the intersection of race/ethnicity, nativity, and gender. It also investigates the impact of objective and subjective social isolation and physical health on group disparities in mental health trajectories.

RESULTS

The findings reveal that, during mid- to early late-life, most Black and Hispanic Americans experience higher levels of depressive symptoms compared to their White counterparts (disparities ranging from 0.184 to 0.463 for men and 0.117 to 0.439 for women). However, this disadvantage diminishes for US-born Hispanic men and US-born Black women (0.014-0.031 faster decrease rates compared to US-born White), while it intensifies for Hispanic immigrants (0.017-0.018 slower decrease rates compared to US-born White) in advanced ages. Mediation analysis demonstrates that both social isolation and physical health contribute to these disparities, with physical health explaining a larger portion, particularly in differences between immigrant Hispanic women and US-born Whites.

CONCLUSION

This study underscores the importance of a life course-intersectional approach in understanding mental health disparities. It emphasizes the need for improved social welfare systems and community-level interventions targeting the specific challenges faced by older Hispanic immigrants, especially women who encounter multiple forms of oppression.

Cause-specific mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities

BACKGROUND

Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial-ethnic group, county, and cause of death and describe the intersection between racial-ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions.

METHODS

We applied small-area estimation models to death certificate data from the US National Vital Statistics system and population data from the US National Center for Health Statistics to estimate mortality by age, sex, county, and racial-ethnic group annually from 2000 to 2019 for 19 broad causes of death. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and generated age-standardised results using direct standardisation to the 2010 US census population.

FINDINGS

From 2000 to 2019, across 3110 US counties, racial-ethnic disparities in age-standardised mortality were noted for all causes of death considered. Mortality was substantially higher in the AIAN population (all-cause mortality 1028·2 [95% uncertainty interval 922·2-1142·3] per 100 000 population in 2019) and Black population (953·5 [947·5-958·8] per 100 000) than in the White population (802·5 [800·3-804·7] per 100 000), but substantially lower in the Asian population (442·3 [429·3-455·0] per 100 000) and Latino population (595·6 [583·7-606·8] per 100 000), and this pattern was found for most causes of death. However, there were exceptions to this pattern, and the exact order among racial-ethnic groups, magnitude of the disparity in both absolute and relative terms, and change over time in this magnitude varied considerably by cause of death. Similarly, substantial geographical variation in mortality was observed for all causes of death, both overall and within each racial-ethnic group. Racial-ethnic disparities observed at the national level reflect widespread disparities at the county level, although the magnitude of these disparities varied widely among counties. Certain patterns of disparity were nearly universal among counties; for example, in 2019, mortality was higher among the AIAN population than the White population in at least 95% of counties for skin and subcutaneous diseases (455 [97·8%] of 465 counties with unmasked estimates) and HIV/AIDS and sexually transmitted infections (458 [98·5%] counties), and mortality was higher among the Black population than the White population in nearly all counties for skin and subcutaneous diseases (1436 [96·6%] of 1486 counties), diabetes and kidney diseases (1473 [99·1%]), maternal and neonatal disorders (1486 [100·0%] counties), and HIV/AIDS and sexually transmitted infections (1486 [100·0%] counties).

INTERPRETATION

Disparities in mortality among racial-ethnic groups are ubiquitous, occurring across locations in the USA and for a wide range of health conditions. There is an urgent need to address the shared structural factors driving these widespread disparities.

FUNDING

National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.

Perceived Racial/Ethnic Discrimination, Citizenship Status, and Self-Rated Health Among Immigrant Young Adults

Both racial/ethnic discrimination and citizenship status are manifestations of racism. Few empirical studies have examined the role of multiple stressors and how both stressors are interlinked to influence health among immigrant young adults. Informed by the theory of stress proliferation, the current study seeks to examine the interplay between perceived racial/ethnic discrimination and citizenship status on health. We used the third wave of the Children of Immigrants Longitudinal Study (CILS) to examine the influence of perceived racial/ethnic discrimination and citizenship status on self-rated health (SRH) among immigrant young adults (N = 3344). Perceived racial/ethnic discrimination was initially associated with SRH. After adjusting for both predictors, those experiencing perceived racial/ethnic discrimination and non-citizen youth were less likely to report better health than youth who did not report perceived racial/ethnic discrimination or citizen youth. In fully adjusted multivariate regression models, racial/ethnic discrimination remained significant, while citizenship status was no longer associated with SRH. To test stress proliferation, an interaction term was included to assess whether the relationship between perceived racial/ethnic discrimination and SRH varied by citizenship status. The interaction term was significant; non-citizen young adults who experienced racial/ethnic discrimination were less likely to report better health in comparison to citizen young adults and those who did not report perceived racial/ethnic discrimination. Results suggest that the interplay between perceived racial/ethnic discrimination and citizenship status may be influential for health among immigrant young adults. These findings underscore the need for further assessment of the role of stress proliferation on immigrant young adults' health.

Race and Ethnicity, Racism, and Population Health in the United States: The Straightforward, the Complex, Innovations, and the Future

For far too long, U.S. racialized groups have experienced human suffering and loss of life far too often and early. Thus, it is critical that the population sciences community does its part to improve the science, education, and policy in this area of study and help to eliminate ethnoracial disparities in population health. My 2022 PAA Presidential Address focuses on race and ethnicity, racism, and U.S. population health in the United States and is organized into five sections. First, I provide a descriptive overview of ethnoracial disparities in U.S. population health. Second, I emphasize the often overlooked scientific value of such descriptive work and demonstrate how such seemingly straightforward description is complicated by issues of population heterogeneity, time and space, and the complexity of human health. Third, I make the case that the population sciences have generally been far too slow in incorporating the role of racism into explanations for ethnoracial health disparities and lay out a conceptual framework for doing so. Fourth, I discuss how my research team is designing, collecting, and disseminating data for the scientific community that will have potential to, among many other purposes, create a better understanding of ethnoracial health disparities and the role of racism in producing such disparities. Finally, I close by suggesting some policy- and education-related efforts that are needed to address racism and population health within U.S. institutions.

The Most Vulnerable Hispanic Immigrants in New York City: Structural Racism and Gendered Differences in COVID-19 Deaths

This paper explores the structural and group-specific factors explaining the excess death rates experienced by the Hispanic population in New York City during the peak years of the coronavirus pandemic. Neighborhood-level analysis of Census data allows an exploration of the relation between Hispanic COVID-19 deaths and spatial concentration, conceived in this study as a proxy for structural racism. This analysis also provides a more detailed exploration of the role of gender in understanding the effects of spatial segregation among different Hispanic subgroups, as gender has emerged as a significant variable in explaining the structural and social effects of COVID-19. Our results show a positive correlation between COVID-19 death rates and the share of Hispanic neighborhood residents. However, for men, this correlation cannot be explained by the characteristics of the neighborhood, as it is for women. In sum, we find: (a) differences in mortality risks between Hispanic men and women; (b) that weathering effects increase mortality risks the longer Hispanic immigrant groups reside in the U.S.; (c) that Hispanic males experience greater contagion and mortality risks associated with the workplace; and (d) we find evidence corroborating the importance of access to health insurance and citizenship status in reducing mortality risks. The findings propose revisiting the Hispanic health paradox with the use of structural racism and gendered frameworks.

Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study

Objectives: This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Methods: Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Results: Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. Conclusions: These findings provide insight into biological differences underlying racial/ethnic disparities in health.

Time to Mainstream the Environment into Migration Theory?

As with all social processes, human migration is a dynamic process that requires regular theoretical reflection; this article offers such reflection as related to the role of the natural environment in contemporary migration research and theory. A growing body of evidence suggests that environmental contexts are increasingly shifting social and ecological realities in ways that are consequential to migration theory. We review some of this evidence, providing examples applicable to core migration theories, including neoclassical economic and migration systems perspectives, the "push-pull" framework, and the new economics of labor migration. We suggest that neglecting consideration of the natural environment may yield misspecified migration models that attribute migration too heavily to social and economic factors particularly in the context of contemporary climate change,. On the other hand, failure to consider migration theory in climate scenarios may lead to simplistic projections and understandings, as in the case of "climate refugees". We conclude that migration researchers have an obligation to accurately reflect the complexity of migration's drivers, including the environment, within migration scholarship especially in the context of global climate change.

Visa type and financial strain on depressive symptoms among Filipino migrants to the United States

Migrants have been theorized to be healthier than their non-migrant counterparts; however, there is limited examination of health selection using binational data and how selection occurs, particularly for mental health outcomes. This study examines the role of visa status and financial strain as critical factors for mental health selection among Filipino migrants to the U.S. and non-migrants who remain in the Philippines. We used the baseline data from the Health of Philippine Emigrants Study (HoPES; n = 1631) to compare depressive symptoms between non-migrants and migrants who were both surveyed prior to their departure to the U.S. We assessed depressive symptoms using linear regression by migration status, financial strain, and by visa categories including fiancée/marriage, unlimited family reunification, limited family reunification, and employment. Overall, all migrants reported lower depressive symptoms than non-migrants; however, depressive symptoms varied by visa type. Fiancée/marriage migrants had lower depressive symptoms than compared to limited family reunification migrants. Additionally, those who reported financial strain had higher depressive symptoms than those without any financial strain. We find that migrants were positively selected for mental health using a unique sample of Filipino migrants before they left for the U.S.

Intersectional Approaches to Minority Aging Research

Purpose of Review

Growing racial/ethnic diversity among America's older adults necessitates additional research specifically focused on health and well-being among aging minoritized populations. Although Black and Latinx adults in the USA tend to face worse health outcomes as they age, substantial evidence points to unexpected health patterns (e.g., the race paradox in mental health, the Latino health paradox) that challenge our understanding of health and aging among these populations. In this review, we demonstrate the value of intersectionality theory for clarifying these health patterns and highlight the ways that intersectionality has been applied to minority aging research. To advance the field, we also make several recommendations for incorporating intersectional approaches in future scholarship on minority aging.

Recent Findings

Scholars have applied intersectional approaches to health and aging to unravel how social statuses and social conditions, such as race, ethnicity, gender, nativity, incarceration history, geographic region, and age, produce distinct shared experiences that shape health trajectories through multiple mechanisms.

Summary

We highlight common intersectional approaches used in minority aging research and underscore the value of this perspective for elucidating the complex, and often unexpected, health patterns of aging minoritized populations. We identify several key lessons and propose recommendations to advance scholarship on minority aging.

Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife

This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.

Diminished Advantage or Persistent Protection? A New Approach to Assess Immigrants' Mortality Advantages Over Time

Much research has debated whether immigrants' health advantages over natives decline with their duration at destination. Most such research has relied on (pooled) cross-sectional data and used years since immigration as a proxy for the duration of residence, leading to the challenge of distilling the duration effect from the confounding cohort-of-arrival and age-of-arrival effects. Because longitudinal studies tend to use self-rated health as the outcome, the changes they observed may reflect shifts in immigrants' awareness of health problems. We illuminate the debate by examining how immigrants' mortality risk-a relatively unambiguous measure tied to poor health-changes over time compared to natives' mortality risk. Our analysis uses the National Health Interview Survey (1992-2009) with linked mortality data through 2011 (n = 875,306). We find a survival advantage for U.S. immigrants over the native-born that persisted or amplified during the 20-year period. Moreover, this advantage persisted for all immigrants, regardless of their race/ethnicity and gender or when they began their U.S. residence. This study provides unequivocal evidence that immigrant status' health protection as reflected in mortality is stable and long-lasting.

Do Immigrants' Health Advantages Remain After Unemployment? Variations by Race-Ethnicity and Gender

Immigrants tend to display more favorable health outcomes than native-born co-ethnics. At the same time, they face considerable employment instability. It is unclear whether immigrants' job conditions may compromise their health advantage. Using U.S. National Health Interview Survey data, this study shows that the experience of unemployment reduces immigrants' health advantage, but unemployed foreign-born Blacks, White women, and Asian women still have lower mortality rates than their native-born employed counterparts. Overall, unemployment is less detrimental to immigrants than to natives, and immigrants' "survival advantage after unemployment" persists as their duration of residence extends. We further find substantial heterogeneity in the unemployment effect within immigrants. Asian immigrants display a much sharper gender difference in the mortality consequence of unemployment than other immigrants. Asian men's worse general health and substantially higher smoking rate, especially among the unemployed, lead them to fare much worse than Asian women following unemployment.

Beyond Black vs White: racial/ethnic disparities in chronic pain including Hispanic, Asian, Native American, and multiracial US adults

ABSTRACT

Previous literature on race/ethnicity and pain has rarely included all major US racial groups or examined the sensitivity of findings to different pain operationalizations. Using data from the 2010 to 2018 National Health Interview Surveys on adults 18 years or older (N = 273,972), we calculated the weighted prevalence of 6 definitions of pain to provide a detailed description of chronic pain in White, Black, Hispanic, Asian, Native American, and multiracial groups. We also estimated modified Poisson models to obtain relative disparities, net of demographic and socioeconomic (SES) factors including educational attainment, family income, and home ownership; finally, we calculated average predicted probabilities to show prevalence disparities in absolute terms. We found that Asian Americans showed the lowest pain prevalence across all pain definitions and model specifications. By contrast, Native American and multiracial adults had the highest pain prevalence. This excess pain was due to the lower SES among Native Americans but remained significant and unexplained among multiracial adults. The pain prevalence in White, Black, and Hispanic adults fell in between the 2 extremes. In this trio, Hispanics showed the lowest prevalence, an advantage not attributable to immigrant status or SES. Although most previous research focuses on Black-White comparisons, these 2 groups differ relatively little. Blacks report lower prevalence of less severe pain definitions than Whites but slightly higher prevalence of severe pain. Net of SES, however, Blacks experienced significantly lower pain across all definitions. Overall, racial disparities are larger than previously recognized once all major racial groups are included, and these disparities are largely consistent across different operationalizations of pain.

The Intersection of Immigrant and Environmental Health: A Scoping Review of Observational Population Exposure and Epidemiologic Studies

BACKGROUND

Transnational immigration has increased since the 1950s. In countries such as the United States, immigrants now account for > 15 % of the population. Although differences in health between immigrants and nonimmigrants are well documented, it is unclear how environmental exposures contribute to these disparities.

OBJECTIVES

We summarized current knowledge comparing immigrants' and nonimmigrants' exposure to and health effects of environmental exposures.

METHODS

We conducted a title and abstract review on articles identified through PubMed and selected those that assessed environmental exposures or health effects separately for immigrants and nonimmigrants. After a full text review, we extracted the main findings from eligible studies and categorized each article as exposure-focused, health-focused, or both. We also noted each study's exposure of interest, study location, exposure and statistical methods, immigrant and comparison groups, and the intersecting socioeconomic characteristics controlled for.

RESULTS

We conducted a title and abstract review on 3,705 articles, a full text review on 84, and extracted findings from 50 studies. There were 43 studies that investigated exposure (e.g., metals, organic compounds, fine particulate matter, hazardous air pollutants) disparities, but only 12 studies that assessed health disparities (e.g., mortality, select morbidities). Multiple studies reported higher exposures in immigrants compared with nonimmigrants. Among immigrants, studies sometimes observed exposure disparities by country of origin and time since immigration. Of the 50 studies, 43 were conducted in North America.

DISCUSSION

The environmental health of immigrants remains an understudied area, especially outside of North America. Although most identified studies explored potential exposure disparities, few investigated subsequent differences in health effects. Future research should investigate environmental health disparities of immigrants, especially outside North America. Additional research gaps include the role of immigrants' country of origin and time since immigration, as well as the combined effects of immigrant status with intersecting socioeconomic characteristics, such as race/ethnicity, income, and education attainment. https://doi.org/10.1289/EHP9855.

Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I² = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I² = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I² = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

Food insecurity, diabetes, and perceived diabetes self-management among Latinos in California: Differences by nativity and duration of residence

We examined associations between food security (FS) status and type 2 diabetes (T2D) prevalence and perceived T2D self-management by nativity and US duration of residence among Latinos living in California. We used the California Health Interview Survey (2012-2017) and included Latinos who lived below 200% of the federal poverty line (n = 16,254) and for our management outcome, those with T2D (n = 2284). Latinos with low FS (OR = 1.44, 95% CI 1.14-1.83) or very low FS (OR = 1.87, 95% CI 1.33-2.61) had a higher odds of T2D compared to their food-secure counterparts. When stratified by nativity/duration in the US, US-born Latinos and Latino immigrants with >10 years duration had a higher odds of T2D if they reported low FS (US-born: OR = 1.60, 95% CI 1.02-2.52; >10 yrs: OR = 1.48, 95% CI 1.12-1.97) or very low FS (US-born: OR = 2.37, 95% CI 1.45-3.86; >10 yrs: OR = 1.78, 95% CI 1.15-2.76) compared to their food-secure counterparts. There was no association among immigrants with <10 years duration. For perceived T2D self-management, those with low or very low FS had lower odds of reporting proper management (OR = 0.56, 95% CI 0.36-0.86; OR = 0.46, 95% CI 0.26-0.83) compared to their food-secure counterparts. When stratified by nativity, the US-born did not differ in their perceived self-management by FS status, while immigrants with low or very FS had lower odds of perceived self-management (OR = 0.54, 95% CI 0.34-0.86; OR = 0.36, 95% CI 0.17-0.74), compared to their food-secure counterparts. Food insecurity may be an important contributor to T2D prevalence and perceived T2D self-management for Latino immigrants.

Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study

Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities

BACKGROUND

There are large and persistent disparities in life expectancy among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial-ethnic groups, in 3110 US counties over 20 years, to describe spatial-temporal variations in life expectancy and disparities between racial-ethnic groups.

METHODS

We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial-ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth.

FINDINGS

Between 2000 and 2019, trends in life expectancy differed among racial-ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [-0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial-ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019.

INTERPRETATION

Disparities in life expectancy among racial-ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all.

FUNDING

National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health.

Stress Exposure and Physical Health among Older African American and Caribbean Black Women

Objectives: This study assessed whether multiple stress exposures and stress accumulation explained differences in physical health among Afro-Caribbean and African American women in older adulthood. Whether specific stressors uniquely influenced the health of African American and Afro-Caribbean women was also examined. Methods: Data were drawn from the National Survey of American Life (NSAL) (N=867; 50 years and older). Physical health was assessed by multiple chronic conditions, functional limitations, and self-rated health. Weighted binary logistic regression and ordered logistic regression analyses were conducted. Results: Compared to Afro-Caribbean women, African American women had worse physical health and greater stress exposure. Nonetheless, stress exposure did not explain ethnic differences in physical health. The association between specific measures of stress and physical health was dependent on the stressor and physical health measure. Discussion: Findings emphasize the importance of ethnic variation in health and stress exposure among older US Black women. Study implications are discussed.

Contextualizing Educational Disparities in Health: Variations by Race/Ethnicity, Nativity, and County-Level Characteristics

Educational disparities in health are well documented, yet the education-health relationship is inconsistent across racial/ethnic and nativity groups. These inconsistencies may arise from characteristics of the early life environments in which individuals attain their education. We evaluate this possibility by investigating (1) whether educational disparities in cardiometabolic risk vary by race/ethnicity and nativity among Black, Hispanic, and White young adults; (2) the extent to which racial/ethnic-nativity differences in the education-health relationship are contingent on economic, policy, and social characteristics of counties of early life residence; and (3) the county characteristics associated with the best health at higher levels of education for each racial/ethnic-nativity group. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that Black young adults who achieve high levels of education exhibit worse health across a majority of contexts relative to their White and Hispanic counterparts. Additionally, we observe more favorable health at higher levels of education across almost all contexts for White individuals. For all other racial/ethnic-nativity groups, the relationship between education and health depends on the characteristics of the early life counties of residence. Findings highlight place-based factors that may contribute to the development of racial/ethnic and nativity differences in the education-health relationship among U.S. young adults.

Health-Care Utilization of Refugees: Evidence from Austria

European countries have experienced significant inflows of migrants in the past decade, including many refugees from regions engaged in armed conflicts. Although previous research on migrant health has largely focused on economic migration, empirical evidence on refugee health is sparse. This article uses administrative data from Austria to differentiate between economic migrants and refugees and to analyze both groups’ health-care expenditures in comparison to natives. We contribute to the literature on migrant health in several dimensions. First, we follow economic migrants and refugees over the first five years after arrival and show different health-care expenditure patterns among migration groups. In contrast to patterns for economic migrants, we find substantially higher health-care expenditures for refugees compared to natives, especially in the first year after arrival. This difference is not explained by specific diseases or individual refugee groups, indicating refugees’ generally inferior health status in the first years of settlement. Second, we focus on the health effects of granting asylum and find that the expenditure differences decrease after a positive asylum decision. In the last part, by using refugees’ quasi-random placement as a natural experiment, we show that the local health-care sector's characteristics do not have a significant effect on expenditure levels. The findings highlight the importance of distinguishing between migrant groups in the analysis of health-care utilization and show that the time spent in the host country, as well as legal status, have a substantial impact on migrants’ health-care utilization.

Disparities in diabetes between US-born and foreign-born population: using three diabetes indicators

We investigated disparities in diabetes between the US-born and foreign-born populations using three diabetes measures: diagnosed diabetes, undiagnosed diabetes, and total diabetes, either diagnosed or undiagnosed diabetes. We analyzed adults aged 30-84 years drawn from the National Health and Nutrition Examination Survey 2009-2018 (n = 21,390). Of cohorts in 2009-2018, foreign-born adults had significantly higher age-standardized prevalence of diagnosed (12.6% vs. 10.6%) and undiagnosed diabetes (4.5% vs. 2.6%), and total diabetes (17.1% vs. 13.2%) than US-born adults. Results from logistic and multinomial regressions adjusting for age, sex, race/ethnicity, limited access to healthcare and BMI showed that the foreign-born had significantly higher odds of total diabetes (OR: 1.25, 95% CI: 1.04-1.50) and undiagnosed diabetes (OR: 1.83, 95% CI: 1.44-2.32) compared to the US-born. There was no significant difference in diagnosed diabetes by nativity (OR: 1.12, 95% CI: 0.96-1.53). Our results show that foreign-born adults were at higher risk of diabetes than US-born adults, and the difference by nativity was largely attributable to BMI and racial/ethnic composition. In addition, we demonstrated the importance of choosing measures of diabetes in studying diabetes mainly due to the foreign-born group's high prevalence of undiagnosed diabetes, which biases the prevalence of diabetes downward when diagnosed diabetes is used.

When in America, do as the Americans? The evolution of health behaviors and outcomes across immigrant cohorts

This study seeks to understand US immigrants' health-related behaviors and outcomes across arrival cohorts. We simultaneously examine risky consumption choices (smoking and drinking) and physical health conditions (asthma, diabetes, vision problems, and coronary heart diseases) using data from the National Health Interview Surveys (1989-2018). We incorporate cohort fixed-effects and the interactions between cohort effects and years since immigration into our empirical framework to capture the dynamics of immigrant health over time. For all health indicators, we find that there are important differences between arriving immigrants and natives. Despite some heterogeneity in the dynamics of unhealthy behaviors, this heterogeneity seems to dissipate as we explore longer-term health outcomes. Overall, our findings provide an interesting outlook on how the integration into the host society affects American immigrants' health. We contribute new results to the immigrant assimilation literature, which has primarily focused on obesity and wages.

Diabetes prevalence among diverse Hispanic populations: considering nativity, ethnic discrimination, acculturation, and BMI

PURPOSE

To compare prevalence of self-reported diabetes between U.S. state-born, Puerto Rico-born, Mexico-born, Cuba-born, and South/Central America-born Hispanic groups, and examine whether risk for diabetes differs by country of origin and experiences with discrimination when accounting for BMI.

METHODS

Data from 6223 Hispanic respondents from the nationally representative NESARC-III study was used. Sociodemographic characteristics were compared across nativity groups, and adjusted odds of self-reported diabetes diagnosis (past year) tested. Differences by perceived discrimination (using endorsement of individual items assessing specific experiences) and by nativity were examined when accounting for sociodemographic characteristics, acculturation, and BMI.

RESULTS

Prevalence of self-reported diabetes diagnosis was significantly higher among the Puerto Rico-born Hispanics, and remained significantly elevated when adjusting for perceived discrimination, acculturation, and health risk behaviors. When adjusting further for BMI, there were no significant differences in the odds of diabetes by nativity. Prevalence of lifetime perceived discrimination was significantly lower among Cuba-born Hispanics. Mean BMI was significantly lower in South/Central America-born Hispanic individuals relative to U.S. state-, Mexico-, and Puerto Rico-born Hispanic groups. Higher BMI was associated with significantly greater risk of diabetes diagnosis across groups.

CONCLUSION

Marked heterogeneity exists in prevalence and in factors associated with diabetes risk and weight status across Hispanic groups in the U.S. Experiences with discrimination may play an important role in accounting for these differences. This should be considered when planning future research to inform the most optimal patient-centered prevention efforts.

LEVEL OF EVIDENCE

Level III, Evidence obtained from well-designed cohort analytic study.

Mexican immigrant health advantage in metabolic syndrome? Examining the contributions of demographic, socioeconomic, and health behavior characteristics

Although Mexican immigrants to the United States (US) have historically held health and mortality advantages over US-born groups, evolving population dynamics in Mexico paired with shifts in Mexico-US immigration patterns and policy regimes have raised new concerns about the metabolic health of recent cohorts of Mexican immigrants. Using a nationally representative sample of adults aged 20-years and older (n = 10,833) from the National Health and Nutrition Examination Study (NHANES, 1999-2016), we assess and seek to explain differences in metabolic syndrome (MetS) risk by race-ethnicity, country of origin, and duration of residence in the US and evaluate whether recent Mexican immigrants continue to exhibit a metabolic health advantage. We decompose the difference in MetS prevalence between US-born whites (45.5%) and recent Mexican immigrants (29.5%) to determine how demographic, socioeconomic, and health behavior characteristics contribute to the patterning of metabolic health. Findings reveal that recent Mexican immigrants hold a metabolic health advantage over all groups, which is accounted for by their younger age structure. Yet recent Mexican immigrants would retain a sizable age-adjusted MetS advantage if they were to achieve parity with US-born whites on education, income, and food security. To ensure that newly-arrived Mexican immigrants continue to experience historically favorable health and mortality prospects, modest policy changes could offer health-promoting protections in the form of increased economic and food security, as well as improved educational opportunities for younger immigrants.

The Weight of Migration: Reconsidering Health Selection and Return Migration among Mexicans

While migration plays a key role in shaping the health of Mexican migrants in the US and those in Mexico, contemporary Mexican migration trends may challenge the health selection and return migration hypotheses, two prevailing assumptions of how migration shapes health. Using data from the Mexican Family Life Survey (2002; 2005), we tested these two hypotheses by comparing the cardiometabolic health profiles of (1) Mexico-US future migrants and nonmigrants and (2) Mexico-US return migrants and nonmigrants. First, we found limited evidence for health selection: the cardiometabolic health of Mexico-US future migrants was not measurably better than the health of their compatriots who did not migrate, although migrants differed demographically from nonmigrants. However, return migrants had higher levels of adiposity compared to those who stayed in Mexico throughout their lives; time spent in the US was also associated with obesity and elevated waist circumference. Differences in physical activity and smoking behavior did not mediate these associations. Our findings suggest positive health selection might not drive the favorable health profiles among recent cohorts of Mexican immigrants in the US. However, the adverse health of return migrants with respect to that of nonmigrants underscores the importance of considering the lived experience of Mexican migrants in the US as an important determinant of their health.

Immigrant Status, Citizenship, and Victimization Risk in the United States: New Findings from the National Crime Victimization Survey (NCVS)

Until recently, national-level data on criminal victimization in the United States did not include information on immigrant or citizenship status of respondents. This data-infrastructure limitation has hindered scientific understanding of whether immigrants are more or less likely than native-born Americans to be criminally victimized and how victimization may vary among immigrants of different statuses. We address these issues in the present study by using new data from the 2017-2018 National Crime Victimization Survey (NCVS) to explore the association between citizenship status and victimization risk in a nationally representative sample of households and persons aged 12 years and older. The research is guided by a theoretical framing that integrates insights from studies of citizenship with the literature on immigration and crime, as well as theories of victimization. We find that a person's foreign-born status (but not their acquired U.S. citizenship) confers protection against victimization. We also find that the protective benefit associated with being foreign-born does not extend to those with ambiguous citizenship status, who in our data exhibit attributes similar to the known characteristics of undocumented immigrants. We conclude by discussing the implications of our findings and the potential ways to extend the research.

Examining the relationship between self-reported lifetime cancer diagnosis and nativity: findings from the National Health and Nutrition Examination Survey (NHANES) 2011-2018

PURPOSE

Cancer incidence in the USA remains higher among certain groups, regions, and communities, and there are variations based on nativity. Research has primarily focused on specific groups and types of cancer. This study expands on previous studies to explore the relationship between country of birth (nativity) and all cancer site incidences among USA and foreign-born residents using a nationally representative sample.

METHODS

This is a cross-sectional study of (unweighted n = 22,554; weighted n = 231,175,933) participants between the ages of 20 and 80 from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Using weighted logistic regressions, we analyzed the impact of nativity on self-reported cancer diagnosis controlling for routine care, smoking status, overweight, race/ethnicity, age, and gender. We ran a partial model, adjusting only for age as a covariate, a full model with all other covariates, and stratified by race/ethnicity.

RESULTS

In the partial and full models, our findings indicate that US-born individuals were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.34, 95% CI [1.93; 2.84], p < 0.01) and (OR 1. 39, 95% CI [1.05; 1.84], p < 0.05), respectively. This significance persisted only among non-Hispanic Blacks when stratified by race. Non-Hispanic Blacks who were US-born were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.30, 95% [CI 1.31; 4.02], p < 0.05).

CONCLUSION

A variety of factors may reflect lower self-reported cancer diagnosis in foreign-born individuals in the USA other than a healthy immigrant advantage. Future studies should consider the factors behind the differences in cancer diagnoses based on nativity status, particularly among non-Hispanic Blacks.

Undocumented Older Latino Immigrants in the United States: Population Projections and Share of Older Undocumented Latinos by Health Insurance Coverage and Chronic Health Conditions, 2018-2038

OBJECTIVES

This paper focuses on the older Latino undocumented population and anticipates how their current demographic characteristics and health insurance coverage might impact future population size and health insurance trends.

METHODS

We use the 2013-2018 American Community Survey as a baseline to project growth in the Latino 55+ undocumented population over the next 20 years. We use the cohort component method to estimate population size across different migration scenarios and distinguish between aging in place and new in-migration. We also examine contemporary health insurance coverage and chronic health conditions among 55+ undocumented Latinos from the 2003-2014 California Health Interview Survey. We then project health insurance rates in 2038 among Latino immigrants under different migration and policy scenarios.

RESULTS

If current mortality, migration, and policy trends continue, projections estimate that 40% of undocumented Latino immigrants will be 55 years or older by 2038 - nearly all of whom will have aged in place. Currently, 40% of older Latino undocumented immigrants do not have insurance. Without policies that increase access to insurance, projections estimate that the share who are uninsured among all older Latinos immigrants will rise from 15% to 21%, and the share that is both uninsured and living with a chronic health condition will rise from 5% to 9%.

DISCUSSION

Without access health care, older undocumented immigrants may experience delayed care and more severe morbidity. Our projections highlight the need to develop and enact policies that can address impending health access concerns for an increasingly older undocumented Latino population.

Prevalence and associated risk factors for hepatitis B and C viruses among refugee populations living in Mahama, Rwanda: A cross-sectional study

INTRODUCTION

As part of the integration of refugees into Rwanda's national hepatitis C elimination agenda, a mass screening campaign for hepatitis B (HBV) and hepatitis C (HCV) was conducted among Burundian refugees living in Mahama Camp, Eastern Rwanda. This cross-sectional survey used data from the screening campaign to report on the epidemiology of viral hepatitis in this setting.

METHODS

Rapid diagnostic tests (RDTs) were used to screen for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) among people of ≥15years old. We calculated seroprevalence for HBsAg and anti-HCV by age and sex and also calculated age-and-sex adjusted risk ratios (ARR) for other possible risk factors.

RESULTS

Of the 26,498 screened refugees, 1,006 (3.8%) and 297 (1.1%) tested positive for HBsAg and Anti-HCV, respectively. HBsAg was more prevalent among men than women and most common among people 25-54 years old. Anti-HCV prevalence increased with age group with no difference between sexes. After adjusting for age and sex, having a household contact with HBsAg was associated with 1.59 times higher risk of having HBsAg (95% CI: 1.27, 1.99) and having a household contact with anti-HCV was associated with 3.66 times higher risk of Anti-HCV (95% CI: 2.26, 5.93). Self-reporting having HBV, HCV, liver disease, or previously screened for HBV and HCV were significantly associated with both HBsAg and anti-HCV, but RDT-confirmed HBsAg and anti-HCV statuses were not associated with each other. Other risk factors for HBsAg included diabetes (ARR = 1.97, 95% CI: 1.08, 3.59) and family history of hepatitis B (ARR = 1.32, 95% CI: 1.11, 1.56) and for anti-HCV included heart disease (ARR = 1.91, 95% CI: 1.30, 2.80) and history of surgery (ARR = 1.70, 95% CI: 1.24, 2.32).

CONCLUSION

Sero-prevalence and risks factors for hepatitis B and C among Burundian were comparable to that in the Rwandan general population. Contact tracing among household members of identified HBsAg and anti-HCV infected case may be an effective approach to targeted hepatitis screening given the high risk among self-reported cases. Expanded access to voluntary testing may be needed to improve access to hepatitis treatment and care in other refugee settings.

Acculturation and biological stress markers: A systematic review

BACKGROUND

The association of acculturation with health among immigrant populations is believed to be mediated, in part, by acculturation-related stress and stress biology.

OBJECTIVES

To review and qualitatively synthesize empirical findings on the relationship of acculturation with stress-related inflammatory and endocrine biomarkers and composite allostatic load (AL) scores.

METHODS

A literature search was performed in the PubMed and PsycInfo databases. Article titles, abstracts or full-texts were screened and checked for match with the search criteria. Studies were eligible if they empirically tested the relationship between acculturation and inflammatory/endocrine stress biomarkers or composite AL scores, and were published in the English language.

RESULTS

Among the 41 articles identified as relevant and included in this review, the majority were published after 2010, included adult Hispanic U.S.-based populations, used cross-sectional study designs, operationalized acculturation as a unidimensional construct, and varied considerably in the selection of covariates in the analyses. Acculturation was significantly associated with stress biomarkers in 29 studies, but the direction of effects varied across studies. Specifically, acculturation, operationalized as a higher orientation towards the host culture, was associated with inflammatory biomarkers in 10 of 14 studies, with endocrine stress biomarkers in 12 of 20 studies, and with composite AL scores in 7 of 8 studies. Overall, language-based proxy measures of acculturation were related to higher levels of stress-related inflammatory and endocrine biomarkers and to lower levels of AL scores, whereas nativity-, generation status- and length of stay-based proxy measures of acculturation were related to higher levels of inflammatory biomarkers and AL score.

DISCUSSION

The majority of studies reported associations between measures of acculturation and stress biomarkers, however the directions of effects varied across studies. We suggest this heterogeneity may, in part, be a function of limitations imposed by cross-sectional research designs and unidimensional measures of acculturation measures, and we highlight the need for longitudinal studies and use of multidimensional measures of acculturation to better uncover the biobehavioral mechanisms and pathways linking acculturation with health outcomes.

Health of Immigrant Children: The Role of Immigrant Generation, Exogamous Family Setting, and Family Material and Social Resources

Although the children of first-generation immigrants tend to have better health than the native population, the health advantage of the children of immigrant families deteriorates over generations. It is, however, poorly understood where on the generational health assimilation spectrum children with one immigrant and one native parent (i.e., exogamous families) lie, to what extent family resources explain health assimilation, and whether the process of assimilation varies across health conditions. We seek to extend our understanding of the process of health assimilation by analyzing the physical and mental health of immigrant generations, assessing the role of exogamous family arrangements, and testing the contributions of family material and social resources to children's outcomes. We use register-based longitudinal data on all children residing in Finland, born in 1986-2000, and alive in 2000; these data are free of reporting bias and loss to follow-up. We estimate the risk of receiving inpatient and outpatient care for somatic conditions, psychopathological disorders, and injuries by immigrant generation status. Our results show evidence of a negative health assimilation process, with both first- and second-generation immigrant children having a higher prevalence of physical problems and particularly mental health problems than native children that is only partially explained by family resources. We find that the children of exogamous families are at especially high risk of developing psychopathological disorders. These results provide strong support for the hypothesis that children of exogamous families constitute a specific health risk group and that the impact on children's health of family social and material resources seems to be secondary to other unobserved factors.

A Systematic Review Exploring Acculturation and Type 2 Diabetes in Spanish-Speaking Populations

BACKGROUND

Acculturation to the United States has been previously studied in Spanish-speaking populations, but little is known about the potential relationship between acculturation and type 2 diabetes mellitus (T2DM).

OBJECTIVE

The purpose of this systematic review was to explore the relationship between acculturation and T2DM in Spanish-speaking populations in the United States.

METHODS

Selected studies collected from a review of literature were analyzed by population, ethnicity, acculturation scale, and significance.

RESULTS

Thirty-two eligible articles showed conflicting data between the effects of acculturation on T2DM.

CONCLUSION

Overall, studies yielded inconclusive results on the significance of the relationship between acculturation and diabetes in Spanish-speaking populations, which merit further investigation.

Aging into disadvantage: Disability crossover among Mexican immigrants in America

The "Hispanic paradox" refers to the accepted finding that Mexican immigrants have lower mortality compared to the US-born population, despite having lower levels of income, educational attainment, and health insurance coverage. However, Mexican immigrants' mortality advantage is not matched by lower disability rates, particularly later in the life course. Past studies have identified a crossover in disability rates for Mexican immigrants using age-specific disability rates but confound the effects of aging and duration of residence. By using the synthetic cohort method, I extend prior work on the disability crossover by tracing immigrant cohorts across the life course and disentangling newly arrived immigrants from those already established in the U.S. I use American Community Survey (ACS) 2015-2019 data to test whether the acculturation or cumulative disadvantage hypotheses account for the disability crossover. I find that, contrary to the expected finding of a socioeconomic health gradient in disability rates, Mexican immigrants' high disability rates converge regardless of education level or immigrant cohort. In addition, Mexican female immigrants are doubly disadvantaged, living in a protracted period of disability compared to males of the same education level. My findings support the negative health acculturation hypothesis as the dominant pathway for Mexican immigrants' later-life disability trajectories and consequently the explanation behind the disability crossover.

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

Objectives

We integrated major theories in immigrant health and assimilation into a single analytical framework to quantify the degrees to which demographic composition, pathways to citizenship, and socioeconomic assimilation account for physical and mental health disparities between naturalized immigrants by region of origin.

Methods

Using the restricted data from the 2015–2016 California Health Interview Survey, we decomposed differences in physical and mental health into demographic factors, path to citizenship, and socioeconomic characteristics by region of origin using the Karlson, Holm, and Breen (KHB) method.

Results

Differences in socioeconomic status mediated most of the disparity in physical health between naturalized immigrants from different regions. Factors associated with major immigrant health theories—demographic composition, pathways to citizenship, and socioeconomic assimilation—did not mediate disparities in mental health.

Conclusion

This article argues that the study of health disparities among immigrants must simultaneously account for differences in demographic composition, immigration experience, and socioeconomic disadvantage. The findings also underscore the need for theory development that can better explain mental health disparities among immigrants.

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Socioeconomic disadvantage accounted for poorer physical health among naturalized citizens who were born in Mexico.

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Psychological distress is pervasive among naturalized citizens from Central and Latin America.

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Differences in SES mediated the disparity in physical health between naturalized immigrants from different regions.

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Demographic characteristics, time to citizenship, and SES did not mediate disparities in mental health.

Factors Associated with Return Migration of First-Generation Immigrants in Belgium (2001-2011)

Belgium is a country with a long and diverse history of migration. Given the diverse context of immigration to Belgium, reasons for return migration will most likely vary as well. With this study, we want to quantify the return migration of Belgium's immigrants and assess whether socio-economic, sociodemographic and health factors are related to return migration. Individually linked census and register data comprising the total Belgian first-generation immigrant population aged 25+ were used. Age-standardized emigration rates (ASER) by migrant origin and gender were calculated for the period 2001-2011. Additionally, relative return migration differences were calculated by country of origin and gender, adjusted for age group, length of stay, household composition, socio-economic indicators (education, home ownership and employment status) and self-rated health in 2001. Return migration was most common among immigrants from Spanish descent and from the neighbouring countries and higher among men than among women. Return migration was highly selective in terms of older age, lower length of stay in Belgium, not living with a partner or children, being high-educated, unemployed and in good health. Key issues for future research include examining the reasons for return migration, identifying the country of destination and accounting for household characteristics.

Estimating the effects of Mexico to U.S. migration on elevated depressive symptoms: evidence from pooled cross-national cohorts

PURPOSE

Migrating from Mexico to the U.S. is a major, stressful life event with potentially profound influences on mental health. However, estimating the health effects of migration is challenging because of differential selection into migration and time-varying confounder mediators of migration effects on health.

METHODS

We pooled data from the Mexican Health and Aging Study (N = 17,771) and Mexican-born U.S. Health and Retirement Study (N = 898) participants to evaluate the effects of migration to the U.S. (at any age and in models for migration in childhood or adulthood) on depressive symptom-count, measured with a modified Centers for Epidemiologic Studies-Depression scale. We modeled probability of migrating in each year of life from birth to either age at initial migration to the U.S. or enrollment and used these models to calculate inverse probability of migration weights. We applied the weights to covariate-adjusted negative binomial GEE models, estimating the ratio of average symptom-count associated with migration.

RESULTS

Mexico to U.S. migration was unrelated to depressive symptoms among men (ratio of average symptom-count= 0.98 [95% CI: 0.89, 1.08]) and women (ratio of average symptom-count = 1.00 [95% CI: 0.92, 1.09]). Results were similar for migration in childhood, early adulthood, or later adulthood.

CONCLUSIONS

In this sample of older Mexican-born adults, migration to the U.S. was unrelated to depressive symptoms.

Racial/Ethnic and Educational Disparities in the Impact of Diabetes on Population Health among the US-Born Population

OBJECTIVES

This study examines total life expectancies (TLE) for both healthy and diabetic US-born populations and two measures capturing quality of life: 1) the proportion of remaining life to be spent without either other chronic conditions or ADL disabilities (ADLs), and 2) the proportion of remaining life to be spent with ADLs for US-born diabetic populations by race/ethnicity and educational attainment.

METHODS

Using the 1998-2014 waves of the Health and Retirement Study (n=16,983), we apply a Bayesian multistate life table method to calculate these quantities from the constructed life tables.

RESULTS

TLE at age 50 is shorter for diabetic individuals than healthy individuals, for non-Hispanic Blacks than members of other racial/ethnic groups, and for less-educated individuals. Gaps in TLE at age 50 between healthy and diabetic populations range from 6.3 to 8.8 years across sex-race combinations, and 5.6 to 9.2 years across sex-education combinations. Among the diabetic population, those with at least a college degree on average have a higher proportion of remaining life to be spent without either other chronic conditions or ADLs. Hispanics and those without a college degree have a particularly high proportion of remaining life to be spent with ADLs. Although diabetic women on average live longer than men, their quality of life tends to be lower.

DISCUSSION

The impact of diabetes on population health varies across racial/ethnic and educational groups. The findings support targeted interventions for vulnerable groups, such as people of color, women, and less-educated individuals.

The determinants of immigrant health insurance in the United States: Understanding the role of health care in origin societies

We examine how immigrants' health insurance in the United States is shaped by institutional traits of the health care systems in their origin societies. Conditional on a wide range of individual, country-of-origin, state-level, and temporal controls, we find the affordability of health care back home helps explain immigrants' US health coverage. Specifically, low- and middle-income migrants from countries with less affordable health care are more likely to get private insurance once in the United States and, correspondingly, less likely to have public coverage, relative to migrants from countries with more affordable care. The relationship conforms to multiple hypotheses. As predicted by the institutional beliefs hypothesis, migrants from countries with less affordable care might anticipate equally expensive health services in the United States and, in turn, insure themselves against high medical bills. Likewise, as predicted by the endogenous preferences hypothesis, migrants from countries with less affordable care might be accustomed to paying more for health care and, in turn, be less reluctant to pay for private health insurance. Overall, the findings underscore the relevance of migrants' past health care experiences in their origin societies in informing their health insurance in the United States even years after migration.