Explaining the Immigrant Health Advantage: Self-selection and Protection in Health-Related Factors Among Five Major National-Origin Immigrant Groups in the United States

Away from home, into the fields: Assessing the health of undocumented and indigenous farmworkers

A large and growing literature argues that the agricultural labor market is stratified by ethnicity and legal status. However, other markers of distinction, such as indigeneity, may overlap with legal status to reveal additional health inequalities. Our study contributes to this scholarly dialogue by assessing the relation between indigeneity, legality, and health among immigrant-origin farmworkers from Latin America. To this end, we use data from the National Agricultural Worker Survey (N = 21,092) to examine health outcomes among indigenous and non-indigenous immigrants. Results indicate that indigenous farmworkers experience higher rates of pain-but not chronic conditions-than their non-indigenous counterparts. While undocumented farmworkers who are not indigenous exhibit especially favorable health, indigenous workers who are documented are significantly more likely to suffer from pain. Finally, there is limited evidence that differences in insurance coverage can fully explain the patterning between legal status, indigeneity, and health. This project sheds light on the well-being of indigenous migrant laborers in the U.S. food system, a population that experiences pervasive barriers to socioeconomic advancement at home and abroad.

The mental health toll of the Great Migration: a comparison of mental health outcomes among descendants of African American migrators

INTRODUCTION

Research is beginning to examine the health outcomes of migrators of the Great Migration, a movement of up to eight million African Americans from the South to the North and West during the twentieth century. However, sparse evidence exists studying the health outcomes of the descendants of Great Migration movers. The aim for this study was to compare the lifetime prevalence of mental health disorders by migration status.

METHODS

We used a sample of 3183 African American adults from the National Survey of American Life (2001-2003). Using birthplaces of participants and their mothers, we classified adults as (1) Southern stayers, (2) migrators to the South, (3) migrators to the North or (4) Northern stayers. The outcomes were lifetime prevalence of any mental health, mood, anxiety, and substance use disorders. We used weighted log-Poisson regression models and adjusted for demographic characteristics and socioeconomic status.

RESULTS

Migrators to the North and Northern stayers had higher risks of any lifetime mental health, mood, anxiety, and substance use disorders compared to Southern stayers in the adjusted models. Migrators to the North and Northern stayers were more likely to report perceived discrimination.

CONCLUSION

This study suggests that migrating families to the North may have experienced mental health adversities.

A validation study for measuring Asian- and Hispanic-serving sociocultural institutions in neighborhoods using business listing data and potential implications for health

Ethnic enclaves influence the health of Asian American and Hispanic or Latinx/a/o populations, likely via neighborhood social, economic, and built environments. To facilitate studies aiming to disentangle these specific neighborhood mechanisms, we describe the creation and validation of two novel measures-Asian-serving and Hispanic-serving sociocultural institutions (SCIs)-to estimate the social, cultural, and economic character of ethnic enclaves in California. Business listing data were used to identify SCIs or businesses that promote cultural and social identity, including arts, civic, historical, religious, social service, and membership organizations. Keyword searches of business names were used to identify potential Asian- or Hispanic-serving SCIs. An online audit of 1,627 businesses within 12 cities confirmed the validity of using keyword searches to assess whether census tracts were high or low in Asian- or Hispanic-serving SCIs (sensitivity: 63%-100%, specificity: 86%-95%; positive predictive value: 63%-89%). In exploratory regression analyses, high presence of SCIs (compared to low presence) may be associated with neighborhood-level health indicators, including greater percentages of residents who had an annual checkup in majority Asian census tracts and lower percentages of residents who were current smokers in majority Asian and Hispanic census tracts. This approach advances methodology in measurement of neighborhood sociocultural environments.

The Immigrant Mortality Advantage Among Over-65 Middle Eastern and North African Immigrants to the United States

Immigrants to the United States often have longer life expectancies than their U.S.-born counterparts, however it is unclear whether a similar "immigrant advantage" exists for immigrants from the Middle East and North Africa (MENA). This study uses a novel machine-learning name classifier to offer one of the first national-level examinations of MENA mortality patterns by nativity in the United States. A recurrent neural network model was developed to identify MENA individuals based on given name and surname characteristics. The model was trained on more than 2.5 million mortality-linked social security records in the Berkeley Unified Numident Mortality Database (BUNMD). Mortality rates and life expectancy were estimated using a Gompertz distribution and maximum likelihood estimation, focusing on high-coverage years between 1988 and 2005 and deaths over age 65. Foreign-born MENA men over 65 showed a significant immigrant mortality advantage with a hazard ratio (HR) of 0.64 and an estimated 3.13 additional years of life expectancy at age 65 compared to U.S.-born counterparts. Foreign-born MENA women also exhibited an advantage, with a HR of 0.71 and an additional 2.24 years of life expectancy at age 65. This study is one of the first national-level analyses of mortality outcomes among the over-65 MENA population in the United States, finding a MENA immigrant mortality advantage. The results suggest further research is needed to identify and disaggregate the MENA population in health research.

Racial and ethnic minority status in country of birth modifies racial and ethnic disparities in influenza vaccination among New York City adults

BACKGROUND

Understanding the relationship between race/ethnicity, birthplace, and health outcomes is important for reducing health disparities. This study assessed the relationship between racial/ethnic identity and minority racial/ethnic status in country of birth on influenza vaccination among New York City (NYC) adults.

METHODS

Using 2015-2019 data from NYC's Community Health Surveys, we assessed the association between racial/ethnic identity and racial/ethnic minority status in birth country with past year influenza vaccination, calculating prevalence differences per 100 and assessing interaction on the additive scale using linear binomial regression, and prevalence ratios and interaction on the multiplicative scale using log-binomial regression.

RESULTS

Effect modification between race/ethnicity and minority racial/ethnic status in birth country was significant on the additive scale for Hispanic (p = 0.018) and Black (p = 0.025) adults and the multiplicative scale for Hispanic adults (p = 0.040). After stratifying by racial/ethnic minority or majority status in birth country, vaccination was significantly lower among Black adults compared with White adults among those in the minority (adjusted prevalence difference [aPD]=-12.98, 95%CI: -22.88-(-2.92)) and significantly higher among Hispanic adults compared with White adults among those in the majority (aPD=9.28, 95%CI: 7.35-11.21).

CONCLUSIONS

Racial/ethnic minority status in birth country is an important factor when examining racial/ethnic differences in vaccination status.

Sociodemographic and Lifestyle Factors and Epigenetic Aging in US Young Adults: NIMHD Social Epigenomics Program

Importance

Epigenetic clocks represent molecular evidence of disease risk and aging processes and have been used to identify how social and lifestyle characteristics are associated with accelerated biological aging. However, most research is based on samples of older adults who already have measurable chronic disease.

Objective

To investigate whether and how sociodemographic and lifestyle characteristics are associated with biological aging in a younger adult sample across a wide array of epigenetic clock measures.

Design, Setting, and Participants

This cohort study was conducted using data from the National Longitudinal Study of Adolescent to Adult Health, a US representative cohort of adolescents in grades 7 to 12 in 1994 followed up for 25 years to 2018 over 5 interview waves. Participants who provided blood samples at wave V (2016-2018) were analyzed, with samples tested for DNA methylation (DNAm) in 2021 to 2024. Data were analyzed from February 2023 to May 2024.

Exposure

Sociodemographic (sex, race and ethnicity, immigrant status, socioeconomic status, and geographic location) and lifestyle (obesity status by body mass index [BMI] in categories of reference range or underweight [<25], overweight [25 to <30], obesity [30 to <40], and severe obesity [≥40]; exercise level; tobacco use; and alcohol use) characteristics were assessed.

Main Outcome and Measure

Biological aging assessed from banked blood DNAm using 16 epigenetic clocks.

Results

Data were analyzed from 4237 participants (mean [SD] age, 38.4 [2.0] years; percentage [SE], 51.3% [0.01] female and 48.7% [0.01] male; percentage [SE], 2.7% [<0.01] Asian or Pacific Islander, 16.7% [0.02] Black, 8.7% [0.01] Hispanic, and 71.0% [0.03] White). Sociodemographic and lifestyle factors were more often associated with biological aging in clocks trained to estimate morbidity and mortality (eg, PhenoAge, GrimAge, and DunedinPACE) than clocks trained to estimate chronological age (eg, Horvath). For example, the β for an annual income less than $25 000 vs $100 000 or more was 1.99 years (95% CI, 0.45 to 3.52 years) for PhenoAgeAA, 1.70 years (95% CI, 0.68 to 2.72 years) for GrimAgeAA, 0.33 SD (95% CI, 0.17 to 0.48 SD) for DunedinPACE, and -0.17 years (95% CI, -1.08 to 0.74 years) for Horvath1AA. Lower education, lower income, higher obesity levels, no exercise, and tobacco use were associated with faster biological aging across several clocks; associations with GrimAge were particularly robust (no college vs college or higher: β = 2.63 years; 95% CI, 1.67-3.58 years; lower vs higher annual income: <$25 000 vs ≥$100 000: β = 1.70 years; 95% CI, 0.68-2.72 years; severe obesity vs no obesity: β = 1.57 years; 95% CI, 0.51-2.63 years; no weekly exercise vs ≥5 bouts/week: β = 1.33 years; 95% CI, 0.67-1.99 years; current vs no smoking: β = 7.16 years; 95% CI, 6.25-8.07 years).

Conclusions and Relevance

This study found that important social and lifestyle factors were associated with biological aging in a nationally representative cohort of younger adults. These findings suggest that molecular processes underlying disease risk may be identified in adults entering midlife before disease is manifest and inform interventions aimed at reducing social inequalities in heathy aging and longevity.

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.

The Sociodemographic and Lifestyle Correlates of Epigenetic Aging in a Nationally Representative U.S. Study of Younger Adults

Importance

Epigenetic clocks represent molecular evidence of disease risk and aging processes and have been used to identify how social and lifestyle characteristics are associated with accelerated biological aging. However, most of this research is based on older adult samples who already have measurable chronic disease.

Objective

To investigate whether and how sociodemographic and lifestyle characteristics are related to biological aging in a younger adult sample across a wide array of epigenetic clock measures.

Design

Nationally representative prospective cohort study.

Setting

United States (U.S.).

Participants

Data come from the National Longitudinal Study of Adolescent to Adult Health, a national cohort of adolescents in grades 7-12 in U.S. in 1994 followed for 25 years over five interview waves. Our analytic sample includes participants followed-up through Wave V in 2016-18 who provided blood samples for DNA methylation (DNAm) testing (n=4237) at Wave V.

Exposure

Sociodemographic (sex, race/ethnicity, immigrant status, socioeconomic status, geographic location) and lifestyle (obesity status, exercise, tobacco, and alcohol use) characteristics.

Main Outcome

Biological aging assessed from blood DNAm using 16 epigenetic clocks when the cohort was aged 33-44 in Wave V.

Results

While there is considerable variation in the mean and distribution of epigenetic clock estimates and in the correlations among the clocks, we found sociodemographic and lifestyle factors are more often associated with biological aging in clocks trained to predict current or dynamic phenotypes (e.g., PhenoAge, GrimAge and DunedinPACE) as opposed to clocks trained to predict chronological age alone (e.g., Horvath). Consistent and strong associations of faster biological aging were found for those with lower levels of education and income, and those with severe obesity, no weekly exercise, and tobacco use.

Conclusions and Relevance

Our study found important social and lifestyle factors associated with biological aging in a nationally representative cohort of younger-aged adults. These findings indicate that molecular processes underlying disease risk can be identified in adults entering midlife before disease is manifest and represent useful targets for interventions to reduce social inequalities in heathy aging and longevity.

Key Points

Question: Are epigenetic clocks, measures of biological aging developed mainly on older-adult samples, meaningful for younger adults and associated with sociodemographic and lifestyle characteristics in expected patterns found in prior aging research?Findings: Sociodemographic and lifestyle factors were associated with biological aging in clocks trained to predict morbidity and mortality showing accelerated aging among those with lower levels of education and income, and those with severe obesity, no weekly exercise, and tobacco use.Meaning: Age-related molecular processes can be identified in younger-aged adults before disease manifests and represent potential interventions to reduce social inequalities in heathy aging and longevity.

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.

Diabetes Among Racial and Ethnically Diverse Older Adults in the United States with Cognitive Limitations

Diabetes is one of the most common coexisting conditions among adults with cognitive limitations. Complexities of diabetes care present challenges for older adults and their caregivers. Few studies have evaluated disparities in the prevalence of coexisting diabetes among older adults with cognitive limitations by race/ethnicity and nativity. Our objectives were to (1) estimate the odds of coexisting diabetes among US- and foreign-born racial/ethnic groups compared to US-born non-Hispanic White older adults and (2) compare US- and foreign-born older adults within each racial/ethnic group. We linked and analyzed 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data among older adults with cognitive limitations (ages ≥ 65 years, n = 4688). The overall prevalence of coexisting diabetes among older adults with cognitive limitations was 30.3%. Among older adults with cognitive limitations and after adjusted for age, sex, education, and risk factors for diabetes and cognitive limitations, non-Hispanic Black (US-born OR = 1.56, 95%CI = 1.23-1.98; foreign-born OR = 2.69, 95%CI = 1.20-6.05) and Hispanic (US-born OR = 2.13, 95%CI = 1.34-3.40; foreign-born OR = 2.02, 95%CI = 1.49-2.72) older adults had higher odds of coexisting diabetes compared to US-born non-Hispanic Whites. There were no differences in the odds of coexisting diabetes among foreign-born non-Hispanic Black and Hispanic adults compared to US-born counterparts. Findings suggest a large potential burden of coexisting diabetes among this growing populations of US- and foreign-born racially/ethnically diverse older adults with cognitive limitations. Future studies are needed to examine how diabetes self-efficacy, treatment, and monitoring are impacted by cognitive limitations and determine ways to improve care in collaboration with caregivers and healthcare providers.

Upward Mobility Context and Health Outcomes and Behaviors during Transition to Adulthood: The Intersectionality of Race and Sex

This study investigates how upward mobility context affects health during transition to adulthood and its variations by race and sex. Using county-level upward mobility measures and data from the Panel Study of Income Dynamics, we apply propensity score weighting techniques to examine these relationships. Results show that low upward mobility context increases the likelihood of poor self-rated health, obesity, and cigarette use but decreases alcohol consumption probability. Conversely, high upward mobility context raises the likelihood of distress, chronic conditions, and alcohol use but reduces cigarette use likelihood. In low-opportunity settings, Black individuals have lower risks of chronic conditions and cigarette use than White men. In high-opportunity settings, Black women are more likely to experience depression and chronic conditions, and Black men are likelier to smoke than White men. Our findings emphasize the complex link between upward mobility context and health for different racial and sex groups.

Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems

Among the health priorities of international migrants, non-communicable diseases such as hypertension are of major interest due to their increasing prevalence, mainly in low- and middle-income countries. Previous evidence has reported a significant risk of hypertension in international migrants derived from multiple exposures during the migration process and at the destination, such as living conditions, health literacy and access to preventive services. Also, poorer disease control has been found compared to the local population. Considering existing deficiencies in access and use of healthcare services related to hypertension prevention and continuity of care of migrants globally, we aimed to offer a Latin American perspective of the challenges faced by international migrants residing in Latin America in accessing hypertension preventive care from a human rights, equity, and universal primary healthcare approaches. From a health systems perspective, we conducted a scoping review of scientific literature on hypertension prevention and control among international migrants in Latin America and the Caribbean. Based on the findings, we discuss the potential influence of migration and health policies on healthcare systems and individual and structural barriers to healthcare access, including lack of insurance, linguistic barriers, limited intercultural competence, and geographical and financial barriers. From existing evidence related to hypertension, we highlight the particular healthcare needs of migrants and their implications for regional public health goals. This aligns with promoting culturally tailored interventions considering the migration process, lifestyle patterns, structural vulnerabilities, and gender particularities in hypertension prevention, diagnosis, and treatment. We advocate for developing universal, voluntary, and systemic regional screening and disease control initiatives in Latin America for hypertension and other chronic conditions.

Maternal Nativity and Preterm Birth

Importance

Preterm birth is a major contributor to neonatal morbidity and mortality, and considerable differences exist in rates of preterm birth among maternal racial and ethnic groups. Emerging evidence suggests pregnant individuals born outside the US have fewer obstetric complications than those born in the US, but the intersection of maternal nativity with race and ethnicity for preterm birth is not well studied.

Objective

To determine if there is an association between maternal nativity and preterm birth rates among nulliparous individuals, and whether that association differs by self-reported race and ethnicity of the pregnant individual.

Design, Setting, and Participants

This was a nationwide, cross-sectional study conducted using National Center for Health Statistics birth registration records for 8 590 988 nulliparous individuals aged 15 to 44 years with singleton live births in the US from 2014 to 2019. Data were analyzed from March to May 2022.

Exposures

Maternal nativity (non-US-born compared with US-born individuals as the reference, wherein US-born was defined as born within 1 of the 50 US states or Washington, DC) in the overall sample and stratified by self-reported ethnicity and race, including non-Hispanic Asian and disaggregated Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Pacific Islander, Vietnamese, and other Asian), non-Hispanic Black, Hispanic and disaggregated Hispanic subgroups (Cuban, Mexican, Puerto Rican, and other Hispanic), and non-Hispanic White.

Main Outcomes and Measures

The primary outcome was preterm birth (<37 weeks of gestation) and the secondary outcome was very preterm birth (<32 weeks of gestation).

Results

Of 8 590 988 pregnant individuals included (mean [SD] age at delivery, 28.3 [5.8] years in non-US-born individuals and 26.2 [5.7] years in US-born individuals; 159 497 [2.3%] US-born and 552 938 [31.2%] non-US-born individuals self-identified as Asian or Pacific Islander, 1 050 367 [15.4%] US-born and 178 898 [10.1%] non-US-born individuals were non-Hispanic Black, 1 100 337 [16.1%] US-born and 711 699 [40.2%] non-US-born individuals were of Hispanic origin, and 4 512 294 [66.1%] US-born and 328 205 [18.5%] non-US-born individuals were non-Hispanic White), age-standardized rates of preterm birth were lower among non-US-born individuals compared with US-born individuals (10.2%; 95% CI, 10.2-10.3 vs 10.9%; 95% CI, 10.9-11.0) with an adjusted odds ratio (aOR) of 0.90 (95% CI, 0.89-0.90). The greatest relative difference was observed among Japanese individuals (aOR, 0.69; 95% CI, 0.60-0.79) and non-Hispanic Black individuals (aOR, 0.74; 0.73-0.76) individuals. Non-US-born Pacific Islander individuals experienced higher preterm birth rates compared with US-born Pacific Islander individuals (aOR, 1.15; 95% CI, 1.04-1.27). Puerto Rican individuals born in Puerto Rico compared with those born in US states or Washington, DC, also had higher preterm birth rates (aOR, 1.07; 95% CI, 1.03-1.12).

Conclusions and Relevance

Overall preterm birth rates were lower among non-US-born individuals compared with US-born individuals. However, there was substantial heterogeneity in preterm birth rates across maternal racial and ethnic groups, particularly among disaggregated Asian and Hispanic subgroups.

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.

Immigrant generation status and its association with pubertal timing and tempo among Hispanic girls and boys

PURPOSE

In the United States, Hispanic-Latino children reach puberty earlier on average than non-Hispanic white children. Yet among U.S. Hispanic/Latino children, pubertal timing comparisons between immigrant generations have not been made, hence we examined whether pubertal timing differs by immigrant generational status, independent of BMI and acculturation measures.

METHODS

Cross-sectional data on 724 boys and 735 girls, aged 10-15 years, from the Hispanic Community Children's Health Study/Study of Latino (SOL) Youth, were used to predict the median ages of thelarche, pubarche, and menarche in girls, and pubarche and voice change in boys, using Weibull survival models, while adjusting for SOL center, BMI, and acculturation.

RESULTS

In girls, the first generation began thelarche earlier than second and third generations (median age [years] [95% confidence interval]: 7.4 [6.1, 8.8] vs. 8.5 [7.3, 9.7] and 9.1 [7.6, 10.7], respectively), but began menarche later (12.9 [12.0,137] vs. 11.8 [11.0, 12.5] and 11.6 [10.6, 12.6], respectively). Pubertal timing and tempo for boys did not differ by generational status.

CONCLUSIONS

First-generation U.S. Hispanic/Latino girls had the earliest thelarche, latest menarche and longest pubertal tempo, compared to second and third generations. Factors beyond BMI and acculturation may account for the differences in pubertal timing by generational status of U.S. Hispanic/Latino girls.

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.

County-Level Relationships Between Foreign-Born Residents, Latinos, Immigration Enforcement, and Child Maltreatment Report Rates in the United States, 2015-2018

U.S. Latino and foreign-born populations show lower child maltreatment report (CMR) rates despite their low socioeconomic positions, perhaps due to protective cultural factors within these populations. However, discriminatory Immigration and Customs Enforcement (ICE) activities may attenuate such protection. We examined how ethnic and foreign-born compositions and local ICE activities were associated with community CMR rates, overall and within racial/ethnic groups (i.e., White, Black, Latino), and how these associations changed over time. We used national county-level data linking multiple administrative/archival data sources (i.e., CMR, Census, and ICE data) longitudinally for 2015 to 2018 across the United States. Multilevel (county-years, counties, and states) models estimated how percentages of Latino, percentages of foreign-born, and ICE arrest rates were related to overall and race/ethnicity-specific CMR rates among counties while adjusting for a range of demographic, socioeconomic, child care burden, health insurance, residential mobility, and urbanicity factors. Higher percentages of foreign-born residents within counties were significantly associated with lower CMR rates, both overall and within all racial/ethnic groups. These protective associations became significantly stronger over the study period. Higher percentages of Latino residents were significantly associated with lower total and White CMR rates but not with Black or Latino CMR rates. The interaction between the percentage of Latino residents and year was not significant. ICE arrest rates showed no significant associations with CMR rates. Our findings suggest that communities with more foreign-born and Latino residents may be more protective against CMRs. While the foreign-born and Latino concentrations were both independently predictive of decreased CMR rates, the protective associations of the foreign-born concentration were more consistent within racial/ethnic groups and grew stronger over time. These findings suggest the need to investigate community-level protective mechanisms that may explain these results. The null findings for ICE activity also require further research with alternative measures of discriminatory state action.

Role of country of origin and state of residence for dietary change among foreign-born adults in the US

Place of origin and place of current residence may shape migrants' health-related behaviors. Using the nationally-representative US New Immigrant Survey (n = 7930), we examined associations between country of origin, state of residence, and dietary changes among foreign-born adults. 65% of migrants reported dietary change since immigration (mean score = 7.3; range = 1-10); 6% of the variance was explained by country of origin characteristics; 1.6% by US state of residence; 1.4% by their interaction. Country of origin factors, specifically availability of animal source foods and sweets, were associated with dietary change, availability of sweets also including greater abandonment of specific foods and adoption of others.

Association of nativity with survival among adults with hepatocellular carcinoma

INTRODUCTION

Immigrants comprise a considerable proportion of those diagnosed with hepatocellular carcinoma (HCC) in the United States. Nativity or birthplace affects incidence and risk factors for HCC, but little is known about its influence on survival after diagnosis.

METHODS

We identified 51 533 adults with HCC with available birthplace in the California Cancer Registry between 1988 and 2017. HCC cases were categorized as foreign born or US born and stratified by mutually exclusive race and ethnicity groups. Primary outcome was all-cause mortality. Race and ethnicity-specific Cox regression propensity score-weighted models evaluated the relationship between nativity and death as well as region of birth among foreign-born patients.

RESULTS

A total of 40% of all HCC cases were foreign born, and 92.2%, 45.2%, 9.1%, and 5.8% of Asian/Pacific Islander (API), Hispanic, White, and Black patients were foreign born, respectively. Five-year survival rates were higher in foreign-born patients compared with US-born patients: 12.9% vs 9.6% for White patients, 11.7% vs 9.8% for Hispanic patients, 12.8% vs 8.1% for Black patients, and 16.4% vs 12.4% for API patients. Nativity was associated with survival, with better survival in foreign-born patients: White patients: hazard ratio (HR) = 0.86 (95% confidence interval [CI] = 0.81 to 0.90), Hispanic patients: HR = 0.90 (95% CI = 0.86 to 0.93), Black patients: HR = 0.89 (95% CI = 0.76 to 1.05), and API patients: HR = 0.94 (95% CI = 0.88 to 1.00). Among foreign-born patients, lower mortality was observed in those from Central and South America compared with Mexico for Hispanic patients, East Asia compared with Southeast Asia for API patients, and East Europe and Greater Middle East compared with West/South/North Europe for White patients.

CONCLUSION

Foreign-born patients with HCC have better survival than US-born patients. Further investigation into the mechanisms of this survival disparity by nativity is needed.

Do immigrants benefit from selection? Migrant educational selectivity and its association with social networks, skills and health

Recent scholarship suggests that immigrant selectivity - the degree to which immigrants differ from non-migrants in their sending countries - can help us understand their labour market outcomes in the receiving country. The selectivity hypothesis rests on three assumptions: first, that immigrants differ from non-migrants in their observed characteristics, such as education; second, that there is an association between such observed selection and (usually) unobserved characteristics, and third that this association drives positive relationships between observed selection and immigrant outcomes. While there is some evidence for a relationship between the degree of immigrants' selectivity and their children's outcomes, a comprehensive assessment of these assumptions for immigrants' own labour market outcomes remains lacking. We use high-quality, nationally representative data for the UK, with large numbers of immigrants from a wide range of different origins and with a rich set of measures of networks, traits and characteristics, as well as economic outcomes, not typically found in surveys of immigrants. This enables us to conduct a comprehensive assessment of the selectivity hypothesis and its assumptions. We find that immigrants to the UK are on average positively selected on educational attainment. However, counter to theoretical assumptions, educational selection has little association with labour market outcomes: it is not or negatively associated with employment; and it is only associated with pay for those with tertiary qualifications and with occupational position for women. We show that the general lack of economic benefits from selection is consistent with an absence of association between educational selectivity and (typically unobserved) mechanisms assumed to link selection and labour market outcomes: social networks, cognitive and non-cognitive skills, and mental and physical health. We contextualise our findings with heterogeneity analysis by migration regime, sending country characteristics, level of absolute education and location of credential.

Foreign-born status and risk of gestational diabetes mellitus by years of residence in the United States

To explore the association between acculturation among foreign-born (FB) women, gestational diabetes (GDM) and GDM-associated adverse birth outcomes, we conducted a retrospective cohort study of 34,696 singleton pregnancies from Houston, TX, between 2011 and 2022. FB women (n = 18,472) were categorized based on years of residence in US (0-5, 6-10, and > 10 years), while US-born women (n = 16,224) were the reference group. A modified Poisson regression model determined the association between acculturative level and GDM within the entire cohort and stratified by race/ethnicity. Compared to US-born women, FB women with 0-5 years [adjusted relative risk (RRadj.) 1.27, 95% confidence interval [CI] 1.14-1.42)], 6-10 years (RRadj. 1.89, 95%CI 1.68-2.11) and > 10 years in the US (RRadj. 1.85, 95%CI 1.69-2.03) had higher risk of GDM. Results were consistent for all racial/ethnic groups, although associations were not significant at 0-5 years. FB women had lower risk of other adverse pregnancy outcomes, except for preeclampsia with severe features at higher levels of acculturation. Results were similar among those with and without GDM. In conclusion, FB status increases risk of GDM among all racial/ethnic groups but is elevated with higher acculturation levels.

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.

Moving to opportunity? Low birth weight outcomes among Southern-born Black mothers during the Great Migration

OBJECTIVE

The Great Migration was a mass movement in the United States during the twentieth century of roughly eight million Black Southerners to the Northeast, Midwest, and West. Despite its significance, little is known about the health outcomes associated with this internal migration. This study assessed the relationship between migration and low birth weight among mothers born in the South between 1950 and 1969.

METHODS

We used approximately 1.4 million birth records of Black infants maintained by the US National Center for Health Statistics. To tease out the roles of the healthy migrant bias and of destination contexts, we compared two migration groups to Southern non-migrators: (1) migrators moving to the North and (2) migrators moving within the South. Non-migrants were matched to migrants using coarsened exact matching. We estimated the relationship between migration status and low birth weight stratified by birth year cohorts using logistic regression models.

RESULTS

There was positive selection in education and marriage among migrants moving out of the South and within the South. Results showed lower odds of low birth weight in both migration groups compared to Southern non-migrants. The odds ratios of low birth weight were similar in both comparisons.

CONCLUSION

We found evidence consistent with a healthy migrant bias in infant health among mothers during the last decades of the Great Migration. Despite better economic opportunity, migrating to the North may not have offered additional protection for infant birth weight outcomes.

Divergent Immigrant Health Trajectories: Disparities in Physical Health Using a Multidimensional Conceptualization of Legal Status

Immigrant health research demonstrates that foreign-born individuals generally experience lower morbidity rates relative to native-born individuals. However, this research often overlooks structural factors that influence the immigrant experience, such as legal status. The present study examines legal status as a multidimensional and dynamic characteristic that shapes immigrant health over time. I use two waves of the New Immigrant Survey (n = 3550) to assess if three dimensions of legal status — initial documentation classification, legal permanent residence (LPR) admission category, and US citizenship — predict likelihoods of reporting a chronic condition among a sample of immigrants who attained LPR. Results indicate that each of the three dimensions of legal status predicted health. Immigrants who obtained US citizenship improved their relative health over time, while immigrants with previous temporarily documented, undocumented, legalization, or refugee experience exhibited persistent disadvantage in the hierarchy of immigrant health. Findings demonstrate that the sociopolitical context continually shapes the physical health of immigrants, and a dynamic and multidimensional conceptualization of legal status can expose previously obscured disparities in the overarching pattern of an immigrant health advantage.

Urbanization and Cognitive Function Among Middle-Aged and Old Adults in China

OBJECTIVES

Our study examined the effect of urbanization on cognitive function and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.

METHODS

Using data from the China Health and Retirement Longitudinal Study, we compared cognitive function among three groups (urbanized-rural residents, rural nonmigrants, and urban nonmigrants). Logistic regression and structural equation models were applied to explore the impact of urbanization on cognitive function and the potential mechanisms.

RESULTS

Compared with the urbanized-rural group, urban nonmigrants had better cognitive function, with a significant coefficient of 1.56 (95% CI: 1.22, 1.89) for global cognition scores and 0.37 (95% CI: 0.22, 0.53) for episodic memory scores. The rural nonmigrants had the worst cognitive function (β = -0.79, 95% CI: -1.04, -0.55) and lower scores of mental intactness (β = -0.65, 95% CI: -0.84, -0.57) and episodic memory (β = -0.14, 95% CI: -0.26, -0.03). The association between urbanization and cognitive function was mainly mediated by income and living conditions among middle-aged and older adults.

DISCUSSION

Rural people who experienced planned urbanization in China had higher cognitive scores than rural non-migrants. Urbanization could thus have a beneficial and cumulative effect on cognitive function. Improvements in living conditions and changes in income are the main drivers behind the relationship. However, urbanization could compensate for the negative impact on cognitive function from disadvantaged early-life conditions, but it cannot completely eliminate the gap between urbanized-rural people and urban nonmigrants.

Adolescent Reproductive Health Outcomes Among Mexican-Origin Women on Both Sides of the U.S.-Mexico Border

PURPOSE

Much reproductive health research on the Latina population overlooks heterogeneity by national origin, nativity, and age and also ignores how U.S.-based populations differ from those in "sending" nations. The purpose of this study is to describe a history of adolescent birth, age at first sex, and contraceptive use at first sex in the Mexican-origin population in both the United States and Mexico.

METHODS

We developed a binational dataset merging two comparable nationally representative cross-sectional surveys in the United States and Mexico and used covariate balancing propensity scores to balance the age structure of our four samples: U.S.-born Latinas of Mexican origin, foreign-born Latinas of Mexican origin, U.S.-born non-Latina Whites, and Mexican women residing in Mexico. We used a negative binomial regression and calculated the predicted probability of experiencing at least one adolescent birth for each ethnicity/nativity group, stratified by 5-year age group. We also described age and contraceptive use at first sex.

RESULTS

Foreign-born Latinas of Mexican origin and Mexicans in Mexico had similar adjusted probabilities of reporting an adolescent birth (30.1% and 29.9%, respectively), which were higher than those of Mexican-Americans (26.2%) and U.S.-born non-Latina Whites (11.6%). History of an adolescent birth is declining across all four groups among younger ages. Differences do not appear to be driven by the timing of first sex but by contraceptive use, which is increasing among younger age groups.

DISCUSSION

Access to and use of effective contraception rather than timing of initiation of sexual activity is a key determinant of U.S. Latina and Mexican adolescent births.

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.

Geographic heterogeneity in Black-white infant mortality disparities

Despite recent decreases in Black infant mortality, racial disparities persist, motivating continued research into factors related to these inequalities. While the inverse association between education and infant mortality has been documented across races, less is known about its geographic heterogeneity. Using vital statistics from the National Center for Health Statistics, this study considers Black-white disparities in infant mortality for births occurring between 2011 and 2015 across regions and metropolitan status of maternal residence. With logistic regressions, we investigate heterogeneity in maternal educational gradients of infant mortality by geographic residence both within and between races. Beyond confirming the well-known relationship between education and infant mortality, our findings document a slight metropolitan advantage for infants born to white mothers as well as lower returns to education for infants born to Black mothers residing in nonmetropolitan counties. We observe a metropolitan advantage for infants born to Black mothers with at least a bachelor's degree, but a metropolitan disadvantage for infants born to Black mothers with less than a high school degree. The South is driving this divergence, pointing to particular mechanisms limiting returns to education for Southern Black mothers in nonmetropolitan areas. This paper's geographic perspective emphasizes that racial infant health disparities are not uniform across the country and cannot be fully understood through individual and household characteristics.

Impact of migration status on incidence of depression in the middle-aged and elderly population in China: Exploring healthy migrant and salmon bias hypotheses from a mental health perspective

BACKGROUND

The healthy migrant and salmon bias hypotheses stipulate that those who are healthier are more likely to migrate (a selection effect) and unhealthy migrants have a greater tendency to return to their origin communities than healthier migrants. It remains unclear whether the hypotheses are relevant for mental health, although they have robust evidence for physical health. The current study expands the theoretical foundation underlying these hypotheses by exploring the impact of migration status on depression among the middle-aged and older population in China.

METHOD

Longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015 and 2018 were used. Participants were divided into three groups, non-migrants, permanent migrants, and return-migrants according to their migration status. The Chinese version of 10-item Center for Epidemiologic Studies Depression Scale was used to assess clinically relevant depressive symptoms. Incidence were estimated by each migration status and compared across strata using log-rank tests. Cox regression models were fit to assess the relationship between migration status and depression incidence.

RESULTS

A total of 9264 middle-aged and elderly participants were included, of whom 7047 (76.1 %) were non-migrants, 1065 (11.5 %) were permanent migrants, and 1152 (12.4 %) were return-migrants, respectively. Incidence rates of depression by different migration statuses were 76.6/10³ person-years (73.7/10³-79.7/10³) in non-migrants, 62.9/10³ person-years (55.9/10³-70.6/10³) in permanent migrants, and 67.3/10³ person-years (60.7/10³-74.5/10³) in return-migrants. After controlling for covariates, only permanent migrants had significantly lower incidence of depression than non-migrants (HR: 0.85 (0.75, 0.96)). After stratifying by current place of residence, urban-permanent-migrants had a lower risk of depression than both rural and urban non-migrants, and the HRs and 95%CIs were 0.62 (0.52-0.74) and 0.81 (0.68-0.97).

LIMITATIONS

Migration statuses of participants may have changed over time, but due to the lack of raw data on migration status in 2013 and 2015, we used migration status at baseline. We were also not able to contextualize the migration experiences among those who migrated, and these trajectories may be heterogeneous.

CONCLUSION

Using depression as an indicator of mental health, the healthy migrant hypothesis was supported among middle-aged and elderly permanent migrants living in urban areas while the salmon bias hypothesis was not. Significant urban-rural inequities in mental health existed among different types of migrants. Especially among permanent migrants who have migrated and converted Hukou from their original registration place to their current residence.

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.

A Systematic Review and Meta-Analysis of the Associations between Immigration Status and Stroke Incidence and Mortality

Methods

We thoroughly searched PubMed, Embase, and MEDLINE databases for the literature on stroke risk for immigrants and host populations by January 2022. Fourteen relevant cohort studies from eight countries met the inclusion criteria, and their data were included in this meta-analysis. Heterogeneity and publication bias were assessed.

Results

The results showed that the immigrant groups suffered from a lower incidence rate of stroke compared with the host populations (HR = 0.81, 95% CI 0.71-0.91, P = 0.001), but there was nonsignificant higher mortality of stroke in immigrants (HR = 1.07; 95% CI 0.84-1.36). However, the pooled adjusted incidence HR reduced to 0.67 (95% CI 0.60-0.75) after adjustment for publication bias. Immigrants had a lower stroke incidence compared to long-term residents, but the association varied with the country of origin, socioeconomic status, residence (urban vs. rural), and comorbid conditions. Discussion. The present systematic review and meta-analysis implicated that stroke risks are different for immigrants and the host populations; therefore, this knowledge may be useful for developing targeted stroke prevention strategies.

The role of SNAP and WIC participation and racialized legal status in U.S. farmworker health

Background

Policies that restrict access to and use of the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) by legal status may disproportionately disadvantage particular racial and ethnic groups. While immigrant legal status, race, and ethnicity are recognized as independent social determinants of health, studies examining the extent to which legal status structures racial and ethnic health disparities are limited. Research is needed to identify factors that mitigate disparate health outcomes, such as SNAP and WIC.

Methods

Cross-sectional data from the 2009/2010 National Agricultural Workers Survey (N = 3,961) were analyzed. Chi-square tests and logistic regressions examined associations among self-reported health, race, ethnicity, legal status, and SNAP/WIC participation.

Results

Farmworkers reporting excellent or good health were more likely to be non-Hispanic White, U.S. citizen, aged 18–25, single, male, educated beyond primary school, living above the poverty level, without chronic health conditions, and located in the Midwest. Hispanic farmworkers had lower odds of reporting excellent or good health (OR 0.27, 95% CI 0.12–0.62). Among SNAP/WIC participants, Hispanic farmworkers had higher odds of reporting excellent or good health (OR 6.74, 95% CI 1.54–29.57) compared to non-Hispanic White farmworkers. There was no significant association between self-reported health and legal status.

Discussion

This study complements the extant literature showing racial and ethnic health disparities among the U.S. farmworker population. Results provide valuable insight on the health-protective potential of programs like SNAP and WIC, particularly among Hispanic farmworkers, who may be both less likely to be eligible and more hesitant to participate. These findings underscore the need to expand U.S. farmworkers’ eligibility and participation in SNAP and WIC.

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.

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.

The Missing Mortality Advantage for European Immigrants to the United States in the Early Twentieth Century

Immigrant populations typically have lower mortality rates and longer life expectancies than their nonimmigrant counterparts. This immigrant mortality advantage has been a recurrent finding in demographic and population health research focused on contemporary waves of immigration. However, historical data suggest that European immigrants to the United States in the early twentieth century had worse health and higher rates of mortality, yet it remains unclear why a mortality advantage was absent for immigrants during this period. This article combines Vital Statistics records and Lee-Carter mortality models to analyze mortality by nativity status for the U.S. White population from 1900 to 1960, examining variation by age, sex, time, and place. Contrary to contemporary expectations of a foreign-born mortality advantage, White immigrants had higher mortality rates in the early 1900s, with the largest foreign-born disadvantage among the youngest and oldest populations. Although foreign-born and U.S.-born White mortality rates trended toward convergence over time, the foreign-born mortality penalty remained into the 1950s. A decomposition analysis finds that immigrants' concentration in cities, which had higher rates of infectious disease mortality, accounted for nearly half of the nativity difference in 1900, and this place effect declined in subsequent decades. Additional evidence, such as a spike in mortality inequalities during the 1918 influenza pandemic, suggests that common explanations for the immigrant mortality advantage may be less influential in a context of high risk from infectious disease.

A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective

BACKGROUND

During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH).

METHODS

We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean).

RESULTS

International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44-0.84; P = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors.

CONCLUSIONS

Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.

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.

Evaluating clinical and demographic influences on health perception: A translation of the SF-12 for use with NHANES

Improving public health depends on an intricate understanding of the factors that influence how individuals perceive and self-report their personal health. Self-perceived health is an independent predictor of future health-related outcomes, but capturing self-perception of health is complex due to the intricate relationship between clinical and perceived health. A commonly used measure of self-perceived health is the Short Form 12 (SF-12), developed in the 1990s. In this study, we aim to evaluate clinical and demographic influences on self-perceived health among American adults using the National Health and Nutrition Examination Survey (NHANES). While NHANES captures information on a number of domains of health, including clinical assessments, it does not include SF-12 items necessary to measure self-perceived health. Therefore, to assess self-perceived health for our study, we constructed and validated a novel SF-12-equivalent measure for use with NHANES using analogous items from the 2015–2016 NHANES interview questionnaires. The developed measure reflects established knowledge of population health patterns and closely parallels the behavior of the original SF-12. An analysis of the clinical and demographic influences on this novel measure of health perception revealed that both clinical and demographic factors, such as depression status and race, influence how healthy individuals perceive themselves to be. Importantly, our analysis indicated that among American adults, while controlling for clinical and demographic covariates, an increase in low-density lipoprotein (i.e., “bad”) cholesterol level was associated with an improvement in self-perceived health. This study contributes significantly in two domains: it provides a novel measure of self-perceived health compatible for use with the widely used NHANES data (as well as details on how the process was developed), and it identifies a critical area in need of improved clinical education regarding the apparent confusion around cholesterol health.

•

Both clinical and demographic factors significantly influence health perception.

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Increased “bad” cholesterol paradoxically associated with better perceived health.

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Novel perceived health measure is reproducible with publicly available survey data.

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Understanding health perception patterns can inform health education and promotion.

Association of maternal socioeconomic status and race with risk of congenital heart disease: a population-based retrospective cohort study in Ontario, Canada

OBJECTIVE

To investigate the interrelationships between maternal socioeconomic status (SES), race and congenital heart diseases (CHD) among infants.

DESIGN

Retrospective cohort study.

STUDY SETTING

Ontario, Canada.

STUDY POPULATION

All singleton stillbirths and live births born in hospitals between 1 April 2012 and 31 March 2018 in Ontario, Canada (n=804 292).

OUTCOME

CHD.

ANALYSIS

Multivariable logistic regression models were performed to assess associations between maternal neighbourhood household income, education level, race and CHD while adjusting for maternal age at birth, assisted reproductive technology, obesity, pre-existing health conditions, substance use during pregnancy, maternal rural residence and infant's sex.

RESULTS

Compared with infants whose mothers lived in the highest median household income neighbourhoods, infants whose mothers lived in the lowest median income neighbourhoods had a higher likelihood of having CHD (adjusted OR 1.15, 95% CI 1.06 to 1.24). Compared with infants whose mothers lived in neighbourhoods with more people with a university or higher degree, those infants whose mothers lived in neighbourhoods with less people with a university or higher degree had a higher chance of developing CHD (adjusted OR 1.26, 95% CI 1.16 to 1.36). Compared with white mothers, black mothers had a higher odds of giving birth to a child with CHD (adjusted OR 1.40, 95% CI 1.27 to 1.54). No association was detected between White and Asian mothers and CHD among infants.

CONCLUSIONS

Our study indicates that there are inequities in CHD burden by maternal SES and race in Ontario, Canada. Further investigation is needed to examine racial variation in CHD using more detailed ethnic data.

U.S. Immigrants Have Highly Heterogeneous Perceptions of How Selected They Are on Health

Measuring immigrant health selection is crucial for understanding population health in immigrant-receiving countries. Recently, studies have measured health selection using respondents' perceptions of their health in comparison with those in their home countries. Yet we do not know how well this measure captures health selection. Using the New Immigrant Survey, the authors visualize respondents' self-reported levels of health selection stratified by self-rated health and by sending country. The visualization indicates that immigrants from the same country who rate their health the same still give very different answers when asked to compare their health with those in their home countries. These variations were observed for immigrants from all top five sending countries and at every level of self-reported health but are much larger among those who rate their health less favorably. Overall, the present findings signal that U.S. immigrants have highly heterogeneous perceptions of how selected they are.

Childhood vaccination timeliness following maternal migration to an informal urban settlement in Kenya

INTRODUCTION

Timely receipt of recommended vaccines is a proven strategy to reduce preventable under-five deaths. Kenya has experienced impressive declines in child mortality from 111 to 43 deaths per 1000 live births between 1980 and 2019. However, considerable inequities in timely vaccination remain, which unnecessarily increases risk for serious illness and death. Maternal migration is a potentially important driver of timeliness inequities, as the social and financial stressors of moving to a new community may require a woman to delay her child's immunizations. This analysis examined how maternal migration to informal urban settlements in Nairobi, Kenya influenced childhood vaccination timeliness.

METHODS

Data came from the Nairobi Urban Health and Demographic Surveillance System, 2002-2018. Migration exposures were migrant status (migrant, non-migrant), migrant origin (rural, urban), and migrant type (first-time, circular [previously resided in settlement]). Age at vaccine receipt (vaccination timeliness) was calculated for all basic vaccinations. Accelerated failure time models were used to investigate relationships between migration exposures and vaccination timeliness. Confounding was addressed using propensity score weighting.

RESULTS

Over one-third of the children of both migrants and non-migrants received at least one dose late or not at all. Unweighted models showed the children of migrants had shorter time to OPV1 and DPT1 vaccine receipt compared to the children of non-migrants. After accounting for confounding only differences in timeliness for DPT1 remained, with the children of migrants receiving DPT1 significantly earlier than the children of non-migrants. Timeliness was comparable among migrants with rural and urban origins and among first-time and circular migrants.

CONCLUSION

Although a substantial proportion of children in Nairobi's informal urban settlements do not receive timely vaccination, this analysis found limited evidence that maternal migration and migration characteristics were associated with delays for most doses. Future research should seek to elucidate potential drivers of low vaccination timeliness in Kenya.

Uncertainty About the Size of the Unauthorized Foreign-Born Population in the United States

One of the most common methods for estimating the U.S. unauthorized foreign-born population is the residual method. Over the last decade, residual estimates have typically fallen within a narrow range of 10.5 to 12 million. Yet it remains unclear how sensitive residual estimates are to their underlying assumptions. We examine the extent to which estimates may plausibly vary owing to uncertainties in their underlying assumptions about coverage error, emigration, and mortality. Findings show that most of the range in residual estimates derives from uncertainty about emigration rates among legal permanent residents, naturalized citizens, and humanitarian entrants (LNH); estimates are less sensitive to assumptions about mortality among the LNH foreign-born and coverage error for the unauthorized and LNH populations in U.S. Census Bureau surveys. Nevertheless, uncertainty in all three assumptions contributes to a range of estimates, whereby there is a 50% chance that the unauthorized foreign-born population falls between 9.1 and 12.2 million and a 95% chance that it falls between 7.0 and 15.7 million.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Racial/Ethnic Residential Segregation and the First Wave of SARS-CoV-2 Infection Rates: A Spatial Analysis of Four U.S. Cities

Previous research has linked racial/ethnic residential segregation to a number of poor health conditions, including infectious disease. Here, we examine how racial/ethnic residential segregation is related to the novel coronavirus, SARS-CoV-2. We examine infection rates by zip code level segregation in four major cities across the U.S.: New York City, Chicago, Houston, and San Diego. We also include a number of area-level Census variables in order to analyze how other factors may help account for the infection rate. We find that both Black and Latino residential clustering are significantly and positively related to a higher SARS-CoV-2 infection rate across all four cities, and that this effect is strong even when accounting for a number of other social conditions and factors that are salient to the transmission of infectious disease. As a result, we argue that neighborhood-level racial/ethnic patterning may serve as an important structural mechanism for disparities in SARS-CoV-2 infection.

Excess mortality among Latino people in California during the COVID-19 pandemic

Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which sociodemographic subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities. Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups categorized by age, sex, nativity, country of birth, educational attainment, occupation, and combinations of these factors. Our results indicate that during the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or a Central American country (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations. In sum, the COVID-19 pandemic has disproportionately impacted mortality among Latino immigrants, especially those in unprotected essential jobs. Interventions to reduce these inequities should include targeted vaccination, workplace safety enforcement, and expanded access to medical care and economic support.

Immigration and improvements in American life expectancy

Despite the immigrant mortality advantage and the increasing share of the population born abroad, relatively little is known about how immigration has impacted trends in US life expectancy. How immigrants contribute to national life expectancy trends is of increasing interest, particularly in the context of an unprecedented stagnation in American mortality. We find that immigration increases US life expectancy by 1.5 years for men and 1.4 years for women. Over half of these contributions occur at the prime working ages of 25-64. The difference between foreign-born and US-born mortality has grown substantially since 1990, with the ratio of US-born to foreign-born mortality rates nearly doubling by 2017. In that year, foreign-born life expectancy reached 81.4 and 85.7 years for men and women, respectively-7.0 and 6.2 years higher than their US-origin counterparts. These life expectancy levels are remarkable by most standards. Foreign-born male life expectancy exceeds that of Swiss men, the world leaders in male life expectancy. Life expectancy for foreign-born women is close to that of Japanese women, the world leaders in female life expectancy. The widening mortality difference between the US-born and foreign-born populations, coupled with an increase in the share of the population born abroad, has been responsible for much of the increase in national life expectancy in recent years. Between 2007 and 2017, foreign-born men and women were responsible for 44% and 60% of national life expectancy improvements. Between 2010 and 2017, immigrants experienced gains while the US-born experienced declines in life expectancy. Thus, nearly all of the post-2010 mortality stagnation is due to adverse trends among the US-born. Without immigrants and their children, national life expectancy in 2017 would be reduced to its 2003 levels. These findings demonstrate that immigration acts to bolster American life expectancy, with particularly valuable contributions at the prime working ages.

Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study

BACKGROUND

Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country.

METHODS

An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees.

RESULTS

A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues.

CONCLUSIONS

The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.