Work Disability Among Native-born and Foreign-born Americans: On Origins, Health, and Social Safety Nets

Does an Immigrant Health Advantage Exist Among US Whites? Evidence from a Nationally-Representative Examination of Mental and Physical Well-Being

This study examines whether an immigrant health advantage exists among US Whites, a group often used as a reference category in research on racial and ethnic health disparities. Using recent data from the National Health Interview Survey (2019-2022), I disaggregate non-Hispanic White adults (n = 41,752) by nativity status and use logistic regression models to assess differences in six measures of mental and physical health. The analysis includes self-reported conditions (depression, anxiety, fair/poor self-rated health) and diagnosed conditions that require interaction with the healthcare system (hypertension, diabetes, and chronic obstructive pulmonary disease, COPD). Foreign-born Whites have a significantly lower prevalence of each health outcome relative to US-born Whites. The immigrant health advantage remains significant for depression, anxiety, fair/poor health (i.e., self-reported conditions) and diagnosed hypertension, after adjusting for sociodemographic and healthcare characteristics. In contrast, the inclusion of these explanatory factors reduces the nativity gap in diagnosed diabetes and COPD to non-significance. Overall, the results indicate important variation in health among Whites that is missed in studies that focus on US-born Whites, alone. Scholars must continue to monitor the health of White immigrants, who are projected to grow to 20% of the US immigrant population in the years to come.

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.

Differences in Work Disability Duration for Immigrants and Canadian-Born Workers in British Columbia, Canada

This study aimed to investigate differences in work disability duration among immigrants (categorized as economic, family member or refugee/other classification upon arrival to Canada) compared to Canadian-born workers with a work-related injury in British Columbia. Immigrants and Canadian-born workers were identified from linked immigration records with workers' compensation claims for work-related back strain, connective tissue, concussion and fracture injuries requiring at least one paid day of work disability benefits between 2009 to 2015. Quantile regression investigated the relationship between immigration classification and predicted work disability days (defined from injury date to end of compensation claim, up to 365 days) and modeled at the 25th, 50th and 75th percentile of the distribution of the disability days. With a few exceptions, immigrants experienced greater predicted disability days compared to Canadian-born workers within the same injury cohort. The largest differences were observed for family and refugee/other immigrant classification workers, and, in particular, for women within these classifications, compared to Canadian-born workers. For example, at the 50th percentile of the distribution of disability days, we observed a difference of 34.1 days longer for refugee/other women in the concussion cohort and a difference of 27.5 days longer for family classification women in the fracture cohort. Economic immigrants had comparable disability days with Canadian-born workers, especially at the 25th and 50th percentiles of the distribution. Immigrant workers' longer disability durations may be a result of more severe injuries or challenges navigating the workers' compensation system with delays in seeking disability benefits and rehabilitation services. Differences by immigrant classification speak to vulnerabilities or inequities upon arrival in Canada that persist after entry to the workforce and warrant further investigation for early mitigation strategies.

Cohort Trends in Working Life Expectancies at Age 50 in the United States: A Register-Based Study Using Social Security Administration Data

Objectives

Little is known about the length of working life, even though it is a key indicator for policy-makers. In this paper, we study how the length of working life at age 50 has developed in the United States from a cohort perspective.

Methods

We use a large longitudinal sample of U.S. Social Security register data that covers close to 1.7 million individuals of the cohorts born from 1920 to 1965. For all of these cohorts, we study the employment trajectories and working life expectancy (WLE) at age 50 by gender and nativity (native-born/foreign-born). For the cohorts with employment trajectories that are only incompletely observed, we borrow information from older cohorts to predict their WLE.

Results

The length of working life has been increasing for the native-born males and females, and the younger cohorts worked longer than the older cohorts. However, WLE might soon peak, and then stall. The gap in WLE between the native-born and the foreign-born has increased over time, although latter group might be able to catch up in the coming years.

Discussion

Our findings show that studying employment from a cohort perspective reveals crucial information about patterns of working life. The future development of the length of working life should be a major concern for policy-makers.

A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. Following integrative review and PRISMA guidelines, we searched four databases in English and performed supplementary searches in Russian, German, and Hebrew to identify qualitative and quantitative studies on FSU immigrants and health literacy. Six articles met inclusion criteria in English and one in German; the majority were published in the last five years. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Four articles were about immigrants with a mean age ≥50 years. All articles stressed the value of translated, culturally relevant health information. The health literacy of FSU immigrants is understudied, despite clear needs. Future research should include assessments of FSU immigrants’ health literacy and include diverse (e.g., age, gender) yet well-defined populations to determine both barriers and facilitators to their health literacy. This review, an example of a multilingual search, provided a comprehensive understanding of existing literature and is a useful approach for global health literacy research.

Disability, food insecurity by nativity, citizenship, and duration

Prior research examines the prevalence of either disability or food insecurity among immigrants. We examine whether the presence of a disability operates as a stronger predictor of food insecurity among prime-aged immigrants relative to the US-born. Probit models estimate the relationship of disability with food insecurity among immigrants and distinguish by duration of US residence and citizenship status using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2014. Descriptively, food insecurity was highest among non-citizen immigrants with longer durations of US residence, compared to non-citizen immigrants with shorter durations and naturalized immigrants. Multivariate results suggest that among Hispanics, the association between disability and food insecurity was stronger among immigrants compared to US-born adults; the disability-food insecurity association varied by an immigrant's duration of US residence and citizenship status. The results emphasize the importance of disaggregating by citizenship status and duration of US residence.

The Immigrant Health Differential in the Context of Racial and Ethnic Disparities: The Case of Diabetes

PURPOSE

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated, and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States.

METHODS

Using the 2000-2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the U.S. in shaping diabetes patterns.

RESULTS

Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the U.S. increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the U.S. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage.

DISCUSSION

Racial/ethnic differentials in diabetes are considerable, and are influenced by each group's nativity composition. Obesity and (for the foreign-born) time in the U.S. influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America's race-conscious society.