Background: Health disparity is an increasingly prominent focus of public health research in the US. In numerous prior studies, sociodemographics have been found to be associated with differing health outcomes. Foreign birth and immigrant-related factors add a layer of complexity to health disparity research as the percentage of non US born individuals in the US has risen from 6.9% to 12.4% since the 1950s. However, although research into the association between immigration and mortality and other objective measures of health have been conducted, little study has been done of the subjective and/or actual health status of the foreign born. In this study, we examined the effect of immigration issues on the association between self-reported health status (SRHS) and selected variables in adults.
Method: Data from the 1997-2005 National Health Interview Survey (NHIS) were assessed examining selected health variables and covariates of non-institutionalized adults and children. Our sample consisted of 871,701 individuals, at least 18 years of age, who reported their SRHS and immigrant status. Odds ratios were estimated from multivariate logistic regression models. In addition, the interaction between nativity and race/ethnicity was assessed. Logistic regression was utilized to identify predictor variables for SRHS in US and foreign born populations. 95% confidence intervals were used to evaluate statistical significance in this study.
Results: During the 1997-2005 period, complete data were available on 136,394 foreign-born immigrants representing 15.65% of the NHIS population sample. Among
foreign-born immigrants, 10.9% reported their health status as “not good” compared to 9.2% of US born persons (crude odds ration = 1.21). However after adjustment for important health-related variables including age, presence of comorbid conditions and education, foreign born individuals were found to have a reduced odds of reporting poor health (adjusted odd ration = 0.88). Significant interactions were observed between nativity and race/ethnicity. Most notably, within the Hispanic population the odds of immigrants reporting “not good” health was 21% less than for US natives, a result likely arising because the US born Hispanics were more apt to be engaged in negative health behaviors and report comorbid conditions.
Conclusion: This study examines the impact of nativity and other selected variables on SRHS and adds new information to the current available research on the role immigration plays in health inequality. The most important finding was that immigrants were significantly more likely to report “not good” health without adjustment for health-associated variables and covariates. However, when these variables were controlled for in logistic regression models, the foreign born population had a 19% reduced risk of self-rating their health as low compared with US natives. Research into health disparity is important to many areas such as health policy and better understanding of the impact foreign-birth is critical in an increasingly global environment. Future study of the association between nativity and sociodemographic and other factors with health status is needed.