Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders

Abstract

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called “epidemiological paradox” or “immigrant health paradox”. To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002–2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes – perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like “immigrant health paradox” which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.

Social Determinants of Health and Mental Health Among Asian Americans in the United States

“…This result supports a recent caution against ignoring or oversimplifying the heterogeneity of the Asian immigrant population because factors that influence physical and mental health are complex and inconsistent across ethnic and cultural subgroups (de Castro et al, 2010;John, de Castro, Martin, Duran, & Takeuchi, 2012). Moreover, our study found that as compared with first-generation immigrants, U.S.-born Asian Americans fared significantly worse on the objective measures of physical and mental health (number of CHCs and any DSM-IV disorder), even though U.S.-born Asian Americans estimated their outcomes to be significantly better on their subjective self-report measures of physical and mental health.…”

Depression in Racial and Ethnic Minorities: the Impact of Nativity and Discrimination

“…More recent work specifies more nuanced patterns across and within racial and ethnic minorities attributable to nativity, socioeconomic status, and other protective effects and risk factors [24][25][26][27][28][29]; therefore, all groups do not react the same way to the same stimuli. For our study, we elected to examine the groups, based on their ethnicity or race (Black and Asian as races, Hispanic and Afro-Caribbean as ethnicities) and place of birth (foreign-born as compared to American-born), including other measures known to influence depression, specifically lifetime major depressive disorder.…”

The ‘healthy worker effect’: Do healthy people climb the occupational ladder?

“…However, the evidence is mixed and inconclusive. For instance, some studies find migrants exhibit poorer health compared to natives (John, et al, 2012) whilst others show that immigrants tend to have better health and mortality profiles than the native born, especially from the same racial/ethnic group (Markides & Rote, 2015). However, most of these studies relate to a small number of countries or a single country, whilst Ljunge (2016), using the same dataset as the one we employ in this study find no evidence of health differences between migrants and natives with the exception of Muslims.…”