Health Care Access and Physical and Behavioral Health Among Undocumented Latinos in California

Abstract

Background:This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California.Methods:This study used data from the 2011–2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented).Results:Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos.Conclusions:Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.

Cardiovascular disease behavioral risk factors among Latinos by citizenship and documentation status

“…The pattern is similar among Latino green card holders and naturalized citizens compared to US-born Latinos, which indicates that there is little or no immigrant health advantage in CVD risk among men, but there likely is among women. Given that undocumented Latino immigrants also have significant barriers to health care, including insurance eligibility, access to health care providers, and language concordant care [9][10][11], future studies should be cognizant of citizenship and documentation statuses when identifying clinical interventions to reduce CVD outcomes.…”

“…Citizens are then asked, "when did you become naturalized?," while noncitizens are asked, "are you a permanent resident with a green card?" Following previous peer-reviewed studies [9][10][11][15][16][17], immigrant participants who are noncitizens and do not have a green card are classified as undocumented. We use information on citizenship and documentation statuses to create the following mutually exclusive groups for Latinos: US-born (8303), naturalized (3879), green card (3369) undocumented (3053).…”

“…Latino immigrant documentation status is associated with access to and utilization of health care, with studies showing undocumented Latino immigrants having lower rates of insurance, usual sources of care and use of health services than other US-born or immigrant Latinos [8][9][10][11] Having access to primary care has been shown to be positively associated with CVD behavioral prevention among Latinos [12]. Using a Los Angeles-based survey that included in-person blood pressure measurements, Young and Pebley (2017) found that undocumented Latino immigrants had higher rates of high blood pressure than documented Latino immigrants, and they had similar rates of high blood pressure to those who were USborn [13].…”

“…These findings suggest that there was not a healthy immigrant effect for undocumented immigrants. A recent study using pooled 2011-2015 waves of the California Health Interview Survey (CHIS) found that while undocumented Latinos had the worst patterns of access to and use of health services, they had better self-reported CVD clinical risk profiles, such as lower rates of overweight/obesity, high blood pressure and diabetes compared with other Latino immigrants and those who were US-born [10].…”

Modeling COVID-19 and Its Impacts on U.S. Immigration and Customs Enforcement (ICE) Detention Facilities, 2020

“…The poor medical care of detainees includes missed diagnoses and incorrect vaccine doses. Additionally, the literature documenting the health of undocumented individuals indicates they are more likely than the general population to be uninsured, have had poor prenatal care, and face stressors such as stigma, discrimination, and fear of deportation-all factors that negatively impact physical and mental health [8][9][10].…”