Immigrant Legal Status and Health: Legal Status Disparities in Chronic Conditions and Musculoskeletal Pain Among Mexican-Born Farm Workers in the United States

Abstract

Immigrant legal status determines access to the rights and privileges of U.S. society. Legal status may be conceived of as a fundamental cause of health, producing a health disparity whereby unauthorized immigrants are disadvantaged relative to authorized immigrants, a perspective that is supported by research on legal status disparities in self-rated health and mental health. We conducted a systematic review of the literature on legal status disparities in physical health and examined whether a legal status disparity exists in chronic conditions and musculoskeletal pain among 17,462 Mexican-born immigrants employed as farm workers in the United States and surveyed in the National Agricultural Workers Survey between 2000 and 2015. We found that unauthorized, Mexican-born farm workers have a lower incidence of chronic conditions and lower prevalence of pain compared with authorized farm workers. Furthermore, we found a legal status gradient in health whereby naturalized U.S. citizens report the worst health, followed by legal permanent residents and unauthorized immigrants. Although inconsistent with fundamental cause theory, our results were robust to alternative specifications and consistent with a small body of existing research on legal status disparities in physical health. Although it is well known that Mexican immigrants have better-than-expected health outcomes given their social disadvantage, we suggest that an epidemiologic paradox may also apply to within-immigrant disparities by legal status. We offer several explanations for the counterintuitive result.

Intra‐Ethnic Differences in Chronic Pain and the Associated Factors: An Exploratory, Comparative Design

“…The findings highlight the influence of the cultural and environmental factors on pain responses in immigrants in the United States. Sociocultural factors such as patient–provider ethnicity concordance, availability of social network and support (Lee, Merighi, & Lee, 2019), and immigrant legal status (Hamilton, Hale, & Savinar, 2019) may explain some of the disparities in chronic health conditions and health behaviors.…”

Disentangling contributions of demographic, family, and socioeconomic factors on associations of immigration status and health in the United States

“…3 Despite the need for evaluating immigrants’ health needs and responses to policy changes, lack of large population-representative individual-level data with respondents’ immigration histories, as well as detailed socio-demographic information, presents a challenge in studying immigrants’ health. 2 4 The potentially sensitive information on a person’s legal immigration category—naturalised citizen, permanent resident, undocumented or temporary visa-holder—makes research in this field especially difficult.…”

“…Our findings substantially expand the scope of the knowledge of immigrants’ health, especially the undocumented, which had predominantly focussed on Latino workers. 4 10–12…”

Pain trends among American adults 2002-2018: Patterns, disparities, and correlates

“…remained largely silent on the topic. For example, Demography, one of the highest-impact journals in population science, has in its 56-year history published only two articles with "pain" in their title or abstract, neither of which treat pain as their primary topic (Hamilton, Hale and Savinar 2019;Reither, Hauser and Swallen 2009). This may be a function of the peculiar status of pain, which until recently was viewed largely as a symptom of other conditions rather than as a condition in itself (Cohen, Quintner and Buchanan 2013;Raffaeli and Arnaudo 2017).…”