Persistent effects of legal status on healthcare access and outcomes: findings from a state-wide representative cross-sectional survey in California

Abstract

BackgroundTo examine how legal status and past undocumented status are associated with healthcare access and health outcomes.MethodsData were collected between 2018 and 2020 as a follow-on, cross-sectional survey to the California Health Interview Survey (N=2010). We used multiple regression models to assess associations between past and current legal status and usual source of care, delayed medical care and psychological distress.ResultsOverall, 26.2% of the sample had ever been undocumented. Compared with citizens who have always held lawful status (CLS), non-citizens who were previously undocumented (adjusted OR (aOR)=0.48, p<0.05) and non-citizens who have always held lawful status (NLS) (aOR=0.41, p<0.01) were less likely to have a usual source of care. Citizens who were previously undocumented were more likely to delay medical care (aOR=2.32, p<0.05) compared with CLS. NLS were more likely to have moderate and above distress (aOR=2.31, p<0.01) compared with CLS.ConclusionPublic health efforts are needed to address the burden of trauma and disadvantage among those experiencing persistent effects of undocumented status.