# Presentation: 668316

## Physical and Mental Health Characteristics of US-born and Foreign-born Adults, 1997–2002

**Physical and Mental Health Characteristics of US-born and Foreign-born Adults, 1997–2002**
**Achintya N. Dey**
**Jacqueline Wilson Lucas**
**Division of Health Interview Statistics**

**Notes:**
The title of my presentation is “Physical and Mental health characteristics of US-born and Foreign-born adults, 1997-2002”

## Background

- 	Immigrants comprise 11.5% of U.S. 	population, largest percentage since 	the 1930’s
-     PRWORA (1996) restricted immigrants’ 	access to health benefits and care, 	placing their health at risk
-     Status of immigrant health, particularly 	physical and mental health status, needs 	to be studied and monitored

- Data source: CDC/NCHS, National Health Interview Survey 1997- 2002

- Preliminary Data

**Notes:**
Immigrants are the fastest growing segment of the US population.  Today immigrants comprise about 12% of US population.

The 1996 Personal Responsibility and Work Opportunities Reconciliation Act restricted immigrants’ access to all federal, state, and local public health care benefits, placing their health at risk.

The status of the immigrants physical and mental health needs to be studied and monitored. 

## Purpose

**Research questions**:
- Are there differences between the native born and foreign-born US population in health characteristics such as mental health status, perceived health status?
- Are there differences between the native born and foreign-born US population in risk factors for chronic diseases, such as obesity, smoking, diabetes, hypertension, and cardiovascular disease?

## Methods

-      Data came from Sample Adult component of the 	1997- 2002 NHIS (n=196,101)
-      Socio-demographic characteristics of US-born and 	Foreign-born adults 18 years old and over
-   	Odd ratios of selected physical and mental health 	measures of US-born and Foreign-born adults, 	adjusting for:
- Age, Sex, Race, Education, Income, Employment status, Family size, Marital status, MSA/Non-MSA, Region of residence

## Measurement of Health

- Physical health:
-  	Self-assessed health
-  	Need help in activities of daily living (ADL)
-  	Need help in instrumental activities of daily living 	(IADL)
-  	Selected chronic diseases and health behaviors:
-      	**Obesity ,smoking, hypertension, diabetes, ****	****cardiovascular diseases, coronary heart disease, ****	****heart disease, stroke, angina**
- Mental health:
- 	Serious psychological distress (K6 battery)

**Notes:**
ADL = Eating, Bathing, Dressing, and Getting around inside the home

IADL = Everyday household chores, Doing necessary business, Shopping, and Getting around for another purpose

K6 battery developed Dr. Ronald C. Kessler
There are 6 mental health items: Sad, Nervous, Restless, Hopeless, Effort, and Worthless.

High score (13 & over) considered as “Serious psychological distress”
Low score (less than 13) considered as “Not serious”

## Percent of Current Immigrants and Region of origin

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
Over half of the US immigrants are from Latin American and Caribbean. Another quarter from Asia, 14% from Europe.

## Age Group by Nativity Status,1997 - 2002

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
The overall foreign born adult population was younger than the native born adults.
In the age group 18-44, there were more foreign-born adults than US-born.
However 45 years and over, there are more US-born than foreign-born (47% vs. 38%) 

## Sex by Nativity Status, 1997 - 2002

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
In both US born and Foreign-born there are more women than men 

## Education by Nativity Status, 1997 - 2002

- Data Source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
One third of immigrant adults did not completed high school diploma.

61% of US-born completed HS and have some college degree compared with 41% foreign-born completed HS and have some college degree. 

About same percentage of US-born and foreign-born adults have 4 years of college degree and above.

## Family Income by Nativity Status,1997 - 2002

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
The US-born population had a higher percent of people whose families earned $20,000 and more.

## Employment Status by Nativity Status,1997 - 2002

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
Almost two third of US-born and Foreign-born adults were employed

## Place of Residence by Nativity Status, 1997 - 2002

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
94% of immigrants live in MSA either in central city or not in central city area. 

Higher percentage of native born adults tended to live outside of  MSA area.

## Region of residence by Nativity Status, 1997-2002  

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
Most of the native born adults lived in South (37%) followed by Midwest (27%), Northeast (19%) and West (17%).
On contrary, most of the immigrants tended to live in West (34%) followed by South (29%), Northeast (25%), and Midwest (12%).

## Adjusted Odds Ratios and Confidence Intervals of Selected Chronic Diseases by Nativity Status, 1997-2002

| Ref. group 
US-born | All Foreign-born | 0-4 years | 5-9 years | 10 & more years |
| --- | --- | --- | --- | --- |
| Obesity
(BMI >= 30) | 0.56
(0.53 – 0.60) | 0.32
(0.28 – 0.37) | 0.45
(0.40 – 0.51) | 0.67
(0.63 – 0.71) |
| Current Smoking | 0.62
(0.58 – 0.66) | 0.58
(0.51 – 0.66) | 0.50
(0.44 – 0.57) | 0.67
(0.62 – 0.72)
 |
| Hypertension | 0.75
(0.71 – 0.80) | 0.49
(0.42 – 0.56) | 0.56
(0.49 – 0.65) | 0.84
(0.79 – 0.89) |
| Diabetes | 0.71
(0.64 – 0.78) | 0.48
(0.35 – 0.65) | 0.40
(0.30 – 0.53) | 0.78
(0.71 – 0.86) |
| Cardiovascular diseases | 0.77
(0.70 – 0.85) | 0.67
(0.49 – 0.91) | 0.60 
(0.45 – 0.80) | 0.79
(0.72 – 0.87) |

**Foreign-born living in US**

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
Odds ratios for all Foreign-born are shown in col. 2
Odds ratios for all Foreign-born stratified into those who have been in US less than 5 years,  5-9 years and 10 year or more are shown in col. 3, 4 and 5

Result indicates that odds ratios of chronic disease morbidity during 1997-2002 among immigrants significantly lower than those for the US-born adults.

For example, compared to the US-born adult, the odds ratio of obesity, smoking, hypertension, diabetes and cardiovascular diseases were lower among the immigrants.  
However, the odds ratios increased with increasing duration of residence in US. And this is particularly true for obesity, smoking, hypertension and diabetes. Compared to the recent immigrants (living less than 5 years), the odds ratios of obesity, smoking, hypertension and diabetes were higher among the long-term immigrants (living 10 years and more).

However, the odds ratio didn’t changed that much for cardiovascular diseases.  

## Adjusted Odds Ratios and Confidence Intervals of Selected Health Status by Nativity, 1997-2002

| Ref. group 
US-born | All Foreign-born | 0-4 years | 5-9 years | 10 & more years |
| --- | --- | --- | --- | --- |
| Need help with IADL (Yes) | 0.73
(0.64 – 0.83) | 0.30
(0.19 – 0.49) | 0.51
(0.35 – 0.73) | 0.83
(0.73 – 0.94) |
| Need help with ADL (Yes) | N.S. | N.S.
 | 0.60
(0.37 – 0.96) | N.S.

 |
| Self-assessed health status (exc/vg/good) | 1.31
(1.22 –1.41) | 1.83
(1.52 – 2.21) | 1.79
(1.51 – 2.13) | 1.16
(1.08 – 1.26) |
| Serious psychological distress (Yes) | 0.81
(0.71 – 0.93) | 0.72
(0.55 – 0.95) | 0.48
(0.35 – 0.64) | N.S.
 |

**Foreign-born living in US**

- Data source: CDC/NCHS, National Health Interview Survey 1997-2002

- Preliminary Data

**Notes:**
Adjusted odds ratios of selected health status

Result shows that compared to the US-born adult, the odds ratio of needed help in IADL was lower among the immigrants. And the odds ratio increased with increasing duration of residence. Compared to the recent immigrants, the odds ratio of help needed for IADL was higher among the long-term immigrants. 
Immigrants were more likely rated their health positively. Again direction changed with the increase of duration of stay. 

Immigrants were less likely to report serious psychological distress.

## Summary

-  	**Immigrants adults enjoy better health than their US-born ****	****counterparts**:
-  	Health behaviors, such as lower risk of smoking and obesity.
-  	Lower risk of diabetes
-  	Less likely to report having hypertension and cardiovascular diseases.
-  	**Immigrants were more likely to rate their health positively**
-  	**Immigrants were less likely to have serious psychological ****	****distress**
-  	***The longer immigrants live in US, the more similar they become to ******	******the native born population***

**Notes:**
Overall results indicated that immigrants adults enjoy better health than their US-born counterparts.

They possess better health behaviors such as lower odds ratios of smoking and obesity, 
Lower odds ratios of diabetes and less likely report hypertension and cardiovascular diseases.
Immigrants were more likely to rate their health positively
Immigrants were less likely to have serious psychological distress
The longer immigrants live in US, the more similar they become to the native born population
This result is consistent with the assimilation theory as immigrants spend time in the US they gradually replace their old health behaviors/habits with those of receiving society.