Citizenship Status and Mortality Among Latinos: Analyses of the US National Health Interview Survey Linked Mortality Files
Authors: Guadamuz Jenny S. , Durazo Ramon , Morales Josefina Flores , Qato Dima M. 
Published: September 2021

Research Objective

Forty million Latino adults reside in the United States, including eleven million who do not possess US citizenship. Noncitizens disproportionately experience poverty, segregation, and inadequate access to healthcare—pathogenic mechanisms that adversely impact health. Here we examine the association between citizenship status (i.e., US‐born citizens, naturalized citizens, or noncitizens) and mortality among Latinos.

Study Design

Cohort study using data from the National Health Interview Survey (NHIS, 1998–2014) and mortality follow‐up through the end of 2015. We examined all‐cause and cause‐specific mortality. We used Poisson regressions adjusted for demographic factors (i.e., age, sex, origin, and region of residence) to estimate mortality rates and examine mortality risk differences. We also conducted mediation analysis to evaluate the extent to which socioeconomic factors (i.e., English fluency, educational attainment, poverty, and health insurance) explain the associations between citizenship status and mortality. All analyses were stratified by age‐group (<55 or ≥ 55 years).

Population Studied

Latino adults who are long‐term residents of the US (≥10 years, n = 177,219), including US‐born citizens (n = 90,494), naturalized citizens (n = 37,676), and noncitizen (n = 49,049).

Principal Findings

Among younger Latinos (<55 years), noncitizens (incidence rate ratio (IRR] 1.40 [95% confidence interval [CI]: 1.31, 1.49)) and naturalized citizens (IRR 1.15 [CI: 1.06, 1.25] have higher all‐cause mortality rates than US‐born citizens. Socioeconomic factors explained a substantial proportion of mortality risk differences between the US‐born population and noncitizens (43% [CI 20%, 67%)) and naturalized citizens (20% (CI: −1%, 41%]). Younger noncitizens were also at higher risk for deaths due to cancer (IRR 2.13 [CI: 1.86, 2.45), cardiometabolic diseases (IRR 1.42 [CI: 1.21, 1.66]), and accidents (IRR 1.54 [CI 1.31, 1.82)) than their US‐born counterparts. Among older Latinos (≥55 years), however, noncitizens had lower all‐cause mortality rates (IRR 0.91 [CI: 0.84, 0.99] than US‐born citizens—socioeconomic factors did not explain this mortality advantage.

Conclusions

Younger Latino noncitizens and, to a lesser extent, naturalized citizens are at higher risk of death than US‐born citizens. Future work should examine the role of structural barriers to health in explaining the mortality disadvantage among young and middle‐aged Latino noncitizens. Research should also focus on the potential role of survival bias in explaining why older Latino noncitizens have a modest mortality advantage.

Implications for Policy or Practice

As noncitizens experience systemic exclusions from labor, healthcare, and wealth, policies to address health disparities in the Latino population should acknowledge that citizenship status is a structural determinant of health.

Primary Funding Source

The Robert Wood Johnson Foundation.