July 13, 2021 -- Immigrants to the U.S. are healthier and have better health outcomes on average than native-born Americans, according to a new study in the journal Health Affairs.

But the longer that immigrants live in the U.S., the more their health profiles resemble those of the native-born.

These findings are among a wealth of details about immigrants’ self-reported health and access to health care included the study. The researchers analyzed data from two large surveys, one national and the other focused only on California. The latter survey was used because it included data on undocumented immigrants that was lacking in the national poll.

Four groups of adult immigrants were compared to native-born adults: naturalized citizens, noncitizen immigrants in the U.S. for more than 5 years, noncitizen immigrants here for 5 years or less, and undocumented immigrants.

Self-reported health status among naturalized immigrants -- who, by definition, must be in the country for at least 5 years -- was similar to that of citizens born in the U.S., the study found. “In contrast, a higher share of noncitizen immigrants who had been in the U.S. for more than 5 years (30.1%) and who had been in the U.S. for 5 years or less (41.6%) had ‘excellent’ health compared with U.S.-born adults (27.1%).”

Both naturalized and noncitizen immigrants had lower rates of high blood pressure, heart disease, arthritis, asthma, and mental conditions, compared with U.S.-born adults. But naturalized citizens were more likely than the native-born to have type 2 diabetes.

The story was different for undocumented people. In the California survey, twice as many undocumented immigrants (33%) reported being in fair or poor health than native-born citizens (16.5%), and only 29.3% of the undocumented said they were in very good or excellent health, compared to 54.2% of native-born Californians.

In the national survey, the noncitizen adult immigrants were considerably younger, on average, than the U.S.-born adults, which partially explains their better health status. In addition, the study notes, “Chronic conditions are likely to be underdiagnosed among underserved immigrants because of poor access to health care.”

Arturo Vargas Bustamante, PhD, a professor of health policy and management, at UCLA’s Fielding School of Public Health, and the paper’s lead author, told WebMD that a third reason for the disparity between the health status of immigrant and native- born populations is the “healthy immigrant effect.” What this means is that people who choose to face the rigors and challenges of emigrating to a foreign nation tend to be stronger, physically and mentally, than other people from their home country.

Why Health Problems Increase

The biggest reason for the narrowing of differences in health status between immigrants and native-born Americans over time, Bustamante explains, is the aging of immigrants, which is linked to the same kinds of health problems that people born in this country have as they enter middle age.

In addition, he says, exposure to the U.S. lifestyle can harm immigrants’ health. “In their native countries, they might have walked to work or used public transport; here, they drive a car,” he notes. “They get hungry at night and start eating fast food, because it’s convenient. So the process of integrating into the U.S. society also comes with the process of assuming the American lifestyle and behavior.”

Finally, he observes, many immigrants live in low-income areas where there are food deserts, environmental hazards, and poor access to health care. “The longer they live in this country, the more exposed they are to these social determinants of health,” he says.

Higher Uninsured Rate

Compared with 11.4% of U.S.-born adults who lacked health insurance, uninsured rates were 12.3% among naturalized immigrants, 43% among noncitizen immigrants in the U.S. for more than 5 years, and 36.4% among noncitizen immigrants in this country for 5 or fewer years.

Although the Affordable Care Act made more legally authorized immigrants eligible for health care and allowed more of them to have insurance coverage, it left out undocumented immigrants. Unsurprisingly, 45% of undocumented people in the California survey were uninsured.

More noncitizen immigrants who had been in the U.S. for at least 5 years (12.3%) were covered by Medicaid than noncitizen immigrants who had been here for a shorter time (7.5%) or U.S. born adults (9%). Private insurance was the main source of coverage across all immigrant groups, except for the undocumented in California, who were more likely to have public coverage.

Fewer Doctor and ER Visits

Uninsured immigrants, naturally, had less access to health care than the insured did. While 71% of U.S.-born adults reported having made a visit to a doctor, only 50.5% of noncitizen immigrants who had been in the U.S. for over 5 years and 44.2% of those in this country for 5 years or less had seen a doctor.

In addition, naturalized immigrants and both groups of noncitizen immigrants were less likely than native-born citizens to use an emergency room.

The underuse of health care cannot be explained purely by the high percentage of immigrants who lack insurance, Bustamante says. Even if immigrants have insurance, they may not seek help from a doctor because they may not get paid for the time taken off from work. In addition, they may be unfamiliar with how the U.S. health care system works. If they don’t speak English, they may not even be able to make an appointment.

Aging Population

Partly due to restrictions on immigration, the immigrant population in the U.S. is aging and therefore subject to worsening health, the study notes. While only a small portion of immigrants are over 65 today, “the process of immigrant aging is going to go really fast if the population of immigrants isn’t replaced by continued flows of new immigrants,” says Bustamante.

The U.S. health care system is poorly prepared to take care of aging immigrants, according to the study. In most states, legally authorized immigrants are subject to a 5-year waiting period before they become eligible for Medicaid, and undocumented immigrants are ineligible for Medicaid and Medicare. “Aging documented immigrants may even find it challenging to qualify for Medicare because they need to account for at least 10 years of Social Security earnings to be eligible,” the study says.

Three of the states with the largest immigrant populations -- Texas, Florida, and Georgia -- severely restrict Medicaid coverage for immigrants, Bustamante says. In contrast, California, Illinois, and New York, which are also home to many immigrants, offer generous Medicaid coverage. In Illinois and California, there are proposals to cover some undocumented people.
What will happen to aging, uninsured immigrants when they get sick?

“That’s a big question,” says Bustamante. “A lot of the care will fall on their families, which are not necessarily high-income families. In some families, the younger people are citizens who will be called on to take care of their grandparents. This could limit the social mobility of U.S.-born family members.”

Show Sources

Health Affairs: “Health Policy Challenges Posed By Shifting Demographics And Health Trends Among Immigrants To The United States.”

Arturo Vargas Bustamante, PhD, professor of health policy and management, Fielding School of Public Health, University of California, Los Angeles.

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