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Citizenship Status and Mortality Among Young Latino Adults in the U.S., 1998‒2015

  • Jenny S. Guadamuz
    Correspondence
    Address correspondence to: Jenny S. Guadamuz, PhD, Department of Clinical Pharmacy, University of Southern California School of Pharmacy, 1985 Zonal Avenue, Los Angeles CA 90089.
    Affiliations
    Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California

    Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
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  • Ramon A. Durazo-Arvizu
    Affiliations
    Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Josefina Flores Morales
    Affiliations
    California Center for Population Research, University of California, Los Angeles, Los Angeles, California
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  • Dima M. Qato
    Affiliations
    Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California

    Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
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Published:February 07, 2022DOI:https://doi.org/10.1016/j.amepre.2021.11.005

      Introduction

      Although Latino immigrants, especially noncitizens, endure structural factors that may increase their risk of death at younger ages, little is known about their risk of death in young adulthood. This study evaluates mortality differences across citizenship status among young Latino adults (aged 18–44 years) in the U.S.

      Methods

      This study used the National Health Interview Survey (1998–2014) with mortality follow-up through 2015. Cox regression models adjusted for age and sex were used to determine baseline differences in mortality. Models adjusted for socioeconomic factors (i.e., English proficiency, education, poverty, and health insurance) were used to determine whether socioeconomic conditions attenuate mortality differences.

      Results

      Participants included noncitizens (n=48,388), naturalized citizens (n=16,241), and U.S.-born citizens (n=63,388). Noncitizens (hazard ratio [HR]=1.40, 95% CI=1.31, 1.51), but not naturalized citizens (HR=1.04, 95% CI=0.94, 1.16), were at greater risk of all-cause death than U.S.-born citizens. Both noncitizens (HR=2.46, 95% CI=2.07, 2.92) and naturalized citizens (HR=1.76, 95% CI=1.40, 2.21) were more likely to die of cancer. Noncitizens were also at a greater risk of death because of cardiometabolic diseases (HR=1.46, 95% CI=1.20, 1.78) and accidents (HR=1.33, 95% CI=1.14, 1.55). Socioeconomic factors attenuated differences in all-cause, cardiometabolic, and accidental deaths, but not differences in cancer mortality.

      Conclusions

      Contrary to the long-held notion of the healthy migrant, young Latino immigrants, especially noncitizens, are at increased risk of death than their U.S.-born counterparts. Efforts to reduce these disparities should focus on improving their socioeconomic conditions and healthcare access early in adulthood.
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