Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders.
Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders.
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DOI：
10.1016/j.socscimed.2012.01.035
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发表时间：
2012-12
期刊：
影响因子：
--
通讯作者：
Takeuchi DT
中科院分区：
文献类型：
--
作者：
John DA;de Castro AB;Martin DP;Duran B;Takeuchi DT
健康方面的强大社会经济梯度是有据可查的，社会经济地位(SES)越高，整个社会经济状况范围内的健康状况就越好。然而，最近对美国种族/少数民族和移民的研究显示出复杂的SES-健康模式(例如，平坦的梯度)，SES低的人的健康状况与他们在美国出生和文化适应程度较高的人相似或更好，即所谓的“流行病学悖论”或“移民健康悖论”。为了检验亚裔美国人中是否存在这种情况，我们调查了出生和职业阶层(白领、蓝领、服务业、失业)与主观健康(自我评估的身体健康、自我评估的心理健康)和12个月的DSM-IV精神障碍(任何精神障碍、焦虑、抑郁)之间的关系。我们使用分层多变量Logistic回归模型分析了1530名亚洲受访者的数据，这些数据来自2002-2003年全国拉丁裔和亚裔美国人劳动力研究，控制了混杂因素、主观社会地位(SSS)、物质和心理社会因素，这些因素被理论上解释了健康不平等。与在美国出生的亚洲人相比，移民的社会经济状况更差，控制了年龄和性别，报告精神健康状况良好/较差的几率增加，患上任何DSM-IV精神障碍和焦虑的几率降低。未发现强烈的职业级-健康梯度。在控制了SSS后，外来出生的健康保护作用持续存在，但在控制了物质和心理社会因素后，这种保护作用变得不明显。英语说得一般/不好与所有结果密切相关。物质和心理社会因素与某些结果相关--感知的经济需要与主观健康、自我评估的精神健康和抑郁的不保险、社会支持、歧视和文化适应压力与全部或大部分DSM-IV结果相关。我们的研究结果告诫人们不要使用“移民健康悖论”这样的术语，因为这些术语过分简化了复杂的模式，掩盖了服务不足的亚群中的负面结果(例如，英语说得一般/很差，经历了文化适应压力)。我们讨论了更好地测量SES和健康的含义，因为在自我评估的健康和DSM-IV精神障碍中，没有梯度和似乎相互矛盾的发现与出生相关的差异。
A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called “epidemiological paradox” or “immigrant health paradox”. To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002–2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes – perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like “immigrant health paradox” which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.
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