Mortality Trends and Differentials by Nativity in the United States Lihua Liu, Ph.D. University of Southern California Gopal K. Singh, Ph.D. U.S. Department of Health & Human Services MERH 2018, Edinburgh, 5/17/2018

Foreign-Born/Immigrants in the U.S.

https://www.census.gov/content/dam/Census/library/visualizations/2014/demo/second-great-wave.jpg

CA: 27% (https://www.census.gov/library/visualizations/2013/comm/foreign_born.html)

Objective – To evaluate the "healthy immigrant effect" among different demographic groups in the contemporary U.S. Methods – Using data from the National Vital Statistics System, National Longitudinal Mortality Study, decennial census, and American Community Survey, we examined life expectancy, all-cause and cause-specific mortality, and chronic disease morbidity by nativity and socioeconomic and demographic characteristics from 1979 to 2013.

Based on data from the US National Vital Statistics System, 1979-2013. The total number of deaths used to calculate life expectancies for USB and FB individuals were: 5,223,160 and 625,396 in 1979-1981; 5,850,910 and 553,013 in 1989-1991; 6,581,830 and 585,335 in 1999-2001; and 6,987,024 and 668,293 in 2011-2013. Based on data from the US National Vital Statistics System, 1979-2013.

Infant Mortality Rate Ratios , USB vs Infant Mortality Rate Ratios , USB vs. FB, 2011-2013 (N=11,797,322 live births) Data derived from the 1985-2013 US National Linked Birth and Infant Death data files. * Indicates statistical significance at 95% confidence level.

Age-Adjusted Cause-Specific Mortality Rate Ratios, FB Vs Age-Adjusted Cause-Specific Mortality Rate Ratios, FB Vs. USB, 2011-2013, U.S.A. (all numbers are statistically significant, p<0.05) (Data derived from the US National Vital Statistics System [NCHS 2016].)

Covariate-Adjusted Mortality Hazard Ratios, FB vs Covariate-Adjusted Mortality Hazard Ratios, FB vs. USB, 1979-2011 (Derived from Cox Regression Models, with 95% CIs) Adjusted for age, sex, race/ethnicity, marital status, rural/urban residence, geographic region, education, occupation, and family income. The US National Longitudinal Mortality Study, 1979-2011

Ethnic-Immigrant Differentials in All-Cause Mortality, 1979-2011, U.S. Adjusted by Cox regression for age, sex, marital status, education, occupation, family income, rural/urban residence, and geographic region. * P<0.01.

Discussion Compared to the US-born, foreign-born/immigrants in the U.S. have higher life expectancy and lower mortality, and the differences are widening. The “healthy immigrant effect” exists across all racial/ethnic groups with varying degrees. Self-selectivity, lower prevalence of many health-risk behaviors, better social/familial support and community integration, are strong contributors to immigrants’ health advantage. Although acculturation may reduce the healthy immigrant effect, the continued arrival of new immigrants from Asian and Latin American countries will likely play a significant role in retaining immigrants’ ethnic and cultural heritage and maintaining their better health than the US-born.

Thank you!