Investigating the Refugee Health Disadvantage Among the U.S. Immigrant Population

ABSTRACT

Much health-disparities research focuses on race and ethnicity, but nativity has proved to be a crucial factor in explaining the immigrant health advantage. Foreign-born subgroups with certain immigration statuses, such as refugees, may have an initial disadvantage. Using nationally representative survey data, we explore differences in health outcomes by analyzing two visa category subgroups in the United States: refugees and nonrefugee immigrants. Our findings show that refugees have a significant disadvantage across multiple health outcomes. This suggests that current refugee health-screening practices should be changed to take into account broader issues, such as chronic disease and functional limitation.

KEYWORDS:

• Refugee health
• screening guidelines for immigrants
• health advantage
• immigration status
• United States

Acknowledgments

We are indebted to Denys Dukhovnov, Ilana Redstone Akresh, and Averi Giudicessi for advice and editorial assistance. We also thank our colleagues at the CUNY Institute for Demographic Research and the anonymous reviewers for their useful comments. We gratefully acknowledge the support given by the Office of Population Research at Princeton University to access the New Immigrant Survey 2003 restricted data.

Notes

1. Refugee admissions ceilings and regional allocations in the United States are established every year by the president in consultation with Congress. In 2013, the total number of refugees authorized for admission was 70,000, with 46% coming from the Near East/South Asia region (primarily Iran, Iraq, and Bhutan). Refugee admissions to the United States are on the rise again, after a nadir of fewer than 30,000 admitted annually in 2002 and 2003, yet the totals are still well below the peak of more than 120,000 refugees admitted in 1990 (Martin & Yankay, 2014).

2. Although refugees may also experience negative acculturation in terms of changing lifestyle and health behaviors, their initial health disadvantage is likely so great that they will show improvements over time even while other immigrant groups are declining. Nevertheless, there is some evidence that the process of acculturation may be quite important for determining refugee health outcomes and may indicate negative acculturation processes at work. For example, in a study of body mass index (BMI) among African refugee children, researchers found that BMI increased more rapidly among those children who arrived in the United States at a very young age than it normally does for young native-born children (Hervey et al., 2009).

3. The U.S. government allocates funds annually for a comprehensive and coordinated program of resettlement of refugees and asylees, who are eligible to receive public assistance including Medicaid and State Children's Health Insurance Program (SCHIP) benefits. Therefore, we might expect refugees to have greater access to health care (due to enrollment in Medicaid insurance). However, Pandey & Kagotho (2010) found that, despite eligibility for SCHIP, 67% of refugees and asylees did not have health insurance. Although they were far more likely to have health insurance than immigrants coming on diversity or family reunification visas, there is clearly a lack of communication and understanding among refugees about eligibility for or how to obtain insurance coverage.

4. The NIS-2003 included sampling weights, and all our results were weighted. To learn more about the weights, visit: http://nis.princeton.edu/.

5. See Appendix found Table 1A to identify the main countries of origin included in our refugee subsample from the NIS-2003-1 and Appendix Table 1B which shows how functional limitations owing to specific conditions—for example, experiencing pain or reporting a physical or nervous condition—limit work and everyday activities for each group.

6. Note that, as shown in Appendix Table 1B, refugees are much more likely to report pain or physical/nervous condition disability than nonrefugees; refugees also are about twice as likely to report high blood pressure as a limitation to activity.