Health-related quality of life, ethnicity and perceived discrimination among immigrants and natives in Spain

Abstract

Objectives

The current study compares subjective mental and physical health among native Spaniards and immigrant groups, and examines the effects of ethnicity and perceived discrimination (PD) on subjective health in immigrants.

Design

Two random samples of 1250 immigrants to Spain from Colombia, Bolivia, Romania, Morocco, and Sub-Saharan Africa and 500 native Spaniards, aged between 18 and 65, were recruited for this cross-sectional study. Several hierarchical regression analyses of ethnicity and PD on subjective mental and physical health (assessed using the health-related quality of life items, HRQLSF-12) were carried out separately for men and women.

Results

Male immigrants from Colombia and Sub-Saharan Africa showed better physical health than natives, controlling for age and socioeconomic and marital status. The immigrants – except for the Colombians – had poorer mental health than natives, especially African men and Bolivian women. Socioeconomic status had no impact on these differences. Among immigrants, PD was the best predictor of physical and mental health (controlling for socio-demographic variables). African men, Bolivian women and women without legal status exhibited the poorest self-rated mental health.

Conclusion

Clear differences in health status among natives and immigrants were recorded. The self-selection hypothesis was plausible for physical health of Colombians and Sub-Saharan African men. Acculturation stress could explain poorer mental health in immigrants compared with natives. The association between ethnicity and poor self-reported mental health appears to be partially mediated by discrimination.

Keywords:

• quality of life
• health
• discrimination
• ethnicity

Acknowledgments

This work was supported by the Spanish Ministry of Science and Innovation grant number MCI PSI2008–02689/PSIC and the University of Basque Country grant number 9/UPV00109.231–13645/2001/2007 GIC07/113-IT-255-07, UFI 11/04.

Notes

1. According to official statistics, in the Basque Country autonomous region, 91% of the foreign-born population were registered, and they had access to public health services, with a between-country variation: from 97% for Colombians to 86% for Sub-Saharan Africans. Twenty-three per cent were undocumented or living in Spain without a residence permit (The Basque Observatory of Immigration, 2009, www.ikuspegi.org).

2. The fieldwork was carried out by a specialist company that meets Spain's legal requirements on data protection.

3. Immigrants with a residence permit, Spanish nationality or European citizenship were categorized as being documented. In other cases, immigrants were categorized as undocumented.