Immigrant Legal Status and Health: Legal Status Disparities in Chronic Conditions and Musculoskeletal Pain Among Mexican-Born Farm Workers in the United States

• Published in: Demography 2019-02, Vol.56 (1), p.1-24
• Main Authors: Hamilton, Erin R., Hale, Jo Mhairi, Savinar, Robin
• Format: Article
• Language: English
• Subjects: Adult; Agriculture; Chronic conditions; Chronic Disease - epidemiology; Chronic illnesses; Chronic pain; Citizens; Demography; Disadvantaged; Emigrants and Immigrants - legislation & jurisprudence; Epidemiology; Farmers; Farms; Farmworkers; Female; Geography; Health disparities; Health problems; Health status; Health Status Disparities; Humans; Immigrants; IMMIGRATION; Legal status; Literature reviews; Male; Medicine/Public Health; Mental disorders; Mental health; Mexican Americans; Mexico - ethnology; Migrant workers; Musculoskeletal pain; Musculoskeletal Pain - epidemiology; Noncitizens; Occupational health; Pain; Population Economics; Rights; Self evaluation; Social Sciences; Sociology; Systematic review; Unauthorized; United States; Workers
• ISSN: 0070-3370; 1533-7790
• DOI: 10.1007/s13524-018-0746-8

Immigrant legal status determines access to the rights and privileges of U.S. society. Legal status may be conceived of as a fundamental cause of health, producing a health disparity whereby unauthorized immigrants are disadvantaged relative to authorized immigrants, a perspective that is supported by research on legal status disparities in self-rated health and mental health. We conducted a systematic review of the literature on legal status disparities in physical health and examined whether a legal status disparity exists in chronic conditions and musculoskeletal pain among 17,462 Mexican-born immigrants employed as farm workers in the United States and surveyed in the National Agricultural Workers Survey between 2000 and 2015. We found that unauthorized, Mexican-bom farm workers have a lower incidence of chronic conditions and lower prevalence of pain compared with authorized farm workers. Furthermore, we found a legal status gradient in health whereby naturalized U.S. citizens report the worst health, followed by legal permanent residents and unauthorized immigrants. Although inconsistent with fundamental cause theory, our results were robust to alternative specifications and consistent with a small body of existing research on legal status disparities in physical health. Although it is well known that Mexican immigrants have better-than-expected health outcomes given their social disadvantage, we suggest that an epidemiologic paradox may also apply to within-immigrant disparities by legal status. We offer several explanations for the counterintuitive result.