A Life-course Perspective on Older Immigrant Health: Features of and Mechanisms for a Later Life Immigrant Health (Dis)advantage

There are over 45 million immigrants in the United States. Among this population, 17% are 65 years and older, up from 12% in 2000. In their early years in the US, immigrants appear to exhibit a health advantage over their native-born counterparts despite experiencing more socioeconomic disadvantage and structural barriers to accessing routine care. This immigrant health paradox (IHP) has been found across different health outcomes, including mental health, chronic illnesses, and mortality, with some variation based on race and ethnicity. Most studies examining the IHP have primarily concentrated on working-age adults, with limited attention to older immigrants. Moreover, few studies have considered how social, ecological, and life course factors influence nativity-based health disparities, especially among older adults. This dissertation aimed to determine the extent to which the IHP persists into old age and to identify the factors contributing to health advantages or disadvantages, to improve the health outcomes of older immigrants. Specifically, it explored differences between foreign-born Hispanic, foreign-born non-Hispanic, native-born Hispanic, and native-born non-Hispanic individuals across various health outcomes. In Chapter 1, I utilized data from the 2018 Health and Retirement Study (HRS) to examine immigrant health advantages and disadvantages across chronic physical health, mobility and functional limitations, mental health, and self-rated health, with attention to variation by ethnicity. In Chapter 2, I used 2014 and 2018 HRS data to examine whether socioeconomic status, neighborhood quality, social support, and discrimination mediate the relationships between nativity and ethnicity and the various health outcomes. In Chapter 3, I used 2018 HRS data to estimate associations between the life-course timing of migration and the physical and mental health outcomes of interest, as well as associations between naturalization and these health outcomes. Findings indicated that nativity-based differences in health varied depending on ethnicity and the specific health outcome. Socioeconomic status and neighborhood disadvantage contributed to health disparities where present, but none of the hypothesized mechanisms were significant drivers of immigrant health benefits. The results also showed slight variation based on age at migration and citizenship status. These findings may inform policies and future research to promote healthy aging and improve the well-being of immigrants.