Department of Society, Human Development, and Health, Harvard School of Public Health, Landmark Center, 401 Park Dr., Boston, MA 02215, USA.
Soc Sci Med. 2012 Dec;75(12):2085-98. doi: 10.1016/j.socscimed.2012.01.035. Epub 2012 Mar 13.
A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called "epidemiological paradox" or "immigrant health paradox". To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002-2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes--perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like "immigrant health paradox" which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.
健康与社会经济地位之间存在明显的梯度关系，较高的社会经济地位（SES）与整个 SES 范围内的健康状况改善相关。然而，最近对美国少数族裔和移民的研究显示，SES 与健康之间的关系较为复杂（例如，平坦的梯度），低 SES 个体的健康状况与他们较为富裕、土生土长且文化程度更高的同龄人相似或更好，这被称为“流行病学悖论”或“移民健康悖论”。为了研究亚裔美国人是否存在这种情况，我们研究了原籍国和职业阶层（白领、蓝领、服务人员、失业人员）与主观健康（自评身体健康、自评心理健康）和 12 个月 DSM-IV 精神障碍（任何精神障碍、焦虑、抑郁）之间的关系。我们分析了 2002-2003 年全国拉丁裔和亚裔美国人劳动力调查中 1530 名亚裔受访者的数据，使用分层多变量逻辑回归模型控制混杂因素、主观社会地位（SSS）、物质和心理社会因素来解释健康不平等现象。与土生土长的亚裔美国人相比，移民的社会经济状况较差，在控制年龄和性别后，报告心理健康状况较差和任何 DSM-IV 精神障碍以及焦虑症的可能性增加，而报告任何 DSM-IV 精神障碍和焦虑症的可能性降低。没有发现明显的职业阶层与健康之间的梯度关系。在控制 SSS 后，外国出生的健康保护作用仍然存在，但在控制物质和心理社会因素后，这种作用变得不显著。英语说得不好与所有结果都有很强的相关性。物质和心理社会因素与一些结果相关——经济需求与主观健康相关，没有保险与自评心理健康和抑郁相关，社会支持、歧视和文化适应压力与所有或大多数 DSM-IV 结果相关。我们的研究结果告诫人们不要使用“移民健康悖论”等术语，这些术语过于简单化了复杂的模式，并掩盖了服务不足的亚群体（例如，英语说得不好、经历文化适应压力）的负面结果。我们讨论了在 SES 和健康的测量中考虑到不存在梯度以及原籍国相关的自评健康和 DSM-IV 精神障碍差异的看似矛盾的发现的含义。
