RAND, Santa Monica, California, USA.
Health Aff (Millwood). 2012 Dec;31(12):2727-37. doi: 10.1377/hlthaff.2011.0973.
Newly arrived Mexican immigrants in the United States generally report better health than do native-born Americans, but this health advantage erodes over time. At issue is whether the advantage is illusory-a product of disease that goes undiagnosed in Mexico but is discovered after immigration. Using results from the National Health and Nutrition Examination Survey, we compared clinical to self-reported diagnosed disease prevalence and found that Mexican immigrants are not as healthy as previously thought when undiagnosed disease is taken into account, particularly with respect to diabetes. About half of recent immigrants with diabetes were unaware that they had the disease-an undiagnosed prevalence that was 2.3 times higher than that among Mexican Americans with similar characteristics. Diagnosed prevalence was 47 percent lower among recent Mexican immigrants than among native-born Americans for both diabetes and hypertension, but undiagnosed disease explained one-third of this recent immigrant advantage for diabetes and one-fifth for hypertension. The remaining health advantage might be explained in part by immigrant selectivity-the notion that healthier people might be more likely to come to the United States. Lack of disease awareness is clearly a serious problem among recent Mexican immigrants. Since undiagnosed disease can have adverse health consequences, medical practice should emphasize disease detection among new arrivals as part of routine visits. Although we found little evidence that health insurance plays much of a role in preventing these diseases, we did find that having health insurance was an important factor in promoting awareness of both hypertension and diabetes.
新抵达美国的墨西哥移民的健康状况普遍优于土生土长的美国人，但这种健康优势会随着时间的推移而逐渐减弱。问题在于这种优势是否是虚幻的——一种在墨西哥未被诊断出但在移民后被发现的疾病的产物。利用国家健康和营养检查调查的结果，我们将临床诊断疾病的流行率与自我报告的诊断疾病的流行率进行了比较，结果发现，考虑到未被诊断出的疾病，墨西哥移民并不像之前认为的那样健康，尤其是在糖尿病方面。大约一半患有糖尿病的新移民不知道自己患有这种疾病——未被诊断出的患病率比具有类似特征的墨西哥裔美国人高 2.3 倍。新墨西哥移民的糖尿病和高血压的诊断患病率比土生土长的美国人分别低 47%，但未被诊断出的疾病解释了糖尿病方面新移民优势的三分之一，以及高血压方面新移民优势的五分之一。剩余的健康优势可能部分可以用移民的选择性来解释——即更健康的人更有可能移民到美国。在新抵达的墨西哥移民中，缺乏疾病意识显然是一个严重的问题。由于未被诊断出的疾病可能会对健康产生不良后果，因此医疗实践应强调在新移民中进行疾病检测，作为常规就诊的一部分。尽管我们发现几乎没有证据表明健康保险在预防这些疾病方面发挥了多大作用，但我们确实发现，拥有健康保险是提高对高血压和糖尿病的认识的一个重要因素。
