Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Lancet Public Health. 2017 Apr;2(4):e175-e181. doi: 10.1016/S2468-2667(17)30047-6. Epub 2017 Mar 15.
The effects of changes in immigration policy on health outcomes among undocumented immigrants are not well known. We aimed to examine the physical and mental health effects of the Deferred Action for Childhood Arrivals (DACA) programme, a 2012 US immigration policy that provided renewable work permits and freedom from deportation for a large number of undocumented immigrants.
We did a retrospective, quasi-experimental study using nationally representative, repeated cross-sectional data from the US National Health Interview Survey (NHIS) for the period January, 2008, to December, 2015. We included non-citizen, Hispanic adults aged 19-50 years in our analyses. We used a difference-in-differences strategy to compare changes in health outcomes among individuals who met key DACA eligibility criteria (based on age at immigration and at the time of policy implementation) before and after programme implementation versus changes in outcomes for individuals who did not meet these criteria. We additionally restricted the sample to individuals who had lived in the USA for at least 5 years and had completed high school or its equivalent, in order to hold fixed two other DACA eligibility criteria. Our primary outcomes were self-reported overall health (measured on a 5 point Likert scale) and psychological distress (Kessler 6 [K6] scale), the latter was administered to a random subset of NHIS respondents.
Our final sample contained 14 973 respondents for the self-reported health outcome and 5035 respondents for the K6 outcome. Of these individuals, 3972 in the self-reported health analysis and 1138 in the K6 analysis met the DACA eligibility criteria. Compared with people ineligible for DACA, the introduction of DACA was associated with no significant change among DACA-eligible individuals in terms of self-reported overall health (b=0·056, 95% CI -0·024 to 0·14, p=0·17) or the likelihood of reporting poor or fair health (adjusted odds ratio [aOR] 0·98, 95% CI 0·66-1·44, p=0·91). However, DACA-eligible individuals experienced a reduction in K6 score compared with DACA-ineligible individuals (adjusted incident risk ratio 0·78, 95% CI 0·56-0·95, p=0·020) and were less likely to meet screening criteria for moderate or worse psychological distress (aOR 0·62, 95% CI 0·41-0·93, p=0·022).
Economic opportunities and protection from deportation for undocumented immigrants, as offered by DACA, could confer large mental health benefits to such individuals. Health consequences should be considered by researchers and policy makers in evaluations of the broader welfare effects of immigration policy.
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有关移民政策变化对无证移民健康结果的影响尚不清楚。我们旨在研究 2012 年美国移民政策《童年入境暂缓遣返行动》（DACA）计划对无证移民身心健康的影响，该计划为大量无证移民提供了可再生工作许可并免除了被驱逐出境的风险。
我们采用回顾性、准实验研究，使用美国全国健康访谈调查（NHIS）在 2008 年 1 月至 2015 年 12 月期间提供的具有全国代表性的重复横断面数据。我们的分析纳入了年龄在 19-50 岁之间的非公民西班牙裔成年人。我们使用差异中的差异策略来比较符合 DACA 主要资格标准（基于移民时的年龄和政策实施时的年龄）的个人在计划实施前后健康结果的变化，以及不符合这些标准的个人的结果变化。我们还将样本限制为至少在美国居住 5 年且完成高中学业或同等学历的个人，以固定另外两个 DACA 资格标准。我们的主要结果是自我报告的整体健康状况（使用 5 分李克特量表测量）和心理困扰（Kessler 6 [K6] 量表），后者对 NHIS 受访者的随机样本进行了评估。
我们的最终样本包括 14973 名用于自我报告健康结果的受访者和 5035 名用于 K6 结果的受访者。在这些人中，3972 人符合自我报告健康分析中的 DACA 资格标准，1138 人符合 K6 分析中的 DACA 资格标准。与不符合 DACA 条件的人相比，DACA 的引入与符合 DACA 条件的个人的自我报告整体健康状况（b=0.056，95%CI-0.024 至 0.14，p=0.17）或报告健康状况不佳或一般的可能性均无显著变化（调整后的优势比[aOR]0.98，95%CI 0.66-1.44，p=0.91）。然而，符合 DACA 条件的个人的 K6 评分较不符合 DACA 条件的个人有所降低（调整后的发病风险比 0.78，95%CI 0.56-0.95，p=0.020），且更不可能符合中度或更严重心理困扰的筛查标准（aOR 0.62，95%CI 0.41-0.93，p=0.022）。
为无证移民提供的经济机会和免于驱逐出境的保护，如 DACA 所提供的，可能会给这些人带来巨大的心理健康益处。研究人员和政策制定者在评估移民政策更广泛的福利影响时，应考虑健康后果。
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