Department of Sociology, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
Department of Sociology, Duke University, Durham, NC, USA.
Soc Sci Med. 2020 Feb;246:112754. doi: 10.1016/j.socscimed.2019.112754. Epub 2019 Dec 20.
Immigration is central to our understanding of U.S. racial and ethnic health disparities, yet relatively little is known about the health of white immigrants - a group whose ethnic origins have become increasingly diverse. To the extent that whites are included in social stratification research, they are typically used as the reference category for gauging health inequities, with little attention to diversity among them. This study addresses this question using nationally representative data from the American Community Survey (2008-2017). We disaggregate non-Hispanic whites by nativity, region of birth, and period of arrival in the U.S. and examine differences in physical disability among adults aged 40 and older (n = 12, 075, 638). The analysis finds that foreign-born whites have a slightly lower prevalence of disability than U.S.-born whites, and this varies by arrival cohort. Immigrants who arrived in the 1981-1990 and 1991-2000 cohorts have a smaller advantage over U.S.-born whites than immigrants in the earlier and later cohorts. Compositional changes in the region of birth of white immigrants, especially the influx of eastern Europeans and Middle Easterners during the 1980s and 1990s, explained this variation. These findings challenge the oft-assumed notion that whites are a monolithic group and highlight growing intra-ethnic heterogeneity that is obscured by the aggregate category. Our findings also suggest that the standard practice of using whites as the reference for benchmarking health inequities may mask health inequities not only among them, but also between whites and other racial and ethnic populations.
移民是理解美国种族和族裔健康差异的核心，但对于白人移民的健康状况，我们知之甚少——这一群体的族裔起源变得越来越多样化。在社会分层研究中，只要将白人包括在内，他们通常就被用作衡量健康不平等的参照类别，而很少关注他们之间的多样性。本研究使用美国社区调查（2008-2017 年）的全国代表性数据来解决这个问题。我们根据出生地、出生地区和到达美国的时间将非西班牙裔白人进行细分，并研究了 40 岁及以上成年人（n=12075638 人）之间的身体残疾差异。分析发现，外国出生的白人残疾率略低于美国出生的白人，而且这一差异因到达队列而异。与早期和后期到达队列的移民相比，1981-1990 年和 1991-2000 年到达的移民相对于美国出生的白人具有较小的优势。白种移民出生地区的构成变化，特别是 20 世纪 80 年代和 90 年代东欧人和中东人的涌入，解释了这种变化。这些发现挑战了人们普遍认为白人是一个单一群体的观点，并强调了日益增长的族裔内异质性，这种异质性被总体类别所掩盖。我们的研究结果还表明，使用白人作为基准健康不平等的参照标准的标准做法，不仅可能掩盖他们之间的健康不平等，而且可能掩盖白人与其他种族和族裔群体之间的健康不平等。
