Assari Shervin, Perez Maryver U, Johnson Nay'Air, Williams Nikesha R, Carrillo Esmeralda, Garcia Leslye, Hollis Xiaxiang T
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA.
Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, USA.
Int J Travel Med Glob Health. 2020 Summer;8(3):116-123. doi: 10.34172/ijtmgh.2020.20.
Although education is among the major socioeconomic status (SES) resources that influence populations' and individuals' health, social marginalization may reduce the health gain that follows access to SES indicators such as education, a pattern called marginalization-related diminished return (MDR). The literature on MDRs, however, has been mainly derived from studies that have defined marginalization based on race, ethnicity, and sexual orientation. Thus, more research is needed on MDRs that may follow as a result of immigration. To extend what is known on immigration status related MDRs, this study compared a national sample of immigrants and non-immigrants for the effect of education on the poor self-rated health (SRH) of adults in the United States.
With a cross-sectional design, this study employed data from the 2015 National Health Interview Survey (NHIS), a survey that had enrolled 33,654 adults who were either immigrants (n = 6225; 18.5%) or non-immigrants (n = 27 429; 81.5%). The independent variable was education level, treated as a categorical variable. The dependent variable was SRH treated as a dichotomous variable. Race, ethnicity, age, gender, marital status, and region were the confounders. Immigration (nativity) was the moderator. Logistic regression was used for data analysis.
Higher education credentials were associated with better SRH in the pooled sample; however, immigration showed a significant statistical interaction with education level (college graduation) on the outcome. This interaction was indicative of a smaller protective effect of college graduation on poor SRH among immigrants than non-immigrant adults.
In line with the MDRs framework, the effect of education on SRH is weaker for immigrants than for non-immigrant adults. There is a need to help highly educated immigrants to mobilize their human capital to secure their best health outcomes, similar to non-immigrants. Such strategies may require bold and innovative policy solutions to reduce discrimination against immigrants, so they can more effectively translate their education and human capital into tangible outcomes such as health.
尽管教育是影响人群和个体健康的主要社会经济地位（SES）资源之一，但社会边缘化可能会减少因获得诸如教育等SES指标而带来的健康收益，这种模式被称为边缘化相关收益递减（MDR）。然而，关于MDR的文献主要来自于那些基于种族、民族和性取向来定义边缘化的研究。因此，需要对可能因移民而产生的MDR进行更多研究。为了扩展对与移民身份相关的MDR的认识，本研究比较了美国全国范围内的移民和非移民样本，以探讨教育对成年人自评健康状况不佳（SRH）的影响。
本研究采用横断面设计，使用了2015年全国健康访谈调查（NHIS）的数据，该调查纳入了33654名成年人，其中移民（n = 6225；18.5%）或非移民（n = 27429；81.5%）。自变量是教育水平，作为分类变量处理。因变量是SRH，作为二分变量处理。种族、民族、年龄、性别、婚姻状况和地区是混杂因素。移民（出生地）是调节变量。采用逻辑回归进行数据分析。
在合并样本中，更高的教育证书与更好的SRH相关；然而，移民在该结果上显示出与教育水平（大学毕业）有显著的统计交互作用。这种交互作用表明，大学毕业对移民中自评健康状况不佳的保护作用比对非移民成年人要小。
与MDR框架一致，教育对移民的SRH的影响比对非移民成年人要弱。需要帮助受过高等教育的移民调动他们的人力资本以确保获得最佳健康结果，类似于非移民。这样的策略可能需要大胆和创新的政策解决方案来减少对移民的歧视，以便他们能够更有效地将其教育和人力资本转化为诸如健康等切实成果。
