Assari Shervin, Cobb Sharon, Cuevas Adolfo G, Bazargan Mohsen
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States.
Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States.
Front Psychiatry. 2020 Nov 27;11:535624. doi: 10.3389/fpsyt.2020.535624. eCollection 2020.
Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States. Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs). The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant ( = 6,225; 18.5%) or native born ( = 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator. Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults. In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.
与边缘化相关的收益递减（MDRs）指的是，与社会特权群体相比，社会边缘化群体的教育程度对健康的影响较弱。然而，现有的关于MDRs的大多数文献都集中在因种族、民族和性取向导致的边缘化问题上。因此，关于美国移民群体中教育程度的MDRs的信息非常有限。基于MDRs框架并使用美国成年人的全国代表性样本，我们比较了移民和本土出生的成年人在教育程度对心理困扰、自评健康（SRH）和慢性病（CDs）方面的影响。2015年全国健康访谈调查（NHIS）纳入了33672名个体，其中移民6225人（占18.5%），本土出生27429人（占81.5%）。自变量（IV）是教育程度，被视为分类变量。因变量包括心理困扰、SRH和CDs，所有这些都是二分变量。年龄、性别、种族、民族和地区是混杂因素。移民（出生状态）是调节变量。较高的教育程度与较低的心理困扰几率、较差的SRH和CDs几率相关。然而，移民在所有结果上都显示出与大学毕业存在显著的统计交互作用，这表明大学毕业对移民的心理困扰、较差的SRH和CDs的保护作用比对本土出生的成年人要小。在美国，与本土出生的成年人相比，移民的教育程度与心理困扰、SRH和CDs之间的关联都较弱。为了预防健康差距，有必要将因教育程度低导致的健康不平等与因教育程度收益递减（即MDRs）导致的健康不平等区分开来。有必要帮助受过高等教育的移民成年人获得与本土出生的同龄人相似的积极健康结果。这种改变可能需要大胆创新的经济、公共和社会政策，以帮助移民成年人更有效地利用他们的教育程度来获得切实的成果。消除美国的健康差距需要超越教育机会均等的努力。
