Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA.
Public Health Rep. 2024 Jan-Feb;139(1):120-128. doi: 10.1177/00333549231208485. Epub 2023 Nov 29.
Substantial data on COVID-19-related morbidity and mortality among medically underserved populations are available, yet data on the social impact of the COVID-19 pandemic among immigrants in the United States are limited. We identified COVID-19-related health and social disparities among US immigrants.
We analyzed predictors of COVID-19-related health and social outcomes (including ever had or thought had COVID-19, vaccine uptake, risk-reduction behaviors, job loss, childcare difficulties, and difficulty paying rent) during the pandemic by citizenship status, using data from the 2021 California Health Interview Survey. The overall sample size included 24 453 US-born citizens, naturalized citizens, and noncitizens aged ≥18 years. We examined relationships between sociodemographic variables, including immigration-related factors, and COVID-19-related health and social outcomes using descriptive, bivariate, and multivariate logistic regression analysis.
When accounting for sociodemographic characteristics, noncitizens had higher odds than naturalized and US-born citizens of experiencing challenges during the COVID-19 pandemic, including difficulty paying rent (adjusted odds ratio [aOR] = 1.54; 95% CI, 1.47-2.42) and job loss (aOR = 1.43; 95%, CI, 1.14-1.79). At the bivariate level, noncitizens had the highest rate of ever had or thought had COVID-19 (24.7%) compared with US-born citizens (20.8%) and naturalized citizens (16.8%; all < .001). Noncitizens also had a significantly higher likelihood of risk-reduction behaviors (eg, always wearing a face covering, getting vaccinated if available) than US-born citizens ( < .001).
These findings reveal the disproportionate impact of the COVID-19 pandemic among noncitizens and reflect limited socioeconomic resources, limited access to health care, and precarious employment among noncitizens in California during the pandemic. Citizenship status should be considered a critical immigration-related factor when examining disparities among immigrant populations.
关于医疗服务不足人群中与 COVID-19 相关的发病率和死亡率，有大量数据，但关于美国移民中 COVID-19 大流行的社会影响的数据有限。我们确定了美国移民中与 COVID-19 相关的健康和社会差异。
我们使用 2021 年加利福尼亚健康访谈调查的数据，根据公民身份分析了与 COVID-19 相关的健康和社会结果（包括是否曾患有或认为患有 COVID-19、疫苗接种率、降低风险行为、失业、儿童保育困难和难以支付租金）的预测因素。总体样本量包括 24453 名年龄≥18 岁的美国出生公民、归化公民和非公民。我们使用描述性、双变量和多变量逻辑回归分析，检查了社会人口统计学变量（包括与移民相关的因素）与 COVID-19 相关的健康和社会结果之间的关系。
在考虑社会人口统计学特征的情况下，非公民比归化公民和美国出生公民在 COVID-19 大流行期间经历挑战的可能性更高，包括难以支付租金（调整后的优势比 [aOR] = 1.54；95%CI，1.47-2.42）和失业（aOR = 1.43；95%CI，1.14-1.79）。在双变量水平上，非公民有 COVID-19 的既往或认为有 COVID-19 的比例最高（24.7%），而美国出生公民（20.8%）和归化公民（16.8%）（均<0.001）。非公民采取降低风险行为的可能性也明显高于美国出生公民（例如，始终佩戴面罩，如果有疫苗就接种疫苗）（<0.001）。
这些发现揭示了 COVID-19 大流行在非公民中的不成比例影响，并反映了加利福尼亚州非公民在大流行期间有限的社会经济资源、有限的医疗保健机会和不稳定的就业。在检查移民人群中的差异时，公民身份应被视为一个关键的移民相关因素。
