Applying lntersectionality and Acculturation Theories to Explain Disparities in Self-rated Health Among Asian and Hispanic Immigrants in the U.S.

Abstract

Minority populations in the United States (U.S.) suffer an unequal burden of morbidity and mortality due to health disparities. The purpose of this descriptive cross-sectional study was to identify factors associated with disparities in self-rated health (SRH) among Asian and Hispanic immigrants. The acculturation theory and intersectionality framework were used to select predictors of SRH that included age, gender, ethnicity, socio-economic status, depressive symptoms, C-reactive protein (CRP) level, acculturation status, social position, and acculturative stress and discrimination events. A systematic review of the literature was completed and data from the 2009-2010 National Health and Nutrition Examination Survey and the 2002-2003 National Latino and Asian American Study were reviewed. This study found that acculturation status was associated with reporting disparities in SRH for both Asian and Hispanic immigrants. Limited English proficiency and being foreign-born was associated with worse SRH for Korean, Chinese, and Mexican immigrants, and in aggregate samples of Asian and Hispanic immigrants, compared to non-Hispanic Whites. Additionally, limited English proficiency was associated with worse SRH for Vietnamese immigrants. Among Mexican immigrants, higher levels of acculturation were associated with better SRH. Other key findings among Mexican immigrants were that depressive symptoms, increasing age, female gender, and elevated CRP were predictors of worse SRH compared to U.S.-born, non-Hispanic Whites. However, female gender and higher CRP were not predictors of worse SRH when level of acculturation was controlled for. For Chinese immigrants, acculturative stress was associated with worse SRH in an additive model while the interactions between social position and discrimination, and between gender, acculturative stress, and social position and education were predictive of worse SRH in multiplicative models. In summary, age, gender, ethnicity, socio-economic status, depressive symptoms, CRP, acculturation status, social position, and acculturative stress and discrimination were associated with disparities in SRH among two ethnic minorities in the U.S. These findings can be used to improve awareness and understanding of these immigrant populations who are vulnerable to poor health outcomes. Additionally, outcomes can assist in developing interventions to reduce the influence of social structures on health and to capture the true complexities of immigrants’ lives.