Among young Latino adults, noncitizens are at greater risk of death than naturalized and U.S.-born citizens

Latino immigrants, especially noncitizens, face a much greater risk of dying than their U.S.-born peers, USC researchers have found.

The findings were published Tuesday in the American Journal of Preventive Medicine.

“We know that noncitizens are more likely to face poverty, segregation and inadequate access to healthcare — mechanisms that adversely impact health,” said Jenny S. Guadamuz, the lead study author and a postdoctoral research fellow at the USC School of Pharmacy and the USC Leonard D. Schaeffer Center for Health Policy & Economics.

“It’s also widely known that immigrants make less use of health care,” Guadamuz said. “But do they spend less on health care because they are healthier and do not need it? Or is it rather because they do not have access and are dying at younger ages?”

Until now, no study had examined Latino immigrants’ risk of death in young adulthood when compared with U.S.-born Latinos. The study evaluated mortality differences across citizenship status among Latino young adults aged 18 to 44 who were living in the United States.

Excessive cancer deaths also raise questions about role of citizenship

Researchers looked at mortality rates and health risk factors among 48,000 noncitizens, 16,000 naturalized citizens and 63,000 U.S.-born citizens, using National Health Interview Survey data from 1998 through 2014.

They found noncitizens were at a greater risk of death because of health issues such as cardiometabolic diseases — which include heart disease, stroke and hypertension, as well as metabolic diseases such as Type 2 diabetes and obesity — than peers who were naturalized and U.S.-born citizens. Noncitizens also faced a greater risk of death because of accidents.

But noncitizens and naturalized citizens were twice as likely to die of cancer than U.S.-born Latinos.

“Young Latino immigrants may be more susceptible to death from cancer because they face screening and treatment barriers, including lack of access to insurance or interpreters, increasing their risk of death from highly treatable cancers,” Guadamuz said.

The researchers say the increased risk of death from cancer needs more study. Earlier studies suggesting that immigrants have lower cancer mortality rates have largely examined all ages rather than focusing on young adults.

COVID-19 pandemic likely worsening disparities

The study does not include recent deaths from the COVID-19 pandemic, although researchers believe COVID-19 has not helped.

Last year, a separate study by researchers at the Keck School of Medicine of USC found Latino immigrants of working age — 20 to 54 — were more than 11 times more likely to die of COVID-19 than U.S.-born men and women who were not Latino. The study was based on California death certificate data from 2020.

The mortality disparities observed in the pre-pandemic study data have likely been exacerbated by COVID-19 deaths, Guadamuz said.

“The socioeconomic conditions that made mortality risk higher among young Latino noncitizens in our study have worsened over time,” she said. “COVID-19 is likely killing the same immigrant populations that were already vulnerable to earlier deaths because of other social structures.”

The research team said efforts to reduce these disparities should focus on improving Latinos’ socioeconomic conditions and healthcare access in early adulthood.

About the study: Additional authors include Ramon A. Durazo-Arvizu of the Keck School of Medicine of USC, Josefina Flores Morales of the California Center for Population Research at UCLA and Dima M. Qato of the USC School of Pharmacy and the USC Schaeffer Center.

Guadamuz and Flores Morales were funded by the Robert Wood Johnson Foundation Health Policy Research Scholar program.