Aging into Disadvantage: Disability Crossover among Mexican Immigrants in America

Abstract

The “Hispanic paradox” refers to the accepted finding that Mexican immigrants have lower mortality compared to the US-born population, despite having lower levels of income, educational attainment, and health insurance coverage. However, Mexican immigrants’ mortality advantage is not matched by lower disability rates, particularly later in the life course. Past studies have identified a crossover in disability rates for Mexican immigrants using age-specific disability rates but confound the effects of aging and duration of residence. By using the synthetic cohort method, I extend prior work on the disability crossover by tracing immigrant cohorts across the life course and disentangling newly arrived immigrants from those already established in the U.S. I use American Community Survey (ACS) 2015–2019 data to test whether the acculturation or cumulative disadvantage hypotheses account for the disability crossover. I find that, contrary to the expected finding of a socioeconomic health gradient in disability rates, Mexican immigrants’ high disability rates converge regardless of education level or immigrant cohort. In addition, Mexican female immigrants are doubly disadvantaged, living in a protracted period of disability compared to males of the same education level. My findings support the negative health acculturation hypothesis as the dominant pathway for Mexican immigrants’ later-life disability trajectories and consequently the explanation behind the disability crossover.

1. Introduction

The older population is steadily rising, with Hispanics being the fastest growing proportion (Garcia et al., 2017; Garcia and Cantu, 2021). Even though Hispanic immigrants are socioeconomically disadvantaged upon coming to America, their health outcomes are equal to or better than the native-born population, commonly referred to as the “Hispanic paradox” (Abraído-Lanza et al., 1999). This is supported by the finding that Hispanic immigrants have lower rates of mortality and higher life expectancies compared to non-Hispanic US-born whites and blacks (Lariscy et al., 2015). Although Hispanic immigrants experience favorable health outcomes, they suffer from high disability rates (Markides and Gerst, 2011). Disability refers to the difficulty or inability to perform tasks essential to everyday life, affecting social roles, and may be a result of physical, emotional, cognitive, or sensory limitations (Albrecht et al., 2012). Disability, a common population health indicator, incurs a large social and financial cost to families and the US economy (Anderson et al., 2011). More than one in four Americans have a disability, making it a widespread medical condition (Okoro et al., 2018). The Hispanic community is an especially vulnerable segment of the population due to their low levels of health insurance coverage, low levels of educational attainment, and high rates of poverty (Goldman et al., 2006). Scholars particularly note the presence of a crossover whereby Mexican immigrants have lower age-specific disability rate in working age compared to US-born whites, but that this reverses in later life (Sheftel and Heiland, 2018).

This study evaluates two potential explanations for the disability crossover, namely the cumulative disadvantage and acculturation hypotheses. For this study, disability operates as an umbrella term for limitations, difficulties, impairments, and participation restrictions. I focus on Mexican immigrants, as they comprise around 64% of the total U.S. Hispanic population (Gonzalez-Barrera and Lopez, 2013). I employ the double-cohort research design, a method that Myers and Lee developed to analyze home ownership trajectories across immigrant cohorts (Myers and Lee, 1998). The double cohort method uses synthetic cohorts (dual marker of birth cohort and immigrant cohort membership) to follow cohorts over time as they age. This study extends the line of inquiry on the disability crossover by testing possible explanations for it. By disentangling immigrant’s duration of residence from aging, the double-cohort method represents an improvement over prior research on the disability crossover (Sheftel, 2017; Sheftel and Heiland, 2018). In addition, this work improves upon prior analyses of disability trends as it adjusts the educational categories to account for the polarized distribution of immigrant educational attainment (Hamilton and Huang, 2020).

2. Literature Review

Hispanic immigrants experience an initial health advantage upon arrival to America, but their post-migration experience is associated with a reversal in health outcomes (Abraído-Lanza et al., 1999). I assess two potential pathways which potentially influence Mexican immigrants’ disability trajectory, a reliable marker of morbidity. The first pathway, acculturation, refers to immigrants’ gradual adoption of the destination country’s dietary and lifestyle behaviors (Riosmena et al., 2015). The second perspective, cumulative disadvantage, focuses on the structural forces that affect individuals. Cumulative disadvantage pertains to the compounding of socioeconomic disadvantage, discrimination, and tenuous legal status throughout the life course. This form of marginalization accrues over the life course and influences health trajectories in later life (Viruell-Fuentes et al., 2012).

Acculturation

The first pathway, acculturation, assumes that Mexican immigrants have protective aspects associated with their origin country’s culture. These origin country characteristics reduce engagement in harmful lifestyle behaviors such as smoking, or provide added socials support and cohesion (McMillan, 2019). They also reduce the effect of stress, unhealthy lifestyles and other health threats (Finch et al., 2009). With time, these cultural benefits are stripped away in favor of the destination country’s customs and lifestyle behaviors, leading to a reversal in the initial immigrant health advantage and convergence with native-born health outcomes (Lara et al., 2005; Riosmena et al., 2013).

The acculturation process is most notably associated with health assimilation, in which immigrants adopt risky health behaviors endemic to dominant U.S. culture (Finch et al., 2009). Mexican immigrants, upon arrival to the U.S., have lower rates of smoking, alcohol consumption, and better dietary habits. However, these trends change with time, resulting in decreased consumption of fruits/vegetables and fiber, increased smoking and drinking, along with a rise in BMI (Akresh, 2007; Antecol and Bedard, 2006; Fenelon, 2013; Jasso et al., 2004; Riosmena et al., 2015). Duration of residence (another common proxy for acculturation) is also associated with increased alcohol and drug use (Abraído-Lanza et al., 2005), increased risk of HIV/AIDS (Haderxhanaj et al., 2015; McCoy et al., 2014) as well as depression and anxiety (Orozco et al., 2013). Additionally, higher acculturation is related to reduced hypertension (Hall et al., 2016) lower likelihood of binge-eating (Arandia et al., 2012), and reduced risk of HIV/AIDS infection behaviors (Parrado et al., 2004).

The acculturation perspective is criticized by some scholars for being too reductive of the immigrant health convergence pathway, ignoring structural forces such as discrimination and institutional patterns of unequal treatment (Viruell-Fuentes, 2007; Viruell-Fuentes et al., 2012; Zambrana and Carter-Pokras, 2010). Acculturation-based frameworks view health outcomes as the sole result of individual-level behaviors, ignoring institutions that reproduce inequality and structural racism (Geronimus and Thompson, 2004).

Cumulative Disadvantage

Another possible contributor to Mexican immigrants’ health decline is cumulative disadvantage. Cumulative disadvantage is defined as “the result of choices made in the context of structural constraints potentially resulting from social vulnerability” (Riosmena and Jochem, 2012, p. 8). Mexican immigrants arguably fit the criteria for social vulnerability due to their relatively high rates of poverty, low rates of health care coverage, and low rates of educational attainment (Hayward et al., 2015).

Cumulative disadvantage notably operates through discrimination. Mexican immigrants experience racial bias in the workplace and stigmatization based on their perceived legal status, occupation, language use, skin color, and appearance (Boen and Hummer, 2019). Discrimination also transcends to differential treatment by healthcare providers and employers because of implicit or explicit bias. The racial discrimination that Mexican immigrants experience directly impacts their access to resources, including healthcare. There is limited evidence concerning healthcare providers’ differential treatment and Mexican immigrants’ subsequent adverse health outcomes (Hall et al., 2015; Martinez and Baron, 2020). In addition, Spanish-speaking immigrants make up more than half of people with limited English-speaking abilities in the US, which makes them vulnerable to experiencing language barriers when utilizing the healthcare system (Zong and Batalova, 2015).

Cumulative disadvantage also manifests through inequalities in socioeconomic status. Economic deprivation is a major source of vulnerability for Mexican immigrants, who are relatively disadvantaged compared to other racial/ethnic groups in terms of educational attainment, income, homeownership rates, and poverty status (Jean and Jiménez, 2011). In addition, even though immigrants are positively selected in terms of schooling, they migrate with low financial and human capital, as well as non-transferable educational credentials (Feliciano, 2005). For lower-income immigrants who rely on federal food assistance, their diet choices are significantly affected by agricultural subsidies that priorities cheap, high-calorie foods, resulting in deleterious health outcomes (Creighton et al., 2012; Van Hook et al., 2018).

Cumulative disadvantage impacts health outcomes because immigrants are exposed to a multiplicity of occupational risks, including but not limited to abusive, hazardous, low-paying, and physically strenuous labor conditions (Moyce and Schenker, 2018). Hispanic immigrants primarily occupy jobs in the agricultural, construction, hospitality, and service sector. These occupational fields often do not offer employer-sponsored healthcare or do not pay enough for immigrants to buy private insurance, in addition to having limited worker protections (Carrasquillo et al., 2000; Holmes, 2020; Tuggle and Crews, 2021). Immigrants who lack legal status whatsoever are not eligible to access federally funded health insurance programs – Medicaid, Medicare, and SCHIP – all of which require the recipient to be U.S. citizen or a legal permanent resident of at least five years (Chavez et al., 1992; Martinez et al., 2015).

Disability Trends

The cumulative disadvantage and acculturation perspectives potentially explain Mexican immigrants’ disability patterns in later life. Even though Mexican immigrants experience an initial health advantage upon arrival, dubbed the “Hispanic paradox,” this advantage deteriorates later in the life course and results in this population group experiencing disproportionately higher rates of disability. Compared to US-born Hispanic men, foreign-born Hispanic men have slightly lower levels of disability, but this same advantage is not found for women (Angel et al., 2015). This supports the finding that women are not as positively selected for health then their male counterparts (Markides and Gerst, 2011). Other researchers similarly find a gendered gap in disability between Mexican Americans, where women are significantly more likely to have functional limitations than men (Garcia et al., 2015; Markides et al., 2007). However, Haas et al. (2012) discovers that, when moderating for parental education, childhood health, and adult SES, foreign-born Hispanics report significantly better lung function than US-born Whites, adding support to presence of an immigrant health advantage.

Other scholars find foreign-born Hispanics to be consistently disadvantaged in terms of disability compared to US-born Whites. Furthermore, foreign-born Mexican women spend over two-thirds of their life after 65 in a disabled state, compared to just over half for men (Angel et al., 2015). Hayward at al. (2014) observes that foreign-born Hispanics have disability levels comparable to that of US-born blacks, a historically marginalized population. Older foreign-Hispanics are also more likely to become disabled compared to native-born Whites (Garcia et al., 2017). Lastly, researchers find that Latinos, especially Latino immigrants, are more likely to report working physically strenuous jobs in comparison to US-born Whites, a job characteristic that is strongly tied to the presence of functional limitations in later life (Pebley et al., 2021).

Scholars who use the intersectionality and life course perspective to look at disability trajectories find that Hispanic women consistently had the highest level of disability, whereas Hispanic men had intermediate levels of disability (Warner and Brown, 2011). Moreover, Brown (2018) establishes that in contrast to white immigrants experiencing a uniform health advantage compared to US-born Whites, black and Hispanic immigrants are faced with a negative health disadvantage that increases with age.

Acculturation or Cumulative Disadvantage?

There is mixed evidence which perspective, acculturation, or cumulative disadvantage, better explains disability outcomes for Mexican immigrants. Age of migration, an established measure of acculturation, is related to heterogeneity in disability trajectories, but the direction and strength of the association is not always consistent with the acculturation perspective. For example, Hispanic immigrant men have similar disability trajectories regardless of immigrant status or age at migration (Monserud, 2019). Additionally, Garcia and Chiu (2016) conclude that late-life female immigrants (who would have spent very little time in the US) are at a particular disadvantage in having a disability compared to their US-born peers. These examples are contrary to the expectations of the acculturation hypothesis. Other research, however, shows that foreign-born Mexican males who migrate in mid to late-life report lower rates of disability compared to their US-born counterparts (Garcia et al., 2017). Late-life immigrants have lower rates of disability initially at 65, but encounter a steep decline in functioning (Garcia and Reyes, 2018). Overall, the disability patterns by age of migration provide inconsistent support for the acculturation hypothesis.

Other studies find support for the acculturation hypothesis in explaining Mexican migrant disability outcomes, whereby individuals with lower levels of acculturation (measured by English language proficiency) report higher ADL and IADL disability (Garcia et al., 2015). Similar research also concludes that foreign-born individuals, particularly females, spend a disproportionate number of years living with dementia compared to their US-born peers, attributing these findings to historical disadvantages in educational attainment, especially in rural areas (Garcia et al., 2019; Saenz et al., 2018).

Moving beyond the individual-level factors of acculturation, there is also varied support for the cumulative disadvantage perspective in explaining differences in disability trajectories and immigrant health erosion (Angel et al., 2015). For instance, there is evidence that immigrants’ legal status shapes disability risks. Immigrants who arrive earlier in the life course and became naturalized are granted better job opportunities and greater political and social inclusion throughout their lives, exhibiting better health outcomes compared to noncitizens (Gubernskaya et al., 2013). Immigrants who arrive in late life and are naturalized, however, report worse health than noncitizens, a result the authors attribute to negative health selection of unhealthy immigrants to become naturalized citizens so they can qualify for public health benefits.

Besides immigrants’ legal status, socioeconomic status is a fundamental cause of disease, influencing onset of disability (Link and Phelan, 1995; Verbrugge and Jette, 1994). Education, a common proxy for socioeconomic status, impacts health behaviors and subsequent life course trajectories, acting as one of the biggest predictors of health outcomes. The socioeconomichealth gradient translates to disproportionate rates of mortality among the less educated as well as an accelerated transition into disability (Singh and Siahpush, 2002). Given that Hispanic immigrants have particularly low levels of education and income, these factors should increase their risk of disability. That said, however, the education-mortality gradient is weaker among Hispanic immigrants than US-born whites, signaling that socioeconomic status may not be a substantial moderator for Mexican immigrant health (Lariscy et al., 2015; Turra and Goldman, 2007). Furthermore, Warner and Brown (Warner and Brown, 2011) find that education has little to no relationship to health outcomes among foreign-born Mexicans compared to Whites.

A potential contributory mechanism behind the disability crossover is “salmon bias,” the selective return migration of infirm and elderly foreign-born individuals to their country of origin (Abraído-Lanza et al., 1999; Diaz et al., 2016). Some researchers find evidence for the salmon bias hypothesis wherein return migrants are less likely to report difficulties with ADLs (activities of daily living) than migrants currently residing in the US (Aguila et al., 2013) while others have found the opposite (Bostean, 2013).

The Current Study

This study tests the possible explanations behind the disability crossover, specifically cumulative diasdvantage and acculturation. This work expands on prior research about the crossover phenomenon, whereby Hispanic immigrants have initially lower age-specific disability rates in their working years but surpass the native-born reference group at older ages, signaling accelerated population deterioration (Sheftel and Heiland, 2018). Sheftel and Heiland’s work depicts an “accelerated aging” process experienced by Hispanic immigrants, leading this group to have higher levels of disability at older ages than their native-born counterparts. However, their cross-sectional examination does not capture cohort-specific trends or track change over time, confounding the aging process with immigrant duration. This is a limitation because immigrant cohorts may experience varying trends in disability rates over the life course, warranting the analysis of both birth and immigrant cohort-specific shifts. Neglecting arrival cohort may also overestimate the degree of negative health assimilation for Hispanic immigrants (Hamilton et al., 2015). In addition, this study respecifies education cutoffs to account for immigrant educational attainment tending to be polarized at very high and very low levels of education (Hamilton and Huang, 2020).

To find support for cumulative disadvantage as a possible explanation behind the disability crossover, the results would yeild divergent trajectories in the predicted probability of disability between high-skill and low-skill Mexican immigrants. In particular, I expect to see that the low-skill have consistently higher rates of disability in later life than their high-skill peers. Low-skill foreign-born Mexicans should also experience a crossover with both low-skill native-born comparison groups: 1) US-born Non-Hispanic Whites and 2) US-born Mexicans. However, high-skill immigrants would not cross over in disability rates with their native-born equals, due to the foreign-born not only having an initial health advantage upon arriving to America, but also exhibiting more protective health and lifestyle behaviors compared to those who are more socioeconomically disadvantaged. If a crossover in disability occurs for both high-skill and low-skill immigrants, findings would yeild a difference in timing of the crossover, by which it occurs earlier in the life course for low-skill immigrants than those that are high-skill. Refer to Figure 1A for a visual representation of the expected findings for the cumulative disadvantage perspective.

Figure 1.

Theoretical expected findings for the cumulative disadvantage hypothesis (A) and the acculturation hypothesis (B) by nativity status

To find support for the acculturation hypothesis as a potential explanation behind the disability crossover, however, I expect to see a convergence in disability rates between high-skill and low-skill immigrants. In addition, findings would yeild no difference in the timing of the disability crossover for Mexican immigrants within skill level. High-skill immigrants may even experience a crossover in disability (compared with their U.S.-born counterparts) at earlier ages than low-skill immigrants, because high-skill immigrants are more likely to be socially acculturated than low-skill immigrants. Since US-born individuals of Mexican descent are fully acculturated and do not experience a health advantage related to migration, then their disability trajectories are not expected to converge with those who are first-generation Mexican. If a convergence between these two nativity groups were to happen, then this findings lends support to acculturation as a possible explanation for the disability crossover. For a visual depiction of the expected findings for the acculturation pathway, refer to Figure 1B.

2. Data and Methods

This study uses data from the 2015–2019 American Community Survey (ACS) public-use microdata sample (PUMS), which randomly sampled 5% of the American population between 2015 and 2019 (Ruggles et al., 2021). The ACS is considered a reliable, nationally representative survey for assessing disability trends among the US population (Siordia, 2014).

Sample Selection

I restrict the sample to specific groups based on ethnicity and nativity. The ACS asks respondents about race, Hispanic origin, and place of birth. Respondents who indicate that they are born in Mexico are the foreign-born focal group. The two native-born comparison groups are: 1) US-born non-Hispanic Whites (those who indicate that their race is “White,” they are not Hispanic, and that they are born in the United States), and 2) US-born Mexicans (those who mark themselves as Mexican and are born in the United States). I include two US-born comparison groups to compare Mexican immigrants to US-born Mexican descendants as well as the racial majority in the US (Whites), a common reference group for health outcomes. The analytic sample is not representative of non-native smaller subpopulations (i.e., Central America or the Caribbean) apart from foreign-born Mexicans that reside in the US.

In terms of age, I further restrict my sample to individuals between the ages of 40 and 80 years old; this age range captures both prime working and retirement phases in the life course. Younger working-age adults are excluded from the native sample because of their comparatively low levels of disability. Adults older than 80 years old are also excluded from the sample because of concerns for differential mortality and attrition bias. To track immigrant duration, the sample omits immigrants who resided in the US for less than one year and those who arrived after 2015, since their duration cannot be tracked all five years of the survey.

Dependent Variable

The first objective of the study is to determine whether Mexican immigrants experience a disability crossover, therefore making the number of disabilities the outcome of interest. The ACS includes six measures of disability – cognitive, ambulatory, self-care, independent living, hearing, and vision difficulties – similar to long form census and international surveys (Verbrugge, 2016). Specifically, independent living and self-care measures are comparable to popular measures of activity limitations, activities of daily living (ADLs) and instrumental activities of daily living (IADLs) (Elo et al., 2011; Markides et al., 2007). ADL measures refer to activities that cannot be done without personal help, such as self-care. IADL activities go a step beyond, covering household management tasks such as balancing a checkbook. The ACS samples the head of the household (proxy reporting), who then reports any disabilities present among the rest of the household. While there are limitations associated with proxy reporting, it is consistently found to be a reliable measure of disability (Gubernskaya et al., 2013; Siordia, 2014).

I construct a count measure of disability from the six ACS measures. Respondents who indicated “yes” to any of the six disabilities indicators are coded as the total number of reported disabilities. Because my target outcome is overall disability, the main analysis includes a simple count measure ranging from 0 (no disabilities) to 6 (presence of all disabilities). To test the robustness of disability as a count measure, I also run supplementary analyses that examine each of the six ACS disability indicators individually. Since there is limited scientific consensus on how to best operationalize disability, I analyze disability status as an aggregate count outcome as well as individually to examine the robustness of the disability crossover.

Focal Independent Variables

The two independent variables at the forefront of the analysis are birth cohort and immigrant cohort. Respondents’ age is used to construct five-year birth cohorts (e.g. 41–45). Ten-year immigrant cohorts (e.g., 1990–1999) are constructed from Mexican immigrants’ year of arrival, grouping immigrants who arrive around the same time together.

Education level also serves as a key independent variable, splitting respondents into two groups 1) those with a high school education or less, and 2) those with at least some college experience. The original cross-sectional study (Sheftel, 2017) that examines the Mexican-American disability crossover dichotomized education level by those who did/did not complete high school or its equivalent. When I apply this programming logic to the ACS data, it results in most of the native-born population being in the high-skill category (90%). To reduce skewness in the educational distribution of the sample, I adjust the cutoff to be higher, reducing the high-skill group to 38%. This adjustment of education also better reflects trends in credential inflation in the US labor market (Collins, 2011; Nasir, 2017).

Control Variables

The analyses include controls for survey year (e.g. 1 = 2015 ACS year, 5 = 2019 ACS year) and dummy variables indicating whether the respondent is foreign-born Mexican or US-born Mexican (with Whites as the reference category). I run models separately by gender because prior literature sees clear gender differences in disability rates (Warner and Brown, 2011). In addition, I specify models where I include year of entry as a robustness test, separating individuals by 10-year immigrant cohorts (except for 2000–2014, which encompasses a 15-year span). I also run models using 5-year immigration cohorts to check for undetected heterogeneity in migrant disability trajectories.

Analytic Strategy

To determine whether cumulative disadvantage or health acculturation better explain the disability crossover, I conduct two steps of analyses. First, I estimate a Poisson regression model and graph the predicted number of disabilities as a count outcome (0–6). This model is based on the double cohort research design, which Myers and Lee pioneered to look at cohort trajectories in homeownership during the late 1990s (1998). This method infers that birth cohorts are nested in immigration cohorts, allowing for cohort estimation on dimensions of aging and migrant duration. Myers and Lee’s double cohort research design is a superior method for estimating disability prevalence because unlike cross-sectional models, it delineates established immigrants who are at the end of their life course from those who are newly arrived and have not experienced the accrued social and environmental effects of their destination country. This advantage enables the double cohort method to separate the effects of cohort duration in the US from the permanent cohort differences in trajectories.

I first combine all arrival cohorts into immigrant/non-immigrant binary comparison groups, where immigrant duration is not accounted for. To test whether acculturation or cumulative disadvantage better explain the disability crossover, I separate nativity groups by education level to see if disability trajectories differ by socioeconomic status. In the third and final analysis, I specify two separate synthetic cohorts, (1) 5-year birth cohorts (those aged 40–80 in the year 2014) and (2) 10-year and 5-year immigrant entry cohorts (those who arrived from 1970–2014). By interacting these two synthetic cohorts with time (ACS year), I can account for separate aging and immigrant duration trends (i.e., birth and entry “double-cohorts”). This supplementary analysis tests the robustness of the crossover in disability for Mexican immigrants, and whether it exists for all or just select immigrant entry cohorts. I estimate cohort advancement by interacting cohort (birth-immigrant dual cohort) by census year. Myer’s method yields specific effects for each birth-immigrant cohort pair (e.g., those aged 41–45 in 2010 who arrived in the US in the 1970s) which are best visualized through the comparison of expected values (predicted probabilities).

The main model includes education (high-skill/low-skill), immigrant group (native-born white, native-born Mexican, and foreign-born Mexican) birth cohort, ACS year, and immigrant cohort as controls. In addition to having the interaction of birth cohort by immigrant cohort, I interact this double cohort effect by ACS year and by education level, separately. These education interactions identify birth and immigration cohorts that are then followed synthetically over time. I plot the predicted probability of disability by nativity along with 95% confidence intervals to ease interpretation of interactions in models. A disability crossover occurs when the predicted probability (disability trajectory) of disability for the immigrant population is lower than that of native-born at working age and then intersects, exceeding the reference group (e.g., US-born Whites) in later life.

To test the robustness of the disability crossover, I estimate a second Poisson regression that includes cohort-specific membership markers (e.g., 1970–1979). Even though the second model appears to include two fewer coefficients than the first model (13 versus 15), the vector of coefficients for MC (immigrant cohort) includes four separate arrival cohorts. The vector of coefficients for BC (birth cohort) has eight cohorts. Using the double cohort method, there are 32 birth-immigrant cohorts. Birth and immigrant cohorts are individually interacted with ACS year to compare the cohort advancement from the beginning of year-interval to the end of year-interval. I plot the predicted probabilities of disability of these results. More information on model specification can be found in the Appendix.

3. Results

Sample Descriptive Statistics

The final analytic sample is comprised of 5,183,847 US-born non-Hispanic whites, 193,811 US-born Mexicans, and 216,470 foreign-born Mexicans. The mean age of the sample is 59.7 and 34.3% of the sample is over the age of 65. In terms of gender, the sample is 51.5% female and 92.7% of the sample is US-born. The subsample of interest, foreign-born Mexicans, are younger than the overall sample with a mean age of 53.8 and 14.2% over the age of 65.

Table 1 shows descriptive statistics by nativity and age group for males and females. In terms of educational attainment, native-born White men and women have the highest level of those considered high-skill (Associate’s degree and above), with 63% and 64%, respectively. Foreign-born Mexicans have the lowest percentage of those considered high-skill, between 18% and 20%.

Table 1.

Sample descriptive statistics by nativity and age group (2015–2019 American Community Survey)

Male	N	High-skill (%)	Mean age	Overall disability (%)	Disability prevalence (%) by age group
					(40,50]	(50,60]	(60,70]	(70,80]
US-born White	2,514,783	63%	59.8	21%	11%	17%	24%	36%
US-born Mexican	92,664	48%	56.3	22%	13%	22%	31%	44%
Foreign-born Mexican	108,331	18%	53.6	12%	6%	12%	23%	40%
Total	2,715,778	61%	59.5	20%	11%	17%	25%	36%
Female	N	High-skill (%)	Mean age	Overall disability (%)	Disability prevalence (%) by age group
					(40,50]	(50,60]	(60,70]	(70,80]
US-born White	2,669,064	64%	60.3	19%	11%	16%	20%	32%
US-born Mexican	101,147	50%	56.9	21%	12%	20%	28%	41%
Foreign-born Mexican	108,139	20%	54	14%	7%	14%	25%	44%
Total	2,878,350	62%	59.9	18%	11%	16%	20%	32%

When all age groups are combined, US-born Mexicans have the highest overall disability rate among the ethnicity- nativity groups, with 22% for men and 21% for women. However, when the results are broken down by age, I see a crossover pattern whereby the foreign-born have lower disability rates than the US-born whites at younger ages but higher rates at older ages. For example, among men, foreign-born Mexicans have the lowest disability rate of the three nativity groups up until ages 71–80. Among this older age group, 40% of Mexican immigrants are disabled compared to 36% of native-born Whites. Foreign-born Mexican women surpass native-born White disability rates between the ages of 61–70, about a decade earlier than their male counterparts. This basic statistic lays the groundwork for examining if a disability crossover occurs when using the double cohort approach.

Disability by Nativity

To determine whether cumulative disadvantage or acculturation better explain the disability crossover, I estimate two separate models for men and women. I use the models to graph predicted probabilities of disability by year and birth cohort while controlling for year of entry. Group trajectories reveal common trends in aging for immigrants and gendered patterns of morbidity.

The results provide support for the acculturation hypothesis as a leading explanation for the disability crossover. The crossover takes place for both men and women, but it occurs earlier in the life course for women than it does for men. Figure 2 shows the predicted probability of having any disability for foreign-born Mexican males. Evident from this first figure, male and female foreign-born Mexicans experience a disability advantage in their 40s and mid-50s. This immigrant group has a lower predicted number of disabilities compared to US-born non-Hispanic whites and US-born Mexicans. However, the migrant advantage in disability starts to decline with age, with foreign-born Mexican women experiencing an earlier crossover in disability with US-born white females between the ages of 55 and age 60. These differences in the predicted probability of disability are statistically significant as evidenced by the 95% confidence intervals.

Figure 2.

Predicted number of disabilities by nativity status

When taking a closer look at Figure 1, a gendered pattern emerges at which the predicted probabilities of disability crossover. Foreign-born Mexican females cross over with their US-born counterparts at age 57. For males, the age at crossover is 66. Mexican-born women experience an earlier age of crossover, which is consistent with literature on the gendered age of retirement. Specifically, women retire at an earlier age than men (Vinet and Zhedanov, 2011). These findings are similar when using US-born Mexicans as the comparison group (see Appendix). Figure 1b shows the disability advantage of foreign-born Mexican females reverses by 66, where this group has overlapping rates of disability with the US-born Mexican females. Foreign-born Mexican males cross over at a later age with their US-born Mexican peers, at age 73.

Disability by Nativity and Education

When looking at disability rates by nativity and education, a bifurcated pattern emerges: immigrants, regardless of skill level, experience an age crossover in disability compared to their native-born peers, but high-skill immigrants uniformly surpass their high-skill native-born counterparts at earlier ages than low-skill immigrants do with their respective low-skill peers. Even from a visual inspection, high-skill immigrants appear to have a larger gap in later-life disability rates with their native-born peers compared to the gap present among low-skill nativity groups. This disability gap in later life is particularly evident between Mexican immigrant and native-born White women in Figure 3, where at age 75 high-skill foreign-born Mexican women have a 0.91 predicted number of disabilities compared to 0.47 for US-born white women.

Figure 3.

Predicted number of disabilities by sex, nativity status, and skill level

For men, the timing for an age crossover in disability varies for low and high skill comparison groups. Among those who are low-skill, Mexican immigrant men have consistently lower rates of disability up until the age of 76, where they surpass non-Hispanic low-skill white men. Among the high-skill, Mexican immigrants cross over with their native high-skill peers at 66 years old, about 10 years younger than their low-skill Mexican immigrants. The timing of the disability crossover provides evidence for the acculturation hypothesis as a central explanation, since high-skill immigrants not only have equal, but worse health outcomes in the form of an earlier age at crossover.

When comparing within-skill level disability rates among women, a similar finding comes to light. High-skill immigrant women experience a crossover in disability earlier in the life course than low-skill immigrant women (when compared to native-born groups of matching skill level). Secondly, low-skill female immigrants have a smaller difference in later-life disability (within-skill level) than high-skill immigrants do.

The disability trends of high-skill foreign-born Mexican women support the acculturation hypothesis in helping explain the disability crossover because high-skill Mexican immigrants, a seemingly advantaged group, cross over with the low-skill US-born comparison group. If support for the cumulative disadvantage perspective was found, then I expect to see separate crossover trends occurring for low-skill immigrants, with no crossover between high-skill and low-skill groups regardless of nativity. Since both high-skill and low-skill foreign-born groups converge in predicted probability of disability and exceed the native-born comparison groups, I find support for the acculturation pathway in helping explain the disability crossover.

Supplementary analyses that examine each ACS disability measure (cognitive difficulty, ambulatory difficulty, independent living difficulty, self-care difficulty, vision, and hearing difficulty) yield comparable results as the main analyses, apart from hearing difficulty. For the case of hearing difficulty, foreign-born Mexican men do not experience a crossover with either US-born Whites or Mexicans, maintaining a consistent health advantage across the life course.

4. Discussion

These analyses set out to determine whether the disability crossover between US-born non-Hispanic whites and US-born Mexicans is primarily operating through the acculturation or cumulative disadvantage pathways. I fail to find evidence for the cumulative disadvantage pathway because my findings illustrate that immigrants experience similar disability trajectories regardless of education level (if anything, those with higher levels of education experienced more rapid increases in disability as they age than those with lower levels of education). When looking at disability trajectories by arrival cohort (figures available in Appendix), the presence of a disability crossover for Mexican immigrants is uniform and consistent. As expected, Mexican immigrant women experience a crossover in disability rates at an earlier age than males, which occurs across all arrival cohorts. While my findings don’t indicate the presence of cumulative disadvantage, they also don’t rule out the impact that discrimination has on migrant health outcomes, regardless of socioeconomic status.

The lack of a socioeconomic gradient in Mexican immigrants’ disability rates also suggests that acculturation may operate as a mechanism for the disability crossover. Arrival cohort sensitivity analyses show that negative health assimilation in the form of a disability crossover occurs for all immigrant entry cohorts. This is in line with previous findings of disability rates being similar for Mexican immigrant by age-of-migration (Sheftel and Heiland, 2018). In addition, this study adds to the growing body of literature on the disability crossover as well as bolstering evidence on the weak socioeconomic health gradient found among Mexican immigrants (Goldman et al., 2006).

These findings also yield important gender differences. Mexican immigrant women experience an earlier disability crossover compared to their male counterparts, which is in line with the existing literature on women’s higher rates of morbidity (Arber and Cooper, 1999; Warner and Brown, 2011). Mexican immigrant women experience the highest rate of disability among all nativity groups, which translates to them living in a protracted period of disability and being “doubly disadvantaged.” This finding may be attributed to Mexican immigrant women occupying traditionally “female” labor sectors (e.g., healthcare, hospitality/food service, retail, and education) which may be more variable in scheduling availability as well as employer benefits (Carratala et al., 2021). My results may also support the “weathering hypothesis,” which refers to an accelerated aging process for Mexican women, due to their higher likelihood in living in disadvantaged neighborhoods, experiencing racial/ethnic discrimination, and general socioeconomic disadvantage (Wildsmith, 2002).

My findings diverge from Sheftel and Heiland’s work (2018) because I do not find a steeper disability age gradient for low-skill foreign-born Mexicans. In fact, I find support for the opposite—both high-skill and low-skill immigrants have similar disability trajectories. In addition. Our findings include more robust measures of educational attainment because I raise the cut-point of the high/low education grouping. Be doing this, I resolve the left-skewed education grouping whereby 93% of US-born Whites are considered high-skill.

Limitations

There are several limitations to my results. First, I cannot account for compositional differences in cohorts. Immigrant cohorts that have been measured at one point in time experience varying rates of emigration and subsequent immigrant selection. Less economically successful individuals who return to their home country are dubbed “failed immigrants” and cannot be accounted for in the sample. This may introduce bias in the results because a sample of less-educated immigrants may not be representative. Similarly, I cannot account for ill or elderly immigrants returning to their home country (“salmon bias”), making the remaining immigrant disability prevalence appear artificially low. However, scholars have found mixed evidence for the effect of return migration and salmon bias on immigrant cohort composition (Abraído-Lanza et al., 1999; Diaz et al., 2016; Fuller Thomson et al., 2013; Turra and Elo, 2008). Although I am unable to empirically test for the presence of selective migration, future studies benefit from examining the role of “salmon bias” for migrant disability trajectories.

Another caveat that limits the scope of these findings is that mortality differentials between immigrants and native-born people may introduce bias. Mexican immigrants have lower rates of mortality than native-born groups, which may result in the most disabled of the native-born population dying at disproportionally high rates, leaving behind a positively selected (i.e., lower disability) population. I can partially discount this limitation because the disability crossover is noted at relatively younger ages (before 65), at which the risk of mortality is low.

An additional limitation is the issue with self-reporting of functional limitations. Those who list themselves as having a disability in the ACS do not need a doctor’s diagnosis to verify their claim. This is especially pertinent to Mexican immigrants, who underutilize preventative and medical care. However, ACS disability measures are considered reliable and nationally representative for understanding national disability patterns (Siordia, 2014). The ACS also does not offer information on immigrants’ legal status, limiting the interpretation of my results. Lastly, I cannot identify the factors leading up to the reported disability. That means that I cannot parse out whether the disability is a result of cumulative wear and tear on the body or a sequela to a chronic condition (e.g., heart disease, diabetes).

Future research should consider how generalizable the disability crossover is among other racial/ethnic groups and how the racialized post-migration experience impacts migrant health outcomes, net of SES. In addition, researchers can benefit from examining why the crossover may not extend to certain measures of disability (i.e., hearing difficulty).

5. Conclusion

Research on the disability crossover is nascent and limited to the foreign-born Hispanic population. Although this study faces data limitations, it offers quantitative support for the assimilation perspective in explaining Mexican immigrants’ disability crossover. These results also contribute to understanding how robust the crossover is in context of arrival cohort. By using the double cohort approach, I determine that both high and low skill Mexican immigrants experience a crossover in disability with the two native-born comparison groups (US-born Whites and US-born Mexicans), surpassing all the remaining nativity groups in later life. I do not find evidence in support of the cumulative disadvantage pathway, which may point to the fact that immigrant status is more salient to influencing disability trajectory than socioeconomic disadvantage. This study adds to the expanding field on the immigrant disability crossover and underlines potentially vulnerable populations.

Highlights.

• Mexican immigrants experience a disability crossover with US-born Whites.

• Regardless of education level, Mexican immigrants have comparable disability rates.

• Mexican immigrant women crossover in disability at earlier ages than males.

• All disability measures, except hearing difficulty, support acculturation.