Occupational class and uninsurance among Asian Americans

Background: Despite many European studies showing that occupational class is a powerful determinant of health, work as a source of health disparities remains largely unexamined in the United States. Numerous significant disparities in the healthcare access and health outcomes of Asian Americans are documented.

Objectives: We investigate how occupational class (white-collar, blue-collar, service, and unemployed) is associated with uninsurance (no private/public health insurance) for Asian Americans and whether nativity and length of residence in the U.S. are effect modifiers.

Methods: We analyzed data from Asian respondents of the National Latino and Asian American Survey who were part of the workforce (employed or unemployed but looking for work) using weighted bivariate and multivariate logistic regression analyses (weighted n=5.4million).

Results: Overall, 13% of Asian American workers were uninsured. Occupational class was strongly associated with uninsurance. Compared to 9% of white-collar workers, 15% of blue-collar, 14% of service, 14% of other and 29% of unemployed workers were uninsured (p=.0004). In sub-groups of nativity, differences by occupational class were most pronounced for recent immigrants. Among immigrants residing in the U.S. for five years or less, 6% of white-collar, 12% of blue-collar, 33% of service, 26% of other and 46% of unemployed workers were uninsured (p=.0012). Multivariate logistic regressions on samples stratified by nativity show that these associations remain relatively stable.

Conclusions: Preliminary results indicate striking differences in the proportion of uninsured workers by occupational class and nativity. Better understanding occupational disparities and reforming policies to expand health insurance coverage can help reduce health disparities.