Associations of occupational class and immigrant status with the health of Asian Americans in the labor force

Background: A socioeconomic gradient in health (lower socioeconomic status (SES) associated with worse health) is well-documented. However, growing evidence depicts a paradox with some low SES, racial/ethnic minority immigrants having more favorable health than their richer, U.S.-born and more acculturated counterparts.

Objective: We investigated how occupational class (white-collar, blue-collar, service work, unemployed), a SES indicator, and immigrant status (U.S.-born, immigrant) are associated with 5 health outcomes (self-rated fair/poor mental, self-rated fair/poor physical health, DSM-IV defined mental disorders in past 12 months-any mental disorder, anxiety, depression) among Asian Americans in the labor force.

Methods: We conducted weighted, multivariate logistic regression analysis of cross-sectional data from Asian respondents (n=1530) of the National Latino and Asian American Survey controlling for age, gender, ethnicity and English proficiency.

Results: We found no occupational class gradients and a strong health protective effect of being foreign-born for most outcomes. Immigrants had significantly lower odds of self-rated fair/poor physical health [OR=.56 (.33-.96)] and any mental disorder, anxiety and depression [adjusted ORs (95%CI)=.43 (.25-.72), .46 (.26-.82), .49 (.29-.84), respectively] than U.S.-born Asians. However, those reporting speaking fair/poor English had higher odds for all negative outcomes than those speaking excellent/good English (adjusted ORs ranged from 2.81-5.02, p<0.01).

Conclusions: Occupational class and immigration-related factors influence health in complex ways. Being foreign-born was associated with better mental health while limited English proficiency was associated with worse mental health. Disentangling and understanding these relationships can inform more equitable efforts to promote health and provide health services to Asian Americans.