Health related quality of life: The role of race and English proficiency for older immigrants

Racial health disparities are well-documented, but little is known how racial differentiation affects the health of older immigrants. This study applies the Commission on Social Determinants of Health model to identify the contribution of race and other immigration related factors on the health of older immigrants. Data from the California Health Interview Survey (2003, 2005) were extracted for foreign-born respondents aged 65 and over. African Americans were excluded due to few raw observations. The study included 2675 immigrant Latino, Asians and non-Hispanic Whites. The four outcomes of health related quality of life (HRQOL) were used as outcome variables in weighted analyses. The results show that race-based differences in HRQOL exist in the unadjusted bivariate model. When English proficiency is entered into the equation, however, the racial differences are partially mediated. In addition, immigrants who speak English poorly are less likely to be in good health compared to English-only speakers. Race-based differences were observed in the three remaining indicators of HRQOL. While racial disparities in health are profound and affect large segments of the population, health promotion efforts for older immigrants the focus ought to include a focus on language-based differentiation. Public health advocates need to develop and employ evidence-based interventions that reach limited English proficient older adults to address the health, psychosocial and access to healthcare challenges they face. Study findings demonstrate that health outreach programs and healthcare services targeted to older immigrant populations would benefit from a focus on reaching under-served populations with varying levels of English proficiency.