Cognitive difficulty and race/ethnicity in the US. does nativity matter?

Extant research on the immigrant health paradox has focused primarily on Latinos, however nativity-related heterogeneity in health outcomes may also be important among other racial/ethnic groups. One health outcome having a profoundly negative impact on individuals' livelihood for which the complex interplay between race/ethnicity and nativity has yet to be explored is cognitive difficulty. We used 2009 ACS PUMS data to explore racial/ethnic differences in cognitive difficulty and possible effect modification by nativity in a large, multiethnic sample of adults in the US, after accounting for important covariates. Compared to non-Hispanic Whites (NHWs), we observed higher odds of cognitive difficulty among non-Hispanic Blacks (NHBs; OR=1.08, 95% CI=1.05-1.10) and non-Hispanic Native Americans/Pacific Islanders (NHNAPIs; OR=1.62, 95% CI=1.53-1.72), whereas we observed protective effects for Hispanics and non-Hispanic Asians (NHAs). Foreign born adults had lower odds of cognitive difficulty than US born adults, although the magnitude of the foreign-born advantage was greatest for foreign born NHBs and NHNAPIs compared to their US born counterparts. Among US born adults only, the magnitude of the racial/ethnic differences between NHBs, NHNAPIs and NHWs were similar to those observed in the total sample, whereas, the protective effects were diminished in magnitude yet still statistically significant for Hispanics and NHAs. Among foreign born adults only, the odds of cognitive difficulty did not differ for Hispanics, NHAs, and NHNAPIs compared to NHWs, whereas a protective effect was observed for NHBs (OR=0.78, 0.70-0.87). We are conducting further analyses to explore the impact of acculturation on the foreign born cognitive difficulty-related “advantage”, especially among NHBs.