Relationship between citizenship and legal status and BMI and hypertension among individuals of Mexican descent in Los Angeles

Background: In literature on Latino health disparities, few studies examine differences between Latino sub-groups.  Research is needed to understand the impact of citizenship and legal status on Latino health, either directly or through effects on socio-economic position and health care access.  Objective: I examine the associations of citizenship or legal status with BMI and hypertension and test for mediation and moderation by socio-demographic and health care characteristics.  Methods:  The sample included Mexican and Mexican-Americans in the Los Angeles Family and Neighborhood Survey.  The independent variable was based on self-identified citizenship or legal status.  The dependent variables included two measures each of BMI and hypertension. Socio-demographic and health care access measures were included. I tested hierarchical regression models of associations between each dependent variable and socio-demographic and health care measures and the independent variable.  I then tested for moderation and mediation by gender, employment, and health care access.  Results:  BMI and hypertension are high across all status groups.  There are significant differences in education, income, and employment; with the highest levels of disadvantage among the undocumented and visa and green card holders.  Preliminary findings indicate that US-born citizenship is associated with a 7% greater BMI (ß, 0.07; CI 0.3-1.84).  Having a place to receive health care is the strongest predictor of hypertension diagnosis (OR, 1.72; CI 1.24-2.39).  Conclusion: This study illuminates the complex relationships between citizenship and legal status and health.  It demonstrates significant disparities in socio-economic position and access to health care, key determinants of health outcomes, across these groups.