Health Related Quality of Life: The Role of Race and English Proficiency for Older Immigrants

Background & Purpose The number of immigrants in the United States is growing, leading to fast expansion in the number of older adults. In 2002, nearly 15% of all immigrants were older than 50. Additionly, now more than ever immigrants bring increased diversity to the older adult population. As one's cultural and racial identify can influence self perceptions, the trend of a larger and increasingly diverse older adult population points to the need for research on how race impacts health. This study applies the Commission on Social Determinants of Health (CSDH) model to answer the following research questions: 1) are there differences in health by race, and 2) do the differences remain once covariates are entered into the model?

Methods Data from the California Health Interview Survey (2003, 2005) were extracted for all foreign-born respondents aged 65 and over to examine the health of older immigrants. Race was categorized using the UCLA Center for Health Policy Research definitions of race. Mixed race respondents were excluded from the study sample to ensure proper classification. African Americans were excluded due to a limited number of observations. The study included 2675 immigrant Latino, Asians and Whites.

Binary and ordered logistic regression models were used to examine the effects of race on the four HRQOL outcomes (general heath, physical limited days, mental health limited days, and combined limited days), while controlling for structural and intermediary factors. Age, gender, insurance status, education, marital status, English proficiency and time in the U.S. were structural covariates. Perceived health and discrimination, as well as the endorsement of selected chronic health conditions were used as intermediary covariates.

Results The results show that race-based differences in HRQOL exist at the unadjusted bivariate model. Whites were the most likely to report being in overall good health (75.4%), with Asians (47.7%) and Latinos (37.6%) reporting significantly lower numbers. Interestingly however, when English proficiency is entered into the equation, however, the racial differences are partially mediated. Results show that the differences between races become less important than the difference in HRQOL respondents who speak English well and those who do not speak English well. Those who speak English well were 3 times more likely to report being in good health than the comparison group. Additionally, respondents who reported speaking English well were less likely (OR=.68) to report limited physical days, less likely report limited mental health days (OR=.89) and less likely to report limited HRQOL days than those who reported not speaking English well.

Conclusion & Implications While racial disparities in health are profound and affect large segments of the population, in order to promote the health of older immigrants the results show that the focus ought to be shifted to language-based differentiation. Social work practice needs to develop and emphasize evidence-based interventions that reach limited English proficient older adults to address the health, psychosocial and access to healthcare challenges they face.