Ambulatory disability among immigrants from China, India, and Mexico: Exploration of heterogeneity in 'immigrant advantage'

Prior studies on immigrant advantage in health have mostly focused on Hispanics with limited attention to immigrants from Asian countries. Significant increase of immigrants from China and India in recent decades highlights the need to understand prevalence and risk of adverse health outcomes among these immigrants groups. Such evidence is essential for the formulation of more inclusive public health policies. This study explores 'immigrant advantage' and potential heterogeneity in the prevalence and risk of ambulatory disability (difficulty with walking or climbing steps) by the duration of exposure to societal influence in the US. We compare immigrants from China, India, and Mexico to their counterparts born in the United States (US) by using information from the American Community Survey (ACS) Public Use Microdata Sample (PUMS) 5-year-file from 2008-2012. The sample of community dwelling adults, aged 25-64, is made up of 860,482 people residing in the US. Prevalence and risk is estimated using a complex grouping scheme that accounts for the age at time of entry to US and years in US since immigration. We observe an immigrant advantage in the prevalence of and risk for ambulatory disability. We also document heterogeneity in the immigrant health advantage by timing and length of exposure to US society. At a same level of exposure, we observe greater risk for ambulatory disability for those arriving early in life. Future public health policies should be cognizant of the role of exposure in producing heterogeneity in the prevalence of ambulatory disability among immigrants of Asian origin.