Understanding The Health Landscapes Where Latinx Immigrants Establish Residence In The US

Abstract

The diversity of health contexts in which members of the US Latinx population establish residence may provide insights into the variety of health challenges they face. We investigated differences in health professional shortages, general health services, health care safety-net supply, health access, and population health rankings across 3,113 US counties classified as established, new, or other Latinx population destinations. Compared with new destinations, established destinations had more health professional shortages, as well as higher rates of child and adult health uninsurance. New destinations had fewer health care safety-net services per 100,000 county residents than established destinations. Health contexts thus differ in significant ways across new and established Latinx destinations, and these differences have key implications for Latinx immigrant health.

EXHIBIT 1. US Latinx destination counties, by type

SOURCE Authors’ categorization based on data from the Census Bureau’s 1990 and 2010 decennial censuses. NOTES Latinx destination counties by type based on county Latinx population in 1990 and Latinx growth from 1990 to 2010. The 3,113 counties in the data set were categorized as established, new, or other destinations based on the percentage of Latinx people in the county in 1990 and Latinx growth in the county from 1990 to 2010. Established destinations were defined as counties with 9 percent or more Latinx population in 1990 (the national average for that year). New destinations were defined as counties with less than 9 percent Latinx population in 1990 that met at least one of the following two criteria: Among all nonestablished destinations, the county had a higher than median Latinx growth rate (272.4 percent or higher) between 1990 and 2010 and was at least 5 percent Latinx by 2010, or the county was a nonestablished destination that was at least 16 percent Latinx by 2010 (the national average for that year). Other destinations were defined as the remaining counties in neither category. This typology was based on previous typologies used in Ackert E, Crosnoe R, Leventhal T. New destinations and the early childhood education of Mexican-origin children (see note in text); and Singer A, Suro R. Latino growth in metropolitan America: changing patterns, new locations (see note in text).

EXHIBIT 2. Adjusted percentage of Latinx destination counties with Health Professional Shortage Area designations in 2020, by destination county and geographic shortage type

SOURCES Authors’ analysis based on an author-compiled data set of publicly available data from the Census Bureau and the Health Resources and Services Administration. NOTES Latinx destination counties by type, based on county Latinx population in 1990 and Latinx growth from 1990 to 2010. The 3,113 counties in the data set were categorized as established, new, or other destinations (defined in the notes to Exhibit 1) based on the percentage of Latinx people in the county in 1990 and Latinx growth in the county from 1990 to 2010. In 2020, 46 percent of established destination counties had primary care shortage designations, compared with 28 percent of new destination counties and 40 percent of other destination counties. (The Health Resources and Services Administration establishes the criteria for Health Professional Shortage Area designations in Health Resources and Services Administration. What is shortage designation? [Internet]. Rockville (MD): HRSA; 2021 Feb [cited 2021 May 7]. Available from: https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation.) The percentages in this exhibit have been adjusted for differences across counties in population size, per capita income, rural/urban status, educational attainment, unemployment rates, and Republican vote share. Appendix table A2 includes a full list of these county characteristics and their mean values for the full sample and across destinations, and appendix table A5 lists the values of the adjusted percentages and standard errors (see note in text). Error bars indicate 95% confidence intervals.

EXHIBIT 3. Adjusted mean federal health centers and community health centers per 100,000 residents in Latinx destination counties, by destination county type

SOURCES Authors’ analysis based on an author-compiled data set of publicly available data from the Census Bureau and the US. Health Resources and Services Administration. NOTES Latinx destination counties by type based on county Latinx population in 1990 and Latinx growth from 1990 to 2010. The 3,113 counties in the data set were categorized as established, new, or other destinations (defined in the notes to Exhibit 1) based on the percentage of Latinx people in the county in 1990 and Latinx growth in the county from 1990 to 2010. The mean numbers in this exhibit have been adjusted for differences across counties in population size, per capita income, rural and urban status, educational attainment, unemployment rates, and Republican vote share. Appendix table A2 includes a full list of these county characteristics and their mean values for the full sample and across destinations, and appendix table A5 lists the values of the adjusted percentages and standard errors (see note in text). Error bars indicate 95% confidence intervals.