Hidden Heterogeneity: How the White Racial Category Masks Interethnic Health Inequality

Abstract

Inequality research has often used non-Hispanic Whites as the reference category in measuring U.S. racial and ethnic health disparities, with less attention paid to diversity among Whites. Immigration patterns over the last several decades have led to greater ethnic heterogeneity among Whites, which could be hidden by the aggregate category. Using data from the National Health Interview Survey (2000-2018), we disaggregate non-Hispanic Whites by nativity status (U.S.- and foreign-born) and foreign-born region of birth (Europe, Former Soviet Union, and the Middle East) to examine diversity in health among adults aged 30+ (n = 290,361). We find that foreign-born Whites do not have a consistent immigrant health advantage over U.S.-born Whites, and the presence of an advantage further varies by birth region. Immigrants from the Former Soviet Union (FSU) are particularly disadvantaged, reporting worse self-rated health and higher rates of hypertension (high blood pressure) than U.S.-born and European-born Whites. Middle Eastern immigrants also fare worse than U.S.-born Whites but have health outcomes more similar to European immigrants than to immigrants from the FSU. These findings highlight considerable diversity in health among White subgroups that is masked by the aggregate White category. Future research must continue to monitor growing heterogeneity among Whites and consider more carefully their use as an aggregate category for gauging racial inequality.

Keywords: Former Soviet Union; Immigration; Middle East; Non-Hispanic Whites; U.S. health disparities.

Fig. 1

Major birth regions for non-Hispanic White immigrants, 1960–2023. Birthplace categories are based on the Office of Management and Budget’s classification scheme. Europe includes individuals born in Northern, Western, and Southern Europe. Eastern Europe includes countries belonging to the Former Soviet Union and other non-USSR countries in the Eastern Hemisphere. Sources: Authors’ tabulations from U.S. Census Bureau (2023) and Migration Policy Institute (2024) data hub.

Fig. 2

Annual admissions by birth region for non-Hispanic White immigrants, 1986–2022. Vertical lines represent key events affecting White immigration. Sources: Authors’ tabulations from the Yearbook of Immigration Statistics published by the U.S. Department of Justice (1996–2001) and U.S. Department of Homeland Security (2002–2022).

Fig. 3

Odds ratios of poor/fair self-rated health by nativity and birth region, with 95% confidence intervals. Odds ratios are derived from logistic regression models shown in Table 2. The baseline model adjusts for survey year, sex, age, and age squared (Model 1). The fully adjusted model adds sociodemographic, immigration, and health characteristics (Model 3).

Fig. 4

Odds ratios of hypertension by nativity and birth region, with 95% confidence intervals. Odds ratios are derived from logistic regression models shown in Table 3. The baseline model adjusts for survey year, sex, age, and age squared (Model 1). The fully adjusted model adds sociodemographic, immigration, and health characteristics (Model 3).