Cognitive Disability Among Arab Americans By Nativity Status: Lack of Evidence for the Healthy Migrant Effect

Abstract

Research ObjectiveLimited research exists on cognitive disabilities among foreign‐born adults, particularly among non‐Hispanic Arab Americans. Objectives were to (a) estimate the age‐ and sex‐adjusted prevalence of cognitive disability by nativity status among Arab Americans compared to non‐Hispanic whites, non‐Hispanic blacks, Hispanics, and Asians and (b) examine associations between race, ethnicity, and nativity status and having a cognitive disability before and after controlling for covariates.Study DesignCross‐sectional.Population StudiedThe sample comprised 10 years (2008‐2017) of data from the American Community Survey (ACS) Public Use Microdata Samples (PUMS). The US Census Bureau conducts the ACS using monthly samples to produce annual national estimates of demographic and socioeconomic factors. The sample was limited to adults ages 45 and older. The final sample included 5 011 469 adults (US‐born = 4 288 842, foreign‐born = 722 627). The age‐ and sex‐adjusted prevalence of cognitive disability was obtained for US‐ and foreign‐born (10 groups) non‐Hispanic whites, Arab Americans, Asians, blacks and Hispanics. Cognitive disability was measured by asking whether participants “have difficulty concentrating, remembering or making decisions” due to a physical, mental or emotional condition (yes or no). Weighted means, percentages, age‐ and sex‐adjusted prevalence estimates, and logistic regression results (crude and adjusted) were calculated. Covariates adjusted for were age, gender, marital status, education, and poverty level. Citizenship status, years living in United States, and English language proficiency were controlled for among foreign‐born adults.Principal FindingsAmong US‐born adults, the age‐ and sex‐adjusted prevalence of cognitive disability among non‐Hispanic Arab Americans was 5.3%, which was lower than non‐Hispanic whites (6.5%), blacks (10.8%), and Hispanics (10.0%). Among foreign‐born adults, the prevalence was highest among non‐Hispanic Arab Americans (7.3%) compared to all other groups. Among US‐born adults, non‐Hispanic Arab Americans had 27% lower odds (95% CI = 0.65, 0.82) of having a cognitive disability compared to US‐born non‐Hispanic whites. After adjusting for demographic (age, sex, marital status) and socioeconomic (education and poverty level) variables, results were not significant. Among foreign‐born adults, there was no significant difference between non‐Hispanic whites and non‐Hispanic Arab Americans in crude models. After adjusting for demographic (age, sex, marital status) and socioeconomic (education and poverty level) variables, foreign‐born non‐Hispanic Arab Americans had 1.42 times greater odds (95% CI = 1.29, 1.56) of having a cognitive disability compared to foreign‐born non‐Hispanic whites. After adjusting for sociodemographic and acculturation characteristics, foreign‐born non‐Hispanic Arab Americans had 1.24 times greater odds (95% CI = 1.12, 1.37) of having a cognitive disability compared to foreign‐born non‐Hispanic whites.ConclusionsThis is the first study to examine cognitive disabilities among US‐ and foreign‐born Arab Americans. More research is needed to better understand factors that may contribute to the increased prevalence of cognitive disabilities found among foreign‐born adults.Implications for Policy or PracticeThis study contributes to a growing body of literature unmasking Arab Americans from the non‐Hispanic white racial group. Furthermore, our results demonstrate that Arab American health may not benefit from increased acculturation like other immigrant groups (the healthy migrant effect). National policy changes are needed to include an ethnic identifier for Arab Americans so estimates of health conditions, health behavior patterns, and health services use can more easily be measured for prevention and intervention studies.Primary Funding SourceMichigan Center for Contextual Factors in Alzheimer's Disease.