Project Summary Title: Immigrant Integration and Health: Multidimensional and Cross-National Analyses Over the Life Course. Older immigrants of color have high levels of cognitive impairment and physical disability, which stands in sharp contrast to the “healthy immigrant effect” where recent immigrant arrivals tend to be healthier than the native-born. With the elderly immigrant population in the U.S. projected to quadruple by 2050, the decline of the healthy immigrant effect over the life course represents a growing public health concern. The existing literature has made much progress in identifying associations between time since immigration and accelerated health declines. However, it remains unclear 1) which mechanisms within the broad process of acculturation and integration drive this decline, 2) how the timing of integration over the life course affects health, and 3) the role of U.S. institutional designs in shaping immigrant health declines, particularly among populations of color. This project will leverage linked survey and administrative data to develop multidimensional and longitudinal measures of immigrant integration and evaluate their impact on older adults’ health. We will also investigate the role of institutional designs on immigrants’ health using a cross-national comparison between the U.S. and Canada. Specific Aim 1 investigates how social, economic, and residential dimensions of integration affect trajectories of physical functioning and cognitive impairment among Black, Hispanic, White, and other immigrants after age 60. We hypothesize that different dimensions of integration will affect different dimensions of health in later life. Furthermore, we expect that Black and Hispanic immigrants will receive especially small or negative returns to integration due to higher exposure to racism. Specific Aim 2 adopts a cross-national design to compare the effect of economic integration trajectories on U.S. and Canadian immigrants’ physical health, including the racial differences in these effects. We hypothesize that the timing of economic integration will be consequential for immigrants’ later-life health outcomes because health (dis)advantages are cumulative over the life course. We further expect that these consequences are more pronounced in the U.S. than in Canada because the latter has universal healthcare, and immigrants have access to programs and resources regardless of their individual economic conditions. The research team contains an interdisciplinary group of sociologists, demographers, and health policy scholars who have the necessary expertise and familiarity with the data and methodology to produce new evidence on immigrant integration and older immigrants’ health. The outcomes of this project can advance our understanding of how racial and immigrant health disparities emerge and what interventions can most effectively reduce them.

Project Narrative This project uses linked survey and administrative data to understand the impact of multidimensional and longitudinal measures of integration into U.S. society on older immigrants’ physical and cognitive health. It also leverages a cross-national comparison to uncover the role of federal institutional designs in shaping the integration-health link. The outcomes of this project will help uncover why immigrants experience accelerated health declines over the life course, as well as identify specific areas for policy intervention to reduce racial/ethnic health disparities among immigrants.