Nativity—encompassing birthplace, length of residence in the U.S., citizenship, and immigration status—profoundly affects the health of immigrants in America. Yet many national health surveys avoid asking about key aspects of nativity, particularly immigration status. This omission hampers efforts to understand health disparities among diverse immigrant groups and to craft effective, evidence-based policies.
To fill this gap, researchers often rely on proxies, such as birthplace or the absence of a social security number, to infer immigration status. However, these methods are fraught with inaccuracies. For instance, some U.S. citizens and permanent residents also lack social security numbers, making it unreliable as a stand-in for undocumented status.
Direct questions
Directly asking about immigration status in surveys could resolve these issues, but concerns linger. Critics argue that such questions might stigmatize respondents, lower participation rates, elicit false answers, or expose participants to risks if law enforcement or immigration authorities access the data.
A recent study from Texas A&M University School of Law challenges these assumptions. The researchers compiled evidence suggesting these objections are overstated and can be addressed with proper safeguards.
“We can no longer rely on the assumption that questions about immigration status are too stigmatizing or will lead to invalid responses,” the authors assert. They emphasize the costs of omission: lost insights and poorly informed health policies.
Successful examples
The study highlights successful examples of surveys that have gathered detailed immigration data, including the National Agricultural Worker Survey, the Kaiser Family Foundation/Los Angeles Times Survey of Immigrants, and the Hispanic Community Health Study/Study of Latinos. These surveys categorize respondents as citizens, unauthorized residents, or those with temporary or pending statuses. Notably, questions about immigration status in these surveys had minimal impact on response rates. For example, less than 5% of foreign-born respondents declined to answer such questions in major studies.
Concerns about invalid responses also appear exaggerated. An analysis of the American Community Survey found that 12.21% of noncitizens misreported their status as citizens—a lower error rate than earlier estimates of up to 34.7%. Moreover, privacy safeguards, such as the Confidential Information Protection and Statistical Efficiency Act, protect personal data from unauthorized use, with violators facing significant penalties.
To further reduce risks, surveys can anonymize immigration data and avoid linking it to identifying information like names or locations. Though complete anonymity is impossible in longitudinal studies, robust privacy laws can offer additional protection.
A clearer picture
The authors argue that including immigration status in national health surveys would enable a clearer understanding of the health effects of immigration-related policies. They also propose oversampling foreign-born populations to improve the statistical power of analyses.
“National health surveys have adapted over time to address topics like mental health, substance use, and sexual orientation—once considered too sensitive to ask about,” the researchers note. “It is time to consistently collect detailed data on immigration status and history to better evaluate how policy affects immigrant health.”
By directly addressing immigration status, health surveys could move beyond unreliable proxies and provide a stronger foundation for equitable policymaking.
