Residential Segregation: Hurting or Helping U.S. Hispanic Health?

Abstract

U.S. Hispanics experience health disparities that are in part socially determined. My dissertation explores the connections between health and residential segregation for Hispanics and key Hispanic subgroups in metropolitan America. I conduct a multivariate analysis combining individual-level health survey data on Hispanics from the 1997-2002 Urban Institute National Survey of America's Families with metropolitan area-level residential segregation scores from Census 2000. My primary research question is: What is the role of residential segregation in shaping the health disparities of U.S. Hispanics? I compare the link between segregation and health for U.S. Hispanics with African Americans, and evaluate differences among Hispanics by nativity and country of origin. My outcome measures are self-rated health, insurance status, and having a usual source of health care. I find a significant negative effect on health status of residential segregation from whites for U.S. Hispanics even after accounting for compositional factors such as poverty status and education. Consistent with spatial assimilation theory, however, much of the observed negative effects of segregation on health are overshadowed by individual-level socioeconomic characteristics. In support of place stratification theory which emphasizes the relative disadvantage of African Americans as racial minorities in the U.S., I find that African Americans experience modestly greater health disparities associated with segregation than Hispanics. Despite my prediction that health outcomes for foreign-born Hispanics may actually improve with higher segregation, nativity does not significantly alter the link between health and segregation among U.S. Hispanics. I do find a significant interaction between nativity and segregation for Mexicans in the prediction of being uninsured and for Cubans in the prediction of self-rated health. For foreign-born Mexicans, segregation is more of a disadvantage in the prediction of being uninsured. The only evidence I find of any positive or protective link between segregation and health is for Cuban-origin Hispanics whose odds of reporting good self-rated health increase with higher levels of segregation. While segregation has a positive association with health status for both U.S.-born and foreign-born Cubans, the effect is substantially stronger for the foreign born. This research highlights the importance of examining residential segregation as a social determinant of health, and reveals important nuances in the link between health and segregation for nativity and country-of-origin subgroups of U.S. Hispanics.