Nonfatal injury and disability in the United States: an examination of racial/ethnic and nativity differences
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Both the socioeconomic and occupational profiles of non-Latino Blacks, Latinos, and labor immigrants are risk factors that predispose these groups to experiencing more injury and disability when compared to non-Latino Whites. The main objective of this dissertation was to determine if injury and disability differences exist between racial/ethnic groups and between foreign-born and U.S.-born individuals. The interaction of race/ethnicity and other risk factors and the interaction of nativity and other risk factors were explored in order to pinpoint additional risks that could place racial/ethnic minorities and immigrants at a heightened disadvantage of experiencing injury and disability. These research questions were examined using the National Health Interview Survey and logistic and multinomial logistic regression methods. viii Although income, education, and occupation are of significant importance in the likelihood of sustaining an injury, this dissertation showed that Blacks and Latinos are less likely to report a work-related injury and other types of injuries. The odds of suffering various types of injuries are also lower among immigrants. These results persisted in gender-specific models and when the unemployed were excluded from the analyses of work-related injuries. In terms of disability, the results were more in line with the racial/ethnic disparities literature. Blacks, Mexican Americans, and other Latinos were more likely to experience more serious disability than nonLatin Whites. Both socioeconomic status and health-related factors helped to explain away or reverse these race/ethnic differences for two of the three disability outcomes. Black-White differences persisted for ADL. Immigrants were also less likely to suffer an injury or experience a disability, but the risk of disability increased with duration. Findings support the double disadvantage hypothesis because age heightens the risk of injury for Latino and the risk of disability for immigrants. Though the odds of sustaining a work-related injury were lower for employed Latino men when compared to their White male counterparts, at older ages, the odds of reporting a work-related injury were higher among employed Latino men relative to employed white men. Similarly, at older ages, immigrants are at a greater risk of needing assistance with multiple activities of daily living relative to their U.S.-born counterparts. Experiencing an injury also heightens the risk of disability for minorities and immigrants when compared to Whites and U.S. born individuals with similar injuries, respectively. These results suggest that race/ethnicity and nativity are ix important to the study of injury and disability and prevention policy aims. The risk of injury and disability, however, may be greatest when race/ethnicity and nativity interact with other risk factors.