Abstract
Despite having lower levels of education and limited access to health care services, Mexican immigrants report better health outcomes than U.S.-born individuals. Research suggests that the Mexican health advantage may be partially attributable to selective return migration among less healthy migrants—often referred to as “salmon bias.” Our study takes advantage of a rare opportunity to observe the health status of Mexican-origin males as they cross the Mexican border. To assess whether unhealthy migrants are disproportionately represented among those who return, we use data from two California-based studies: the California Health Interview Survey; and the Migrante Study, a survey that samples Mexican migrants entering and leaving the United States through Tijuana. We pool these data sources to look for evidence of health-related return migration. Results provide mixed support for salmon bias. Although migrants who report health limitations and frequent stress are more likely to return, we find little evidence that chronic conditions and self-reported health are associated with higher probabilities of return. Results also provide some indication that limited health care access increases the likelihood of return among the least healthy. This study provides new theoretical considerations of return migration and further elucidates the relationship between health and migration decisions.
Similar content being viewed by others
Notes
The combined response rate for these two flows is 67.7 %. Supplementary analyses of voluntary returners indicate that respondents who were unmarried, female, and earned a high school diploma or a higher level of attainment were significantly less likely to participate. We address this source of bias by controlling for such observables (excluding gender) in our analyses of Mexican-origin men.
The CHIS landline sample household response rate was 17.0 %, a product of the screener and extended interview at 31.6 % and 53.9 %, respectively; the cellphone sample household response rate was 18.3 % (screener = 33.0 %, extended interview = 55.5 %).
CHIS data were continuously collected over two years (during 7- to 9-month periods each year) in order to reduce risks related to nonrepresentativeness due to seasonality of surveying.
Among the Migrante sample, duration of stay is asked for the latest U.S. trip and does not include prior U.S. visits.
For instance, female migrants may require additional health services, including prenatal care and breast cancer screening, or could be more inclined to seek medical care than their male counterparts.
Based on the Migrante data, a higher percentage of return migrants and deportees are male (73 % and 87 %, respectively).
Although stayers appear to be advantaged compared with return migrants, their rate of health care usage is much lower than that of the overall U.S. population. In 2013, 13.4 % of all persons in the United States did not have health insurance coverage (Smith and Medalia 2014) compared with 34 % of Mexican-born stayers in our data.
We estimated similar specifications that exclude stayers with comparably less U.S. experience in light of concerns surrounding seasonal migration patterns. Because the average length of stay for Mexican-origin males is approximately three years (e.g., Reyes 2001), we excluded those who resided in the United States for less than five years (2.8 % of stayers) as a conservative test. These results, which are available upon request, are substantively similar to all results shown.
Encuesta sobre Migración en la Frontera Norte de México (EMIF Norte) is supported by Mexico’s Colegio de la Frontera Notre. More details are available online (http://www.colef.mx/emif/eng/bases_metodologicas.php). Results from this exercise are available upon request.
References
Abraído-Lanza, A. F., Chao, M. T., & Flórez, K. R. (2005). Do healthy behaviors declines with greater acculturation? Implications for the Latino mortality paradox. Social Science & Medicine, 61, 1243–1255.
Abraído-Lanza, A. F., Dohrenwend, B. P., Ng-Mak, D. S., & Turner, J. B. (1999). The Latino mortality paradox: A test of the “salmon bias” and healthy migrant hypotheses. American Journal of Public Health, 89, 1543–1548.
Acevedo-Garcia, D., Bates, L. M., Osypuk, T. L., & McArdle, N. (2010). The effect of immigrant generation and duration on self-rated health among U.S. adults 2003–2007. Social Science & Medicine, 71, 1161–1172.
Akresh, I. R. (2007). Dietary assimilation and health among Hispanic immigrants to the United States. Journal of Health and Social Behavior, 48, 404–417.
Amuedo-Dorantes, C., Puttitanun, T., & Martinez-Donate, A. P. (2013). How do tougher immigration measures impact unauthorized immigrants? Demography, 50, 1067–1091.
Arenas, E., Goldman, N., Pebley, A. R., & Teruel, G. (2015). Return migration to Mexico: Does health matter? Demography, 52, 1853–1868.
Bastida, E., Brown, H. S., III, & Pagán, J. A. (2008). Persistent disparities in the use of health care along the US–Mexico border: An ecological perspective. American Journal of Public Health, 98, 1987–1995.
Blumberg, S. J., Luke, J. V., & Cynamon, M. L. (2006). Telephone coverage and health survey estimates: Evaluating concern about wireless substitution. American Journal of Public Health, 96, 926–931.
Bostean, G. (2013). Does selective migration explain the Hispanic paradox? A comparative analysis of Mexicans in the U.S. and Mexico. Journal of Immigrant and Minority Health, 15, 624–635.
Bustamante, A. V., Fang, H., Garza, J., Carter-Pokras, O., Wallace, S. P., Rizzo, J. A., & Ortega, A. N. (2012). Variations in healthcare access and utilization among Mexican immigrants: The role of documentation status. Journal of Immigrant and Minority Health, 14, 146–155.
Buttenheim, A., Goldman, N., Pebley, A. R., Wong, R., & Chung, C. (2010). Do Mexican immigrants “import” social gradients in health to the US? Social Science & Medicine, 71, 1268–1276.
Ceballos, M. (2011). Simulating the effects of acculturation and return migration on the maternal and infant health of Mexican immigrants in the United States: A research note. Demography, 48, 425–436.
Cervantes, I. F., Brick, J. M., & Edwards, S. (2014). Report 4: Response rates (CHIS 2011–2012 Methodology Report Series). Los Angeles, CA: UCLA Center for Health Policy Research.
Chiquiar, D., & Hanson, G. H. (2005). International migration, self-selection, and the distribution of wages: Evidence from Mexico and the United States. Journal of Political Economy, 113, 239–281.
Chirikos, T. N., & Nestel, G. (1985). Further evidence on the economic effects of poor health. Review of Economics and Statistics, 67, 61–69.
Chiswick, B. R., Lee, Y. L., & Miller, P. W. (2008). Immigrant selection systems and immigrant health. Contemporary Economic Policy, 26, 555–578.
Cornelius, W. A. (2001). Death at the border: Efficacy and unintended consequences of US immigration control policy. Population and Development Review, 27, 661–685.
Crimmins, E. M., Soldo, B. J., Kim, J. K., & Alley, D. E. (2005). Using anthropometric indicators for Mexicans in the United States and Mexico to understand the selection of migrants and the “Hispanic paradox.” Biodemography and Social Biology, 52, 164–177.
Dechter, A. R., & Preston, S. H. (1991). Age misreporting and its effects on adult mortality estimates in Latin America. Population Bulletin of the United Nations, 31–32, 1–16.
Dougherty, M., Wilson, D., & Wu, A. (2006). Immigration enforcement actions: 2005 (Annual report). Washington, DC: U.S. Department of Homeland Security, Office of Immigration Statistics.
Dreby, J. (2015). Everyday illegal: When policies undermine immigrant families. Oakland: University of California Press.
Elo, I. T., Turra, C. M., Kestenbaum, B., & Ferguson, B. R. (2004). Mortality among elderly Hispanics in the United States: Past evidence and new results. Demography, 41, 109–128.
Espiritu, Y. L. (1999). Gender and labor in Asian immigrant families. American Behavioral Scientist, 42, 628–647.
Flores, G. (2006). Language barriers to health care in the United States. New England Journal of Medicine, 355, 229–231.
Fong, V. L. (2008). The other side of the healthy immigrant paradox: Chinese sojourners in Ireland and Britain who return to China due to personal and familial health crises. Culture, Medicine & Psychiatry, 32, 627–641.
Golash-Boza, T., & Hondagneu-Sotelo, P. (2013). Latino immigrant men and the deportation crisis: A gendered racial removal program. Latino Studies, 11, 271–292.
Goldman, D. P., Smith, J. P., & Sood, N. (2005). Legal status and health insurance among immigrants. Health Affairs, 24, 1640–1653.
Groot, W. (2000). Adaptation and scale of reference bias in self-assessments of quality of life. Journal of Health Economics, 19, 403–420.
Hagan, J. M., Rodriguez, N., & Castro, B. (2011). Social effects of mass deportation by the United States government, 2000–10. Ethnic and Racial Studies, 38, 1374–1391.
Hao, L., & Kim, J. H. J. (2009). Immigration and the American obesity epidemic. International Migration Review, 43, 237–262.
Herrick, D. M. (2007). Medical tourism: Global competition in health care (Report No. 304). Washington, DC: National Center for Policy Analysis.
Horton, S., & Cole, S. (2011). Medical returns: Seeking health care in Mexico. Social Science & Medicine, 72, 1846–1852.
Hummer, R. A., Benjamins, M. R., & Rogers, R. G. (2004). Racial and ethnic disparities in health and mortality among the U.S. elderly population. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 53–94). Washington, DC: National Academies Press.
Hummer, R. A., Biegler, M., De Turk, P. B., Forbes, D., Frisbie, W. P., Hong, Y., & Pullum, S. G. (1999). Race/ethnicity, nativity, and infant mortality in the United States. Social Forces, 77, 1083–1117.
Hummer, R. A., Powers, D. A., Pullum, S. G., Gossman, G. L., & Frisbie, W. P. (2007). Paradox found (again): Infant mortality among the Mexican-origin population in the United States. Demography, 44, 441–457.
Hummer, R. A., Rogers, R. G., Amir, S. H., Forbes, D., & Frisbie, W. P. (2000). Adult mortality differentials among Hispanic subgroups and non-Hispanic whites. Social Science Quarterly, 81, 459–476.
Jasso, G., Massey, D. S., Rosenzweig, M. R., & Smith, J. P. (2004). Immigrant health: Selectivity and acculturation. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 227–266). Washington, DC: National Academies Press.
Jürges, H. (2007). True health vs response styles: Exploring cross-country differences in self-reported health. Health Economics, 16, 163–178.
Kimbro, R. T., Bzostek, S., Goldman, N., & Rodríguez, G. (2008). Race, ethnicity, and the education gradient in health. Health Affairs, 27, 361–372.
Knaul, F. M., Gonzales-Pier, E., Gomez-Dantes, O., Garcia-Junco, D., Arreola-Ornelas, H., Barraza-Llorens, M., . . . Frenk, J. (2012). The quest for universal health coverage: Achieving social protection for all in Mexico. Lancet, 380, 1259–1279.
Kohli, A., Markowitz, P. L., & Chavez, L. (2011). Secure communities by the numbers: An analysis of demographics and due process (Chief Justice Earl Warren Institute on Law and Social Polity research report). Berkeley: University of California, Berkeley Law School.
Ku, L., & Matani, S. (2001). Left out: Immigrants’ access to health care and insurance. Health Affairs, 20, 247–256.
Landeck, M., & Garza, C. (2003). Utilization of physician health care services in Mexico by U.S. Hispanic border residents. Health Marketing Quarterly, 20, 3–16.
Lara, M., Gamboa, C., Kahramanian, M. I., Morales, L. S., & Buatista, D. E. H. (2005). Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context. Annual Review of Public Health, 26, 367–397.
Lariscy, J. T., Hummer, R. A., & Hayward, M. D. (2015). Hispanic older adult mortality in the United States: New estimates and an assessment of factors shaping the Hispanic paradox. Demography, 52, 1–14.
LeClere, F. B., Jensen, L., & Biddlecom, A. E. (1994). Health care utilization, family context, and adaptation among immigrants to the United States. Journal of Health and Social Behavior, 35, 370–384.
Lu, Y., & Qin, L. (2014). Healthy migrant and salmon bias hypotheses: A study of health and internal migration in China. Social Science & Medicine, 102, 41–48.
Macias, E. P., & Morales, L. S. (2001). Crossing the border for health care. Journal of Health Care for the Poor and Underserved, 12, 77–87.
Markides, K. S., & Eschbach, K. (2005). Aging, migration, and mortality: Current status of research on the Hispanic paradox. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 60(Special Issue 2), S68–S75.
Martinez-Donate, A. P., Hovell, M. F., Rangel, M. F., Zhang, X., Sipan, C. L., Magis-Rodriguez, C., & Gonzalez-Fagoaga, J. (2015). Migrants in transit: The importance of monitoring HIV risk among migrant flows converging on the Mexico-U.S. border. American Journal of Public Health, 105, 497–509.
Menjívar, C. (1999). The intersection of work and gender: Central American immigrant women and employment in California. American Behavioral Scientist, 42, 601–627.
Morales, L. S., Marielena, L., Kington, R. S., Valdez, R. O., & Escarce, J. J. (2002). Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. Journal of Health Care for the Poor and Underserved, 13, 477–503.
Ortega, A. N., Fang, H., Perez, V. H., Rizzo, J. A., Carter-Pokras, O., Wallace, S. P., & Gelberg, L. (2007). Health care access, use of services, and experiences among undocumented Mexicans and other Latinos. Archives of Internal Medicine, 167, 2354–2360.
Palloni, A., & Arias, E. (2004). Paradox lost: Explaining the Hispanic Adult mortality advantage. Demography, 41, 385–415.
Palloni, A., & Morenoff, J. D. (2001). Interpreting the paradoxical in the Hispanic paradox. Annals of the New York Academy of Sciences, 954, 140–174.
Powers, D. A. (2013). Paradox revisited: A further investigation of racial/ethnic differences in infant mortality by maternal age. Demography, 50, 495–520.
Reyes, B. I. (2001). Immigrant trip duration: The case of immigrants from Western Mexico. International Migration Review, 35, 1185–1204.
Rosenberg, H. M., Maurer, J. D., Sorlie, P. D., Johnson, N. J., MacDorman, M. F., Hoyert, D. L., & Scott, C. (1999). Quality of death rates by race and Hispanic origin: A summary of current research, 1999 (Vital and Health Statistics, Series 2, No. 128). Hyattsville, MD: National Center for Health Statistics.
Rubalcava, L. N., Teruel, G. M., Thomas, D., & Goldman, N. (2008). The healthy migrant effect: New findings from the Mexican Family Life Survey. American Journal of Public Health, 98, 78–84.
Salomon, J. A., Tandon, A., & Murray, C. J. L. (2004). Comparability of self rated health: Cross sectional multi-country survey using anchoring vignettes. BMJ, 328, 258. doi:10.1136/bmj.37963.691632.44
Scribner, R. (1996). Paradox as paradigm—The health outcomes of Mexican Americans. American Journal of Public Health, 86, 303–305.
Simanski, J. F. (2014). Immigration enforcement actions: 2013 (Annual report). Washington, DC: U.S. Department of Homeland Security, Office of Immigration Statistics.
Smith, J. C., & Medalia, C. (2014). Health insurance coverage in the United States: 2013 (Current Population Reports, No. P 60–250). Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.
Smith, J. P. (1999). Healthy bodies and thick wallets: The dual relation between health and economic status. Journal of Economic Perspectives, 13(2), 144–166.
Sorlie, P. D., Backlund, E., & Keller, J. B. (1995). US mortality by economic, demographic, and social characteristics: The National Longitudinal Mortality Study. American Journal of Public Health, 85, 949–956.
Stark, O., & Bloom, D. E. (1985). The new economics of labor migration. American Economic Review, 75, 173–178.
Turra, C. M., & Elo, I. T. (2008). The impact of salmon bias on the Hispanic mortality advantage: New evidence from Social Security data. Population Research and Policy Review, 27, 515–530.
Ullmann, S. H., Goldman, N., & Massey, D. S. (2011). Healthier before they migrate, less healthy when they return? The health of returned migrants in Mexico. Social Science & Medicine, 73, 421–428.
Van Hook, J., & Zhang, W. (2011). Who stays? Who goes? Selective emigration among the foreign-born. Population Research and Policy Review, 30, 1–24.
Wallace, S. P., Mendez-Luck, C., & Castañeda, X. (2009). Heading south: Why Mexican immigrants in California seek health services in Mexico. Medical Care, 47, 662–669.
Warner, D. C. (1991). Health issues at the US-Mexican border. Journal of the American Medical Association, 265, 242–247.
Acknowledgments
The Migrante study was supported by the National Institutes of Health (NIH) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant R01 HD046886; PI: Martinez-Donate). The second author received support from the National Institute on Aging (Grant T32 AG00129), the Center for Demography and Ecology (Grant P2C HD047873), and the Center for Demography of Health and Aging at the University of Wisconsin–Madison (Grant P30 AG017266). An early version of this article was presented at the 2015 Annual Meeting of the Population Association of America. The authors would like to thank Erin Hamilton, Jenna Nobles, and Alberto Palloni for helpful comments on earlier drafts. Authors are solely responsible for all content.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Diaz, C.J., Koning, S.M. & Martinez-Donate, A.P. Moving Beyond Salmon Bias: Mexican Return Migration and Health Selection. Demography 53, 2005–2030 (2016). https://doi.org/10.1007/s13524-016-0526-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13524-016-0526-2