, Volume 56, Issue 1, pp 1–24 | Cite as

Immigrant Legal Status and Health: Legal Status Disparities in Chronic Conditions and Musculoskeletal Pain Among Mexican-Born Farm Workers in the United States

  • Erin R. HamiltonEmail author
  • Jo Mhairi Hale
  • Robin Savinar


Immigrant legal status determines access to the rights and privileges of U.S. society. Legal status may be conceived of as a fundamental cause of health, producing a health disparity whereby unauthorized immigrants are disadvantaged relative to authorized immigrants, a perspective that is supported by research on legal status disparities in self-rated health and mental health. We conducted a systematic review of the literature on legal status disparities in physical health and examined whether a legal status disparity exists in chronic conditions and musculoskeletal pain among 17,462 Mexican-born immigrants employed as farm workers in the United States and surveyed in the National Agricultural Workers Survey between 2000 and 2015. We found that unauthorized, Mexican-born farm workers have a lower incidence of chronic conditions and lower prevalence of pain compared with authorized farm workers. Furthermore, we found a legal status gradient in health whereby naturalized U.S. citizens report the worst health, followed by legal permanent residents and unauthorized immigrants. Although inconsistent with fundamental cause theory, our results were robust to alternative specifications and consistent with a small body of existing research on legal status disparities in physical health. Although it is well known that Mexican immigrants have better-than-expected health outcomes given their social disadvantage, we suggest that an epidemiologic paradox may also apply to within-immigrant disparities by legal status. We offer several explanations for the counterintuitive result.


Health Immigration Legal status Mexico–United States Farm workers 



We gratefully acknowledge support from the Western Center for Agricultural Health & Safety, which is funded by National Institute of Occupational Health and Safety Grant No. 2U54OH007550, and from the Max Planck Institute for Demographic Research. We also thank Trish Hernandez and Susan Gabbard at JBS International; Daniel Carroll at the U.S. Department of Labor; Don Villarejo and Gail Wadsworth at the California Institute for Rural Studies; Marc Schenker, Heather Riden, and Emily Sousa at the Western Center for Agricultural Health and Safety; and Angelo Lorenti.

Supplementary material

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Copyright information

© Population Association of America 2018

Authors and Affiliations

  • Erin R. Hamilton
    • 1
    Email author
  • Jo Mhairi Hale
    • 2
    • 3
  • Robin Savinar
    • 1
  1. 1.Department of SociologyUniversity of California, DavisDavisUSA
  2. 2.School of Geography and Sustainable Development, Irvine BuildingUniversity of St AndrewsSt AndrewsUK
  3. 3.Max Planck Institute for Demographic ResearchRostockGermany

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