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Nativity and cognitive disability among children: a unique comparison with reduced selection bias

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International Journal of Public Health



We examined the impact of nativity on self-reported cognitive disability by comparing children who were born outside of the USA (first-generation immigrants) with US-born offspring (second-generation immigrants) of foreign-born parents.


We analyzed a diverse, nationally representative, sample of 77,324 first-generation immigrant and second-generation immigrant children (aged 5–17 years) from the 2009 American Community Survey. Multivariate logistic regression was used to assess the association between nativity and self-reported cognitive disability after adjustment for demographics and household characteristics.


Self-reported cognitive disability was observed in 1.7 % of the sample. The prevalence was higher among first second-generation immigrants than among second first-generation immigrants (1.9 vs 1.1 %, p < 0.001). After multivariate adjustment, the advantage of being foreign-born remained (OR = 0.63, 95 % CI = 0.53–0.75). Further analysis revealed effect modification of the immigrant health advantage by household income (p = 0.003).


We observed an immigrant advantage in self-reported cognitive disability; however, it was only evident among economically disadvantaged children. Future research should examine the contribution of the accumulation of poverty over time to the relationship between nativity and children’s health.

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The author acknowledges her mentor, Dr. Emilia Bagiella, and colleague (and good friend), Dr. Mary K. Townsend, for their critical insight during the preparation of this manuscript. The author is currently a recipient of the NIH Extramural Loan Repayment Program for Health Disparities Research. Preliminary findings from this study were presented at the 2014 Women in Statistics Conference.

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Correspondence to Emma K. T. Benn.

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Benn, E.K.T. Nativity and cognitive disability among children: a unique comparison with reduced selection bias. Int J Public Health 59, 809–817 (2014).

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