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.
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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.
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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.
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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
- Migrant health
- Health selection
- Return migration
- Mexican migrants