Using ‘White’ as Racial Benchmark May Obscure Health Data

DURHAM, N.C. — The use of “White” as a benchmark when comparing racial and ethnic health disparities is far too broad and fails to account for variations among easily identifiable subgroups, according to a study out of Duke University.

As a result, says study author Jen’nan Read, a Carnegie scholar and chair of Duke’s Department of Sociology, health disparities within these subgroup populations are easily overlooked.

The study was published Monday in the Journal of Immigrant and Minority Health.

Read’s research comes at a time when the health and well-being of immigrants is a subject of growing public health concern.

In 2022, immigrants made up 13.9% (roughly 46.2 million people) of the U.S. population, up from 7.9% (or 19.8 million people) in 1990.

As this population has grown, it has also diversified, both in terms of race and ethnic background, a reality that has important implications for the overall health of the U.S. population and the health care system.

While there has been a relative wealth of research into the health of racial and ethnic minorities, Read found that surprisingly little is known about the health of non-Hispanic White immigrants.

“This is an important oversight for several reasons,” the study says. “First, foreign-born Whites make up 17% (7.6 million) of the U.S. immigrant population and are projected to grow to 20% (15.6 million) by 2060.

“Not only will their numbers contribute to patterns in immigrant health, but also to patterns in overall population health via growth in the second and third generations,” it adds. 

“Second, Whites are ethnically diverse and defined by the U.S. Census as persons who trace their ancestry to ‘any of the original peoples of Europe, the Middle East and North Africa.’

“When the federal government established standards for racial and ethnic categories in 1977, western European Whites comprised over 70% of the total U.S. population and 60% of the foreign-born White population. 

“Today,” the study notes, “those numbers have dropped to roughly one-third each, while Middle Eastern and Eastern European immigrants — who are also classified as White — have grown to comprise over one-half (53%) of the foreign-born White population.”

Read writes that the majority of immigrants from the Middle East and Eastern Europe have arrived in the United States, since 1990, after the Iran-Iraq War, the fall of the former Soviet Union, and the beginning of the first Gulf War.

“They are linguistically, phenotypically, and culturally more diverse than their western European predecessors, and many have migrated under challenging circumstances due to political and civil unrest in their countries of origin,” she writes.

Studies that disaggregate White ethnic subgroups, such as Arab Americans, have indeed found higher rates of diabetes, heart disease, disability, cognitive limitations, psychological distress] and poorer self-rated health than U.S.-born Whites.

Immigrants from the former Soviet Union, who are also classified as White, likewise report higher rates of hypertension, disability and poorer self-rated health when compared to U.S.-born Whites. 

“While informative, research on specific ethnic subgroups paints a partial picture of White immigrant health,” Read writes. “Studies that compare all foreign-born Whites to U.S.-born Whites are limited, and even fewer have examined multiple mental and physical health outcomes in the same analytic framework. 

“Thus, the extent to which U.S.- and foreign-born Whites differ across a range of outcomes is unknown. Less is also known about compositional variation among White immigrants on factors related to health, such as poverty and access to health care. Evaluating the compositional characteristics of Whites could provide a more complete understanding of the mechanisms driving observed health disparities,” she continues. 

The study is based on merged data from the 2019-2022 National Health Interview Survey. The analytic sample includes U.S.-born and foreign-born non-Hispanic White adults aged 25-64.

But Read acknowledges that data was not without its limitations. For instance, she was unable to disaggregate White immigrants by region or country of birth due to the removal of region of birth in the 2019 NHIS survey redesign. 

“Future research will need to continue monitoring the composition of U.S. Whites to better specify the conditions that contribute to within- and between-group racial health disparities,” she writes.

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