Persistent effects of legal status on healthcare access and outcomes: findings from a state-wide representative cross-sectional survey in California

Abstract

Background To examine how legal status and past undocumented status are associated with healthcare access and health outcomes.Methods Data were collected between 2018 and 2020 as a follow-on, cross-sectional survey to the California Health Interview Survey (N=2010). We used multiple regression models to assess associations between past and current legal status and usual source of care, delayed medical care and psychological distress.Results Overall, 26.2% of the sample had ever been undocumented. Compared with citizens who have always held lawful status (CLS), non-citizens who were previously undocumented (adjusted OR (aOR)=0.48, p<0.05) and non-citizens who have always held lawful status (NLS) (aOR=0.41, p<0.01) were less likely to have a usual source of care. Citizens who were previously undocumented were more likely to delay medical care (aOR=2.32, p<0.05) compared with CLS. NLS were more likely to have moderate and above distress (aOR=2.31, p<0.01) compared with CLS.Conclusion Public health efforts are needed to address the burden of trauma and disadvantage among those experiencing persistent effects of undocumented status.