Is Acculturation the Culprit? Acculturative Discordance and Immigrants’ Later-Life Health

Abstract

Immigrants have similar or higher disability levels than the U.S.-born in later life, which is puzzling given they have a health advantage upon arrival. A popular explanation is that acculturation harms health, but existing evidence is mixed. This study constructs multidimensional acculturation measures (linguistic, residential, marital, civic) using the American Community Survey (N = 958,211) and examines their associations with disability. I find that immigrants indeed lose their health advantage over the U.S.-born between ages 65 and 80, but most acculturation measures predict lower rather than higher disability. Instead, I propose and find evidence for a theory of acculturative discordance, where (1) net of demographic and socioeconomic characteristics, immigrants who are acculturated on some dimensions but not acculturated on others have poorer health and (2) minoritized immigrants experience discordance between their behavioral inclusion into the U.S. society and exposure to structural exclusion and receive more disadvantaged health returns to acculturation than non-Hispanic White immigrants.

Keywords

acculturation disability immigrant health advantage racialization status inconsistency

Introduction

Older immigrants have higher or similar levels of disability (Levchenko 2021; Melvin et al. 2014) despite lower mortality than the U.S.-born (Zheng and Yu 2025). This means immigrants spend more years with poor health in later life even as a sizable share of the population faces economic, social, and linguistic barriers to care (Boen and Hummer 2019). Given that this population is projected to nearly double between now and 2050 (U.S. Census Bureau 2025), it is imperative to understand why vulnerabilities exist and how to address them.

Notably, older immigrants’ outcomes stand in sharp contrast to recent arrivals, who are healthier than the native-born due to positive health selection (Feliciano 2020). Over the life course, immigrants initially hold a health advantage over the U.S.-born, but this advantage diminishes or even reverses in mid- to later life (Sheftel 2017; Zheng and Yu 2025). A popular interpretation of this phenomenon is that acculturation, namely, the process of immigrants adapting to the surrounding context and becoming more like the U.S.-born, harms immigrants’ health.

Existing work has tested this hypothesis using various acculturation measures. They include immigrants’ attitudes toward origin- versus host-society cultures (e.g., Schumann et al. 2020), proxies such as duration of stay in the United States (e.g., Cho et al. 2004), and increasingly also social behavior adaptation, such as citizenship acquisition and residential integration (Burns et al. 2025; Kimbro 2009). Recognizing the multidimensional nature of acculturation, studies have increasingly modeled multiple measures simultaneously (Kim and Gorman 2022; Riosmena et al. 2015) or used acculturation indices combining various indicators (Lee et al. 2013). This literature has been highly productive, although its findings have been mixed regarding the direction and nature of the acculturation–health link.

The current study takes a step further from the multidimensional approach to explain why immigrants lose their health advantage. Building on status inconsistency theory (House and Harkins 1975) and on the migration literature that highlights the interconnectedness of various dimensions of the immigrant experience (Portes and Zhou 1993), I propose viewing acculturation as an interactive system where the impact of some acculturation dimensions also depends on the individual’s acculturation level on other dimensions. Rather than independent indicators of acculturation, it is potentially the discordance between acculturative dimensions within the same individual—for example, being integrated residentially but not linguistically—that creates particularly stressful situations that put a strain on health. I first demonstrate this by showing that different dimensions of immigrants’ behavioral acculturation indeed interact with each other to shape health. I then show that individuals who experience a high level of discordance indeed drive the erosion in the immigrant health advantage.

Existing research has also typically considered acculturation to belong in the behavioral realm, which is heavily influenced by but nonetheless separate from structural explanations of health disparities. The current study connects them by introducing a second form of discordance between acculturation and racialization. Given immigrants’ exposure to structural racism and intersectionality (Brown 2018; Sorrell et al. 2019), I hypothesize that racially and ethnically minoritized immigrants who are relatively acculturated may experience discordance between their high levels of behavioral inclusion into the U.S. society and exposure to structural exclusion. I show evidence that the association between acculturation and health indeed depends on race and that it is less positive among Black, Hispanic, and Asian immigrants than among White immigrants. Among immigrants with similarly high acculturation levels, people of color experience an erosion in their health advantage relative to the U.S.-born in later life, but White individuals maintain their advantage.

Background

The Erosion of Immigrants’ Health Advantage

Despite having lower socioeconomic status (SES) on average, foreign-born individuals have better overall health and lower chronic condition prevalence than the U.S.-born (Cunningham, Ruben, and Narayan 2008; Jasso et al. 2004). The immigrant health advantage is most commonly attributed to selective migration, where individuals with more robust health profiles are more likely to immigrate (Feliciano 2020; Riosmena, Kuhn, and Jochem 2017). The selective outmigration of unhealthy immigrants (Turra and Elo 2008) and the protective effect of strong ethnic networks (Eschbach et al. 2004) also contribute to this phenomenon.

However, immigrants’ health advantage weakens or reverses with age, which is sometimes referred to as a “disability crossover” (Levchenko 2021; Sheftel and Heiland 2018). This pattern holds true for many chronic conditions and disabilities (Jasso et al. 2004; Zheng and Yu 2025). It points to the importance of understanding immigrants’ exposure to potential stressors as they live in the United States for longer, and a growing literature examines the role of acculturation in shaping immigrants’ health.

Acculturation and Health

Prior research has generally adopted the hypothesis that higher acculturation leads to worse health (for comprehensive reviews, see Lara et al. 2005; Salant and Lauderdale 2003) but measured acculturation in varied ways. Among the most popular conceptualizations is Berry’s (1997) modes of acculturation, measured using scales consisting of respondents’ self-reported strength of identities and attitudes toward origin- versus host-society cultures (e.g., Schumann et al. 2020). Although widely applied to health research, acculturation scales have received criticism that they are unclear about what “cultural differences” actually constitute and that immigrants’ health declines are being attributed to stereotypical traits rather than concrete social determinants (Hunt, Schneider, and Comer 2004).

Another common approach is to measure immigrants’ level of exposure to the host society using proxies, typically duration of residence, age at migration, or English language proficiency/usage (Cho et al. 2004; Gubernskaya 2015; Lee, Nguyen, and Tsui 2011). For example, studies have concluded that immigrants experience “unhealthy assimilation” upon observing an increase in obesity among immigrants who have lived in the United States for longer (Antecol and Bedard 2006) or arrived at younger ages (Roshania, Narayan, and Oza-Frank 2008). They have argued that acculturation is a risk factor when they observe that higher English proficiency, net of other factors, is associated with increased likelihood of poor health (Lee et al. 2011). In addition, immigrants’ smoking and alcohol use increases with longer stay and/or more English language use (Abraído-Lanza, Chao, and Flórez 2005; Lopez-Gonzalez, Aravena, and Hummer 2005), and their fruit and vegetable consumption declines (Akresh 2007).

Although measures such as duration of residence are widely available in data sets, they offer a limited view on what acculturation entails, and English language proficiency/use only captures one of many dimensions of acculturation. Increasingly, the literature on immigrant health has examined a broad set of outcomes under the umbrella of social behavioral acculturation—outcomes that typically change as immigrants live longer in the United States, from citizenship acquisition (Burns et al. 2025; Lopez-Gonzalez et al. 2005) to residential context (Fenelon 2017; Kimbro 2009). Furthermore, because immigrant adaptation is multidimensional in nature (Gordon 1964), studies have also increasingly modeled multiple social behavioral measures simultaneously (Kim and Gorman 2022; Riosmena et al. 2015) or used acculturation indices combining various indicators (Lee et al. 2013).

Notably, studies using this broader definition of acculturation have found that higher acculturation is not always associated with worse health; instead, it is often the opposite. For example, although higher English usage is associated with less healthy behavior (Lopez-Gonzalez et al. 2005), linguistic acculturation can also be an indicator of social capital and is associated with better health outcomes (Garcia et al. 2015; Tegegne 2018). On a different dimension, residence in immigrant enclaves—an indicator of low acculturation—is associated with lower consumption of high fat foods but also with lower neighborhood walkability and healthy food availability (Osypuk et al. 2009). Accounting for selection, higher co-ethnic density is associated with increased cardiovascular risks (Li, Wen, and Henry 2017), and living outside of enclaves is associated with lower mortality (Fenelon 2017). Finally, research has found mixed results regarding civic acculturation, typically measured with citizenship. On the one hand, citizenship is associated with increased risks of activity limitations, potentially due to negative health selection into naturalization (Gubernskaya, Bean, and Van Hook 2013). On the other hand, noncitizens have a disadvantage in certain chronic conditions, self-rated health, and distress (Hamilton, Patler, and Savinar 2022; Kaestner et al. 2009), and there is a protective effect of naturalization on mortality (Khuu, Van Hook, and Lowrey 2025).

The current study builds on this work by defining acculturation as a multidimensional concept containing social behaviors that typically change as immigrants adapt to the host society. In doing so, I seek to bring together commonly used measures, such as linguistic acculturation, and measures that have rarely appeared in studies of immigrant health but are active avenues of inquiry in the broader literature. For example, research on acculturation and integration has given increasing attention to intermarriage (Lichter, Qian, and Tumin 2015), but research on immigrant health has not yet examined the impact of marital acculturation. This study incorporates spouse nativity as a dimension of inquiry alongside linguistic, residential, and civic acculturation. More importantly, I examine whether confluence or discordance across acculturation dimensions are associated with health, something prior work has not yet investigated.

Acculturative Discordance

Research to date has significantly expanded and clarified the concept of acculturation. On the one hand, such expansion demonstrated how each acculturative dimension is relevant for health—an effort that this study seeks to continue. On the other hand, these new findings have suggested that acculturation itself does not necessarily harm health and therefore cannot be fully responsible for immigrants’ eroding health advantage; at the very least, the story is quite complex. This suggests the need for new theorization about the acculturation–health link.

One remaining gap is that existing research on immigrant health has considered acculturation as a series of indicators on different dimensions, but these indicators are generally independent from each other. In the broader migration literature, classic assimilation theory has considered immigrant adaptation to be straight-line and unilinear, but segmented assimilation has argued that human capital, contexts of reception, and ethnic community operate together to shape varying trajectories (Portes and Zhou 1993). Later work has added legal status as another important dimension that conditions immigrants’ membership in other aspects of life (Kreisberg 2019; Morris 2003). The current study builds on this framework to think of acculturation as a dynamic system, with parts that interact with one another. In this section, I consider how these interactions operate.

Discordance between acculturation dimensions

There is stratification in society by education, occupation, and income, and each individual has a different configuration of statuses across these socioeconomic dimensions. Although the majority of statuses are relatively consistent across dimensions (e.g., having a high-prestige occupation and high income), some individuals experience a mismatch. Status inconsistency theory posits that such mismatches can lead to cognitive dissonance and uncertainty, which translates into chronic stress and physiological dysregulation (Braig et al. 2011; House and Harkins 1975).

Status inconsistency has sometimes been applied to the case of immigrants because they often experience educational mismatch. Highly educated immigrants who held high-prestige occupations in their home country typically experience occupational downgrade upon arrival because not all of their skills translate immediately to the host-society labor market (Akresh 2008). Although educational mismatch is associated with poorer health (Dunlavy, Garcy, and Rostila 2016), it cannot explain the erosion of the immigrant health advantage because it is new arrivals, rather than longer-term immigrants, who are more likely to experience severe mismatch.

Immigrants may nonetheless experience high inconsistency during the acculturation process in other dimensions of life. Imagine an “acculturation spectrum” where one end is having characteristics that are most common among new immigrants and the other end is having characteristics common among native-born individuals. This spectrum, just like the continuum of stratification, is multidimensional. Rather than having income, education, and occupation as its dimensions, however, the acculturation spectrum contains dimensions such as residential context (living in an immigrant-dominated area vs. not), linguistic proficiency (speaks English well vs. not), marital integration (married to a U.S.-born spouse vs. foreign-born spouse), or civic engagement (being a naturalized citizen vs. noncitizen). And just as status inconsistency can cause stress and dysregulation, having different degrees of acculturation on different dimensions may present a source of dissonance that accelerates the aging process (Epel et al. 2004). I call this phenomenon “acculturative discordance” to differentiate it from status inconsistency because it is not about social status but about acculturation.

The discordance between linguistic and residential or marital acculturation can be particularly stressful. Being less proficient in English but living in a residential area where few fellow immigrants are present, for example, might present challenges in everyday communications and lead to social isolation in the long run. These challenges are less present among immigrants with consistent acculturation levels across dimensions. I also hypothesize that discordance between one’s own citizenship—capturing the civic dimension of acculturation—may interplay with one’s spousal nativity. In the United States, citizenship is highly contentious and deeply stratifies insurance and health care access (Joseph 2025; Nam 2012). Being a noncitizen with a native-born spouse may present inequality within the family in terms of resource access and political engagement, which can be stressful and affect later-life health. Although I focus my discussion on these configurations in the main results, I examine all configurations between acculturation dimensions and make results available in the Supplemental Appendix in the online version of the article.

Discordance between acculturation and racialization

Another rising strand of research that helps explain immigrants’ health declines is the structural perspective, which argues that immigrant health is not just a product of their behavior but also of their cumulative exposure to the social environment. This has two implications for empirics. First, immigrants’ social behaviors are also shaped by structural forces: Immigrants face constraints to where they live, who they marry, what opportunities they have to acquire language skills, and whether they are eligible for naturalization. This study incorporates this by accounting for SES and race-ethnicity in investigating the link between acculturation and health.

Second, structural disadvantage is a direct source that presents challenges to immigrants’ health. Stress associated with adapting to new social norms and values—known as “acculturative stress”—contributes to poorer mental and physical health, particularly among Hispanic immigrants (Bekteshi and Kang 2020; Finch and Vega 2003). There is also evidence from biomarkers, where Mexican immigrants have lower allostatic load—a marker of chronic stress exposure—than U.S.-born Mexican Americans, and this advantage wears off with longer duration in the United States (Kaestner et al. 2009). Studies have also argued that the cumulative exposure to vulnerable legal statuses (Asad and Clair 2018; Torres and Young 2016) as well as pre- and postmigration exposure to racism (Hagos and Hamilton 2024) are both important in shaping health disadvantages. When compared with U.S.-born White adults, minoritized immigrants experience intersectional challenges that result in accelerated aging (Brown 2018; Viruell-Fuentes, Miranda, and Abdulrahim 2012).

Although recognizing their deep connections, the literature has generally considered the structural perspective to be an alternative to social behavioral explanations. Yet immigrants adopt new behavior at the same time that they are exposed to social stressors, and the impact of acculturation on health may further depend on exposure to racism.

To explore this, I hypothesize that acculturative discordance also manifests as discordance between acculturation and racialization. Immigrants’ acculturation levels indicate how much they act like “insiders” in the U.S. society, adopting behaviors that are highly similar to their American counterparts. However, not all immigrants are received equally by others. White immigrants, with higher racial capital (Emirbayer and Desmond 2015), may become fully accepted as insiders of society when they are highly acculturated. Racially and ethnically minoritized immigrants, however, have to confront the racial system as they adapt to life in the United States (Sorrell et al. 2019). Those who are highly acculturated may be particularly vulnerable when they confront a mismatch between their “insider” behavior and their perception by others as racialized “outsiders.” This mismatch may be felt subtly through day-to-day microaggressions, such as accent bias and ascriptions of criminality (Sissoko and Nadal 2021), or more structurally through labor, housing, and marriage market discrimination (Ciscato 2024; Pager and Shepherd 2008). It operates similarly as the discordance between acculturative dimensions, but one of the dimensions is exposure to racism. Specifically, I expect the acculturation–health link to be systematically less positive among minoritized immigrants than among non-Hispanic White immigrants.

In summary, the current study proposes two forms of acculturative discordance that may be associated with poorer health. Ultimately, they may also help explain why the immigrant health advantage diminishes in later life. I ask the following questions:

Research Question 1: Is there an erosion in the immigrant health advantage in disability?

Research Question 2: How are the residential, linguistic, marital, and civic dimensions of acculturation associated with disability among immigrants?

Research Question 3: How is discordance between (1) different acculturative dimensions and (2) acculturation and racialization associated with immigrant health?

Research Question 4: Does acculturative discordance help explain any potential erosion in immigrants’ health advantage in later life?

Data and Methods

Data

I used the 2005 to 2023 waves of the American Community Survey (ACS) and retrieved the data from IPUMS (Ruggles et al. 2023). The ACS is an annual, nationally representative survey of the entire U.S. population, which provides a large immigrant sample. I started the observation in 2005 because ACS experienced changes in its disability questions and survey modes right before and around 2005 (Stern and Brault 2005), making previous waves of data less comparable.

I focused on individuals ages 65 to 80 and did so for two reasons. First, disability is more prevalent after 65, and prior work has documented a disability crossover between immigrants and the U.S.-born during or close to this age range (Levchenko 2021; Sheftel and Heiland 2018). Second, although the entire later life is of theoretical interest, differential mortality selection by immigrant status is strong at the oldest ages (Zheng and Yu 2025). Setting the age cutoff at 80 helped minimize this bias.

The immigrant population represented in the ACS consists of all individuals born outside the United States to foreign-born parents. This includes undocumented immigrants, although they are nondistinguishable from documented noncitizens in the sample. It also includes individuals born on U.S. territories, who were kept in the sample because they contribute to the phenomenon that this study sought to explain.

Measures

Outcome variables

Disability was measured using independent living difficulty and ambulatory difficulty. Independent living difficulty (binary) was defined as difficulty performing basic activities outside the home alone, such as to shop or visit a doctor, due to a long-lasting physical, mental, or emotional health condition. It aligns closely with instrumental activities of daily living, a common measure in the health literature (Garcia et al. 2015; Melvin et al. 2014). Ambulatory difficulty (binary) was defined as having a condition that severely limits one’s ability to do activities such as lifting, reaching, and climbing stairs. This measure, focused on physical mobility, is the single most prevalent type of disability among U.S. older adults (He and Larsen 2014). These measures are widely used for nationally representative estimates of disability (Elo, Mehta, and Huang 2011; Sheftel 2017).

Measures of acculturation

Residential acculturation was measured by the percentage of U.S.-born individuals in respondent’s Public Use Microdata Area (PUMA) of residence, dichotomized at the median for all immigrants: 75%. Because it is the lowest geographic level in public-use data, PUMA-level population composition is a common proxy of residential context and social environment (Ackert 2017; Yu and Myers 2007). I dichotomized the measure to allow easier comparison across acculturative dimensions because all other dimensions were categorical/binary in nature. In supplemental analysis, I confirmed that the direction of associations was the same using the continuous versus dichotomized version. Those who live in PUMAs where 75% or more of the residents are U.S.-born were considered as living in a U.S.-born dominated area and more acculturated on this dimension. Linguistic acculturation was measured by respondent’s self-rated English proficiency, dichotomized as speaking English well/very well/speaks only English versus speaks English not well/does not speak English. Marital acculturation had three categories: unmarried, foreign-born spouse, and U.S.-born spouse. I considered being married to a U.S.-born spouse (relative to foreign-born spouse) as a marker of acculturation, and those unmarried were included in models as a separate category. Civic acculturation was proxied by respondent’s citizenship status, with three categories: noncitizens, birthright citizens (including those born on certain outlying territories), and naturalized citizens. I considered naturalized citizens (relative to noncitizens) as more acculturated on this dimension.

Control variables

All models accounted for demographics including sex, age, race-ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic of any race), and census year dummies. In addition, all models accounted for educational attainment and household income quartile. Accounting for race-ethnicity and SES ensured that the coefficients focus on the influence of immigrants’ social behavioral acculturation without being conflated with their exposure to structural racism and (relatedly) economic integration. I formally examined behavioral–structural interactions separately in the article. Models that contained only immigrants additionally accounted for age at migration because it is a confounder of social behavioral acculturation and later-life health. Due to collinearity, I did not include years in the United States in the model. Instead, I conducted supplemental checks replacing age at migration with years in the United States. These results are available in the Supplemental Appendix (Table A1), in the online version of the article, and were similar to the main results. I chose to focus on age at migration rather than years in the United States given that the former is a more common marker of the acculturation experience among older immigrants (Gubernskaya 2015).

Analytical Approach

The first goal of the study was to describe the nativity difference in disability and its age patterns. I first estimated logistic regressions to understand the association between nativity and disability and then interacted nativity with age. Throughout the analysis, I specified age as categorical (five-year intervals) to capture nonlinearity and for easier interpretation of interaction terms. All models were also estimated using quadratic age terms confirming that results were similar (Supplemental Appendix Figure A1, in the online version of the article).

The second study aim was to understand the associations between acculturation and disability. I restricted the sample to foreign-born individuals and estimated associations between residential, linguistic, marital, and civic acculturation and both disability outcomes. For the first two aims, models were stratified by sex to observe whether age and acculturation related to disability differently between women and men.

The third and primary aim of the study was to test whether acculturative discordance shaped immigrants’ health. To test whether different acculturation dimensions interact with each other, I added interaction terms between residential and linguistic, linguistic and marital, and marital and civic acculturation. I visualized the predicted probability of disability by different acculturation configurations to demonstrate whether having discordant acculturative experiences was associated with an increased probability of disability. I also examined all remaining configurations of acculturation dimensions, and results are available in the Supplemental Appendix in the online version of the article.

To test whether there was discordance between acculturation and racialization, I interacted each acculturative measure with race-ethnicity. The reference category contained White immigrants, and a higher odds ratio (OR) for each interaction term (e.g., Black immigrant × U.S.-born dominated PUMA) can be interpreted as minoritized immigrants experiencing lower returns to acculturation than White immigrants. Following these regressions, I plotted the average marginal effects (AMEs) to visualize the relationship between each acculturation measure and health by race-ethnicity.

Finally, I returned to a pooled sample with both immigrants and the native-born and explore the extent to which acculturative discordance explained the loss of the immigrant health advantage. I first categorized immigrants by acculturation level: consistently low, discordant, and consistently high. Immigrants with low acculturation were those who live in a high-immigrant PUMA, did not speak English well, were unmarried or had a foreign-born spouse, and were noncitizens. Immigrants with high acculturation were those living in a U.S.-born dominated PUMA, spoke English well, were married to a U.S.-born spouse, and were naturalized or birthright citizens. Immigrants with discordant acculturation were more acculturated on some dimensions than on others. Through regressions interacting each immigrant acculturation group with age (reference group: U.S.-born), I demonstrated whether and when immigrants who were acculturated to different extents lost their health advantage over the U.S.-born.

I then ran another regression focusing on immigrants with relatively high acculturation, this time interacting each immigrant racial-ethnic group with age (reference group: U.S.-born). This model demonstrated whether and when similarly acculturated immigrants from different racial-ethnic groups lost their health advantage over the U.S.-born.

All analyses were estimated using the ACS person-level weights with robust standard errors. For sake of brevity, I left most regression tables in the Supplemental Appendix (Table A3–A5), in the online version of the article, and only included derived figures in the main text.

Results

Table 1 describes the study population. Compared with the U.S.-born, immigrants ages 65 to 80 have higher independent living difficulty (13% vs. 10%) and slightly lower ambulatory difficulty prevalence (18% vs. 19%). The sex and age compositions are similar by nativity, but there are clear differences in racial composition: The largest group among immigrants is Hispanic (37%), followed by White (29%), Asian (27%), and Black (7%). By comparison, the vast majority of older U.S.-born adults are White (86%); Black adults take up 10% of the population, with a very small share being Hispanic (3%) or Asian (1%).

Table 1.

Weighted Sample Statistics.

	Immigrants	U.S.-Born
Independent living difficulty	12.83 (.04)	10.33 (.01)
Ambulatory difficulty	18.28 (.05)	19.31 (.02)
Female	56.38 (.06)	53.80 (.02)
Age
65–69	41.29 (.06)	40.60 (.02)
70–74	31.86 (.06)	31.85 (.02)
75–80	26.85 (.06)	27.55 (.02)
Race-ethnicity
White	28.88 (.06)	86.10 (.02)
Black	6.58 (.03)	9.83 (.02)
Asian	27.10 (.06)	.59 (.00)
Hispanic	37.43 (.06)	3.48 (.01)
Lives in a U.S.-born dominated PUMA	47.68 (.06)	89.36 (.01)
Speaks English well	64.36 (.06)	99.70 (.00)
Spouse status
Married to a foreign-born spouse	44.65 (.06)	2.35 (.01)
Married to a U.S.-born spouse	12.04 (.04)	56.96 (.02)
Unmarried	43.32 (.06)	40.70 (.02)
Citizenship status
Noncitizen	25.16 (.06)
Naturalized citizen	69.11(.06)
Birthright citizen (outlying territories)	5.73(.03)
Observations	958,211	7,275,281

Source. Data from the American Community Survey 2005–2023.

Note. Shown are percentages with standard errors in parentheses. N = 958,211. PUMA = Public Use Microdata Area.

The U.S.-born, by definition, have extremely high levels of acculturation; immigrants have much lower levels on average. Nearly 90% of U.S.-born older adults live in a U.S.-born dominated PUMA, compared with fewer than half of immigrants. Essentially 100% of the U.S.-born report speaking English well, compared with 64% of immigrants. In terms of marital status, immigrants are slightly more likely to be unmarried than the U.S.-born (43% vs. 41%). Within those who are married, 96% (=56.96 / [56.96 + 2.35]) of the U.S.-born population have a U.S.-born spouse, compared with just 21% of immigrants. Finally, 100% of the U.S.-born population are U.S. citizens, compared with about three-fourths of older immigrants.

Is There an Erosion in the Immigrant Health Advantage in Disability?

Table 2 shows the association between nativity and disability by sex, with a first model to identify the overall association and a second one interacting nativity with age. The first model shows that accounting for demographic characteristics and SES, immigrant men have an advantage in both independent living difficulty (OR = .853, p < .001) and ambulatory difficulty (OR = .671, p < .001). Immigrant women do not differ from their U.S.-born counterparts in the odds of independent living difficulty, and they have an advantage in ambulatory difficulty (OR = .776, p < .001). Disabilities increase significantly with age for both sexes.

Table 2.

Associations between Nativity and Disability (Odds Ratios).

	Independent Living				Ambulatory
	Men		Women		Men		Women
Foreign-born	.853*** (.00827)	.732*** (.0110)	.994(.00723)	.835*** (.00975)	.671*** (.00519)	.612*** (.00703)	.776*** (.00477)	.677*** (.00635)
Age (reference category: 65–69)
70–74	1.299*** (.00779)	1.275*** (.00809)	1.376*** (.00701)	1.334*** (.00734)	1.207*** (.00532)	1.196*** (.00553)	1.241*** (.00478)	1.218*** (.00498)
75–80	2.060*** (.0119)	1.974*** (.0121)	2.401*** (.0116)	2.283*** (.0118)	1.684*** (.00740)	1.643*** (.00758)	1.822*** (.00690)	1.753*** (.00704)
Interactions
Foreign-born 70–74		1.142*** (.0213)		1.189*** (.0170)		1.080*** (.0160)		1.137*** (.0135)
Foreign-born 75–80		1.340*** (.0236)		1.334*** (.0180)		1.226*** (.0178)		1.300*** (.0150)
Observations	3,806,595	3,806,595	4,426,897	4,426,897	3,806,595	3,806,595	4,426,897	4,426,897

Source. Data from the American Community Survey 2005–2023.

Note. Models also account for year, race-ethnicity, educational attainment, and household income quartile. Robust standard errors are in parentheses. N = 3,806,595 for men and N = 4,426,897 for women.

***

p < .001.

The second model shows that although immigrant men and women both have lower odds of disability than their U.S.-born counterparts at ages 65 to 69, their disability odds increase more with age. Figure 1 visualizes predicted probabilities for easier interpretation, holding covariates at means. In the case of independent living, U.S.-born men’s probability of disability increases from .07 to .12 between 65 and 80; immigrant men’s probability increases more steeply, from .05 to .12. As a result, although immigrant men have an advantage in independent living difficulty at ages 65 to 69, they are on par with the U.S.-born by ages 75 to 80. Patterns are similar for women except that immigrants’ initial advantage is even smaller, and they have a small disadvantage relative to the U.S.-born by ages 75 to 80. In the case of ambulatory difficulty, immigrant men and women both lose some but not all of their health advantage over the U.S.-born between ages 65 and 80.

Figure 1.

Age patterns of the immigrant health advantage.

How Are Acculturation Dimensions Associated with Disability among Older Immigrants?

Net of demographics, SES, and age at migration, most measures of acculturation are associated with lower rather than higher odds of disability (Table 3). Higher residential acculturation (living in a U.S.-born dominated PUMA) is associated with a 6% reduction in the odds of independent living disability among immigrant men and a 4% reduction among women. Similarly, residentially acculturated immigrants have slightly lower ambulatory disability. Higher linguistic acculturation is associated with a nearly 50% reduction in the odds of independent living difficulty and a 35% reduction in ambulatory difficulty for both sexes. Having a U.S.-born spouse, which represents higher marital acculturation relative to having a foreign-born spouse, is associated with a 15% reduction in men’s odds of independent living difficulty and a 21% reduction in women’s. Patterns are similar for ambulatory difficulty, although the associations are slightly weaker. Perhaps unsurprisingly, being unmarried is associated with higher odds of disability for both sexes. The only acculturative measure associated with an increase in the odds of disability is civic acculturation. Relative to noncitizens, naturalized citizens’ odds of disability are 12% to 20% higher across the two outcomes and sexes. Immigrants who are birthright citizens also have higher odds of disability, although their citizenship is not an indicator of acculturation because it was determined at birth.

Table 3.

Associations between Acculturation Measures and Disability among Immigrants (Odds Ratios).

	Independent Living		Ambulatory
	Men	Women	Men	Women
Lives in a U.S.-born dominated PUMA	.936*** (.0136)	.960*** (.0105)	.943*** (.0114)	.960*** (.00918)
Speaks English well	.527*** (.00925)	.510*** (.00667)	.658*** (.00957)	.651*** (.00746)
Spouse status (reference category: foreign-born spouse)
U.S.-born spouse	.849*** (.0224)	.790*** (.0170)	.934*** (.0188)	.875*** (.0150)
Unmarried	1.633*** (.0241)	1.548*** (.0174)	1.487*** (.0188)	1.490*** (.0147)
Citizenship status (reference category: noncitizen)
Naturalized citizen	1.124*** (.0198)	1.169*** (.0155)	1.169*** (.0177)	1.204*** (.0142)
Birthright citizen	1.857*** (.0589)	1.997*** (.0482)	1.787*** (.0473)	1.957*** (.0413)
Age (reference category: 65–69)
70–74	1.400*** (.0246)	1.500*** (.0199)	1.273*** (.0179)	1.342*** (.0150)
75–80	2.447*** (.0413)	2.734*** (.0350)	1.951*** (.0272)	2.127*** (.0235)
Age at migration (reference category: 0–17)
18–34	.880*** (.0206)	.930*** (.0166)	.886*** (.0162)	.905*** (.0134)
35–49	.950(.0249)	1.126*** (.0225)	.897*** (.0187)	1.005(.0169)
50+	1.195*** (.0327)	1.355*** (.0281)	.910*** (.0206)	1.046*(.0187)
Observations	420,177	538,034	420,177	538,034

Source. Data from the American Community Survey 2005–2023.

Note. Models also account for year, race-ethnicity, educational attainment, and household income quartile. Robust standard errors are in parentheses. N = 420,177 for men and N = 538,034 for women. PUMA = Public Use Microdata Area.

***

p < .001.

Acculturative Discordance as a Predictor of Disability

I now turn to the central inquiry of the article: When there is discordance in immigrants’ acculturative experience, does it predict higher disability in later life? Starting from this section, I pool together both sexes given that the previous section has established similar associations between acculturation dimensions and disability across men and women. I also omit the coefficients for unmarried immigrants and birthright citizens given that they do not offer a test of acculturative discordance.

Discordance between acculturative dimensions

Table 4 shows that there are indeed interactions between the focal pairs of acculturation dimensions. When immigrants are acculturated on one dimension and less so on another, they tend to have higher odds of disability.

Table 4.

Key Interactions between Dimensions of Acculturation (Odds Ratios).

	Residential × Linguistic		Linguistic × Marital		Marital × Civic
	Independent Living	Ambulatory	Independent Living	Ambulatory	Independent Living	Ambulatory
U.S.-born dominated PUMA	1.080*** (.0133)	1.044*** (.0119)	.950*** (.00829)	.952*** (.00713)	.951*** (.00832)	.953*** (.00714)
Speaks English well	.573*** (.00700)	.697*** (.00735)	.481*** (.00693)	.616*** (.00744)	.514*** (.00539)	.650*** (.00586)
U.S.-born dominated PUMA × Speaks English well	.770*** (.0130)	.846*** (.0125)
U.S.-born spouse	.839*** (.0140)	.914*** (.0119)	1.038(.0437)	1.172*** (.0419)	1.034(.0370)	1.115*** (.0321)
Speaks English well × U.S.-born spouse			.790*** (.0361)	.765*** (.0293)
Naturalized citizen	1.153*** (.0122)	1.883*** (.0310)	1.151*** (.0122)	1.188*** (.0110)	1.119*** (.0178)	1.163*** (.0160)
U.S.-born spouse × Naturalized citizen					.743*** (.0296)	.774*** (.0245)
Observations	958,211	958,211	958,211	958,211	958,211	958,211

Source. Data from the American Community Survey 2005–2023.

Note. Models also account for age, sex, age at migration, year, race-ethnicity, educational attainment, and household income quartile. Unmarried individuals and birthright citizens are in the model, but coefficients are omitted. Robust standard errors are in parentheses. N = 958,211. PUMA = Public Use Microdata Area.

***

p < .001.

In the previous model without interaction terms (Table 3), living in a U.S.-born dominated PUMA is associated with slightly reduced odds of disability. Once I allow this effect to vary by linguistic characteristics, however, higher residential integration is associated with higher odds of disability among immigrants with low language acculturation (Table 4). This association is significantly smaller among those who speak English well. Figure 2a visualizes these patterns in predicted probability terms. Among immigrants who do not speak English well, higher residential integration predicts higher probability of disability by 1 percentage point. Among those with higher linguistic acculturation, higher residential integration predicts lower probability of disability by 2 percentage points.

Figure 2.

Predicted probability of disability by acculturation configurations. (a) Residential × linguistic. (b) Linguistic × marital. (c) Marital × civic.

Similarly, linguistic acculturation interacts with intermarriage among immigrants. The previous regression model from Table 3 found that having a U.S.-born spouse, relative to having a foreign-born spouse, predicts a reduction in disability. The middle columns of Table 4 together with Figure 2b illustrate that intermarriage with the native-born is only protective of health among those with high linguistic acculturation. Among those who do not speak English well, marital acculturation has no protective effect on independent living difficulty and predicts an increase in the probability of ambulatory difficulty by 2 percentage points.

Marital acculturation also interacts with civic acculturation (Table 4 last columns and Figure 2c). Among naturalized citizens, those with a U.S.-born spouse have a lower probability of either type of disability by 2 percentage points; among noncitizens, however, having a U.S.-born spouse is not associated with independent living difficulty and is associated with a higher probability of ambulatory disability by 1 percentage point. Supplemental analysis (Supplemental Appendix Table A2 in the online version of the article) shows that acculturative discordance involving spousal nativity operates in the same way when the sample is restricted only to those who are married.

I also examined the associations between all remaining acculturative configurations and disability in supplemental analyses (Table A6 in the online version of the article). For two out of three remaining pairs, having consistent acculturation is also associated with further reduced disability; in other words, having discordant acculturation is predictive of worse health in later life.

Discordance between acculturation and exposure to racial exclusion

Next, I test whether acculturation is also discordant with racialization. The regression model (Supplemental Appendix Table A3 in the online version of the article) contains interactions between race-ethnicity and each acculturation measure. With the exception of citizenship, each acculturation dimension is associated with reduced odds of disability among White immigrants. These associations, however, are different (and sometimes in the opposite direction) among racially-ethnically minoritized immigrants.

Figure 3 demonstrates these relationships with the AME of each acculturation measure by race-ethnicity. Living in a U.S.-born dominated PUMA is, on average, associated with a 3% reduction in the probability of both types of disability for White immigrants. However, it is associated with a small increase in independent living difficulty for Black, Asian, and Hispanic immigrants. In the case of ambulatory difficulty, high residential acculturation is associated with a small increase in disability among Black immigrants and no change for Hispanic and Asian immigrants. Speaking English well is associated with about a 15% reduction in both types of disability for White immigrants—the largest reduction for any acculturative measure for any group. Yet it is associated with a smaller reduction (2% to 5%) for minoritized immigrants. Similarly, having a U.S.-born spouse (relative to having a foreign-born spouse) is associated with a 4% reduction in both disability outcomes for White immigrants but no change in disability for Black immigrants. For Asian immigrants, having a U.S.-born spouse is associated with 2% reduction in independent living difficulty and no change in ambulatory difficulty. For Hispanic immigrants, having a U.S.-born spouse is associated with a small increase in both types of disability. The only outcome where I did not find any racial-ethnic difference is civic acculturation.

Figure 3.

Average marginal effect of acculturation measures by race-ethnicity. (a) Independent living difficulty. (b) Ambulatory difficulty.

The results show that on the residential, linguistic, and social dimensions, being highly acculturated derives health benefits for White immigrants but not for minoritized immigrants. It supports the hypothesis that for the latter group, the experience of being highly integrated into the U.S. society is discordant with the exposure to racial exclusion.

Can Acculturative Discordance Explain the Decline of the Immigrant Health Advantage?

Discordance between dimensions can account for some of the decline in the immigrant health advantage. In the case of independent living difficulty, immigrants with discordant acculturation have a small advantage relative to the U.S.-born at ages 65 to 69, no advantage at ages 70 to 74, and a small disadvantage at ages 75 to 80 (Figure 4a). This pattern is similar to their counterparts with consistently low acculturation. In the case of ambulatory difficulty, immigrants with discordant acculturation have lower disability than the U.S.-born at ages 65 to 69 but higher disability than their counterparts with either low or high acculturation. With age, those with discordant and consistently low acculturation have a more accelerated increase in disability than the U.S.-born.

Figure 4.

Age patterns of the immigrant health advantage by acculturation level and race-ethnicity. (a) By acculturation level (N = 8,233,492). (b) By race-ethnicity, for immigrants with relatively high acculturation (N = 7,767,947).

For both disability outcomes, immigrants with high acculturation hold a consistent health advantage over the U.S.-born across age groups. This reaffirms that acculturation itself is not the culprit for immigrants’ eroding health advantage. On the contrary, being highly acculturated contributes to the maintenance of the immigrant health advantage. Furthermore, immigrants with discordant acculturation are either similar to or even more disadvantaged than immigrants with consistently low acculturation in their age patterns in disability, indicating that the relationship between acculturation level and health is not linear—rather, something about experiencing discordant acculturation presents a unique challenge for immigrants’ health.

Next, I seek to understand the big picture implications of discordance between acculturation and racialization. Here, I compare the U.S.-born with immigrants from different racial-ethnic groups who are acculturated on at least three out of the four dimensions. This allows me to focus on individuals that have similarly high acculturation across most dimensions while retaining a sizable sample across subgroups. Figure 4b shows that relatively acculturated White immigrants have the lowest independent living and ambulatory difficulty across age groups. Relatively acculturated Hispanic immigrants have higher disability than White immigrants and lower disability than the U.S.-born, although their independent living advantage relative to the U.S.-born is smaller at older ages. Among Asian and Black immigrants with high levels of acculturation, however, older age is associated with a clear reduction in their health advantage over the U.S.-born. This is especially clear in the case of independent living difficulty, where both groups no longer have an advantage over the U.S.-born at ages 75 to 80. These findings show that minoritized immigrants—in particular, Asian and Black immigrants—do not derive the same health benefits from their acculturation as White immigrants. While minoritized immigrants who are highly acculturated experience an eroding health advantage in later life, similarly acculturated White immigrants maintain their advantage over the U.S.-born.

Discussion

The erosion of the immigrant health advantage brings the urgent question of whether the process of adapting to the U.S. society harms immigrant health in the long term. Prior literature has investigated this topic using various definitions of acculturation, but evidence has been mixed. The current study builds upon the latest trend of using multidimensional behavioral measures and clarifies how residential, linguistic, marital, and civic acculturation are associated with disabilities in later life. Taking a step further from existing theorization of acculturation as independent indicators, I test whether it is acculturative discordance—the phenomenon of having inconsistent levels of acculturation on different dimensions—that presents challenges for immigrants’ health. Drawing on structural perspectives, I also propose a second form of discordance between acculturation and racialization that affects the well-being of minoritized immigrants in particular. I find evidence that acculturation itself is unlikely to be the culprit of immigrants’ loss of health advantage in later life. Instead, it is acculturative discordance that is associated with worse health, and both types of discordance drive the erosion of the health advantage among U.S. immigrants ages 65 to 80.

Contrary to the conventional hypothesis of negative acculturation, this study found that being more acculturated on most dimensions predicts lower rather than higher odds of disability among aging immigrants. Although this finding may seem surprising, it is consistent with recent work that adopted a similar operationalization of acculturation on specific social behavioral dimensions (Fenelon 2017; Garcia et al. 2015; Tegegne 2018). Higher residential, linguistic, and marital acculturation may signal more integration into the U.S. society, more social capital, and better access to information and resources, all of which would be positively linked with health. On the other hand, I found that being a naturalized citizen, relative to being a noncitizen, is associated with increased odds of disability. Consistent with prior work, Supplemental Appendix Table A7, in the online version of the article, shows that this “citizenship penalty” is primarily pronounced among arrivals after age 35. Rather than suggesting a negative impact of civic acculturation on health, the overall association between citizenship is likely driven by immigrants who arrive at midlife or later and self-select into naturalization for better health care (Gubernskaya et al. 2013). There is unlikely the same selection on other dimensions given that citizenship is uniquely linked with access to care in the United States (Nam 2012).

Why, then, might immigrants’ health advantage erode if most dimensions of acculturation predict better health? I provide evidence that the incongruence between dimensions contributes to health disadvantages. This demonstrates that status inconsistency is highly relevant to immigrants’ experience of adapting to the United States. Prior applications of the theory focused on educational mismatch (Dunlavy et al. 2016), but the current study is the first to extend status inconsistency to noneconomic aspects of immigrants’ adaptation. Connecting acculturative discordance directly with the immigrant health advantage, I also find that it is those with either discordant or consistently low acculturation that experience faster acceleration in health risks than the U.S.-born in later life. In other words, acculturation drives the erosion of immigrants’ health at older ages through two pathways: having low acculturation across dimensions, which signals an accumulation of low social capital, and acculturative discordance, which signals cumulative exposure to dissonance and distress. Those with consistently high acculturation are not exposed to either pathway, and they also do not experience an erosion of the immigrant health advantage.

Yet not all of those that are highly acculturated are equal. Whereas White immigrants receive a clear benefit from most acculturation dimensions, minoritized immigrants receive a smaller benefit, no benefit, or a small penalty depending on the dimension. Although acculturation generally represents immigrants’ social behavior, this article shows that the impact of this process depends on the exposure to structural disadvantage. Immigrants who are highly acculturated have made progress toward the status of a behavioral insider in America, but they still have to confront race-based social exclusion. Minoritized immigrants may derive a smaller (or even negative) benefit from their acculturation due to this conflict. This resonates with prior literature that found higher stressors among people of color who have achieved high SES (Gaydosh et al. 2018) and points to the need for further research on how immigrants navigate the consequences of racialization.

This study has several limitations. First, although it commits to a multidimensional framework of acculturation, the actual dimensions under consideration are limited by data availability. Existing research has produced thoughtful discussions of what acculturation encompasses (Abraído-Lanza et al. 2006; Salant and Lauderdale 2003). Most importantly, lifestyle (e.g., smoking) and cultural participation (e.g., media consumption) are both potentially consequential for health but were not available in the data. It is possible that because cultural participation is directly linked with individuals’ identities, its discordance with social behavioral acculturation or with the exposure to racism can be particularly stressful. Although the ACS cannot answer these questions, there are possibilities for future research with measures of health behavior, social belonging, and mental health from other sources, such as the National Health Interview Survey and the General Social Survey.

Second, measures used in this study do not fully capture the underlying acculturation process. Although it is common to use PUMA or county-level information to measure residential context, ideally a lower level (e.g., census tract) would offer higher accuracy and capture residence in immigrant and/or ethnic enclaves. On the marital dimension, I can only draw a meaningful comparison between those with a foreign-born spouse versus a native-born spouse, but there is also certainly variation within the unmarried population in terms of social connections. On the civic dimension, there is also heterogeneity within the noncitizen population between documented and undocumented immigrants. Future research can use specialized data sets that contain more detailed geographic and network information to answer these questions.

Third, this study cannot observe the trajectory of acculturation. To evaluate the extent to which acculturation is dynamic among older immigrants, Supplemental Appendix Table A8, in the online version of the article, leverages additional ACS information and tabulates immigrant respondents’ number of years since marriage, naturalization, and moving into the current residence. Most individuals have had static acculturation in the last decade: 97% of immigrants who are married have been married to their current spouse for at least 10 years, and 85% of those who are naturalized have been naturalized for at least 10 years. Residence status is more dynamic, where 62% of older adults moved into their current dwelling at least 10 years ago; however, the share of individuals with static residence at the PUMA level is likely higher. Nonetheless, the full trajectories of acculturation, if available in future data, will allow us to consider the amount of progress made and the timing of such progress.

Fourth, the current study cannot observe selective return migration. If immigrants who are less healthy are more likely to move, then the current study contains a positively selected immigrant sample, and the selection gets stronger with age. This would lead to an overestimation of immigrants’ health advantage and a downward bias in the erosion of this advantage. The implication for the findings on acculturation and health is more difficult to assert, and it would depend on whether the selection for outmigration is stronger on health or on dimensions of acculturation. In general, given that individuals who are the least attached to the U.S. society and who are the least healthy are both more likely to move, this study likely underestimates the association between acculturation and health.

Fifth, although this study established associations between acculturative discordance and health, it did not have the data to test mechanisms linking them. Prior literature offers likely pathways: Status inconsistency leads to stress, cognitive dissonance, and poor mental health (Braig et al. 2011; House and Harkins 1975). Chronic stress exposure has been linked with accelerated biological aging both directly and indirectly through health behaviors (Epel et al. 2004; Umberson, Liu, and Reczek 2008). The fact that most immigrants have been exposed to their current acculturative status for the last decade (Supplemental Appendix Table A8 in the online version of the article) is consistent with the idea of cumulative exposure. With increased biomarker collection and more diverse samples in longitudinal surveys, an important next step is to uncover full mechanisms with proximate determinants of health.

Despite these limitations, this study makes contributions that have broad implications. Theoretically, the concept of acculturative discordance is applicable to other contexts. For example, while scholars have employed segmented assimilation to explain why the children of immigrants have divergent outcomes from one another (Haller, Portes, and Lynch 2011), acculturative discordance offers new insight into potential conflicts between second-generation immigrants’ identity, social behavior, and exposure to racism.

Empirically, this study identifies configurations of acculturation that predict health vulnerability, highlighting potential blind spots in policy. For example, immigrants with limited English proficiency who live in U.S.-born dominated areas may have little access to resources that are available in high-immigrant areas. Ensuring that multilingual service and information also cover areas that are not traditional immigration destinations, then, may improve the health of immigrants who are particularly isolated. It is also notable that even among immigrants with the same social behavioral outcomes, racially-ethnically minoritized individuals are systematically disadvantaged in later life. Improving immigrant health would thus require the promotion of racial equity at a broader level. Overall, this study suggests that immigrants’ well-being is the product of systems of inequality rather than of individual indicators and that an intersectional lens is essential for tackling health challenges.

Supplemental Material

sj-docx-1-hsb-10.1177_00221465261450447 – Supplemental material for Is Acculturation the Culprit? Acculturative Discordance and Immigrants’ Later-Life Health

Supplemental material, sj-docx-1-hsb-10.1177_00221465261450447 for Is Acculturation the Culprit? Acculturative Discordance and Immigrants’ Later-Life Health by Leafia Zi Ye in Journal of Health and Social Behavior

Footnotes

Acknowledgements

I would like to thank Jason Fletcher, Alberto Palloni, Fernando Riosmena, Matthew Hall, Hui Zheng, Cullen Cohane, anonymous JHSB reviewers, and JHSB editors for their thoughtful comments and suggestions on previous versions of this article. I would like to thank Cesar Ramirez for excellent research assistance. This work has also benefited from generous feedback from attendees at several events: a National Institute on Aging grantee meeting on “Behavioral and Social Research on the Role of Immigration on Life Course Health and Aging, Including AD/ADRD,” a research presentation at the Max Planck Institute for Demographic Research, a sociology colloquium at the University of Utah, and a presentation at the Population Association of America’s Annual Meeting in 2026. All errors are my own.

ORCID iD

Leafia Zi Ye

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by Grant 1R21AG089167-01 from the National Institute on Aging, National Institutes of Health.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material is available online.

Author Biography

Leafia Zi Ye is an assistant professor in the Department of Sociology at the University of Toronto, where she is cross-appointed at the Institute for Life Course & Aging and affiliated with the Global Migration Lab at the Munk School of Global Affairs and Public Policy. Dr. Ye is a social demographer and a scholar of migration and aging. Her research identifies barriers to immigrant integration into host societies by documenting how and why socioeconomics and health inequalities evolve over the life course. Her work has received multiple awards, including a best student paper award from the ASA Section on Life Course and Aging and a distinguished contribution to scholarship award from the ASA Population Section.

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