Health Policy and Health Services Research
Background: In 2011, our group demonstrated that the perceived threat of being identified as undocumented is an influencing factor for undocumented Latino immigrants (UDLI) presenting to the emergency department (ED). We conducted a follow-up study in the new anti-immigrant political climate.
Methods: We conducted a cross-sectional study from June 2017-December 2018 at three county EDs, enrolling a convenience sample of adult subjects UDLI, Legal Latino Resident (LLR) and non-Latino US citizens (NLUSC). We excluded minors, critically ill, incarcerated, intoxicated, altered mental status, psychiatric holds and those arriving by ambulance
Results: Of the 1,513 subjects approached, 1,327 (87.7%) consented, with 456 (34.4%) classified as UDLI, 476 (35.8%) as LLR and 395 (29.8%) as NLLR, with 51.5% male. Spanish was the primary language in 97% of the UDLI group with 77.6% reporting understanding “a little or none” for their English proficiency. Living in the US for less than 1 year was reported by 5.1% of UDLI, while 8.9% reported 1-5 years and 86% greater than 5 years. Nearly all UDLI knew who the president is and had heard anti-immigrant statements from the president (99%: 95% CI = 97.7% to 99.7%) and (95%: 95% CI = 92.6% to 96.9%), respectively. With NLUSC as the control group, UDLI had greater rhetoric recall on the following statements: building a wall (92.7% vs 77.0%, P < 0.0001), deporting immigrants (92.7% vs 76.2%, P < 0.0001), denying services (87.2% vs 62.8%, P < 0.0001), preventing from working in the US (86.8% vs 58.4%, P < 0.0001) or from getting health care (78.9% vs 52.1%, P < 0.0001). More UDLI believed that some or all of these are currently occurring (53.1% vs 40.8%, P < 0.0001) and more UDLIs and LLR expressed feeling worried or unsafe living in the US (75.0% vs 38.5%, P < 0.0001) and (52.6% vs 38.5%, P < 0.0001), respectively. Furthermore, more UDLI expressed fear in presenting to the ED (26.5% vs 3.5%, P < 0.0001). UDLI and LLR reported similar rates of knowing people who did not come to the ED out of fear of discovery, 20.9% and 22.9%, respectively – both significantly greater (p < 0.0001) than the rate reported by NLUSC (12.7%).
Conclusions: The majority of UDLI have heard presidential anti-immigrant statements. This has resulted in UDLI and LLR living with fear in the US, being afraid to come to the ED for emergency care and knowing people that were deterred from presenting.