What were the reasons most immigrants old and new come to the United States?
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NewCourtland Center for Transitions and Health, 3615 Chestnut Street, Ralston – Penn Center, Rm 326, Philadelphia, PA 19104, Phone: (215) 573-4314, Fax: (215) 573-4225, ude.nnepu.gnisrun@vamla Show
Find articles by Alma Vega Karen HirschmanNewCourtland Term Chair in Health Transitions Research, 3615 Chestnut Street, Ralston Penn-Center, Rm 334, Philadelphia, PA 19104, 215-573-3755, ude.nnepu.gnisrun@khcsrih, [email protected] Find articles by Karen Hirschman Disclaimer Alma Vega, NewCourtland Center for Transitions and Health, 3615 Chestnut Street, Ralston – Penn Center, Rm 326, Philadelphia, PA 19104, Phone: (215) 573-4314, Fax: (215) 573-4225, ude.nnepu.gnisrun@vamla; .  Declaration of contribution of authors Both Alma Vega and Karen Hirschman designed the statistical analysis, interpreted results and drafted the write-up. Alma Vega conducted the statistical analysis.Copyright notice The publisher's final edited version of this article is available free at Ageing Soc AbstractMexicans are the largest immigrant group in the United States and are ageing rapidly. Data support that many return to Mexico due to economic factors such as employment. Few studies have investigated if older immigrants return to Mexico for different reasons than younger immigrants. Using the Mexican Health and Aging Study (N=952), we examine whether Mexican immigrants in the United States who returned to Mexico at age 50 and older report different reasons for returning than those who returned at younger ages. Few immigrants (regardless of age) returned to Mexico for economic reasons. The most commonly reported reason for returning to Mexico for both groups was missing family. However, the odds of listing illness over missing family as their main reason for returning were higher for older immigrants than younger immigrants after controlling for duration in the United States and other sociodemographic factors (OR=0.27; 95% CI=0.11, 0.68). These results challenge existing theories of international migration which focus on employment considerations. Keywords: migration, Hispanics, international retirement migration BackgroundMexicans are the largest immigrant group in the United States (U.S.) (29.3%) () and are ageing rapidly. Between 1990 and 2011, the proportion of Mexican immigrants in the U.S. aged 50 years and older increased nine percentage points from 14 per cent to 23 per cent (). The presence of older Mexican immigrants in the U.S. affects consumption of public programmes (), health care expenditures () and househould finances (). While less than five per cent of Mexican immigrants aged 50 years and older returned to Mexico during the latter half of the 1990s (), they represent a growing share of the Mexican immigrant population and thus, the absolute number of those who return to Mexico may increase in years to come. If more older Mexican immigrants return back to Mexico, they are less likely to impact the U.S. social welfare system and household and health expendidures. The implications of the migration patterns of this population likely depend heavily on the characteristics of older immigrants who return to Mexico and their reasons for returning. While most Mexican immigrants report returning to Mexico because they missed family (), to the authors’ knowledge there are no studies that examine age differences in this outcome. Most studies that look at age differences in return migration examine the characteristics associated with return migration (e.g., ; ), most notably health (e.g., ; ; ), but do not examine the reasons immigrants report for returning to their home countries. Such an omission can mask the sense of urgency associated with return migration. For example, immigrants who return to Mexico to use health care services because they do not have access to U.S. health care services have a specific medical purpose for returning compared to immigrants who return to Mexico to visit family and happen to use health care services while on vacation in Mexico. Moreover, simply observing the health status of return migrants does not indicate where they receive health care. One group of older Canadian immigrants who spent the greater part of the year in Florida, for example, received most of their health care in Canada (). Thus, a snapshot of the health of return migrants does not necessarily illustrate which country absorbs the costs of the health services they receive. If, on the other hand, immigrants report returning specifically due to health-related reasons, this may be a better indication of where they plan on being treated. The literature suggests Mexico’s health care system may be a viable alternative to U.S. health care for former U.S. immigrants in Mexico. Research shows that the implementation of Mexico’s Seguro Popular social insurance health care programme in 2003 may have decreased the proportion of immigrants who return to Mexico from the U.S. who are uninsured (). Even when they are not eligible for need-based care, former U.S. immigrants in Mexico sometimes have the means to pay for Mexican health care. One group of former U.S. immigrants in Mexico did not have the required work histories to participate in Mexico’s public health care system but, unlike Mexicans who had never been to the U.S., were able to pay out-of-pocket to participate in these programmes (). More recently, as part of Mexico’s health care reform, Mexican immigrants in the U.S. are able to enroll in Mexico’s Seguro Popular health care programme for coverage in case they return to Mexico in the future (). Existing studies that are based on self-reports examine temporary health-related return migration but do not examine permanent moves. found that a nontrivial 5–6 per cent of Mexican immigrants in California traveled to their home country for health care in the previous year compared to less than one per cent of U.S. born non-Latino Whites. This number was ten per cent in one nationally representative study of Hispanic immigrants (). The immigrants in these studies traveled to their home countries specifically to receive health care and reentered the U.S. shortly thereafter. Similarly, in one small qualititative study, Mexican immigrants returned to Mexico to visit family but took advantage of their time in Mexico to use Mexican healthcare services which they reported as being of better quality (). There is no available literature that indicates the extent to which Mexican immigrants return to Mexico on a long-term basis for health-related reasons. Temporary versus permanent health-related migration can have dramatically different consquences for the U.S. economy. For example, in 2011, Medicaid spending per adult enrollee aged 65 and older was $13,249. While per enrollee spending was only $3,247 for non-elderly adults, it is likely that this amount was higher for the 50-to-64-year-old population (). Assuming immigrants who return to Mexico permanently have patterns of health service use similar to those of the average adult in the U.S., there could be substantial savings in this large expenditure. Immigrants who return temporarily to use health services in Mexico will only produce a fraction of this amount in savings depending on the amount of health care received abroad. Given the difficulty of international travel, it is possible that immigrants who return temporarily for health reasons do so for elective type health care services but not for acute health issues that require immediate attention. They may be less likely to receive emergency services abroad, nearly 70 per cent of that which is used by the 65 and older population is paid for by Medicare (). Despite their greater need for care, however, older Mexican immigrants need not necessarily move for this reason. Although not specific to older adults, existing theories of international migration underline economic motivations (e.g., ; ; ; ; ). Older Mexican immigrants encounter numerous economic obstacles that may prompt them to return to Mexico for economic reasons similar to their younger counterparts who migrate to and from Mexico and the U.S. for such reasons (; ; ). In their preretirement years, older Hispanics experience higher unemployment rates in the U.S. than non-Hispanic whites () and at retirement age, sometimes lack sufficient work credits with which to receive social security benefits (). In the face of these economic challenges, immigrants may emigrate from the U.S. to avail themselves of Mexico’s lower cost-of-living. found that males in Mexico aged 50 years and older who spent at least one year in the U.S. had a median monthly household income of only $30.30 (). While former U.S. immigrants in Mexico are at the higher end of the Mexican wealth distribution than non-migrants (), mean household net worth ($4,000 in 2003) for former U.S. immigrants is far below U.S. standards (). Thus, although they are more likely to be in poorer health than younger immigrants (), older immigrants may be just as likely to base their migration decisions on economic reasons given their relatively low socioeconomic status in the U.S. The literature also points to the important role of family in the migration decisions of older immigrants. Older Italian and Spanish immigrants in Switzerland ranked the proximity of children as the most important factor in deciding whether to return to their home country (). The quality of health services was a far second. Older British immigrants in Australia seriously considered returning to Britain to care for young grandchildren (). Others considered returning to reunite with siblings (Percival 2013). Although older adults themselves, some British immigrants in Australia returned to their home countries to care for elderly parents (). As notes, “[t]he presence of family in the home country, and an abiding bond with them, can exert a strong attraction for people in or approaching older age (p. 121).” Given Mexican immigrants’ strong ties to family living abroad (), it is possible that family supercedes health and economic factors in deciding whether to return to Mexico. In this way, the decision to return to Mexico can be thought of as a mosaic of competing priorities in which certain factors take up more space on the canvas. Family, health, and economic and other factors may all be important to immigrants as they decide whether they return to Mexico but one of these factors may create the tipping point at which they commit to the action. Understanding the relative importance of these factors is critical to projecting future trends in return migration and understanding the resulting effects on the U.S. economy as the population continues to age (). If, for example, older immigrants return to their home countries due to illness, it is feasible to expect savings in U.S. health care costs. These immigrants presumably receive in Mexico the services they would have received in the U.S. On the other hand, if older immigrants return to reunite with family, savings in health care costs can be much lower since they may not be as prone to consume health care services had they stayed in the U.S. If immigrants return to Mexico for economic reasons, the more socially vulnerable immigrants would no longer be in the U.S., possibly transfering some of the burden of assisting this population to Mexico. Aside from the economic implications of their migration patterns, their reasons for returning to Mexico can shed light on the experience of ageing for immigrants in the U.S. While most older immigrants in the U.S. own a home (), are English language proficient () and are U.S. citizens (), these estimates do not include those who may have returned to their home countries because they fared poorly on these outcomes. Research shows that Mexican immigrants in the U.S. (of all ages) who return to Mexico are less educated and have lower wages that those who stay in the U.S. (). However, it is not clear if these patterns also pertain to older Mexican return migrants. Knowing the reasons why immigrants return to Mexico, and if these reasons differ across age of return, can shed light on these issues. Conceptual frameworkWe use a life course perspective to examine the propensity for the largest immigrant group in the U.S., namely Mexican immigrants (), to return to Mexico due to health-related reasons. Unlike existing theories of international migration which focus on employment factors that are common during working ages (), life course theory posits that social roles change across the age spectrum (). As a result, the rationale for migrating varies across the life course (; ). Life course theory consists of four tenets (). The first tenet, timing of lives, encapsulates the changing social roles across age. Employment may hold greater sway for an immigrant with a newly formed household while health may be more important for an older widow seeking assistance. Duration in the U.S. also reflects the timing of lives in that it is associated with the location of immediate family (), employment (; ) and likely other factors with a bearing on migration decisions. The second tenet, the interplay of human lives and historical times, maintains that social roles are interwoven into historical context. The ability of individuals to migrate, whether for employment, to reunite with family or for health, is affected by prevailing immigration laws and other features of historical time. For example, those aged 65 years and older when the Immigration Reform and Control Act (IRCA) passed were exempted from proving minimal knowledge of English and American history (THOMAS n.d.) and more easily obtained U.S. legal status. Upon obtaining U.S. legal status, these immigrants became eligible for Medicare and had less incentive to return to Mexico due to illness, at least to seek health care. The third tenet, linked lives, describes the central role human relationships play in determining behaviour over the life course. The decision to migrate is shaped by family considerations whether they be providing economically for family (), directly caring for family () or missing family (). Finally, the tenet of human agency highlights constraints and facilitators across the life span. Factors such as income, citizenship status and other demographic characteristics influence an immigrant’s ability to return to the home country for health-related reasons. Using a lifecourse framework, the goal of this study is to explore which tenets explain the decision to return to Mexico and if these tenets differ across age. In this way, this study challenges the prevailing focus on economic motivations in determining international migration and considers whether age of return influences this decision. This work departs from previous efforts by examining the specific reasons immigrants reported for returning to Mexico rather than the association between particular characteristics and return migration. MethodsDataWe employ data from the Mexican Health and Aging Study (MHAS) for this study. The MHAS is a nationally representative sample of the 50 and older population in Mexico that oversamples regions that have historically sent large numbers of emigrants to the U.S. The first wave, fielded in 2001, contains 15,186 completed interviews and had a response rate of 91.8 per cent. Respondents were reinterviwed in 2003, along with 125 new spouses (93.3% response rate). In 2012, 14,283 of original respondents were reinterviewed, along with 385 new spouses and 6,259 new respondents (88.1% response rate) (). Although the present study uses data from the 2012 wave, responses were used from previous waves when appropriate. For example, respondents who did not travel to the U.S. between 2003 and 2012 were not asked about their experiences in the U.S. in the 2012 wave. In these cases, responses from previous waves were used. Examining those aged 50 and older provides the advantage of eliminating younger immigrants from the analysis who might still be at risk of returning to Mexico at working ages. Older immigrants are not likely to reenter the U.S. after returning to Mexico. Less than five per cent of former U.S. immigrant males in Mexico reentered the U.S. within a five-year period (). As such, this analysis is likely to capture immigrants who are not planning to reenter the U.S. SampleSampled individuals and spouses are included in the sample. Of the 1,269 former U.S. immigrants aged 50 and older in the sample, a nontrivial 11.3 per cent (N=143) proxies were dropped from the sample since they were not asked the reason the respondent last returned from the U.S. We conducted a logistic regression of having a proxy interview on available variables from the final model (Table 1) to determine how excluding this group might bias results. Results suggest that respondents with proxy interviews were more likely to be U.S. citizen or legal permanent residents. We discuss the implications of this difference in the discussion section. Table 1.Logit multivariate model predicting the probability of having a proxy interview among Mexicans in Mexico aged 50 years and older who at some point returned from the U.S. OR [95% Conf. Interval] In in U.S. at least 10 years1.04 [0.54,1.98]Current age (natural log)2.01 [0.28,14.3]No. living children1.04 [0.96,1.12]U.S. citizen/Legal Permanent Resident (LPR) Not U.S. citizen/LPR0.33*** [0.19,0.59] Missing citizen/LPR0.32** [0.14,0.75]Completed elementary school1.23 [0.59,2.54]Sex0.60 [0.33,1.11]Unweighted N1,243 Open in a separate window *p<0.05 **p<0.01 ***p<0.001 Source: Authors’ calculations using the 2012 Mexican Health and Aging Study (MHAS). Estimated weighted using MHAS-provided sampling weights. Standard errors are clustered at the household level. Only variables from questions asked of proxy respondents are included in the model. The model includes the non-imputed version of citizenship status. Of the remaining 1,126 non-proxy interviews, 55 (4.9%) did not report the reason they last returned from the U.S. Of the 1,071 respondent that were not missing this information, 137 (12.8%) were missing information on their migration experience due to questionnaire skip patterns. In 2001, these 137 respondents reported not having ever been to the U.S. and in 2003, reported having been to the U.S. but not within the past two years. This discrepancy is not surprising since older adults are more likely to have deficits in episodic memory and have more trouble remembering when they experienced an event, often affecting their responses on surveys (). These respondents were skipped out of series of questions regarding their migration experience, including the age at which they last returned from the U.S. and whether they were U.S. citizens or legal permanent residents. However, it was possible to determine whether they returned at age 50 and older for 78 out of the 137 (56.9%) respondents using their employment information. These respondents worked at their current job long enough to have returned before age 50 from the U.S. Applying this single imputation produced 952 complete cases. Unfortunately, we could not use a similar method to replace missing values for U.S. citizenship/legal permanent residence. Of these 952 cases, 78 (8.2%) were missing information regarding their citizenship status due to the questionnaire skip pattern issue mentioned above and an additional 11 (1.2%) cases refused to answer this question or reported not knowing. Instead of excluding these cases, we use multiple imputation (MI) to replace most of these missing values. The model used for multiple imputation is shown in Table 2. The MI procedure imputed 72 of the 89 cases (80.9%) who did not report whether they were U.S. citizens or legal permanent residents. The area under the Receiver Operating Characteristics (ROC) for the imputation model was 85.0 per cent which is considered excellent discrimination (). As another check of the imputation model, we compare the proportion of complete cases who were U.S. citizens/legal permanent residents to those predicted to be U.S. citizens/legal permanent residents. These two numbers were within two percentage points of each other (16.1% and 17.9%, respectively; analysis not shown). We did not impute missing values for other variables with missing values since the models considered for the imputation did not perform well on the aforementioned two measures. For this reason, only 72 of the 89 missing values for citizenship status could be imputed given missing values for other variables. Table 2.Logit multivariate model predicting the probability of being a U.S. citizen/legal permanent resident among Mexicans in Mexico aged 50 years and older who at some point returned from the U.S. OR [95% Conf. Interval] Receive or expect to receive U.S. Social Security48.35*** [12.99,179.90]Last returned from U.S. at age 50+2.50** [1.29,4.88]Years in the U.S. (ref: <10) 10–191.35 [0.56,3.24] 20+12.13*** [2.87,51.20]Current age (natural log)68.47*** [5.85,801.40]Completed elementary school0.77 [0.34,1.71]Married last returned from U.S.2.60+ [0.89,7.55]No. living children0.98 [0.89,1.08]Speaks English3.81** [1.54,9.42]Reason returned (ref: Illness) Economic reasons2.60 [0.50,13.56] Missed family2.19 [0.53,9.15] Family problems in Mexico0.519 [0.068,3.99] Migration problems0.094* [0.013,0.67] Difficult to be in U.S.2.36 [0.51,11.05] Other0.87 [0.22,3.51]Male0.29*** [0.15,0.56]Observations807 Open in a separate window Source: Authors’ calculations using the 2012 Mexican Health and Aging Study (MHAS). Notes: This is the model that was used to impute missing values for citizenship status. Standard errors clustered at the household level. *p<0.05 **p<0.01 ***p<0.001 Dependent variableThe dependent variable is the reason the respondent identified for having last returned from the U.S. There were eight response options to the question,”Think about the last time you were in the U.S. Why did you come back to Mexico?”: 1) “You were ill,” 2) “You missed your family,” 3) “It was difficult to remain in the U.S.,” 4) “It was too expensive to remain in the U.S.,” 5) “Insufficient earnings,” 6) “Problems regarding migration,” 7) “Family problems in Mexico,” and 8) “Other.” To increase cell size, categories four (“It was difficult to remain in the U.S.”) and five (“Insufficient earnings”) were combined to represent having returned for economic reasons, resulting in seven possible reasons for returning. Respondents could list more than one reason but, as is described below, most only reported one. Table 4 shows the proportion of respondents who reported returning for each of the seven reasons as well as the distribution of the main reason for returning. As will be discussed, in regression modelling, the dependent variable is the main reason the respondent returned to Mexico. Thus, response categories are mutually exclusive for this variable in the models. Table 4.Reasons reported for having last returned from the United States among Mexicans in Mexico aged 50 years and older who at some point returned from the U.S. Reason for returningaMain reason for returningb Age returned<5050+Total<5050+TotalUnweighted N631321952631321952 Illness (%)4.48.45.66.26.96.4Missed family (%)36.326.133.33.49.45.2Difficult to be in U.S. (%)16.512.815.432.225.430.2Economic reasons (%)9.48.99.3106.28.9Migration problems (%)5.98.16.55.65.35.5Family problems in Mexico (%)10.66.99.513.71012.6Other (%)25.83729.125.434.628.1Missing (%)0.200.23.42.23.1Total reasons listed1.101.101.10--- Open in a separate window *p-value<0.05 **p-value<0.01 ***p-value<0.001 Source: Authors’ calculations using the 2012 Mexican Health and Aging Study (MHAS). Estimates weighted by MHAS-provided sampling weights. aCategories are not mutually exclusive. bCategories are mutually exclusive. If respondents selected more than one reason for returning, they were asked to select the main reason. Independent variablesThe independent variable of interest is whether respondents were aged 50 years and older when they last returned from the U.S. We use this cutoff instead of the normal retirement age, 65, since several diseases are often diagnosed after age 50 and before age 65 (; ; ), possibly affecting the reason for returning. Based on the four tenets of life course theory, eight variables are included in the model. The indicator for whether the immigrant last returned at age 50 and older and duration in the U.S. are included in the model to account for the timing of lives. In line with other studies (e.g., ; ), short-term migration is characterized by spending less than ten years in the U.S. To account for the second tenet in the conceptural framework, interplay of human lives and historical time, the regression model controls for age at the time of the survey. Biological age holds a one-to-one relationship to birth cohort in the present analysis since there is only one year of data. The model considers the tenet of linked lives by controlling for whether respondents were married when they last returned from the U.S. and their number of living children. Several variables in the model represent human agency: gender, education, and citizenship. Based on the literature, there are marked differences in the reasons why males and females migrate (; ). Therefore, gender is included in the model. Education was included since the more educated may have the social capital with which to navigate relocation during later life. Citizenship status is included since a higher proportion of former U.S. immigrant males in Mexico who are U.S. citizens or legal permanent residents returned to Mexico at retirement ages than those who do not have U.S. legal status (). It should be noted that the MHAS does not include employment and income characteristics at the time that immigrants last returned from the U.S., only during their longest stay in the U.S. However, as previously noted, duration in the U.S. is associated with numerous characteristics such as employment status (), English language ability () and other factors that are tied to immigrants’ socioeconomic context when they last returned. Although the variable for citizenship in the dataset reflects their status in the survey year, it is unlikely that immigrants obtained citizenship status after last returning from the U.S. This is because upon becoming legal permanent residents, immigrants must not travel outside of the U.S. to the extent that it is determined they did not intend to make the U.S. their permanent residence (). Statistical analysisStata 14 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.) was used to conduct all analyses. Descriptive statistics were completed to compare the two groups (i.e., those who returned to Mexico before age 50 and those who returned at age 50 years and older). Bivariate analyses were performed on the aforementioned eight variables that reflect the four tenets of the life course framework (Table 3). For each of the seven possible reasons for having last returned from the U.S., the association between listing this reason and whether or not the respondent last returned from the U.S. at age 50 and older was completed using a Rao-Scott chi-squared test for weighted data () (Table 4). Table 3.Demographic characteristics of Mexicans in Mexico aged 50 years and older who at some point returned from the United States. Age returned<5050+TotalUnweighted N631321952 In in U.S. at least 10 years (%)15.2***33.920.7 Missing0.20.20.2Mean age ± Standard Deviation61.0±9.6***66.3±9.662.6±9.9 [Range][50–96][51–93][50–96]Married last time returned from U.S. (%)81.5***91.684.5 Missing1.83.82.3Mean no. living children ± Standard Deviation4.5±2.9*5.4±3.64.8±3.2 [Range][0–19][0–21][0–21]U.S. citizen/Legal Permanent Resident – imputed (%)10.6***30.316.4 Neither87.569.182.1 Missing1.90.51.5Completed elementary school (%)89.4***71.084.0Male (%)84.179.382.7 Open in a separate window *p-value<0.05 **p-value<0.01 ***p-value<0.001 in Rao-Scott chi-squared tests for categorical variables using non-missing values and one-way analysis of variance tests for continuous variables using non-missing values. Estimates weighted by MHAS-provided sampling weights. Source: Authors’ calculations using the 2012 Mexican Health and Aging (MHAS). To assess the relative importance of each of these reasons compared to illness, a multinomial logistic regression was performed on the main reason for returning to Mexico. Multinomial logistic regression resembles traditional logistic regression but can accommodate a discrete-choice outcome with more than two levels (). In multinomial regression modelling, the reference category is the reason for return that hypothesize is likely to differ among younger and older immigrants: illness. For each of the reasons for returning, a comparison was made between immigrants who reported that reason and immigrants who reported returning due to illness. These comparisons help explain whether age directly influences whether immigrants return for health reasons or if this relationship is the result of other characteristics that are associated with age of return. In this way, we assess the relative importance of health compared to family, and economic and other factors suggested in the literature that are important in the decision to return while ruling out the influence of different characteristics across groups. We do not conduct separate logistic regressions of each of these comparisons due to the loss of efficient in doing so when compared to multinomial logistic regression (). The model includes all variables deemed important based on prior literature. Since respondent spouses were also interviewed, standard errors are clustered at the household level to adjust for correlation within households. All estimates are weighted using MHAS-provided population weights (Instituto Nacional de Estadística y Geografía (INEGI) [National Institute of Statistics and Geography] 2013). ResultsDescriptive profilesThe descriptive profiles of immigrants who last returned at age 50 and older, and those who returned at younger ages suggest distinct life course trajectories (See Table 3). Those who returned at older ages spent more time in the U.S., indicating more exposure to U.S. customs and culture at the time of return. Approximately 33.9 per cent of those who returned at age 50 and older spent at least ten years in the U.S. compared to only 15.2 per cent of those who returned before age 50 (p<0.001). Those who returned at age 50 and older were, on average, five years older than those who returned before age 50 (66.3 versus 61.0, respectively, p<0.001). Those who returned at age 50 and older also potentially had more attachments to immediate family when they last returned from the U.S. Ninety-two percent of immigrants who returned at age 50 and older were married when they last returned from the U.S. compared to 81.5 per cent of those who returned before age 50 (p<0.001). Older return migrants also had more children at the time of the survey than younger return migrants (5.4 and 4.5, respectively; p<0.05). A much higher proportion of older return migrants were U.S. citizens or legal permanent residents (30.3%) than younger return migrants (10.6%; p<0.001). This finding suggests that the former group could more easily return to and from Mexico, possibly affecting their reason for return. A lower proportion of those who returned at age 50 or older completed elementary school compared to those who last returned before age 50 (71.0% versus 89.4%; p<0.001). Reasons for returning to MexicoThe crucial role of family for both younger and older return migrants can be seen in the data presented in Table 4. This table shows the proportion of older and younger immigrants who reported each reason for returning as well as distribution of their main reason for returning. Close to one-third of immigrants in both groups reported missing family as the main reason for having last returned from the U.S. Moreover, relatively few immigrants returned for economic reasons (≥50 years old: 8.9%; <50 years old: 9.4%). Although given the choice to report multiple reasons for returning to Mexico, most immigrants in the both groups reported only one reason for last returning from the United States. Somewhat surprisingly, immigrants who last returned to Mexico at age 50 or older were just as likely to have listed illness as a reason for last returning to Mexico than those who returned at younger ages (see Table 4). While illustrative, it is necessary to account for differences across groups that may be underpinning these patterns. Multinomial logistic resultsThe results of a multinomial logistic regression accounting for the four tenets of life course theory are presented in Table 5. This table shows the characteristics associated with choosing one reason over another for last returning from the U.S. Results show that older immigrants were more likely to have indicated illness over family as their main reason for returning to Mexico. Specifically, the odds of having listed missing family instead of illness as their main reason for returning was 73 per cent lower for immigrants who returned to Mexico at age 50 and older than those who returned at younger ages (p<0.01). Thus, while missing family was the most prevalent reason reported for returning for both older and younger immigrants, the former were still more likely to chose health over missing family. This pattern also holds for chosing family problems in Mexico as the main reason for returning (OR=0.17, p<0.05), chosing the difficulty of living in the U.S. as the main reason (OR=0.30, p<0.05) and chosing other reasons (OR=0.40, p<0.05). Older immigrants were more likely to have chosen illness over these other reasons than younger immigrants. In contrast, older immigrants were just as likely to return due to illness as they were to return due to economic reasons (OR=0.39, p>0.05) and migration problems (OR=0.43, p>0.05). Table 5.Multinomial logit model predicting whether former U.S. immigrants aged 50 years and older chose economics, family problems in Mexico, migration problems, difficult to be in U.S. or other reasonsa over illness as the main reaon for last returning from the U.S. (N=883) OutcomeEconomic reasons VariablesOR [95% CI]OR [95% CI]OR [95% CI]Timing of lives Returned at age 50 and older0.57 [0.15,2.22]0.27** [0.11,0.68]0.17** [0.05,0.65] In in U.S. at least 10 years0.16* [0.03,0.77]0.45 [0.15,1.40]1.04 [0.18,5.85]Interplay of human lives and historical time Current age (natural logarithm)2.05 [0.01,384.50]2.41 [0.052,110.70]23 [0.21,2498.70]Linked livesMarried/In union when last returned0.10 [0.01,1.01]0.16+ [0.02,1.29]0.090* [0.01,0.82] No. living children0.93 [0.78,1.10]0.99 [0.86,1.14]1.1 [0.95,1.27]Human agency U.S. citizen/Legal Permanent Resident (imputed)1.46 [0.35,6.06]2.52 [0.73,8.71]0.66 [0.10,4.20] Completed elementary school1.12 [0.27,4.64]0.87 [0.26,2.96]3.13 [0.67,14.70] Male10.5* [1.19,92.90]1.35 [0.32,5.64]0.64 [0.13,3.06]OutcomeMigration problems vs. illnessDifficult to be in U.S. vs. illnessOther vs. illnessVariablesOR [95% CI]OR [95% CI]OR [95% CI]Timing of lives Returned at age 50 and older0.41 [0.12,1.43]0.30* [0.10,0.86]0.43 [0.17,1.08] In in U.S. at least 10 years1.32 [0.34,5.09]0.25* [0.075,0.83]0.49 [0.16,1.46]Interplay of human lives and historical time Current age (natural logarithm)52.2 [0.77,3524.40]25.8 [0.39,1722.50]475.1** [9.34,24173.70]Linked lives Married/In union when last returned0.081* [0.01,0.65]0.16+ [0.02,1.25]0.15 [0.02,1.14] No. living children0.9 [0.77,1.04]0.95 [0.82,1.11]0.83** [0.73,0.95]Human agency U.S. citizen/Legal Permanent Resident (imputed)0.074** [0.01,0.43]1.77 [0.47,6.65]1.37 [0.44,4.25] Completed elementary school2.54 [0.57,11.40]1.69 [0.47,6.17]1.57 [0.47,5.25] Male4.55 [0.82,25.30]1.34 [0.28,6.42]1.51 [0.36,6.31] Open in a separate window Source: Authors’ calculations using the 2012 Mexican Health and Aging Study (MHAS). Estimates weighted using MHAS-provided sampling weights. Every column represents a comparison of the characteristics of immigrants who returned to Mexico for that particular reason compared to those who returned due to illness. All columns represent comparisons within the same model. Notes: Standard errors are clustered at the household level. aThe reference category is missing family. *p<0.05 **p<0.01 ***p<0.001 DiscussionFindings in the present study indicate that relatively few former U.S. immigrants, regardless of age, report returning to Mexico due to economic reasons. The most commonly reported reason for returning to Mexico for both groups was missing family. However, the odds of listing illness over missing family as their main reason for returning were higher for older immigrants than younger immigrants after controlling for duration in the U.S. and other sociodemographic factors. In contrast, older immigrants were just as likely to chose illness instead of economic issues and migration after controlling for these factors. These results have several implications. First, the finding that relatively few former U.S. immigrants return to Mexico for economic reasons calls into question the focus on economic motivations in explaining international return migration (e.g., ; ; ). Approximately nine per cent of older and younger return migrants reported returning for such reasons. This suggests that while economic factors may pull immigrants toward the U.S., they may not be as important in motivating return to the country of origin regardless of where immigrants are in the life couse. One explanation for this finding may be our focus on former U.S. immigrants in Mexico who at some point emigrated to the U.S. and returned rather than those who emigrated to the U.S. since 2009 and returned. In a recent study by , former U.S. immigrants who emigrated to the U.S. since 2009 and returned to Mexico, most commonly reported lack of work in the U.S. as their reason for returning to Mexico. The small number of immigrants who returned after 2009 in the MHAS did not allow us to examine differences between those who returned before and after the economic downturn. Our results may reflect the changing priorities of immigrants over their duration in the U.S. Employment and wages may be the most important factors upon arriving to the U.S. but social relationships make take precedence as immigrants reach their initial financial goals the longer they are in the U.S. regardless of age. Instead, findings highlight the pivotal role of family, or in lifecourse framework terminology, linked lives, in determining return migration for both age groups. Familial ties exerted the greatest influence in their decision to return for both older and younger Mexican immigrants. This result falls in line with previous research which finds that family was the most cited reason for returning for Mexican immigrants in the U.S. who returned to Mexico (). The results of the present study suggest that this is true across age of return. It remains unclear, however, how the nature of family ties change across age. Younger return migrants were less likely to be married than older return migrants when they last returned from the U.S., suggesting that younger return migrants returned due to their closeness with non-spouse family members. Other research has shown that older immigrants also maintain close ties to non-spouse family members (; ). Older immigrants return migrate to reunite with siblings, grandchildren and elderly parents (; ). Our finding may reflect strong family connections that may change across age but that do not diminish the allure of the home country. Our results also challenge existing typologies of older movers. While family plays a primal role in theory of older movers, they do so only as caregivers rather than through the emotional bonds they share with immigrants. posits that older adults tend to move closer to family members as they become more frail in order to receive assistance. This model recognizes life course factors that encourage physical closeness to family for assistance reasons but does not account for the closer family ties within immigrant communities even across international borders (). The results of the present study connote strong family bonds across the life course irrespective of the need for assistance. move closer to characterizing later-life migration among older immigrants, only to the extent that they acknowledge that this group does not fall into their theory. argue that native-born older adults move to seek amenities and then to seek assistance as their health begins to decline. Furthermore, Litwak and Longino acknowledge that older immigrants are likely to deviate from this pattern since they have stronger family ties and are less likely to use institutional care. The results presented herein support this assertion and highlight the need for theories of international migration specific to older adults. Despite the importance of family for immigrants who returned to Mexico from the U.S. at both younger and older ages, our findings reveal gradation in the motives undergirding migration across the life course. Those who returned at older ages were more likely to have chosen illness over missing family and family problems in Mexico as the main reason for returning. Therefore, even though missing family was the most important reason for returning, older immigrants were still more likely to view illness as the most imminent reason for returning. On one level this is not surprising; older immigrants are more likely to be ill () and thus, have grounds for prioritizing their health over family. On the other hand, poor health need not necessarily motivate immigrants to return to their countries of origin. While some studies find evidence that immigrants return to their home countries in anticipation of death (e.g., ), authors argue that poor health may actually motivate immigrants to stay in the U.S. because of its superior health care system (). The results of the present study show that despite the presumed better quality of the U.S. health care system, eight per cent of older immigrants who returned to Mexico did so because of illness. Although not nearly as large as the proportion who moved for family reasons, this number can have non-neglible effects on health spending given the disproportionate amount of health spending that goes toward older adults. In 2010, adults aged 45 and older constituted 39 per cent of the U.S. population () but consumed 47 per cent of all Medicaid dollars (). Mexican immigrants who return to Mexico at this age for health reasons potentially diminish these expenditures, particularly in states with large immigrant populations. One explanation for this result may be that in the absence of U.S. health coverage, older Mexican immigrants turn to Mexico’s lower-cost health care system as an alternative. found that pre-retirement Latino immigrants are more likely to lose health coverage than both native-born non-Hispanic whites as well as other immigrant groups. It is possible that uninsured immigrants return to Mexico to substitute hospital-based medical attention with informal care provided by private pharmacies, a common practice in Mexico (). Future research should examine whether the number of immigrants returning to Mexico due to illness has decreased after the Affordable Care Act was passed into law in March 2010, which provides access to lower-cost health care through the Exchange Marketplace for naturalized citizens and legal permanent residents. Another reason why illness may motivate older Mexican immigrants to return to Mexico is the absence of a caregiver in the U.S. Older immigrants who are not living in their home countries have been shown to be separated from caregivers who are in the home country (). Interestingly, after controlling for the other tenets of life course theory, older immigrants were just as likely to report returning due to illness as they were to report returning for economic reasons. This is partially explained by the greater tendency for older return migrants to have lived in the U.S. more than ten years compared to younger return migrants. This suggests that the protective effect of age against experiencing migration issues such as deportation and economic issues is entirely due to duration in the U.S. Immigrants at all stages of the life course are susceptible to these challenges if they have not lived in the U.S. for very long. Given the growing proportion of new immigrants who are older adults (), future research may show that older immigrants are just as likely to return due to illness as they are to return for economic reasons. LimitationsIt is important to mention noteworthy limitations of this study. First, this analysis is limited to respondents with direct interviews and does not include those with proxy interviews. An analysis of the differences between respondents both types of interview indicates that the latter group were more likely to be U.S. citizens or legal permanent residents. Immigrants with U.S. legal status may be less likely to return due to declining health since they are eligible for Medicare and Medicaid. Moreover, since they presumably have more ties to the U.S., they may be more likely to have family in the U.S. to care for them during later life. If this were the case, this would further validate the finding from this study regarding the importance of familial bonds in the migration decision. Another limitation is that the data do not contain information regarding the location of or proximity to family members when immigrants last returned to Mexico. Such information would illuminate possible family ties weighting on the decisions of immigrants. Nonetheless, the present analysis controls for whether the immigrant was married when she last returned from the U.S., thereby accounting for the greater responsibility associated with forming one’s own household. Yet another limitation is that older adults aged 70 and older have cited health as a major incentive for moving domestically () but “younger” older immigrants are thought to move for amenities (). Unfortunately, it was not possible to disaggregate older immigrants into more granular categories for age of return due to sample size restrictions. Nonetheless, this anlaysis provides a general accounting of differences between older and younger immigrants which is more than is currently available for this population. Finally, another limitation is the high proportion of respondents who report “other” reasons for having last returned from the U.S. (29.1%). This result signals the need for further inquiry into the reasons for returning to Mexico among Mexican immigrants in the U.S. Qualitative work on other groups, for example, suggests that immigrants return to their home countries to assist family members abroad (; ), and to enjoy a better climate () and a more active social life (), reasons that were not listed as a separate category in the questionnaire. Not knowing the reasons embedded in the “other” category, however, does not preclude us from knowing the importance of health and missing family in the return migration decision. ConclusionNet migration from Mexico to the U.S. (entering immigrants minus exiting emigrants) is at its lowest since the 1990s (). Research suggests that economic factors such as landownership (), asset accumulation () and the availability of jobs in the U.S. () play an important role in migration decisions. However, the present study finds that few immigrants reported returning for economic reasons. Instead, the most cited reason for returning to Mexico among those who returned at older and younger ages was missing their family. This is the case even as the former group was more likely to return due to illness. These results illuminate the reasons for decisions to return to Mexico for a growing population whose actions have major ramifications for U.S. health care spending, public programme usage and the U.S. economy at large. AcknowledgmentsStatement of funding This study was funded by the NewCourtland Center for Transitions and Health (no grant number) at the University of Pennsylvania School of Nursing. The NewCourtland Center played no role in the design, execution, analysis or interpretation of data, or the writing of the study. FootnotesStatement of ethical approval This work is based on publicly available de-identified data and therefore, does not constitute human subjects research. Statement of conflict of interest The authors report no conflicts of interest. Contributor InformationAlma Vega, NewCourtland Center for Transitions and Health, 3615 Chestnut Street, Ralston – Penn Center, Rm 326, Philadelphia, PA 19104, Phone: (215) 573-4314, Fax: (215) 573-4225, ude.nnepu.gnisrun@vamla. Karen Hirschman, NewCourtland Term Chair in Health Transitions Research, 3615 Chestnut Street, Ralston Penn-Center, Rm 334, Philadelphia, PA 19104, 215-573-3755, ude.nnepu.gnisrun@khcsrih, [email protected]. References
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