The Association Between Parental Nativity and Developmental Disabilities in the United States: The National Survey of Children’s Health

Background: One in six (17%) children ages 3-17 are diagnosed with developmental disabilities (DD) in the United States. Due to the significant burden of DD on children and families, it is important to understand upstream factors that may contribute to this condition. Nativity has been explored in studies examining child health outcomes; however, few studies exist assessing the relationship between nativity and DD. Our study examined the associations between parental nativity and DD. We also examined whether this association differed by race, acculturation, or child nativity. Methods: This cross-sectional study was conducted using the 2018-2019 National Survey of Children’s Health (unweighted N= 47,678). We compared the prevalence of DD between children with US-born and foreign-born parents. We fit unadjusted and adjusted log-binomial regression models to estimate DD prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs). Multivariable models were adjusted for child sex, income level, parental education level, and child health insurance status. We also fitted adjusted models stratified by child nativity, acculturation (defined by primary language spoken at home), and race/ethnicity (White, Hispanic, Black, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Multi-race, and “Other”). In addition, we fitted adjusted models including interaction terms for the exposure and each potential effect modifier (child nativity, acculturation, and race/ethnicity) to assess statistical significance of interaction. Results: The population in the study included a weighted total of 54,451,765 children ages 3- 17. 21% of parents were told by their doctor, health care provider, or educator that their child had a DD; 15% among children with foreign-born parents and 23% among children with US- born parents. Children with parents born in the US had a higher prevalence of DD compared to children with foreign-born parents (aPR = 1.58, 95%CI: 1.41 – 1.77). Among US-born children, children with US-born parents, compared with children with foreign-born parents, had a higher prevalence of DD (aPR=1.22; 95% CI: 1.19 – 1.25). Similar but weaker associations were observed among foreign-born children (aPR=1.07; 95%CI: 1.06 -1.09). In not acculturated households (households whose primary language is not English), DD prevalence was significantly higher among children with US-born parents compared with children with foreign- born parents (aPR= 1.07, 95%CI: 1.05 – 1.08). This association was not present in accultured households (aPR=0.99; 95%CI: 0.97 – 1.01, interaction p = 0.747). Children with US-born parents had higher rates of DD compared with foreign-born parents among Blacks (aPR=1.10, 95%CI: 1.06 – 1.14), American Indians or Alaska Natives (aPR of 1.20, 95%CI: 1.18 – 1.22) and Native Hawaiians or Pacific Islanders (aPR =1.17 CI: 1.16 – 1.19). Weaker associations were observed for Whites (aPR=1.03, 95%CI: 1.01 – 1.05), Hispanics (aPR = 1.05, 95%CI: 1.08 – 1.13) and Asians (aPR=1.07, 95%CI: 1.14 – 1.21). The interaction p-value for parental nativity and “Other” race was not statistically significant (p=0.630); however, the interaction p-value for multi-race was statistically significant (p=0.23). Conclusion: Children of immigrant parents have a lower prevalence of DD compared to children with US-born parents, particularly among immigrant children, children in not accultured households, and children from Black, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander families. Our results may reflect the healthy immigrant effect or inadequate DD screening/detection. Future research should focus on a better understanding of the associations and potential underdiagnosis of DD among children of immigrant parents.