A new study by Eleonora Trappolini, Elisa Barbiano di Belgiojoso and Stefania M.L. Rimoldi, published in SSM – Population Health, tackles this question with an unusually direct research design. Drawing on the 2025 MIGHTY Survey of migrants in Lombardy, Italy, the authors asked respondents to rate their health twice: once as it was before they left their country of origin, and once as it stood at the time of interview. This retrospective pre-migration measure, rare in European datasets, allowed the researchers to compare each individual with their own past self, rather than comparing different groups of people who may differ in countless unobserved ways. The analytical sample comprised 2,331 foreign-born residents of Lombardy, roughly half of them women, including undocumented migrants and naturalised citizens who are typically invisible to residence-based statistics.

The methodological core of the study is a correlated random-effects ordinal logistic regression, a statistical framework that separates within-individual change from between-individual differences. Each respondent contributed two observations, one pre-migration and one post-migration, with age treated as a time-varying covariate and supplemented by Mundlak terms, which capture the individual-level means of time-varying variables and allow the model to distinguish ageing from the effect of migration itself. Because the outcome, self-rated health, is measured on a five-point scale from very good to very bad, the authors used ordinal models and, when diagnostic tests revealed that the proportional-odds assumption was violated, they relaxed it, presenting category-specific marginal effects rather than forcing a single summary coefficient onto a process that operates differently at different points of the health distribution.

The headline finding is stark: once ageing is accounted for, post-migration health deterioration is concentrated among women. Among female respondents, the odds of reporting poorer self-rated health after migration were roughly four times higher than before, an association that remained stable across every model specification. Among men, the corresponding coefficient was smaller and not statistically significant. Before migration, men and women reported almost identical probabilities of being in very good health, 38.5 percent and 38.0 percent respectively. After migration, those probabilities fell to 29.1 percent among men and 24.6 percent among women, opening a gender gap where none had existed. The decline was driven primarily by the loss of very good health and its redistribution into the fair category, with women gaining seven percentage points in the fair category compared with four points among men. Movement into the worst health categories remained modest for both groups.

This gendered pattern is consistent with the double burden hypothesis. Migrant women in Italy are disproportionately employed in domestic and care work, sectors characterised by social isolation, emotional labour, irregular schedules, blurred boundaries between work and rest, and weak labour protections. On top of paid employment, many carry disproportionate unpaid and transnational caregiving responsibilities, juggling the roles of worker, mother, partner and breadwinner simultaneously. The authors caution that their survey does not directly measure time use or caregiving, so these mechanisms remain plausible interpretations rather than demonstrated pathways. But the fact that the gender gap emerges only after migration, from a baseline of near-identical health, strongly suggests that it reflects post-migration experiences rather than differential selection into migration.

Occupational status told a more complicated story, and one that differed sharply by gender. Among men, the decline in very good health varied significantly across occupational positions, ranging from under five percentage points among employees in non-physically demanding jobs to nearly twenty points among those in marginal or non-standard work arrangements. Self-employed men in non-physically demanding occupations also showed pronounced deterioration, a finding the authors interpret in light of the Italian context, where self-employment often functions as a fallback for those shut out of standard employment and can entail economic insecurity, long hours and weak social protections. Among women, by contrast, the decline was both larger and remarkably uniform across occupational categories; the interaction between migration timing and occupational status was not statistically significant in this group. This asymmetry, confirmed by a significant three-way interaction between migration timing, gender and occupation, complicates any simple double-burden narrative. One reading is that the burdens migrant women face, combining paid work with unpaid care, cut across occupational positions, elevating deterioration everywhere and leaving little room for occupation to differentiate the decline. For men, health consequences appear more tightly bound to specific working conditions.

The authors are careful about what their design can and cannot establish. Occupational status was measured at interview, after the health change had occurred, so the associations cannot be read causally; migrants whose health has deteriorated may also drift into self-employment or out of employment altogether, a selection process that could partly generate the observed gradients. Unemployed and inactive respondents showed smaller losses in the best health categories but larger increases in poor health, a pattern consistent with reverse causation, whereby illness pushes people out of work. The authors also acknowledge that their occupational classification, which distinguishes physically demanding from non-physically demanding jobs, may understate the physical and psychosocial strain of domestic and care work, the very sectors where migrant women are concentrated, potentially masking heterogeneity among women.

Retrospective self-reports carry their own hazards, and the study confronts them head-on. Recall bias may lead some respondents to idealise their pre-migration health, a phenomenon known as rosy retrospection, while response shift, a change in the internal standards against which people judge their health, may alter how the same objective condition is reported before and after years of life in a new society. Robustness analyses suggest these mechanisms may inflate the magnitude of the estimated decline but do not manufacture it: deterioration is present even among the most recently arrived migrants, the gender difference survives fixed-effects specifications, and a bounding analysis indicates that only a large, gender-specific recall bias could overturn the result. Other limitations include the restriction to Lombardy, the observational equivalence of cumulative exposure and ageing in a two-observation design, and the possibility of selective return migration, the so-called salmon bias, which could bias estimates in either direction.

What the study ultimately delivers is a reframing of migrant health inequality as a dynamic process rather than a static comparison. The probability of reporting bad or very bad health remained low both before and after migration, confirming that migrants are a positively selected population, but the erosion of that advantage is neither uniform nor random. It is steeper for women than for men, and for men it tracks occupational position, with the sharpest declines among those at the margins of the labour market. The authors argue that this stratification calls for differentiated policy: for men, stronger labour protections and occupational health services extended to non-standard and undeclared work; for women, interventions that reach beyond the workplace to address the combined weight of paid and unpaid care, including extending health surveillance into private households and improving physicians’ capacity to identify work-related illness among migrant home-care workers. As Europe’s workforce ages and its dependence on migrant labour deepens, the finding that the price of migration is paid unevenly, and most heavily by women, is one that policymakers cannot afford to ignore.

Subject of Research: Gender and occupational differences in post-migration health decline among migrants in Italy

Article Title: Do all migrants decline equally? Gender and occupational status differences in post-migration health in Italy

Article References: Trappolini, E., Barbiano di Belgiojoso, E., & Rimoldi, S. M. (2026). Do all migrants decline equally? Gender and occupational status differences in post-migration health in Italy. SSM – Population Health, Article 101971. https://doi.org/10.1016/j.ssmph.2026.101971

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101971

Keywords: migrant health, healthy immigrant effect, exhausted migrant effect, self-rated health, gender inequality, occupational status, Italy, Lombardy, longitudinal analysis, cumulative disadvantage, care work, labour market segmentation

Acculturation, defined as the process by which immigrants adopt the cultural norms, language, and behaviors of their host country, has been widely thought to erode the initial health advantage. However, this study suggests the inverse may be true: higher levels of acculturation, particularly as measured by English language proficiency and social integration indicators, actually confer substantial health benefits in later life. The research, based on data from the expansive American Community Survey encompassing close to one million immigrants aged 65 to 80, reveals that immigrants who speak English well have between 40 and 50 percent lower odds of experiencing disability compared to those with limited English proficiency.

The investigation goes beyond the simplistic binary of acculturated versus non-acculturated and introduces the concept of “acculturative discordance.” This term refers to situations where immigrants attain certain markers of cultural adaptation—such as marrying a U.S.-born spouse—but fail to meet others, notably language proficiency. Results indicate that this discordance correlates strongly with worse health outcomes, particularly an increase in ambulatory disabilities, including difficulties related to mobility, such as walking or climbing. These impairments are among the most prevalent disabilities in the U.S. elderly population, affecting roughly one in four adults aged 65 and older, underscoring the public health relevance of these findings.

The physiological mechanisms linking acculturative discordance to disability are yet to be fully elucidated but likely involve psychosocial stress pathways. Leafia Ye, the study’s author and an assistant professor of sociology at the University of Toronto, explains that immigrants who are perceived as culturally incongruent—mimicking American behaviors but lacking linguistic fluency—may encounter social exclusion and chronic stress. This “half-included” status can impose allostatic load—the cumulative wear and tear on the body from chronic stress—manifesting in diminished physical health and increased vulnerability to disability later in life.

The research further delineates how racial and ethnic identity intersects with acculturation to influence health trajectories. Interestingly, the protective effects of acculturation are most pronounced among white immigrants. In contrast, Black, Hispanic, and Asian immigrants experience attenuated health benefits from acculturation. The authors theorize that this discrepancy arises because racially minoritized immigrants often face a double bind; adapting linguistically and culturally may increase exposure to racial discrimination and systemic exclusion, thereby counteracting the potentially protective aspects of acculturation.

This duality offers a nuanced look into the persistent racial health disparities evident in older immigrant populations. While white immigrants retain their health advantage relative to native-born Americans when highly acculturated, minoritized groups lose this advantage, suggesting that structural racism is a significant modulator in the relationship between cultural adaptation and health outcomes. The study highlights how societal forces operate synergistically with individual-level experiences to shape health across the life course.

The dataset’s sheer scale and demographic coverage provide robust empirical grounding for these conclusions. By analyzing data from the American Community Survey, which includes nearly a million older immigrants, the authors capture a comprehensive portrait of immigrant health within the U.S. context. Such a large sample size enables sophisticated adjustments for confounders and the exploration of nuanced interaction effects between acculturation dimensions and racial identities, rendering the findings highly generalizable.

The implications of this research extend well beyond academic interest, touching on policy and community interventions aimed at improving immigrant health and social integration. Traditional approaches that view acculturation as detrimental may need to be reconsidered in light of the study’s indication that fostering language acquisition and social integration could enhance health outcomes. Moreover, there is a critical need to address the social conditions that produce acculturative discordance and the racialized barriers that erode the health benefits of acculturation, particularly for minoritized immigrant groups.

The findings underscore the importance of holistic health frameworks that incorporate sociocultural factors alongside biomedical indicators. The notion that immigrants can be “half-included” speaks to the psychosocial toll of navigating between cultural identities without fully belonging to either. This in-between status can induce chronic stress responses, contributing to physical disabilities that exacerbate with age. Such insights are vital for healthcare practitioners, social workers, and policymakers designing elder care and social support systems sensitive to the immigrant experience.

Leafia Ye, who also serves as an affiliate faculty member at the Institute for Life Course & Aging and the Global Migration Lab at the Munk School of Global Affairs & Public Policy, emphasizes the critical need to recognize and ameliorate the health detriments of acculturative discordance. By reconceptualizing acculturation not as a unidimensional trajectory but as a multidimensional experience with complex psychosocial ramifications, this study propels the discourse on immigrant health into new and essential territory.

In sum, these findings challenge the prevalent narrative that acculturation undermines immigrant health over time. Instead, they reveal a more intricate picture where cultural and linguistic integration generally enhance health outcomes, but mismatches among acculturation components coupled with racial discrimination can produce physical health declines and mobility limitations. This underscores the urgency of tailored interventions that address both individual adaptation and structural inequities in the pursuit of health equity for aging immigrant populations.

As global migration continues to shape societies, understanding the social determinants of health for immigrants becomes not only a scholarly imperative but a social justice necessity. This study, by elucidating the paradoxes and disparities embedded in the process of cultural integration, offers a timely and critical foundation for future research and policy aimed at improving the well-being of immigrant communities during their later years.

Subject of Research: People
Article Title: Is Acculturation the Culprit? Acculturative Discordance and Immigrants’ Later-Life Health
News Publication Date: 3-Jun-2026
Web References: 10.1177/00221465261450447
Keywords: Immigrant health, acculturation, acculturative discordance, disability, aging, racial disparities, social epidemiology, American Community Survey, language proficiency, social integration, allostatic load, racial discrimination