title: Nativity and cognitive disability among children: a unique comparison with reduced selection bias.
abstract: OBJECTIVE
  We examined the impact of nativity on self-reported cognitive disability by comparing children who were born outside of the USA (first-generation immigrants) with US-born offspring (second-generation immigrants) of foreign-born parents.
  
  
  METHODS
  We analyzed a diverse, nationally representative, sample of 77,324 first-generation immigrant and second-generation immigrant children (aged 5-17 years) from the 2009 American Community Survey. Multivariate logistic regression was used to assess the association between nativity and self-reported cognitive disability after adjustment for demographics and household characteristics.
  
  
  RESULTS
  Self-reported cognitive disability was observed in 1.7 % of the sample. The prevalence was higher among first second-generation immigrants than among second first-generation immigrants (1.9 vs 1.1 %, p < 0.001). After multivariate adjustment, the advantage of being foreign-born remained (OR = 0.63, 95 % CI = 0.53-0.75). Further analysis revealed effect modification of the immigrant health advantage by household income (p = 0.003).
  
  
  CONCLUSIONS
  We observed an immigrant advantage in self-reported cognitive disability; however, it was only evident among economically disadvantaged children. Future research should examine the contribution of the accumulation of poverty over time to the relationship between nativity and children's health.
authors.affiliation: Department of Health Evidence and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA, emma.benn@mountsinai.org.
authors.forename: Emma K T
authors.initials: EK
authors.lastname: Benn
mesh_terms: D000293:Adolescent; D044466:Asian People / Q000706:statistics & numerical data; D001722:Birth Order; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American