Implications of Mexican Health Care Reform on the Health Coverage of Nonmigrants and Returning Migrants

Objectives. To assess health coverage among Mexicans with US migration experience, before and after the implementation of Mexico’s universal health care program, Seguro Popular

Uninsured migrants: Health insurance coverage and access to care among Mexican return migrants

Background: Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development. Objective: Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care. Methods: I use descriptive and multivariate techniques to analyze data from the 2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID, combined n=632,678). Results: Analyses reveal a large and persistent gap between recent return migrants and non-migrants, despite rising overall health coverage in Mexico. Multivariate analyses suggest that unemployment among recent arrivals contributes to their lack of insurance. Relative to non-migrants, recently returned migrants rely disproportionately on private clinics, pharmacies, self-medication, or have no regular source of care. Mediation analysis suggests that returnees' high rate of uninsurance contributes to their inadequate access to care. Conclusion: This study reveals limited access to medical care among the growing population of Mexican return migrants, highlighting the need for targeted policies to facilitate successful reintegration and ensure access to vital resources such as health care

New Skills, New Jobs: Return Migration, Skill Transfers, and Business Formation in Mexico

Numerous studies have documented a high propensity for self-employment and business formation among return migrants relative to non-migrants. The literature points to the importance of remitted savings, migration duration, and number and types of jobs abroad for business formation upon return. Implicit in this scholarship is the assumption that migrants acquire not only financial capital, but also human capital, which expands their opportunities upon return. Empirical work has demonstrated how the transfer of formal human capital, such as language skills and professional credentials, influences the mobility pathways of professional return migrants. More recent research has also found that the transfer of informal human capital, such as social and technical skills learned on the job, shape the mobility pathways of return migrants with little schooling. Absent from this scholarship, however, are studies that directly test the relationship between the transfer of informal human capital and the odds of business formation among return migrants. In this paper, we address this gap. Using a multidimensional skills variable, which includes social, technical, and English language competences, we measure and test the relationship between skill acquisition and transfer and business formation among return migrants. Drawing on findings from a survey of 200 return migrants and 200 non-migrants in Mexico, we show that return migrants who successfully acquire and transfer new skills across the migratory circuit often leverage their new knowledge to launch businesses. Our findings have wide implications for how social scientists conceptualize and measure human capital formation across the migratory circuit

Uninsured Migrants: Access to Healthcare among Mexican Return Migrants

Numerous academic studies and policy reports indicate that Mexican return migrants are underinsured relative to their non-migrant counterparts. However, insufficient consideration has been given to Mexican return migrants’ access to healthcare since the creation of Seguro Popular, a universal insurance program implemented in 2003. This study analyzes data from the 2010 Mexican Census, to assess the association between a recent migration experience and the odds of having health insurance coverage. Subsequently, longitudinal data from the Mexican Family Life Survey (MxFLS) is used to test whether migrant selection on uninsurance accounts for observed disparities in coverage among men following return. Results reveal that working-age returnees are 23% and 16% less likely to be insured (for women and men respectively). This study highlights a need for greater attention to factors that affect the reintegration and access to key resources, such as healthcare, among Mexican return migrants.Master of Art

Work, Inequality, and Gender: Migration and Mobility in Twenty-First Century Mexico

Over the last two decades migration between Mexico and the United States has undergone a profound transformation. While circular migration has long been characteristic of the U.S.-Mexico system, the great recession and increased interior and border enforcement by the U.S. Government escalated return migration to Mexico. Moreover, returnees are increasingly opting to settle in Mexico rather than return to the United States. Between 2005 and 2014, 2.4 million Mexican immigrants returned home from the United States, resulting in a 10 percent decline in the U.S. Mexican-born population. During the same period, annual Mexican migration to the United States fell by 70 percent. Escalating return migration has motivated considerable research on the labor market reintegration of migrants into their origin communities. Mexican migrants are returning to a heterogeneous set of rural and urban communities with widely varying industrial profiles and disparate labor market opportunities. The Mexican labor market is highly stratified and opportunities vary by geography. The majority of workers with fewer than twelve years of schooling consigned to work in the informal sector of the economy, a loose conglomeration of small firms that do not provide health insurance, pensions, severance pay, or written contracts, and generally employ fewer than five workers. Because of the precarious working conditions and low wages associated with the informal sector, self-employment represents the primary upward mobility pathway for individuals with low levels of formal education who face significant barriers to attaining formal employment. Business formation offers an opportunity to maximize returns to social and technical skills that workers accumulate across years of informal sector work. This dissertation consists of three independent chapters that examine mechanisms related to economic mobility across different social and geographic groups of Mexican workers: U.S. migrants and non-migrants, women and men, and more and less educated workers. The first chapter investigates how U.S. migration experience leads to self-employment among Mexican return migrants and how their self-employment affects economic mobility. To examine alternative labor market trajectories, I rely on biographical narratives, which I constructed from in-depth interviews conducted with return migrants five years apart (2010 and 2015). Using the biographical narratives, I explore the heterogeneity of self-employment among return migrants and associated variations in their reasons for traveling to the United States and economic mobility upon return to Mexico. The second chapter assesses how the relationship between U.S.-migration experience and labor market mobility upon return varies by sending community context. To examine the relationship between international migration and labor market mobility by context, I draw on the biographical narratives used in Chapter 1 and additional interviews conducted in a number of rural communities. I conceptualize migration as a social process in which migrants plans and decisions evolve over time as they gain information and acquire resources across the migratory circuit: before, during, and after migration. My contextual analysis documents the ways in which migration behavior and preparation for economic activity upon return are shaped by economic opportunities in sending communities. The third chapter explores the relationship between educational attainment and business survival among self-employed Mexican men and women. I argue that the well-documented positive relationship between educational attainment and successful self-employment reflects a gradient in access to financial resources, rather than disparate human capital skills. To assess the impact of educational attainment on successful self-employment, I estimate a series of proportional hazards models of business survival using piece-wise exponential regression. To account for workers’ access to financial resources, I adjust for possession of a designated business structure outside the home and receipt of formal or informal financial support to establish the business.Doctor of Philosoph

Uninsured migrants: Health insurance coverage and access to care among Mexican return migrants

Background: Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development. Objective: Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care. Methods: I use descriptive and multivariate techniques to analyze data from the 2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID, combined n = 632,678). Results: Analyses reveal a large and persistent gap between recent return migrants and nonmigrants, despite rising overall health coverage in Mexico. Multivariate analyses suggest that unemployment among recent arrivals contributes to their lack of insurance. Relative to nonmigrants, recently returned migrants rely disproportionately on private clinics, pharmacies, self-medication, or have no regular source of care. Mediation analysis suggests that returnees' high rate of uninsurance contributes to their inadequate access to care. Contribution: This study reveals limited access to medical care among the growing population of Mexican return migrants, highlighting the need for targeted policies to facilitate successful reintegration and ensure access to vital resources, such as health care

Genetic architecture of subcortical brain structures in 38,851 individuals

Subcortical brain structures are integral to motion, consciousness, emotions and learning. We identified common genetic variation related to the volumes of the nucleus accumbens, amygdala, brainstem, caudate nucleus, globus pallidus, putamen and thalamus, using genome-wide association analyses in almost 40,000 individuals from CHARGE, ENIGMA and UK Biobank. We show that variability in subcortical volumes is heritable, and identify 48 significantly associated loci (40 novel at the time of analysis). Annotation of these loci by utilizing gene expression, methylation and neuropathological data identified 199 genes putatively implicated in neurodevelopment, synaptic signaling, axonal transport, apoptosis, inflammation/infection and susceptibility to neurological disorders. This set of genes is significantly enriched for Drosophila orthologs associated with neurodevelopmental phenotypes, suggesting evolutionarily conserved mechanisms. Our findings uncover novel biology and potential drug targets underlying brain development and disease

Novel genetic loci associated with hippocampal volume

The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (rg =-0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness

Novel genetic loci underlying human intracranial volume identified through genome-wide association

Intracranial volume reflects the maximally attained brain size during development, and remains stable with loss of tissue in late life. It is highly heritable, but the underlying genes remain largely undetermined. In a genome-wide association study of 32,438 adults, we discovered five novel loci for intracranial volume and confirmed two known signals. Four of the loci are also associated with adult human stature, but these remained associated with intracranial volume after adjusting for height. We found a high genetic correlation with child head circumference (ρgenetic=0.748), which indicated a similar genetic background and allowed for the identification of four additional loci through meta-analysis (Ncombined = 37,345). Variants for intracranial volume were also related to childhood and adult cognitive function, Parkinson’s disease, and enriched near genes involved in growth pathways including PI3K–AKT signaling. These findings identify biological underpinnings of intracranial volume and provide genetic support for theories on brain reserve and brain overgrowth

Analysis of shared heritability in common disorders of the brain

ience, this issue p. eaap8757 Structured Abstract INTRODUCTION Brain disorders may exhibit shared symptoms and substantial epidemiological comorbidity, inciting debate about their etiologic overlap. However, detailed study of phenotypes with different ages of onset, severity, and presentation poses a considerable challenge. Recently developed heritability methods allow us to accurately measure correlation of genome-wide common variant risk between two phenotypes from pools of different individuals and assess how connected they, or at least their genetic risks, are on the genomic level. We used genome-wide association data for 265,218 patients and 784,643 control participants, as well as 17 phenotypes from a total of 1,191,588 individuals, to quantify the degree of overlap for genetic risk factors of 25 common brain disorders. RATIONALE Over the past century, the classification of brain disorders has evolved to reflect the medical and scientific communities' assessments of the presumed root causes of clinical phenomena such as behavioral change, loss of motor function, or alterations of consciousness. Directly observable phenomena (such as the presence of emboli, protein tangles, or unusual electrical activity patterns) generally define and separate neurological disorders from psychiatric disorders. Understanding the genetic underpinnings and categorical distinctions for brain disorders and related phenotypes may inform the search for their biological mechanisms. RESULTS Common variant risk for psychiatric disorders was shown to correlate significantly, especially among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia. By contrast, neurological disorders appear more distinct from one another and from the psychiatric disorders, except for migraine, which was significantly correlated to ADHD, MDD, and Tourette syndrome. We demonstrate that, in the general population, the personality trait neuroticism is significantly correlated with almost every psychiatric disorder and migraine. We also identify significant genetic sharing between disorders and early life cognitive measures (e.g., years of education and college attainment) in the general population, demonstrating positive correlation with several psychiatric disorders (e.g., anorexia nervosa and bipolar disorder) and negative correlation with several neurological phenotypes (e.g., Alzheimer's disease and ischemic stroke), even though the latter are considered to result from specific processes that occur later in life. Extensive simulations were also performed to inform how statistical power, diagnostic misclassification, and phenotypic heterogeneity influence genetic correlations. CONCLUSION The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level. This suggests a deeply interconnected nature for psychiatric disorders, in contrast to neurological disorders, and underscores the need to refine psychiatric diagnostics. Genetically informed analyses may provide important "scaffolding" to support such restructuring of psychiatric nosology, which likely requires incorporating many levels of information. By contrast, we find limited evidence for widespread common genetic risk sharing among neurological disorders or across neurological and psychiatric disorders. We show that both psychiatric and neurological disorders have robust correlations with cognitive and personality measures. Further study is needed to evaluate whether overlapping genetic contributions to psychiatric pathology may influence treatment choices. Ultimately, such developments may pave the way toward reduced heterogeneity and improved diagnosis and treatment of psychiatric disorders