Social determinants of health among culturally and linguistically diverse people in Australia

Reporting one or more long-term health condition(s), multimorbidity, arthritis, diabetes and heart disease were most common in people who were aged 65 or over when they first arrived in Australia. Asthma and mental health conditions were the most commonly reported conditions in people who arrived aged 0 to 14 years or who were born in Australia. People who were aged 15 to 24 when they arrived in Australia had the lowest odds of reporting one or more long-term health condition(s), multimorbidity, arthritis, asthma or heart disease; people born in Australia were least likely to report diabetes and those who arrived in Australia aged 65 years or more were least likely to report mental health conditions. 

Modelling the odds of selected long-term health conditions from age at arrival in Australia

This section reports the results of logistic regression modelling the odds of each long-term health condition based on a person’s age at arrival in Australia. In these models, the Australian-born population is used as the reference category, when estimating the odds ratios. Full output from all regression models is provided in the supplementary tables (Tables S3.1­–S3.4).

The overall results observed from all regression models indicate after adjusting for the effects of age and social determinants of health, people who first came to Australia as children (aged 0 to 14 years) were more likely to report long-term health conditions, compared with people born in Australia. The exception was reporting diabetes, which increased in odds with increasing age at arrival. Detailed findings from the modelling are presented below.

1. Unadjusted models

The odds ratios from the unadjusted models showed that, compared with those born in Australia, the odds of reporting: 

• one or more long-term health condition(s), multimorbidity, arthritis and heart disease were higher for people who arrived in Australia when aged 65 years and over, and similar or lower for those who arrived at younger ages 
• asthma and mental health conditions were lower for overseas-born people regardless of their age at arrival in Australia
• diabetes was higher for overseas-born people regardless of their age at arrival in Australia, and in particular for those aged 65 years and over at arrival.

2. Adjusting separately for age and social determinants of health

When the results were separately adjusted for age and the social determinants of health, controlling for age substantially changed the odds ratios for reporting the long-term health conditions other than asthma and mental health conditions. The largest effect was for those who arrived in Australia at age 65 years or older. Adjusting separately for social determinants of health slightly changed the odds ratios for all reported long-term health conditions for those who arrived in Australia at ages younger than 65 years. However, for both males and females who came to Australia at ages 65 and over, controlling for labour force status or occupation more than halved the odds of reporting long-term health conditions compared with people born in Australia. Adjusting for citizenship status doubled the odds of those who arrived in Australia aged 65 years or more reporting long-term health conditions other than asthma and mental health conditions, compared with those born in Australia. 

3. Fully adjusted models

In the fully adjusted models, the odds ratios for the reported long-term health conditions remained generally similar to the age adjusted odds ratios, regardless of age at first arrival in Australia. However, there were some exceptions for those who arrived in Australia when 65 years and over. For example, when unadjusted, the odds of reporting one or more long-term health condition(s) for males who arrived in Australia at ages 65 years and over was 2.3 times higher than the Australian-born males. The odds ratio dropped to 0.5 after adjusting for age alone, which was lower compared with an odds ratio of 0.7 when adjusting for the effects of age, education, labour force status, income, housing suitability, tenure, citizenship status, remoteness, and marital status (Table 3 below). For those aged 65 years or older at arrival, a similar pattern is seen when assessing the odds of reporting one or more long-term health condition(s) among females and the odds of reporting mental health conditions for both males and females.  In the fully adjusted models, compared with those born in Australia, the odds of reporting: 

• all reported long-term health conditions, except diabetes, were lower for overseas-born people, regardless of their age at arrival
• diabetes was higher for overseas-born people, regardless of age at arrival.

Notes

1. Results are from the fully-adjusted the model which included the covariates, age at arrival in Australia, age, education, income, employment, tenure, housing suitability, remoteness, citizenship, marital status. Analysis excluded overseas visitors, people who live in non-private dwellings or Migratory, offshore and shipping SA1s, non-classifiable households or Visitor only households. 
2. Analyses included 7,751,459 males and 8,065,784 females aged 15 and over living in Australia in occupied private dwellings on Census Night, who were not overseas visitors and provided a valid response to the 2021 Census questions on year of arrival in Australia, age, the selected determinants of health, and the long-term health conditions. 
3.  ‘Born in Australia' was selected as the reference category, when calculating the odds ratios for the age groups of arrival in Australia, and Australia includes External Territories. 
4. OR (95% CI) refers to odds ratio odds ratio and the 95% confidence interval.
5. All odds ratios are rounded to two decimal places.

Source: AIHW analysis of PLIDA, 2021.