Childhood adversity and self-rated health disparities by citizenship in middle-aged-and-older Latino adults in California

Objectives: We assessed the association between adverse childhood experiences (ACEs) and fair/poor self-rated health (SRH), and whether citizenship modifies it among Latinos aged ≥50 years. Methods: = 5493) were included. Weighted log-binomial generalized linear models estimated prevalence ratios (PRs) of the associations between ACEs, citizenship, and fair/poor SRH, including interaction terms to assess effect modification on multiplicative and additive scales. Results: High ACE exposure (≥4) was associated with a higher fair/poor SRH prevalence (PR = 1.38, 95% CI:1.21, 1.57) relative to low ACEs. Immigrant Latinos had higher fair/poor SRH prevalence than U.S.-born Latinos, strongest among noncitizens (PR = 2.19, 95% CI:1.86, 2.57). Multiplicative interaction by citizenship was statistically significant; however, the relative association between high ACEs and fair/poor SRH was smaller among immigrant Latinos than U.S.-born Latinos. On the additive scale, high ACEs corresponded to meaningful absolute increases in fair/poor SRH across all groups (U.S.-born: +14 percentage points; naturalized: +6; noncitizens: +12). Conclusions: High ACE exposure is consistently associated with poorer SRH among Latinos aged ≥50, but citizenship shapes how this risk is expressed. Evaluating both additive and multiplicative scales clarifies that smaller relative effects among noncitizens coexist with substantial absolute health burdens.