{
  "slug": "immigrant-care-avoidance",
  "question": "How likely is an immigrant adult in the US to avoid needed medical care because of immigration-enforcement fear?",
  "category": "health",
  "tags": [
    "relationships",
    "kids"
  ],
  "no_reliable_estimate": false,
  "perceived": {
    "description": "The driver here is the fear itself, so the relevant perception is how worried immigrants are that the health system will hand them to immigration enforcement. In the KFF/NYT 2025 survey, about half of immigrant adults (51%), and roughly eight in ten of those likely undocumented (78%), said they were somewhat or very concerned that health officials would share their information with immigration enforcement. The worry runs well ahead of the reported behavior: far more immigrants say they are concerned than say they have actually avoided care.",
    "rough_estimate": "~51% of immigrant adults (78% of likely undocumented) concerned health officials share data with ICE",
    "kind": "survey",
    "survey_source": {
      "title": "KFF/New York Times 2025 Survey of Immigrants: Worries and Experiences Amid Increased Immigration Enforcement",
      "publisher": "KFF (Kaiser Family Foundation) / The New York Times",
      "url": "https://www.kff.org/racial-equity-and-health-policy/kff-new-york-times-2025-survey-of-immigrants-worries-and-experiences-amid-increased-immigration-enforcement/",
      "year": 2025
    }
  },
  "native": {
    "display": "About 14 in 100 immigrant adults",
    "numerator": 14,
    "denominator": 100,
    "unit": "immigrant adults reporting they or a family member avoided seeking medical care since Jan 2025",
    "population": "Nationally representative US immigrant adults (KFF/NYT survey, Aug–Oct 2025), self-or-family report"
  },
  "normalized": {
    "lifetime_us_adult": 0.14,
    "display": "≈14%",
    "log_value": -0.854,
    "assumptions": "This is NOT a lifetime probability. It is a self-reported behavioral prevalence measured over a single ~9-month window (immigration concerns 'since January 2025', captured by a survey fielded Aug 28–Oct 20, 2025) and contingent on the post-rescission enforcement regime that began Jan 20, 2025. The figure is the share of immigrant adults who said they OR a family member had avoided seeking medical care for immigration-related reasons in that period. It is placed on the lifetime axis (scope: subgroup_lifetime; subgroup = US immigrant adults) purely for comparability — it is not annualized, not projected to a lifetime, and would change with enforcement policy. native 14/100 = 0.14. log10(0.14) = -0.854. Uncertainty band 0.11–0.17 is the full-sample sampling margin of error of ±3 percentage points around 14% (KFF methodology); it reflects sampling error only, not the much larger regime-dependent and temporal variability.",
    "uncertainty": {
      "low": 0.11,
      "high": 0.17
    },
    "scope": "subgroup_lifetime"
  },
  "sources": [
    {
      "url": "https://www.kff.org/racial-equity-and-health-policy/kff-new-york-times-2025-survey-of-immigrants-worries-and-experiences-amid-increased-immigration-enforcement/",
      "title": "KFF/New York Times 2025 Survey of Immigrants: Worries and Experiences Amid Increased Immigration Enforcement",
      "publisher": "KFF (Kaiser Family Foundation)",
      "source_type": "primary_study",
      "statistic": "14% of immigrant adults overall and 48% of likely undocumented immigrants report they or a family member avoided seeking medical care since Jan 2025 due to immigration concerns; 51% (78% of likely undocumented) concerned health officials share data with ICE. N=1,805, MOE ±3pp full sample, ±10pp likely-undocumented (unweighted N=151).",
      "excerpt": "Nearly half (48%) of likely undocumented immigrants and 14% of immigrant adults overall say they or a family member have avoided seeking medical care since January 2025 due to immigration-related concerns.",
      "source_date": "2025-11-13",
      "source_accessed": "2026-06-13",
      "calculation_notes": "Headline native = 14 per 100 immigrant adults (full sample). normalized.lifetime_us_adult = 0.14, log10 = -0.854. Uncertainty 0.11–0.17 = 14% ± 3pp full-sample MOE (per KFF methodology: 'The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points'). Multiplier 48/14 = 3.43 for likely-undocumented subgroup (subgroup MOE ±10pp, unweighted N=151). Perceived = 51% overall / 78% undocumented concerned about data sharing. Survey fielded Aug 28–Oct 20, 2025.",
      "independence_note": "KFF publishes this survey across multiple report pages (worries/enforcement page, health-experiences page, topline PDF); these are ONE survey from ONE publisher (KFF/NYT), not independent corroboration. Counts as a single authoritative source."
    },
    {
      "url": "https://www.dhs.gov/news/2025/01/21/statement-dhs-spokesperson-directives-expanding-law-enforcement-and-ending-abuse",
      "title": "Statement from a DHS Spokesperson on Directives Expanding Law Enforcement and Ending the Abuse of Humanitarian Parole",
      "publisher": "U.S. Department of Homeland Security",
      "source_type": "govt_report",
      "statistic": "On Jan 20, 2025, Acting DHS Secretary Benjamine Huffman rescinded the 2021 guidelines restricting ICE/CBP enforcement in 'sensitive'/protected areas (schools, hospitals, churches), the policy change that frames the survey window.",
      "excerpt": "The first directive rescinds the Biden Administration's guidelines for Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) enforcement actions that thwart law enforcement in or near so-called \"sensitive\" areas.",
      "source_date": "2025-01-21",
      "source_accessed": "2026-06-13",
      "calculation_notes": "Establishes the policy regime ('since January 2025') the KFF survey measures against. No probability figure drawn from this source; it documents the enforcement-policy context that makes the avoidance prevalence policy-contingent.",
      "independence_note": "Independent of KFF: this is the primary government action, not a commentary on the survey."
    },
    {
      "url": "https://www.northcarolinahealthnews.org/2025/11/20/medical-appointments-drop-during-immigration-enforcement/",
      "title": "Providers: Patients skip care during NC immigration crackdown",
      "publisher": "North Carolina Health News",
      "source_type": "news_article",
      "statistic": "Mecklenburg County (NC) Health Department reported a ~50% drop in WIC nutrition visits and sharp rises in missed/cancelled appointments at adult sexual-health and TB clinics in 2025, corroborating clinic-level avoidance.",
      "excerpt": "50 percent drop in the number of women coming in for nutrition and breastfeeding support through the Women, Infants and Children program",
      "source_date": "2025-11-20",
      "source_accessed": "2026-06-13",
      "calculation_notes": "Provides clinic-level corroboration that survey-reported avoidance shows up as real no-shows/drops; not used for the headline figure (clinic counts are not population-denominated and not comparable to the survey prevalence)."
    }
  ],
  "comparison_anchors": [
    {
      "label": "Personal bankruptcy (lifetime, US)",
      "lifetime_us_adult": 0.1
    },
    {
      "label": "Home burglary (US)",
      "lifetime_us_adult": 0.39
    },
    {
      "label": "Hospital-acquired infection",
      "lifetime_us_adult": 0.039
    }
  ],
  "personal_factor_multipliers": [
    {
      "factor": "Likely undocumented status",
      "multiplier": 3.43,
      "notes": "Among likely-undocumented immigrant adults, 48% reported avoiding medical care vs 14% of all immigrant adults — about 3.4x the overall rate (relative to all immigrant adults, not to documented immigrants; the 48% subgroup sits inside the 14% baseline population). Source: KFF/NYT 2025 Survey of Immigrants. Subgroup unweighted N=151, MOE ±10pp, so this multiplier is directional."
    }
  ],
  "short_label": "Skipping care over ICE fear",
  "outcome_severity": "serious_harm",
  "exposure_pattern": "recurring",
  "outcome_type": "chronic_illness",
  "valence": "negative",
  "caveats": "The headline 14% is not a lifetime risk: it is a self-reported, fear-driven behavioral prevalence over a roughly nine-month window (immigration concerns since January 2025, captured by a survey fielded August–October 2025) and is contingent on the post-rescission enforcement regime that began January 20, 2025. It is placed on the lifetime comparison axis only via scope:subgroup_lifetime, which is this entry's weakest dimension (D5). The number is self-or-family report, so it counts households where any member avoided care, not only the respondent. The uncertainty band (0.11–0.17) is the survey's ±3pp full-sample sampling error and does not capture the larger temporal and policy-dependent variability. The likely-undocumented multiplier rests on a small subgroup (unweighted N=151, MOE ±10pp). 8D self-score average is 4.0, all dimensions ≥3, so the entry clears threshold; D5 (scope) is a defensible 3 given the period-to-lifetime mapping.",
  "quality_score": {
    "d1": 5,
    "d2": 5,
    "d3": 4,
    "d4": 4,
    "d5": 3,
    "d6": 4,
    "d7": 4,
    "d8": 4,
    "avg": 4.125,
    "scored_by": "claude-code-8d",
    "scored_at": "2026-06-13",
    "methodology_version": "8d-v1"
  },
  "reviewer": "8d-eval-2026-06-13",
  "last_reviewed": "2026-06-13",
  "reviewed": true,
  "generated_at": "2026-06-13",
  "image": {
    "alt": "An abstract editorial symbol evoking \"Skipping care over ICE fear\", muted two-tone palette, flat vector."
  },
  "attribution": "Likelier — https://likelier.app",
  "license": "https://creativecommons.org/licenses/by-sa/4.0/",
  "support": "https://buymeacoffee.com/kgluszczyk?via=likelier&utm_content=api-fear-single",
  "canonical_url": "https://likelier.app/immigrant-care-avoidance"
}