Atopic disease prevalence by nativity, citizenship, and years of residence in the United States.

INTRODUCTION: Although atopic disease, including atopic dermatitis (AD), asthma, and allergic rhinitis, is less prevalent among immigrants than natives in developed nations, its prevalence is poorly characterized among US immigrants. In this study, we investigated the individual and joint effects of nativity, US citizenship, and duration of US residence on the prevalence of atopic disease among US adults. METHODS: We analyzed 25,597 US-born and 4,714 immigrant sample adults from the 2024 National Health Interview Survey. We generated nationally-representative prevalence estimates and fitted sociodemographic-adjusted multivariable logistic regression models. RESULTS: Compared to US-born individuals, immigrants reported less AD (4.5% vs 8.5%; aOR: 0.56, 95% CI: [0.45-0.70]). Noncitizens also reported less AD (aOR: 0.38 [0.28-0.52]) than citizens. Moreover, compared to US-born participants, immigrant noncitizens (2.5%; aOR: 0.33 [0.23-0.45]) reported less AD than immigrant citizens (6.2%; aOR: 0.68 [0.54-0.87]). Compared to US-born participants, immigrants residing <15 years in the US (4.2%; aOR: 0.47 [0.32-0.69]) reported less AD than immigrants with ≥15 years of residence (4.7%; aOR: 0.60 [0.48-0.75]); longer US residence may erode the protective effect of immigration via immigrants' gradual adoption of US-specific health behaviors, including proinflammatory diets and obesity, increasing AD risk. In joint stratification analysis, AD prevalence increased progressively from recent immigrant noncitizens (2.7%; aOR: 0.30 [0.19-0.45]) to long-term immigrant citizens (5.7%; aOR: 0.64 [0.51-0.81]), and ultimately US-born citizens (8.5%; reference level), suggesting a dose-dependent relationship between acculturation and AD risk. Study limitations include self-reported outcomes. Results were similar for asthma, allergic rhinitis, and overall atopic disease. CONCLUSIONS: Early-life environmental exposures abroad may promote immune profiles associated with reduced AD risk. Longer US residence may erode the protective effect of immigration via immigrants' gradual adoption of US-specific health behaviors, including proinflammatory diets and obesity, increasing AD risk. Our results demonstrate a dose-dependent relationship between acculturation and atopic disease risk. Study limitations include self-reported outcomes. Citizenship demonstrated greater differences in outcomes than duration of US residence, suggesting it may capture additional factors influencing variation in atopic disease and merits further study.