Disparities in unmet needed paid leave across race, ethnicity and citizenship status among employed Californians: a cross-sectional study.

Objectives: Paid leave is essential for public health in order to prevent presenteeism (i.e., working while sick), provide an economic safety net for workers when ill, and promote family well-being through parental leave. While racial and ethnic disparities in unmet paid leave (or needing but not being able to take paid leave) are well documented, little evidence of the intersecting role of citizenship status exists. This study examined disparities in unmet paid leave across race, ethnicity and citizenship status.

Study Design: This was a cross-sectional study of employed adults in California, USA.

Methods: Weighted, multivariable logistic regressions were used to assess disparities in unmet needed paid leave across race, ethnicity and citizenship status categories, including non-citizen, naturalised, and citizen Latinx and Asian respondents, and naturalised and non-citizen White respondents, relative to US-born White respondents, controlling for demographic, familial, health-related and work-related covariates. This study examined a representative sample of Californian adults using the 2021 California Health Interview Survey (CHIS). A total of 24,453 people completed the CHIS from March to October 2021. This analysis was restricted to individuals who had complete data, were employed at the time of the survey and were part of the study race and ethnic groups of interest, leading to an analytical sample of 12,485 respondents.

Results: While 16.9% of employed Californians reported forgoing needed paid leave, disparities across race, ethnicity and citizenship status were evident. Specifically, 31.8% of non-citizen Latinx respondents, compared to 11% of US-born White respondents, did not use paid leave when they needed it due to fear of job loss, fear of negative impacts on job advancement, employers denying it, lack of information or knowledge regarding the process or ineligibility. In the fully adjusted analyses, respondents identifying as non-citizen Latinx (adjusted odds ratio [aOR] = 2.57, 95% confidence interval [CI] = 1.94-3.40), naturalised Latinx (aOR = 1.90, 95% CI = 1.46-2.48), US-born Latinx (OR = 1.30, 95% CI = 1.06-1.60), non-citizen Asian (aOR = 2.34, 95% CI = 1.69-3.23) and naturalised Asian (aOR = 1.78, 95% CI = 1.35-2.34) had a statistically significantly higher likelihood of experiencing unmet needed paid leave compared to US-born White respondents.

Conclusions: Despite its importance for health, disparities across race, ethnicity and citizenship status exist in those who experience unmet paid leave. It is recommended that the administrative and enforcement agencies in California further communicate eligibility, facilitate the application process and enforce equitable access to paid leave for all workers.