Moving Beyond Salmon Bias: Mexican Return Migration and Health Selection

Revisiting the Immigrant Health Advantage: Self-Reported Health and Smoking Among Sexual Minority Immigrants

This study aims to examine how the immigrant health advantage (IHA) may differ by sexual orientation. Using data from the 2015-2019 National Health Interview Survey, we examined general health status (n = 131,635) and smoking behavior (n = 131, 658) for US-born and foreign-born heterosexual and sexual minority adults, as well as how the duration of stay in the U.S. may influence sexual minority immigrants' health. Logistic regression models were adopted to examine the health outcomes of immigration in different immigrant groups divided by sexual orientation. Findings show a weaker immigrant health advantage among sexual minorities than heterosexual persons, which disappears or turns into a disadvantage for several subpopulations (i.e., foreign-born homosexual individuals who stayed for 10-15 or 15 + years in the U.S.). Foreign-born homosexual individuals having stayed in the U.S. for a decade or more have substantially higher odds of reporting poor/fair health and smoking currently than their US-born counterparts. Although immigrants' health advantage overall attenuates over time, sexual minority immigrants' health erodes more with time spent in the U.S. The disparities in immigrants' health advantages suggest a segmented health acculturation (or even marginalization) process and entail higher sexual orientation-based health disparities among immigrants than among US-born individuals, likely reinforcing the preexisting health disparities in the country. The findings call for policies to address the multifaceted barriers to health equity at the intersection of social disadvantages.

Return Migration Selection and Its Impact on the Migrant Mortality Advantage: New Evidence Using French Pension Data

The migrant mortality advantage (MMA) has been observed in many immigrant-receiving countries, but its underlying factors remain poorly understood. This article examines the role of return migration selection effects in explaining the MMA among males aged 65+ using a rich, unique dataset from France. This dataset contains information on native-born and foreign-born pensioners who are tracked worldwide until they die, providing a rare opportunity to assess return migration selection effects and their impact on the MMA. Results provide evidence of substantial and systematic negative return migration selection among foreign-born males in France. Old-age returns, in particular, appear particularly affected by such selection; however, they are not frequent enough to explain the MMA at ages 65+. By contrast, returns at younger ages are much more frequent, and the MMA at ages 65+ essentially disappears once these earlier returns are considered. This study extends the literature on negative selection at return and its impact on the MMA by providing evidence that such negative selection may operate not only at older ages but throughout the life course, with impacts on the MMA that are larger than previously suggested.

The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border

Background

Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project.

Methods/design

In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey.

Discussion

Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.

Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study

Objectives: This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Methods: Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Results: Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. Conclusions: These findings provide insight into biological differences underlying racial/ethnic disparities in health.

Unauthorized Mexican-Born Immigrants, Occupational Injuries, and the use of Medical Services in the United States

This article examines how unauthorized immigrant status is associated with the risk of suffering a work-related accident or illness and with the use of medical services after experiencing an injury among Mexican immigrants in the United States. Using individual-level data on 81,004 Mexican immigrants who previously worked in the United States and were interviewed when they returned to Mexico in the Survey of Migration in the Northern Border of Mexico from 2010 to 2018, we estimate a series of probit models and nonlinear decompositions to analyze legal status differences in the incidence of occupational injuries among immigrant workers. The results show that among Mexican immigrants in the United States unauthorized status was associated with a greater probability of experiencing an occupational injury. The higher injury rate among unauthorized immigrants was partly driven by the fact that they worked more hours per day, more days per week, and were employed in riskier occupations than authorized immigrants. If unauthorized immigrants were older and had higher levels of English-language ability, the injury gap would have been even larger. Unauthorized status was also associated with a lower likelihood of using medical services after suffering an occupational injury because unauthorized workers had less access to medical care. The findings show that the right to legal work has important implications for the health of immigrants by setting a higher risk level for injury on the job and limiting access to health care following such an injury.

Housing cost burden, homeownership, and self-rated health among migrant workers in Chinese cities: The confounding effect of residence duration

Housing is a critical social determinant of health. Research on the impact of housing on health among migrants is more complex than that of the general population because of migrants' health decline over time: while migrants exhibit a health advantage upon arrival, they gradually lose it as they stay longer in the host city. Existing studies on migrants' housing and health have paid little attention to the confounding effect of residence duration and are thus prone to misleading results. Using data from the 2017 China Migrants Dynamic Survey (CMDS), this study fills in the gap by examining how the incorporation of residence duration alters the relationship of housing cost burden and homeownership with migrant self-rated health (SRH). The study shows that migrant workers with higher housing cost burden and longer residence duration tend to have worse SRH. Incorporating residence duration attenuates the crude association between homeownership and worse SRH. The results imply that the health decline among migrants can be attributed to the discriminatory hukou system-a system that limits migrants' access to social welfare and puts them in a socioeconomically disadvantaged position. The study thus emphasizes the removal of structural and socio-economic barriers faced by the migrant population.

Scoping review protocol on the health of sub-Saharan African migrants in the Asia-Pacific region

INTRODUCTION

Increasing economic opportunities have attracted people from sub-Saharan Africa to migrate to the Asia-Pacific region in the last two decades. The information on the health situation of these migrants is limited. We aim to assess scientific evidence on the health of sub-Saharan African migrants in the Asia-Pacific region using a scoping review.

METHODS AND ANALYSIS

The review will be conducted according to the JBI guide on evidence synthesis, and the final results will be organised and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. Search strategies have been developed centred on population-concept-context elements including sub-Saharan Africa, Asia-Pacific, migration and health. A total of eight databases will be searched, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, ProQuest, Scopus, Web of Science, Wanfang and CNKI. Title and abstract screening and full-text screening will be conducted by two researchers independently. Data will be charted according to predesigned form.

ETHICS AND DISSEMINATION

This study involves neither human participants nor unpublished secondary data. Institutional review board approval is therefore not required. Findings of this scoping review will be disseminated through publication in a peer-reviewed journal, through academic network and project report.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis

BACKGROUND

Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population.

METHODS

We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I² statistic was used to measure heterogeneity.

RESULTS

Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I² >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only.

CONCLUSION

Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.

Hypertension and Diabetes Status by Patterns of Stress in Older Adults From the US Health and Retirement Study: A Latent Class Analysis

Background

Hypertension and diabetes disproportionately affect older non‐Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time.

Methods and Results

Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self‐fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self‐Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35–2.39]) and diabetes (OR, 1.94; [95% CI, 1.45–2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10–2.05]). Non‐Hispanic Black participants compared with non‐Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self‐Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59–4.58]; OR, 1.99; [95% CI, 1.15–3.43]; and OR, 4.74; [95% CI, 3.32–6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non‐Hispanic White participants, non‐Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42–0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13–0.86]; and OR, 3.02; [95% CI, 1.16–7.87], respectively).

Conclusions

Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.

The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans

This study investigates how mediating (e.g. history of health conditions) and moderating (e.g. self-rated health) factors are associated with nativity status on depression and anxiety in Mexican immigrants. Using data from the 2019 National Health Interview Survey (NHIS), results found a significant direct association between nativity status and anxiety and depression. Additionally, the association between nativity status and mental health was mediated by the history of health conditions, and self-rated health was a significant moderator in both mediation models. Study findings are discussed within the context of barriers to care, current literature, and strengths-based interventions. Future research can expand upon these findings by examining the specific types of physical and mental health conditions that may support the Hispanic Paradox, as well as how self-efficacy and internal locus of control are associated with the paradox within this population.

Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study

Background

Studies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin.

Methods

A longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden.

Results

Immigrants with low (RR = 0.83; 95% CI: 0.76–0.90) moderate (RR = 0.70; 95% CI: 0.62–0.80) and high (RR = 0.62; 95% CI: 0.48–0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities.

Conclusions

The study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.

Trends in health equity in mortality in the United States, 1969-2019

RATIONALE

Health equity is a significant concern of public health, yet a comprehensive assessment of health equity in the United States over time is lacking. While one might presume that overall health will improve with rising living standards, no such presumption is warranted for health equity, which may decline even as average health improves.

OBJECTIVES

To assess trends in national and state-level health equity in mortality for people up to age 25, ages 25-64 and aged 65 and older.

METHODS

A health equity metric was calculated as the weighted mean life expectancy relative to a benchmark level, defined as the life expectancy of the most socially-privileged subpopulation (white, non-Latinx males with a college education or higher).We analyzed 114,558,346 death records from the National Center for Health Statistics, from January 1, 1969 to December 31, 2019 to estimate health equity annually at the national and state-level. Using ICD-9/ICD-10 classification codes, inequities in health were decomposed by major causes of death.

RESULTS

From 1969 to 2019, health equity in the United States improved (+0.36 points annually [95% CI 0.31-0.41]), albeit at a slower rate over the last two decades (+0.08 points annually [95% CI 0.03-0.14] from 2000 to 2019, compared to +0.57 points annually from 1969 to 2000 [95% CI 0.50-0.65]). Health equity among those under 25 improved substantially (+0.82 points annually [95% CI 0.75-0.89]) but remained flat for adults 25-64 (-0.01 points annually [95% CI -0.03-0.003]) For those over 65, health equity displayed a downward trend (-0.08 points annually [95% CI -0.09 to -0.07]). Gains in equity from reduced unintentional injuries and homicides have been largely offset by rising mortality attributable to drug overdoses.

CONCLUSIONS

The US is failing to advance health equity, especially for adults. Keeping policy-makers accountable to a summary measure of health equity may help coordinate efforts at improving population health.

The Weight of Migration: Reconsidering Health Selection and Return Migration among Mexicans

While migration plays a key role in shaping the health of Mexican migrants in the US and those in Mexico, contemporary Mexican migration trends may challenge the health selection and return migration hypotheses, two prevailing assumptions of how migration shapes health. Using data from the Mexican Family Life Survey (2002; 2005), we tested these two hypotheses by comparing the cardiometabolic health profiles of (1) Mexico-US future migrants and nonmigrants and (2) Mexico-US return migrants and nonmigrants. First, we found limited evidence for health selection: the cardiometabolic health of Mexico-US future migrants was not measurably better than the health of their compatriots who did not migrate, although migrants differed demographically from nonmigrants. However, return migrants had higher levels of adiposity compared to those who stayed in Mexico throughout their lives; time spent in the US was also associated with obesity and elevated waist circumference. Differences in physical activity and smoking behavior did not mediate these associations. Our findings suggest positive health selection might not drive the favorable health profiles among recent cohorts of Mexican immigrants in the US. However, the adverse health of return migrants with respect to that of nonmigrants underscores the importance of considering the lived experience of Mexican migrants in the US as an important determinant of their health.

Importance of accounting for loss to follow-up when comparing mortality between immigrants and long-term residents: a population-based retrospective cohort

OBJECTIVES

To evaluate the association between immigration status and all-cause mortality in different disease cohorts, and the impact of loss to follow-up on the observed associations.

DESIGN

Population-based retrospective cohort study using linked administrative health data in Ontario, Canada.

SETTING

We followed adults with a first-ever diagnosis of ischaemic stroke, cancer or schizophrenia between 2002 and 2013 from index event to death, loss to follow-up, or end of follow-up in 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our outcomes of interest were all-cause mortality and loss to follow-up. For each disease cohort, we calculated adjusted HRs of death in immigrants compared with long-term residents, adjusting for demographic characteristics and comorbidities, with and without censoring for those who were lost to follow-up. We calculated the ratio of two the HRs and the respective CL using bootstrapping methods.

RESULTS

Immigrants were more likely to be lost to follow-up than long-term residents in all disease cohorts. Not accounting for this loss to follow-up overestimated the magnitude of the association between immigration status and mortality in those with ischaemic stroke (HR of death before vs after accounting for censoring: 0.78 vs 0.83, ratio=0.95; 95% CL 0.93 to 0.97), cancer (0.74 vs 0.78, ratio=0.96; 0.95 to 0.96), and schizophrenia (0.54 vs 0.56, ratio=0.97; 0.96 to 0.98).

CONCLUSIONS

Immigrants to Canada have a survival advantage that varies by the disease studied. The magnitude of this advantage is modestly overestimated by not accounting for the higher loss to follow-up in immigrants.

Recasting the Immigrant Health Paradox Through Intersections of Legal Status and Race

Immigrant health research has often noted an "immigrant health paradox", the observation that immigrants are "healthier" compared to their native-born peers of similar demographic and socioeconomic profile. This paradox disappears as immigrants stay longer in the host country. Multiple arguments, including migrant selectivity and cultural and behavioral factors have been proposed as reasons for the apparent paradox. Recently, the field has focused on immigrant legal status, especially its racialization. We review the literature on the immigrant health paradox, legal status, and racialized legal status to examine how this debate has taken a more structural approach. We find that immigrant health research has taken a needed intersectional approach, a productive development that examines how different markers of disadvantage work concurrently to shape immigrants' health. This approach, which factors in immigration enforcement practices, aligns with explanations for poor health outcomes among other racialized groups, and promises a fruitful avenue for future research.

Racial/Ethnic Residential Segregation and the First Wave of SARS-CoV-2 Infection Rates: A Spatial Analysis of Four U.S. Cities

Previous research has linked racial/ethnic residential segregation to a number of poor health conditions, including infectious disease. Here, we examine how racial/ethnic residential segregation is related to the novel coronavirus, SARS-CoV-2. We examine infection rates by zip code level segregation in four major cities across the U.S.: New York City, Chicago, Houston, and San Diego. We also include a number of area-level Census variables in order to analyze how other factors may help account for the infection rate. We find that both Black and Latino residential clustering are significantly and positively related to a higher SARS-CoV-2 infection rate across all four cities, and that this effect is strong even when accounting for a number of other social conditions and factors that are salient to the transmission of infectious disease. As a result, we argue that neighborhood-level racial/ethnic patterning may serve as an important structural mechanism for disparities in SARS-CoV-2 infection.

Aging into disadvantage: Disability crossover among Mexican immigrants in America

The "Hispanic paradox" refers to the accepted finding that Mexican immigrants have lower mortality compared to the US-born population, despite having lower levels of income, educational attainment, and health insurance coverage. However, Mexican immigrants' mortality advantage is not matched by lower disability rates, particularly later in the life course. Past studies have identified a crossover in disability rates for Mexican immigrants using age-specific disability rates but confound the effects of aging and duration of residence. By using the synthetic cohort method, I extend prior work on the disability crossover by tracing immigrant cohorts across the life course and disentangling newly arrived immigrants from those already established in the U.S. I use American Community Survey (ACS) 2015-2019 data to test whether the acculturation or cumulative disadvantage hypotheses account for the disability crossover. I find that, contrary to the expected finding of a socioeconomic health gradient in disability rates, Mexican immigrants' high disability rates converge regardless of education level or immigrant cohort. In addition, Mexican female immigrants are doubly disadvantaged, living in a protracted period of disability compared to males of the same education level. My findings support the negative health acculturation hypothesis as the dominant pathway for Mexican immigrants' later-life disability trajectories and consequently the explanation behind the disability crossover.

Poverty, Material Hardship, and Telomere Length Among Latina/o Children

BACKGROUND

Despite increased attention on the links between poverty and the health and wellbeing of youth, few have attempted to understand the physiological consequences associated with different forms of economic disadvantage among Latina/o children. The present study begins to address this gap by (1) examining whether different forms of economic disadvantage were related to telomere length for Latina/o children and (2) determining whether parents' nativity shapes economic disadvantage-telomere length relationships.

METHODS

Data were drawn from the Fragile Families and Child Wellbeing Study, a longitudinal, stratified multistage probability sample of couples and children in 20 large US cities. The sample consisted of 417 Latina/o children and their parents that were followed from birth to age 9. Ordinary least squares regressions were used to examine relationships between economic disadvantage and telomere length.

RESULTS

Findings revealed that poverty status was not significantly related to telomere length, whereas some forms of material hardship were shown to play a role in the risk of premature cellular aging. More specifically, medical hardship and difficulty paying bills were associated with shorter telomere length at age 9. Results also provide minimal evidence economic disadvantage-telomere length patterns varied by parents' nativity. Only medical hardship was related to shorter telomere length at age 9 for children with at least one foreign-born parent.

CONCLUSION

Overall, results indicate that the risk of premature cellular aging depends on the measure of economic disadvantage under investigation. Findings from this study can inform targeted strategies designed to reduce the deleterious consequences associated with economic deprivation.

Revisiting the Immigrant Epidemiological Paradox: Findings from the American Panel of Life 2019

Objective: Immigrants enjoy a health advantage over their US-born counterparts (termed the immigrant paradox), though the extent of this paradox may not extend to all health outcomes. Methods: We analyzed data from the RAND American Life Panel. Using multivariable logistic regression, we examined the associations between immigrant status and a wide range of health outcomes (e.g., cardiovascular diseases, mental health), adjusting for sociodemographic characteristics. Results: Being an immigrant was associated with lower odds of having any health condition, multimorbidity, and number of health conditions. When looking at specific conditions, however, immigrant status was only significantly associated with lower odds of depression, nerve problem causing numbness or pain, and obesity, but not other conditions. Conclusion: The immigrant paradox is evident when examining overall health, and specifically depression, nerve problems, and obesity.

A Global Meta-analysis of the Immigrant Mortality Advantage

A large body of research on the “Healthy Immigrant Effect” (or “Paradox”) has reported an immigrant mortality advantage. However, other studies do not find such significant effects, and some even present contradictory evidence. This article is the first systematic meta-analysis that investigates the immigration-mortality relationship from a global perspective, examining 1,933 all-cause and cardiovascular mortality risk estimates from 103 publications. Our comprehensive analysis allows us to assess interactions between origin and destination regions and to reexamine, on a global scale, some of the most notable explanations for the immigrant mortality advantage, including suggestions that this paradox may be primarily the result of selection effects. We find evidence for the existence of a mild immigrant mortality advantage for working-age individuals. However, the relationship holds only for immigrants who moved between certain world regions, particularly those who immigrated from Northern Africa, Asia, and Southern Europe to richer countries. The results highlight the need in the broader migration literature for an increased focus on selection effects and on outcomes for people who chose not to migrate or who were denied entry into their planned destination country.

Understanding Immigration as a Social Determinant of Health: Cardiovascular Disease in Hispanics/Latinos and South Asians in the United States

PURPOSE OF REVIEW

The main purpose of this review is to summarize the epidemiology of cardiovascular disease and its risk factors among two of the largest and most diverse immigrant groups in the United States (Hispanics/Latinos and South Asians).

RECENT FINDINGS

While the migration process generates unique challenges for individuals, there is a wide heterogeneity in the characteristics of immigrant populations, both between and within regions of origin. Hispanic/Latino immigrants to the United States have lower levels of cardiovascular risk factors, prevalence, and mortality, but this assessment is limited by issues related to the "salmon bias." South Asian immigrants to the United States generally have higher levels of risk factors and higher mortality. In both cases, levels of risk factors and mortality generally increase with time of living in the United States (US). While immigration acts as a social determinant of health, associations between immigration and cardiovascular disease and its risk factors are complex and vary across subpopulations.

Internal migration, urban living, and non-communicable disease risk in South Africa

This paper offers theoretical and substantive contributions to migration-health scholarship by employing rich panel data with biomarkers to estimate the effect of migration and urban living on non-communicable disease risk in South Africa. Internal migration and urbanization continue to be pervasive demographic and socio-economic phenomena that structure daily life in low- and middle- income countries (LMICs). Yet, how these processes affect illness and disease in low-resource settings is still not well understood. Five waves (2008-2017) of South Africa's National Income Dynamics Study data and fixed-effects modeling are used to estimate the relationship between urban residence, migration, and health. Results indicate that the migration-health relationship differs by gender: urban living for men is associated with lower blood pressure. While urban residence appears to convey a health advantage when men reside in urban compared with rural places, there is no evidence of an urban health advantage among women. Migration does, however, negatively affect women's health through higher blood pressure (BP). These findings highlight the need for further interrogation of the ways in which processes and health consequences of migration and urban living are structured by gender in LMICs. Given the importance of urbanization and the prevalence of migration in LMICs, the gendered determinants of blood pressure may be key to understanding rising hypertension incidence in contexts like South Africa.

Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx

INTRODUCTION

The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx.

METHODS

Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020.

RESULTS

Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites.

CONCLUSIONS

Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.

Languages of othering and cultural hybridity. Transnational cultures of ageing in the context of return to the Azores

This article foregrounds the role of migration and transnational cultural exchange in the (trans)formation of cultures of ageing. It argues that sustained emigration and return to the Azores archipelago have contributed to the transnational production of hybrid cultures of ageing. The paper suggests that understanding transnational cultures of ageing in the context of return requires a broader field of enquiry that considers return migrants’ discursive framings in tension with transnational and local contexts. Returnees’ accounts of ageing, produced in relation to transnational exchange and local interactions, emphasise three intersecting themes – health and the ageing body, ageing and care, and mindset and work ethic in later life – which reveal a cultural shift towards forms of active ageing. The discussion shows that new, hybrid lexicons of ageing are articulated through practices and languages of othering and negotiating that are conducive to unsettling social relations and economic contexts in the homeland.

Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity. Study in newborns of first generation immigrants

Objective: The aim of the study was to investigate the influence of ethnicity and cerebroplacental ratio (CPR) on the birth weight (BW) of first generation Indo-Pakistan immigrants' newborns.Methods: This was a retrospective study in a mixed population of 620 term Caucasian and Indo-Pakistan pregnancies, evaluated in two reference hospitals of Spain and Italy. All fetuses underwent a scan and Doppler examination within two weeks of delivery. The influence of fetal gender, ethnicity, GA at delivery, CPR, maternal age, height, weight and parity on BW was evaluated by multivariable regression analysis.Results: Newborns of first generation Indo-Pakistan immigrants were smaller than local Caucasian newborns (mean BW mean= 3048 ± 435 g versus 3269 ± 437 g, p < .001). Multivariable regression analysis demonstrated that all studied parameters, but maternal age and ethnicity, were significantly associated with BW. The most important were GA at delivery (partial R² = 0.175, p < .001), CPR (partial R² = 0.032, p < .001), and fetal gender (partial R² = 0,029, p < .001).Conclusions: The propensity to a lower BW, explained by placental dysfunction but not by maternal ethnicity is transmitted to newborns of first generation immigrants. Whatever are the factors implied they persist in the new residential setting.

Health Profile and Health Care Access of Mexican Migration Flows Traversing the Northern Border of Mexico

BACKGROUND

The health of Latino migrants is most often studied with samples of immigrants settled in the United States or returned migrants in Mexico. We examine health outcomes and health care access of Mexican migrants traversing the Mexican border region to gain a better understanding of migrant health needs as they transition between migration phases.

METHODS

We used data from a 2013 probability survey of migrants from Northbound and Southbound migration flows in Tijuana, Mexico (N=2412). Respondents included Northbound migrants with and without US migration experience, Southbound migrants returning home from the United States or the Mexican border region, and migrants returning to Mexico via deportation. Descriptive statistics and regression models were estimated to characterize and compare their health status, behavioral health, and health care access across migration phases.

RESULTS

Northbound migrants with US migration experience, Southbound migrants from the United States, and deported migrants had worse levels of health insurance, health care utilization, and diabetes than Northbound migrants without US migration experience. Southbound migrants returning from the border reported worse self-rated health and deportees had higher odds of reported substance use compared with Northbound migrants without US migration experience.

CONCLUSIONS

Mexican migrants' health profile and health care access vary significantly across migration flows and generally are worse for migrants with US migration experience. The results add to our understanding of Mexican migrant health along the migration continuum and can inform services in sending, receiving, and intermediate communities.

Temporal Trends in Mortality Rates among Kaiser Permanente Southern California Health Plan Enrollees, 2001-2016

BACKGROUND

Temporal analyses of death rates in the US have found a decreasing trend in all-cause and major cause-specific mortality rates.

OBJECTIVES

To determine mortality trends in Kaiser Permanente Southern California (KPSC), a large insured population, and whether they differ from those of California and the US.

METHODS

Trends in age-adjusted all-cause and cause-specific mortality rates from 2001 to 2016 were determined using data collected in KPSC and those derived through linkage with California State death files and were compared with trends in the US and California. Trends of race/ethnicity-specific all-cause and cause-specific mortality rates were also examined. Average annual percent changes (AAPC) and 95% confidence intervals (CI) were calculated.

RESULTS

From 2001 to 2016, the age-adjusted all-cause mortality rate per 100,000 person-years decreased significantly in KPSC (AAPC = -1.84, 95% CI = -2.95 to -0.71), California (AAPC = -1.60, 95% CI = -2.51 to -0.69) and the US (AAPC = -1.10, 95% CI = -1.78 to -0.42). Rates of 2 major causes of death, cancer and heart disease, also decreased significantly in the 3 populations. Differences in trends of age-adjusted all-cause mortality rates and the top 10 cause-specific mortality rates between KPSC and California or the US were not statistically significant at the 95% level. No significant difference was found in the trends of race/ethnicity-specific, sex-specific, or race/ethnicity- and sex-specific all-cause mortality rates between KPSC and California or the US.

CONCLUSION

Trends in age-adjusted mortality rates in this insured population were comparable to those of the US and California.

Has Rural-Urban Migration Promoted the Health of Chinese Migrant Workers？

The relationship between health and migration has always been an important theme in immigration research. This research develops a new approach to test the healthy migrant hypothesis and the salmon bias hypothesis in China by examining an interaction term combining agricultural hukou and migrant status, non-agricultural employment history, and subsequent area of residence. Based on two Chinese micro-databases, CGSS 2015 and Harmonized CHARLS, we conducted an empirical test on the relationship between migration and health. Our empirical evidence suggests that the initial health advantage among Chinese rural migrant workers was largely due to self-selection rather than migration effects. After controlling for demographic and socioeconomic characteristics, this advantage disappeared. After their health deteriorated, migrant workers returned to their original location. This could exacerbate the contradiction between the allocation of medical resources and the demand in rural and urban China, further intensifying the already widening health status gap between rural and urban residents.

Familism and the Hispanic Health Advantage: The Role of Immigrant Status

It is well known that Hispanic immigrants exhibit better physical and mental health than their U.S.-born counterparts. Scholars theorize that stronger orientations toward the family, also known as familism, could contribute to this immigrant advantage. Yet, little work directly tests whether familial attitudes may be responsible for the favorable health of foreign-born Hispanics. We investigate this possibility using biomarkers, anthropometrics, and mental health assessments from the Hispanic Community Health Study/Study of Latinos (N = 4,078). Results demonstrate that the relationship between familial attitudes and health vary depending on the outcome assessed. While Hispanics with strong attitudes toward familial support have fewer symptoms of depression and anxiety, those who report high referent familism display worse mental health outcomes. We find little evidence that familism is linked to physical health or that immigrant generation moderates the relationship of interest. Our results challenge assumptions that familism is responsible for the comparably better health of foreign-born Hispanics.

Divergent trends in life expectancy across the rural-urban gradient and association with specific racial proportions in the contiguous USA 2000-2005

OBJECTIVES

To estimate county-level adult life expectancy for Whites, Black/African Americans (Black), American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (Asian) populations and assess the difference across racial groups in the relationship among life expectancy, rurality and specific race proportion.

METHODS

We used individual-level death data to estimate county-level life expectancy at age 25 (e25) for Whites, Black, AIAN and Asian in the contiguous USA for 2000-2005. Race-sex-stratified models were used to examine the associations among e25, rurality and specific race proportion, adjusted for socioeconomic variables.

RESULTS

Lower e25 was found in the central USA for AIANs and in the west coast for Asians. We found higher e25 in the most rural areas for Whites but in the most urban areas for AIAN and Asians. The associations between specific race proportion and e25 were positive or null for Whites but were negative for Blacks, AIAN, and Asians. The relationship between specific race proportion and e25 varied across rurality.

CONCLUSIONS

Identifying differences in adult life expectancy, both across and within racial groups, provides new insights into the geographic determinants of life expectancy disparities.

The Relationship Between Educational Attainment and Health Care Access and Use Among Mexicans, Mexican Americans, and U.S.-Mexico Migrants

The aim of the study was to assess the relationship between educational attainment and health care access and use among Mexican-origin populations. Data from the 2012 Mexican National Health and Nutrition Study, the 2013 Project Migrante Health Care Access and Utilization Survey, and the 2013-2014 California Health Interview Survey were used to examine educational gradients in health insurance, medical home, and hospitalization among Mexicans in Mexico, northbound, southbound, and deported migrants, and U.S.-and foreign-born Mexican Americans. College graduates had greater odds of being insured relative to those with less than a high school degree among Mexicans (AOR = 1.48, p < 0.001), northbound migrants (AOR = 3.69, p < 0.001), and the foreign-born (AOR = 2.01, p < 0.01), and of having a medical home among Mexicans (AOR = 1.95, p < 0.001) and the foreign-born (AOR = 2.14, p < 0.05). Eliminating differences by educational attainment in the U.S. will require policy changes like making immigrants eligible for public insurance. In Mexico, it will require targeted outreach to enroll underserved populations in existing public insurance programs.

Investigating Health Selection Within Mexico and Across the US Border

Despite acquiring lower levels of attainment and earnings, Mexican immigrants exhibit favorable health outcomes relative to their native-born counterparts. And while scholars attempt to reconcile this so-called paradoxical relationship with a variety of theoretical and empirical approaches, patterns of selective migration continue to receive considerable attention. The present study contributes to the literature on health selection by extending the healthy migrant hypothesis in a number of ways. First, we rely on a unique combination of data sets to assess whether the healthy are disproportionately more likely to migrate. We use the latest wave of the Mexican Family Life Survey and the 2013 Migrante Study, a survey that is representative of Mexican-born persons who are actively migrating through Tijuana. Pooling these data also allow us to differentiate between internal and US-bound migrants to shed light on their respective health profiles. Results provide modest support for the healthy migrant hypothesis. Although those who report better overall health are more likely to migrate, we find that the presence of certain chronic conditions increases migration risk. Our findings also suggest that internal migrants are healthier than those traveling to the US, though this is largely because those moving within Mexico reflect a younger and more educated population. This study takes an important step in uncovering variation across migrant flows and highlights the importance of the timing at which health is measured in the migration process.

Household wellbeing and health risks in Mexican households with and without migrants: a cross-sectional analysis

BACKGROUND

Migration between Mexico and the USA constitutes the world's largest migration corridor with more than 13 million movements of people in 2016. Furthermore, Mexico has a complex migration profile, being a country of origin, transit, destination, and return. While there has been discussion on the relationship between migration and development of origin communities, evidence on social and health issues faced by origin households is limited. This case study is a first attempt at documenting, through analyzing a national representative health survey of Mexican households (n = 9474), the relationship between international migration from Mexico and origin household health characteristics.

CASE PRESENTATION

Mexican international migration moves largely (90% of migrants) toward the USA. Migration has passed from being mostly circular (from the early to late 1990s) to a permanent pattern of residence in the destination country due to changes in migration policies that have progressively restricted the irregular entrance of immigrants making re-entry more difficult.The present case study compares the socioeconomic, demographic, and health characteristics of households in Mexico with and without emigrants using data from a national representative health survey. Accordingly, in 2016, 5.8% (n = 1,802,980) of all Mexican households reported having a member living abroad.Households with members living abroad were found to more likely be headed by a female (45.8%), have Seguro Popular health insurance, and not to be among the poorest household population. In terms of health profile, a higher frequency of adults with a reported diagnosis of diabetes and/or hypertension (33.9 vs 21.7% for households with vs without emigrants, respectively; p = 0.067), and a higher severity of diabetes reflected a higher probability of hospitalization.

CONCLUSIONS

Results showed that socioeconomic, demographic, and health conditions differed between households with and without emigrants. These differences were determined as not being attributable to migration and cannot be considered as predisposing factors of migration.

Uninsured Migrants: Health Insurance Coverage and Access to Care Among Mexican Return Migrants

BACKGROUND

Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development.

OBJECTIVE

Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care.

METHODS

I use descriptive and multivariate techniques to analyze data from the 2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID, combined n=632,678).

RESULTS

Analyses reveal a large and persistent gap between recent return migrants and non-migrants, despite rising overall health coverage in Mexico. Multivariate analyses suggest that unemployment among recent arrivals contributes to their lack of insurance. Relative to non-migrants, recently returned migrants rely disproportionately on private clinics, pharmacies, self-medication, or have no regular source of care. Mediation analysis suggests that returnees' high rate of uninsurance contributes to their inadequate access to care.

CONCLUSION

This study reveals limited access to medical care among the growing population of Mexican return migrants, highlighting the need for targeted policies to facilitate successful reintegration and ensure access to vital resources such as health care.

Illegal gold miners in French Guiana: a neglected population with poor health

Background

In French Guiana, a French overseas territory in South America, 6 to 10 thousands undocumented persons work illegally in gold mining sites in the Amazonian forest. Precarious life conditions lead to poor health but few data exist on the health status of illegal gold miners in French Guiana. The objective of this article was to describe the sociodemographic and health status of this vulnerable population.

Method

A prospective cross-sectional survey was conducted in 2015 on gold mine supply sites at the border between French Guiana and Suriname. Health status was assessed through medical examination, past medical history, haemoglobin concentration, and HIV and malaria testing. A questionnaire was used to collect data about the migration itinerary and life conditions on mining sites.

Results

Among the 421 adults included in the study, 93.8% (395/421) were Brazilian, mainly from Maranhão (55.7%, 220/395), the poorest Brazilian state. The sex ratio was 2.4. Overall, 48% of persons never went to school or beyond the primary level. The median time spent in gold mining was quite long (10 years), with a high turn-over. One third of the surveyed population (37.1%, 156/421) had high blood pressure, and only two had a medical follow-up. Most persons had experienced malaria (89.3%, 376/421). They declared frequent arboviroses and digestive disorders. Active leishmaniasis was observed in 8.3% of gold miners. Among women, 28.5% were anemic. Concerning HIV, 36.6% (154/421) of persons, mainly men, never got tested before and 6 were tested positive, which represented an HIV prevalence of 1.43% (95%CI =0.29–2.5).

Conclusion

These findings support the hypothesis that mining in remote areas is linked to several specific illnesses. Theoretically, gold miners would be presumed to start their economical migration to French Guiana as a healthy group. However, their strenuous working and living conditions there lead to poor health caused by infectious and non infectious diseases. This description of their health status is precious for health policy planners in French Guiana given the importance of controlling communicable disease, and the severity and range of specific illnesses acquired by this neglected population.

Trial registration

Clinical trial registration PRS N° NCT02903706.

Retrospectively registered 09/13/2016.

Explaining the Immigrant Health Advantage: Self-selection and Protection in Health-Related Factors Among Five Major National-Origin Immigrant Groups in the United States

Despite being newcomers, immigrants often exhibit better health relative to native-born populations in industrialized societies. We extend prior efforts to identify whether self-selection and/or protection explain this advantage. We examine migrant height and smoking levels just prior to immigration to test for self-selection; and we analyze smoking behavior since immigration, controlling for self-selection, to assess protection. We study individuals aged 20-49 from five major national origins: India, China, the Philippines, Mexico, and the Dominican Republic. To assess self-selection, we compare migrants, interviewed in the National Health and Interview Surveys (NHIS), with nonmigrant peers in sending nations, interviewed in the World Health Surveys. To test for protection, we contrast migrants' changes in smoking since immigration with two counterfactuals: (1) rates that immigrants would have exhibited had they adopted the behavior of U.S.-born non-Hispanic whites in the NHIS (full "assimilation"); and (2) rates that migrants would have had if they had adopted the rates of nonmigrants in sending countries (no-migration scenario). We find statistically significant and substantial self-selection, particularly among men from both higher-skilled (Indians and Filipinos in height, Chinese in smoking) and lower-skilled (Mexican) undocumented pools. We also find significant and substantial protection in smoking among immigrant groups with stronger relative social capital (Mexicans and Dominicans).