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Causevic S, Ekström AM, Orsini N, Kagesten A, Strömdahl S, Salazar M. Prevalence and associated factors for poor mental health among young migrants in Sweden: a cross-sectional study. Glob Health Action 2024; 17:2294592. [PMID: 38180014 PMCID: PMC10773640 DOI: 10.1080/16549716.2023.2294592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Young migrants face multiple challenges that can affect their mental, sexual and reproductive health. OBJECTIVE To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15-25) in Sweden. METHODS Data were drawn from a cross-sectional survey conducted with migrants aged 15-65 years old in Sweden between December 2018 and November 2019 (n = 6449). Among these, 990 participants aged 15-25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables. RESULTS Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18-2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17-3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25-3.17), and to live alone (AOR:1.95, 95% CI:1.25-3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37-4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33-0.88), Asia (AOR:0.44, 95% CI:0.22-0.86), Europe (AOR:0.30, 95% CI:0.14-0.61) and Africa (AOR 0.37, 95% CI: 0.23-0.60) had lower odds of poor mental health than those arriving from Syria. CONCLUSION The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.
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Affiliation(s)
- Sara Causevic
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Anna Mia Ekström
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | - Nicola Orsini
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
| | - Anna Kagesten
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
| | - Susanne Strömdahl
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
- Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
- Swedish Public Health Agency, Stockholm, Sweden
| | - Mariano Salazar
- Global and Sexual Health (GloSH) Research Group, Department of Global Public Health, Karolinska Institutet, Widerströmska huset, Stockholm, Sweden
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Amin R, Mittendorfer-Rutz E, Undem K, Mehlum IS, Hasting RL. Does country of resettlement influence the risk of labor market marginalization among refugees? A cohort study in Sweden and Norway. Scand J Work Environ Health 2024; 50:279-289. [PMID: 38527330 PMCID: PMC11129853 DOI: 10.5271/sjweh.4154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES This study aimed to compare the risk of labor market marginalization among refugees across different host countries of resettlement and examine the moderating role of birth country and length of stay on these associations. METHODS Cohorts of refugees and native-born individuals aged 19-60 in Sweden (N=3 605 949, 3.5% refugees) and Norway (N=1 784 861, 1.7% refugees) were followed during 2010-2016. Rates (per 1000 person-years) of long-term unemployment, long-term sickness absence, and disability pension were estimated for refugees and the host populations. Cox regression models estimated crude and adjusted (for sex, age, educational level, and civil status) hazard ratio (HRadj) for refugees compared to their respective host population, with 95% confidence intervals (CI). Analyses were also stratified by birth country and length of stay. RESULTS Refugees in Norway and Sweden had a higher incidence of labor market marginalization compared to their host population. Refugees in Sweden had a comparatively lower relative risk of long-term unemployment but higher risk of disability pension (HRadj 3.44, 95% CI, 3.38-3.50 and HRadj 2.45, 2.35-2.56, respectively) than refugees in Norway (HRadj 3.70, 3.58-3.82 and HRadj 1.57, 1.49-1.66, respectively). These relative risks varied when stratifying by birth country. A shorter length of stay was associated with a higher risk of long-term unemployment and a lower risk of disability pension, with a stronger gradient in Sweden than in Norway. CONCLUSIONS The relative risk of labor market marginalization varied by the refugees' birth country but followed similar trends in Sweden and Norway. Although speculative, these findings may hint at non-structural factors related to the refugee experience playing a more important role than host country structural factors for the risk of labor market marginalization among refugees. Future research, including host countries with more variability in structural factors, is required to further investigate these associations. The higher risk of long-term unemployment among refugees with shorter length of stay indicates a need for more efficient labor market integration policies for newly-arrived refugees.
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Affiliation(s)
- Ridwanul Amin
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden.
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Roelfs DJ, Shor E. The problematic nature of existing explanations for differential immigrant mortality: Insights from a comparative cross-national systematic review and meta-analysis. Soc Sci Med 2024; 349:116897. [PMID: 38648707 DOI: 10.1016/j.socscimed.2024.116897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Empirical studies in multiple disciplines have frequently observed an immigrant mortality advantage. Yet, questions remain regarding the possible mechanisms underlying this phenomenon. We obtained data from 61 studies of relative immigrant mortality from single origin-destination country pairings, providing information on immigrants from 77 origin countries. We systematically review the arguments made in these studies about origin-country factors that might influence immigrant mortality and then use meta-analyses to examine the veracity of these arguments. We find that most existing origin-country explanations for immigrant mortality patterns (e.g., health behaviors, genetic characteristics, environmental conditions, and socioeconomic conditions) are problematic or insufficient when accounting for differential mortality by origin country. We identify non-comparative analyses and geographic aggregation as the two major obstacles to understanding the mechanisms underlying the immigrant mortality advantage. We conclude by advocating for a risk-factor-based, cross-national approach.
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Krüger H. Everyday discrimination, co-ethnic social support and mood changes in young adult immigrants in Germany-Evidence from an ecological momentary assessment study. J Migr Health 2024; 9:100212. [PMID: 38282918 PMCID: PMC10820660 DOI: 10.1016/j.jmh.2024.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Objective In the context of international migration flows, Germany is the second largest receiving country of migrants in the world. The aim of this study is to investigate the momentary mood effects of discrimination experiences for young adult immigrants and which social resources can buffer negative effects. A distinction is made between the importance of inter and intra-ethnic interaction partners in processing stressors. Method Using an ecological momentary assessment design, first-generation migrants in Germany who had recently migrated from Poland, Turkey or Syria were interviewed three times a day over seven days in June 2021 (N individuals = 976; N observations = 11,470). The timing of the short surveys was chosen at random using a signal contingent sampling method. Participants reported their momentary mood and instances of discrimination, along with information on social support perception and interaction partners during the preceding hour in the context of their everyday lives. Hybrid mixed-effects regression models were estimated and the research questions were tested with three-way interactions. Results The results indicate that perceived social support only moderately buffers the negative effect of everyday discrimination experiences on mood. A positive main effect on mood is observed for situational variations in perceived social support as well as for support from interaction partners. Conclusion The findings illustrate that being embedded in supportive relationships is important in everyday life, regardless of the occurrence of stressors. Furthermore, the study suggests that the level of perceived support is more important for first-generation migrants than the ethnic origin of the support provider.
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Affiliation(s)
- Heike Krüger
- Institute of Sociology and Social Psychology, University of Cologne, Albertus-Magnus-Platz, Köln 50923, Germany
- Institute of Sociology, RWTH Aachen University, Eilfschornsteinstraße 7, Aachen 52056, Germany
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Grande R, García-González JM, Stanek M. Differences in the risk of premature cancer mortality between natives and immigrants in Spain. Eur J Public Health 2023; 33:803-808. [PMID: 37390810 PMCID: PMC10567247 DOI: 10.1093/eurpub/ckad102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The healthy immigrant paradox has found wide support in the literature. To evaluate this hypothesis that immigrants have better health outcomes than the native population, this study aimed to compare the premature cancer mortality between the native and immigrant populations in Spain. METHODS We obtained the 2012-15 cause-specific mortality estimates from administrative records and participant characteristics data from the 2011 Spanish census. Using Cox proportional hazards regression models, we calculated the risks of mortality of the native and immigrant populations, and the latter populations' risk based on their regions of origin, and determined the effects of covariates of interest on the calculated risk. RESULTS Our results show that the risk of premature cancer mortality is lower among immigrants than among natives, and this gap is higher among men than among women. There is a lower mortality rate among Latin American immigrants (Latino men are 81% less likely to die prematurely from cancer than native-born men, and Latino women are 54% less). Moreover, despite social class disparities, immigrants' advantage in cancer mortality remained constant and decreased with increasing length of residence in the host country. CONCLUSIONS This study provided novel evidence on the 'healthy immigrant paradox', associated with the fact that migrants are favorably selected at origin, cultural patterns of the societies of origin and, in the case of men, there is some convergence or an 'unhealthy' integration that explains the fact that this advantage over natives is lost with more years of residence in Spain.
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Affiliation(s)
- Rafael Grande
- Department of Sociology, Universidad de Málaga, Málaga, Spain
| | | | - Mikolaj Stanek
- Department of Sociology, Universidad de Salamanca, Salamanca, Spain
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Östergren O, Cederström A, Korhonen K, Martikainen P. Migrant mortality by duration of residence and co-ethnic density - A register-based study on Finnish migrants in Sweden with matched controls in the origin and the destination. Health Place 2023; 83:103064. [PMID: 37348292 DOI: 10.1016/j.healthplace.2023.103064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
Migrant health depends on factors both at the origin and at the destination. Health-related behaviors established before migration may change at the destination. We compare the mortality rates from alcohol- and smoking-related causes and cardiovascular diseases (CVD) of Finnish migrants in Sweden to matched controls in both Sweden and Finland with similar sociodemographic characteristics. Migrant mortality rates from behavioral risk factors lie in-between the rates of non-migrants in the origin and destination. A longer duration of residence is associated with lower mortality and with mortality patterns more similar to Swedes for men. For women, a longer duration of residence is associated with higher mortality, in particular smoking-related mortality, with no tendency of a gradual convergence. The density of Finnish migrants in the local area is modestly associated with mortality. However, CVD mortality tends to be higher and more similar to the level in Finland for migrants in areas with a higher density of Finnish migrants. The results suggest that behavioral changes can reduce mortality differences between migrants and natives and that this can be either beneficial or detrimental to migrant health.
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Affiliation(s)
- Olof Östergren
- Department of Public Health Sciences, Stockholm University, Sweden; Ageing Research Center, Karolinska Institutet, Sweden.
| | | | | | - Pekka Martikainen
- Department of Public Health Sciences, Stockholm University, Sweden; Population Research Unit, University of Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany
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Smith ML, Seegulam V, Szentkúti P, Horváth-Puhó E, Galea S, Lash TL, Rosellini AJ, Schnurr PP, Sørensen HT, Gradus JL. Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1305-1316. [PMID: 36449069 DOI: 10.1007/s00127-022-02391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement. METHODS We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults). RESULTS Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth. CONCLUSION Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.
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Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya Seegulam
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St., Boston, MA, 02118, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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Juárez SP, Cederström A, Aradhya S, Rostila M. Differences in hospitalizations associated with severe COVID-19 disease among foreign- and Swedish-born. Eur J Public Health 2023:7030753. [PMID: 36749018 DOI: 10.1093/eurpub/ckad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Differences in pre-existing health conditions are hypothesized to explain immigrants' excess COVID-19 mortality compared to natives. In this study, we evaluate whether immigrants residing in Sweden before the outbreak were more likely to be hospitalized for conditions associated with severe COVID-19 disease. METHODS A cohort study using population-register data was conducted with follow-up between 1 January 1997 and 31 December 2017. Poisson regression was fitted to estimate incidence rate ratio (RR) and 95% confident intervals (95% CI) for 10 causes of hospitalization. RESULTS Compared to Swedish-born individuals, most immigrant groups showed a decreased risk of hospitalization for respiratory chronic conditions, CVD, cancer, chronic liver conditions and neurological problems. All immigrant groups had increased risk of hospitalization for tuberculosis [RR between 88.49 (95% CI 77.21; 101.40) for the Horn of Africa and 1.69 (95% CI 1.11; 2.58) for North America], HIV [RR between 33.23 (95% CI 25.17; 43.88) for the rest of Africa and 1.31 (95% CI 0.93; 1.83) for the Middle East] and, with a few exceptions, also for chronic kidney conditions, diabetes and thalassemia. CONCLUSIONS Foreign-born individuals-including origins with excess COVID-19 mortality in Sweden-did not show increased risk of hospitalizations for most causes associated with severe COVID-19 disease. However, all groups showed increased risks of hospitalization for tuberculosis and HIV and, with exceptions, for chronic kidney conditions, diabetes and thalassemia. Although studies should determine whether these health conditions explain the observed excess COVID-19 mortality, our study alerts to an increased risk of hospitalization that can be avoidable via treatment or preventive measures.
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Affiliation(s)
- Sol P Juárez
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Agneta Cederström
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Siddartha Aradhya
- Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Dalla Zuanna T, Batzella E, Pitter G, Russo F, Spadea T, Canova C. Adult first-generation immigrants and cardiovascular risk factors in the Veneto Region, Northeast Italy. Front Public Health 2023; 11:956146. [PMID: 36875357 PMCID: PMC9975734 DOI: 10.3389/fpubh.2023.956146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction The health condition of immigrants traditionally follows a transition from a low disease occurrence to the epidemiological profile of the deprived groups in the host country. In the Europe, studies examining differences in biochemical and clinical outcomes among immigrants and natives are lacking. We examined differences in cardiovascular risk factors between first-generation immigrants and Italians, and how migration pattern variables could affect health outcomes. Material and methods We included participants between 20 and 69 years recruited from a Health Surveillance Program of the Veneto Region. Blood pressure (BP), total cholesterol (TC) and LDL cholesterol levels were measured. Immigrant status was defined by being born in a high migratory pressure country (HMPC) and subdivided by geographical macro-areas. We used generalized linear regression models to investigate differences between these outcomes among immigrants compared to native-born, adjusting for age, sex, education, BMI, alcohol consumption, smoking status, food consumption, salt consumption in the BP analysis and the laboratory in charge for cholesterol analysis. Within immigrant subjects, the results were stratified by variables of the migration pattern: age at immigration and length of residence in Italy. Results Thirty seven thousand three hundred and eighty subjects were included in the analysis, 8.6% were born in an HMPC. Heterogeneous results were seen by the macro-areas of origin and sex, with male immigrants from CE Europe (β = 8.77 mg/dl) and Asia (β = 6.56 mg/dl) showing higher levels of TC than native-born, while female immigrants from Northern Africa showed lower levels of TC (β = -8.64 mg/dl). BP levels were generally lower among immigrants. Immigrants residing in Italy for more than 20 years had lower levels of TC (β = -2.9 mg/dl) than native-born. In contrast, immigrants who arrived <20 years ago or arrived older than 18 years had higher levels of TC. This trend was confirmed for CE Europeans and was inverted for Northern Africans. Conclusions The large heterogeneity in the results depending on sex and macro-area of origin indicates the need for targeted intervention in each specific immigrant group. The results confirm that acculturation leads to a convergence toward the epidemiological profile of the host population that depends on the starting condition of the immigrant group.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero, Padova, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | | | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
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Wallace M, Thomas MJ, Aburto JM, Jørring Pallesen AV, Mortensen LH, Syse A, Drefahl S. Immigration, mortality, and national life expectancy in the Nordic region, 1990–2019. SSM Popul Health 2022; 19:101177. [PMID: 36046066 PMCID: PMC9421394 DOI: 10.1016/j.ssmph.2022.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Immigrants have higher life expectancy at age 1 than the native-born in Denmark, Finland and Norway do from 1990 to 2019. Immigrants in Denmark, Finland and Norway increasingly enhance national life expectancy at age 1 over time. Immigrants in Sweden have lower life expectancy at age 1 than native-born in Sweden do in 1990, but similar levels by 2019. The effect of immigrants on national life expectancy at age 1 in Sweden transforms from negative to positive over time. The unique mortality of immigrants affects rankings of life expectancy at age 1 in the Nordic region in recent years.
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Affiliation(s)
- Matthew Wallace
- Stockholm University, Stockholm, Sweden
- Corresponding author. Sociology Department, Stockholm University, SE-106 91, Stockholm, Sweden.
| | | | - José Manuel Aburto
- University of Oxford, Oxford, England, UK
- University of Southern Denmark, Odense, Denmark
| | | | - Laust Hvas Mortensen
- University of Copenhagen, Copehagen, Denmark
- Statistics Denmark, Copehagen, Denmark
| | - Astri Syse
- Norwegian Institute of Public Health, Oslo, Norway
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Delgado-Cáceres FM, Silva-Parra KA, Torres-Slimming PA. Association between time of residence and self-perception of distress, interpersonal relationships, and social role in Venezuelan immigrants in Lima, Peru 2018-19: mixed-methods study. BMC Public Health 2022; 22:1093. [PMID: 35650547 PMCID: PMC9157030 DOI: 10.1186/s12889-022-13459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigrants arriving in a new country face changes that affect their social, employment, and migratory status. We carried out a mixed-methods study in the rapidly growing Venezuelan immigrant population in Lima, Peru. The objective was to determine whether there was an association between time in Peru and self-perception of symptom distress (SD), interpersonal relationships (IR), and social role (SR). METHODS The quantitative central component consisted of a cross-sectional study, surveying 152 participants using the Outcome Questionnaire 45.2 (OQ-45.2). The qualitative component, based on phenomenology, explored experiences and challenges during the migration process. Semi-structured in-depth interviews were conducted in 16 informants. RESULTS An association that was observed was the increase in the risk of clinically significant SR score with additional years of age. All informants mentioned having witnessed or experienced xenophobia in Peru. Every informant stated that significant labor differences existed between the countries. The most reported somatic symptoms were symptoms of anxiety and alterations of sleep. Additionally, no informant expressed a desire to remain in Peru long term. CONCLUSIONS A minority of participants registered a clinically significant total score and in each of the three domains of SD, IR, and SR. No association between months in Lima and the self-perception of distress was found. However, this could be due to the short amount of time spent in Peru and any change in self-perception might only be perceived after years or decades spent in Peru. This study is one of the first to use mixed-methods to explore the mental health of the immigrant Venezuelan population.
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Affiliation(s)
- Frank Milton Delgado-Cáceres
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Alameda San Marcos cuadra 2, Chorrillos, 15067, Lima, Peru
| | - Kevin Angel Silva-Parra
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Alameda San Marcos cuadra 2, Chorrillos, 15067, Lima, Peru
| | - Paola A Torres-Slimming
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Alameda San Marcos cuadra 2, Chorrillos, 15067, Lima, Peru. .,Red Internacional América Latina, África, Europa, El Caríbe (ALEC) "Territorio(s), Poblaciones Vulnerables y Políticas Públicas." Faculté des Lettres et Sciences Humaines, Université de Limoges, Limoges, France.
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Ghaznavi C, Eguchi A, Tanoue Y, Yoneoka D, Kawashima T, Suzuki M, Hashizume M, Nomura S. Pre- and post-COVID-19 all-cause mortality of Japanese citizens versus foreign residents living in Japan, 2015–2021. SSM Popul Health 2022; 18:101114. [PMID: 35601222 PMCID: PMC9118913 DOI: 10.1016/j.ssmph.2022.101114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Medical Education Program, Washington University School of Medicine in St Louis, Saint Louis, USA
| | - Akifumi Eguchi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Yuta Tanoue
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takayuki Kawashima
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Mathematical and Computing Science, Tokyo Institute of Technology, Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
- Corresponding author. Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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13
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Geirsdottir G, Mittendorfer-Rutz E, Björkenstam E, Chen L, Dorner TE, Amin R. Differences in labour market marginalisation between refugees, non-refugee immigrants and Swedish-born youth: Role of age at arrival and residency duration. Scand J Public Health 2022:14034948221079060. [PMID: 35343330 DOI: 10.1177/14034948221079060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated. METHODS All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals. RESULTS Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1). CONCLUSIONS Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP.
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Affiliation(s)
- Gerdur Geirsdottir
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Emma Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Lingjing Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Thomas E Dorner
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Karl-Landsteiner Institute for Health Promotion Research, Austria
| | - Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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14
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Dunlavy A, Cederström A, Katikireddi SV, Rostila M, Juárez SP. Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study. Eur J Public Health 2022; 32:226-232. [PMID: 35040957 PMCID: PMC8975526 DOI: 10.1093/eurpub/ckab222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Andrea Dunlavy
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Srinivasa Vittal Katikireddi
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.,Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Sol P Juárez
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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15
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The Effects of Ethno-cultural Origin-Destination Interactions on Immigrants' Longevity. J Immigr Minor Health 2021; 24:1345-1366. [PMID: 34529210 DOI: 10.1007/s10903-021-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
A large body of research has documented an immigrant mortality advantage. However, we still do not know enough about how interactions between the characteristics of origin and destinations countries shape variabilities in immigrants' experiences and health. In this paper, we examine the effects of ethno-cultural similarities and differences between the country of origin and the country of destination on immigrants' longevity. We use meta-regression methods to examine data on 78 origin and 16 destination countries (1092 risk estimates from 69 studies). In contrast to expectations from approaches that focus on immigration/acculturation stress, we found that a shared official linguistic family, moving to a country where one is not likely to be considered a visible minority, and more integrative immigration policies actually reduce or even eliminate the immigrant mortality advantage. We discuss potential explanations for these findings and argue that selection mechanisms provide a better account.
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16
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Rostila M, Cederström A, Wallace M, Brandén M, Malmberg B, Andersson G. Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population-Based Cohort Study. Am J Epidemiol 2021; 190:1510-1518. [PMID: 33710317 PMCID: PMC7989658 DOI: 10.1093/aje/kwab057] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/20/2022] Open
Abstract
Preliminary evidence points to higher morbidity and mortality from coronavirus disease 2019 (COVID-19) in certain racial and ethnic groups, but population-based studies using microlevel data are lacking so far. We used register-based cohort data including all adults living in Stockholm, Sweden, between January 31, 2020 (the date of the first confirmed case of COVID-19) and May 4, 2020 (n = 1,778,670) to conduct Poisson regression analyses with region/country of birth as the exposure and underlying cause of COVID-19 death as the outcome, estimating relative risks and 95% confidence intervals. Migrants from Middle Eastern countries (relative risk (RR) = 3.2, 95% confidence interval (CI): 2.6, 3.8), Africa (RR = 3.0, 95% CI: 2.2, 4.3), and non-Sweden Nordic countries (RR = 1.5, 95% CI: 1.2, 1.8) had higher mortality from COVID-19 than persons born in Sweden. Especially high mortality risks from COVID-19 were found among persons born in Somalia, Lebanon, Syria, Turkey, Iran, and Iraq. Socioeconomic status, number of working-age household members, and neighborhood population density attenuated up to half of the increased COVID-19 mortality risks among the foreign-born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher risk of COVID-19 mortality.
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Affiliation(s)
- Mikael Rostila
- Correspondence to Dr. Mikael Rostila, Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Sveavägen 160, SE-106 91 Stockholm, Sweden (e-mail: )
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17
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Östergren O, Korhonen K, Gustafsson NK, Martikainen P. Home and away: mortality among Finnish-born migrants in Sweden compared to native Swedes and Finns residing in Finland. Eur J Public Health 2021; 31:321-325. [PMID: 33230544 PMCID: PMC8071591 DOI: 10.1093/eurpub/ckaa192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Most first-generation migrants have lower mortality compared to the native population. Finnish-born migrants in Sweden instead have higher mortality; possibly because of health behaviours established before migration. To increase our understanding of this excess mortality, we compared the cause-specific mortality of Finnish migrants in Sweden to both the native population of Sweden and the native Finnish population residing in Finland. Methods We used Swedish and Finnish register data, applying propensity score matching techniques to account for differences in sociodemographic characteristics between the migrants, Swedes and Finns. The index population were Finnish migrants aged 40–60, residing in Sweden in 1995. We compared patterns of all-cause, alcohol- and smoking-related, and cardiovascular disease mortality across the groups in the period 1996–2007. Results Finnish migrant men in Sweden had lower all-cause mortality compared to Finnish men but higher mortality compared to the Swedish men. The same patterns were observed for alcohol-related, smoking-related and cardiovascular disease mortality. Among women, all three groups had similar levels of all-cause mortality. However, Finnish migrant women had higher alcohol-related mortality than Swedish women, similar to Finnish women. Conversely, migrant women had similar levels of smoking-related mortality to Swedish women, lower than Finnish women. Conclusions Finnish-born migrants residing in Sweden have mortality patterns that are typically in between the mortality patterns of the native populations in their country of origin and destination. Both the country of origin and destination need to be considered in order to better understand migrant health.
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Affiliation(s)
- Olof Östergren
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | | | - Pekka Martikainen
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,The Max Planck Institute for Demographic Research, Rostock, Germany
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18
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Shor E, Roelfs D. A Global Meta-analysis of the Immigrant Mortality Advantage. INTERNATIONAL MIGRATION REVIEW 2021. [DOI: 10.1177/0197918321996347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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19
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Wallace M, Wilson B. Age variations and population over-coverage: Is low mortality among migrants merely a data artefact? Population Studies 2021; 76:81-98. [PMID: 33565944 DOI: 10.1080/00324728.2021.1877331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The migrant mortality advantage has been observed extensively, but its authenticity is debated. In particular, concerns persist that the advantage is an artefact of the data, generated by the problems of recording mobility among foreign-born populations. Here, we build on the intersection of two recent developments: the first showing substantial age variation in the advantage-a deep U-shaped advantage at peak migration ages-and the second showing high levels of population over-coverage, the principal source of data artefact, at the same ages. We use event history analysis of Sweden's population registers (2010-15) to test whether this over-coverage can explain age variation in the migrant mortality advantage. We document its U-shape in Sweden and, crucially, demonstrate that large mortality differentials persist after adjusting for estimated over-coverage. Our findings contribute to ongoing debate by demonstrating that the migrant mortality advantage is real and by ruling out one of its primary mechanisms.
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Affiliation(s)
| | - Ben Wilson
- Stockholm University.,London School of Economics
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20
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Helgesson M, Rahman S, Saboonchi F, Mittendorfer Rutz E. Disability pension and mortality in individuals with specific somatic and mental disorders: examining differences between refugees and Swedish-born individuals. J Epidemiol Community Health 2021; 75:721-728. [PMID: 33472869 PMCID: PMC8292560 DOI: 10.1136/jech-2019-213436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 10/15/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022]
Abstract
Background More than half a million refugees have arrived to Sweden during the last decade. The aim was to investigate differences between refugees and Swedish-born individuals regarding different specific somatic and mental disorders, and subsequent disability pension and mortality. Methods All refugees (n=239 742) and Swedish-born individuals (n=4 133 898), aged 19–60 years, resident in Sweden on 31st of December in 2009 were included in this population-based prospective cohort study. Data from six nationwide Swedish registers were linked by the unique anonymised identification number. HRs with 95% CIs were computed for disability pension and mortality 2010–2013 by Cox regression models. Results Compared with their Swedish-born counterparts with mental or somatic diagnoses, refugees with these diagnoses had a higher risk of subsequent disability pension and a lower risk of mortality. Highest estimates for disability pension were seen for refugees with neoplasm (HR: 1.72; 95% CI: 1.56 to 1.91), musculoskeletal disorders (HR: 1.57; 95% CI: 1.47 to 1.67), diseases of the circulatory system (HR: 1.33; 95% CI: 1.22 to 1.45), depressive disorders (HR: 1.31; 95% CI: 1.21 to 1.41) and diabetes mellitus (HR: 1.30; 95% CI: 1.15 to 1.47). The risk of mortality was lowest for refugees with regard to bipolar disorders (HR: 0.37; 95% CI: 0.16 to 0.82), post-traumatic stress disorder (HR: 0.37; 95% CI: 0.25 to 0.54) and least pronounced in regard to neoplasm (HR: 0.69; 95% CI: 0.61 to 0.77) compared with Swedish-born with similar disorders. Conclusion Refugees have a generally higher risk of disability pension compared with Swedish-born with specific somatic and mental disorders. Despite this, refugees with all specific disorders have lower risk estimates of mortality, probably due to a healthy selection. The higher risk of disability pension might therefore be due to other causes besides poor health.
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Affiliation(s)
- Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.,Department of Health Sciences, The Swedish Red Cross University, College, SE-102 15 Stockholm, Sweden
| | - Ellenor Mittendorfer Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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21
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Honkaniemi H, Juárez SP, Katikireddi SV, Rostila M. Psychological distress by age at migration and duration of residence in Sweden. Soc Sci Med 2020; 250:112869. [PMID: 32120203 PMCID: PMC8325349 DOI: 10.1016/j.socscimed.2020.112869] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/02/2019] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
Migrants suffer from worse psychological health than natives in many countries, yet the extent to which this varies by age at migration and duration of residence in the receiving context remains unexplored in Sweden. Drawing on a life course approach, we investigate differences in psychological distress by age at migration and duration of residence in working-age migrants to Sweden, and examine the role of various social determinants of health in explaining these differences relative to Swedish-born. Using pooled cross-sectional data from the 2011/2015 Health on Equal Terms survey in Västra Götaland Region, Sweden (n = 58,428), we applied logistic regression analysis to calculate predicted probabilities and average marginal effects (AME) of migrant status, by age at migration and duration of residence, on psychological distress. Analyses were stratified by sex and region of origin and controlled for indicators of socioeconomic status (SES), social cohesion, and discrimination to assess their potential contribution to differences in migrants' and natives' psychological distress. All migrants except men from OECD-predominant regions had a greater probability of psychological distress than Swedish-born (ranging from AME 0.031 [95% Confidence Interval or CI 0.000-0.062] for OECD women to AME 0.115 [95% CI 0.074-0.156] for non-OECD men). Marginal effects of migration status on psychological distress probabilities generally increased with age at migration and duration of residence. Differences between migrants and natives were largely attenuated after controlling for social determinants, the greatest contribution coming from inequalities in social cohesion, followed by inequalities in discrimination and SES. Our results suggest a relative health advantage of early-life compared to later-life migration, albeit with worse outcomes with longer residence in Sweden. The predominance of integration opportunities in childhood strengthens calls for supportive policies to assist older migrants' integration directly upon arrival, which may ultimately improve their psychological wellbeing.
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Affiliation(s)
- Helena Honkaniemi
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
| | - Sol Pía Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | | | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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22
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Mehta NK, Martikainen P, Cederström A. Age at Immigration, Generational Status, and Death Among Children of Immigrant Mothers: A Longitudinal Analysis of Siblings. Am J Epidemiol 2019; 188:1237-1244. [PMID: 30834450 DOI: 10.1093/aje/kwz055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Studies have documented that age at immigration and generational status are important predictors of socioeconomic outcomes among children of immigrants. Whether these characteristics are related to long-term risk of death is unknown. Leveraging variation within sibships, we evaluated the association of age at immigration and generational status (i.e., first or second generation) with death among children of immigrant mothers to Sweden. Data included 272,429 individuals (126,701 sibships) aged 15 or more years from the total Swedish population followed between 1990 and 2009. Population-average and sibling fixed-effect regressions were estimated, with the latter controlling for unobserved factors shared by siblings. The foreign-born children of immigrants experienced a 17% higher risk of death than the Swedish-born children of immigrants. This excess risk was evident for external and nonexternal causes of death. In general, a graded association was not detected between age at immigration and death among the foreign-born individuals; however, those arriving during primary school ages appeared especially vulnerable. This study provides robust evidence that among children of immigrants, being foreign born was associated with a long-term death penalty compared with being born in the host country.
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Affiliation(s)
- Neil K Mehta
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Sweden
- The Max Planck Institute for Demographic Research, Germany
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23
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Dunlavy AC, Juárez S, Toivanen S, Rostila M. Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status. Soc Psychiatry Psychiatr Epidemiol 2019; 54:579-590. [PMID: 30421040 DOI: 10.1007/s00127-018-1621-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence. METHODS Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models. RESULTS Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed. CONCLUSIONS Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.
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Affiliation(s)
- Andrea C Dunlavy
- Department of Public Health Sciences, Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Sveavägen 160, Sveaplan, 106 91, Stockholm, Sweden.
| | - Sol Juárez
- Department of Public Health Sciences, Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Sveavägen 160, Sveaplan, 106 91, Stockholm, Sweden
| | - Susanna Toivanen
- Department of Public Health Sciences, Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Sveavägen 160, Sveaplan, 106 91, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Sveavägen 160, Sveaplan, 106 91, Stockholm, Sweden
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24
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25
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Brydsten A, Rostila M, Dunlavy A. Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden. Int J Equity Health 2019; 18:48. [PMID: 30944004 PMCID: PMC6889340 DOI: 10.1186/s12939-019-0950-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/11/2019] [Indexed: 01/18/2023] Open
Abstract
Background The increasing mental health inequalities between native- and foreign-born persons in Sweden is an important public health issue. Improving social integration has been stressed as a key strategy to combat this development. While a vast amount of studies have confirmed the importance of social integration for good mental health, less is known about the role of different types of social integration, and how they relate to mental health inequalities. This study aimed to examine the extent to which indicators of social integration explained mental health inequalities between the native- and foreign-born. Methods Based on the Health on Equal Terms survey from 2011/2015 in Västra Götaland, Sweden (n = 71,643), a non-linear Oaxaca–Blinder decomposition analysis was performed comparing native- and foreign-born individuals from Nordic-, European- and non-European countries. The General Health Questionnaire was used to assess psychological distress, while 11 items assessed employment conditions and economic disparities, social relations, and experiences of discrimination to measure different aspects of social integration. Results Differences in social integration explained large proportions of observed mental health differences between the native- and foreign-born. Important indicators included low levels of social activity (20%), trust in others (17%) and social support (16%), but also labour market disadvantages, such as being outside the labour market (15%), unemployment (10%) and experiencing financial strain (16%). In analyses stratified by region of origin, low trust in others and discrimination contributed to the mental health gap between the native-born and European-born (17 and 9%, respectively), and the native-born and non-European-born (19 and 10%, respectively). Precarious labour market position was a particularly important factor in the mental health gap between the native-born and Nordic-origin (22%), and non-European origin (36%) populations. Conclusion Social integration factors play a central role in explaining the mental health inequality between natives and migrants in Sweden. Our findings suggest that public health actions targeting mental health gaps could benefit from focusing on inequalities in social and economic recourses between natives and migrants in Sweden. Areas of priority include improving migrants’ financial strain, as well as increasing trust in others and social support and opportunities for civic engagement.
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Affiliation(s)
- Anna Brydsten
- Department of Public Health Science, Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-105 91, Stockholm, Sweden.
| | - Mikael Rostila
- Department of Public Health Science, Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-105 91, Stockholm, Sweden
| | - Andrea Dunlavy
- Department of Public Health Science, Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-105 91, Stockholm, Sweden
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26
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Wallace M, Khlat M, Guillot M. Mortality advantage among migrants according to duration of stay in France, 2004-2014. BMC Public Health 2019; 19:327. [PMID: 30898125 PMCID: PMC6427872 DOI: 10.1186/s12889-019-6652-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 03/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background The migrant mortality advantage is generally interpreted as reflecting the selection of atypically healthy individuals from the country of origin followed by the wearing off of selection effects over time, a process theorised to be accelerated by progressive and negative acculturation in the host country. However, studies examining how migrant mortality evolves over duration of stay, which could provide insight into these two processes, are relatively scarce. Additionally, they have paid little attention to gender-specific patterns and the confounding effect of age. In this study, we analyze all-cause mortality according to duration of stay among male and female migrants in France, with a particular focus on the role of age in explaining duration of stay effects. Methods We use the Échantillon Démographique Permanent (Permanent Demographic Sample; EDP), France’s largest socio-demographic panel and a representative 1% sample of its population. Mortality was followed-up from 2004 to 2014, and parametric survival models were fitted for males and females to study variation in all-cause mortality among migrants over duration of stay. Estimates were adjusted for age, duration of stay, year, education level and marital status. Duration of stay patterns were examined for both open-ended and fixed age groups. Results We observe a migrant mortality advantage, which is most pronounced among recent arrivals and converges towards the mortality level of natives with duration of stay. We show this pattern to be robust to the confounding effect of age and find the pattern to be consistent among males and females. Conclusions Our novel findings show an intrinsic pattern of convergence of migrant mortality towards native-born mortality over time spent in France, independent from the ages at which mortality is measured. The consistent pattern in both genders suggests that males and females experience the same processes associated with generating the migrant mortality advantage. These patterns adhere to the selection-acculturation hypothesis and raise serious concerns about the erosion of migrant health capital with increasing exposure to conditions in France. Electronic supplementary material The online version of this article (10.1186/s12889-019-6652-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew Wallace
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden.
| | - Myriam Khlat
- Institut national d'études démographiques, French National Demographic Institute, 133 Boulevard Davout, 75020, Paris, France
| | - Michel Guillot
- Institut national d'études démographiques, French National Demographic Institute, 133 Boulevard Davout, 75020, Paris, France.,Population Studies Center, University of Pennsylvania, 242 McNeil Building, Philadelphia, PA19104, USA
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Aldridge RW, Nellums LB, Bartlett S, Barr AL, Patel P, Burns R, Hargreaves S, Miranda JJ, Tollman S, Friedland JS, Abubakar I. Global patterns of mortality in international migrants: a systematic review and meta-analysis. Lancet 2018; 392:2553-2566. [PMID: 30528484 PMCID: PMC6294735 DOI: 10.1016/s0140-6736(18)32781-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/14/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND 258 million people reside outside their country of birth; however, to date no global systematic reviews or meta-analyses of mortality data for these international migrants have been done. We aimed to review and synthesise available mortality data on international migrants. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Library, and Google Scholar databases for observational studies, systematic reviews, and randomised controlled trials published between Jan 1, 2001, and March 31, 2017, without language restrictions. We included studies reporting mortality outcomes for international migrants of any age residing outside their country of birth. Studies that recruited participants exclusively from intensive care or high dependency hospital units, with an existing health condition or status, or a particular health exposure were excluded. We also excluded studies limited to maternal or perinatal outcomes. We screened studies using systematic review software and extracted data from published reports. The main outcomes were all-cause and International Classification of Diseases, tenth revision (ICD-10) cause-specific standardised mortality ratios (SMRs) and absolute mortality rates. We calculated summary estimates using random-effects models. This study is registered with PROSPERO, number CRD42017073608. FINDINGS Of the 12 480 articles identified by our search, 96 studies were eligible for inclusion. The studies were geographically diverse and included data from all global regions and for 92 countries. 5464 mortality estimates for more than 15·2 million migrants were included, of which 5327 (97%) were from high-income countries, 115 (2%) were from middle-income countries, and 22 (<1%) were from low-income countries. Few studies included mortality estimates for refugees (110 estimates), asylum seekers (144 estimates), or labour migrants (six estimates). The summary estimate of all-cause SMR for international migrants was lower than one when compared with the general population in destination countries (0·70 [95% CI 0·65-0·76]; I2=99·8%). All-cause SMR was lower in both male migrants (0·72 [0·63-0·81]; I2=99·8%) and female migrants (0·75 [0·67-0·84]; I2=99·8%) compared with the general population. A mortality advantage was evident for refugees (SMR 0·50 [0·46-0·54]; I2=89·8%), but not for asylum seekers (1·05 [0·89-1·24]; I2=54·4%), although limited data was available on these groups. SMRs for all causes of death were lower in migrants compared with the general populations in the destination country across all 13 ICD-10 categories analysed, with the exception of infectious diseases and external causes. Heterogeneity was high across the majority of analyses. Point estimates of all-cause age-standardised mortality in migrants ranged from 420 to 874 per 100 000 population. INTERPRETATION Our study showed that international migrants have a mortality advantage compared with general populations, and that this advantage persisted across the majority of ICD-10 disease categories. The mortality advantage identified will be representative of international migrants in high-income countries who are studying, working, or have joined family members in these countries. However, our results might not reflect the health outcomes of more marginalised groups in low-income and middle-income countries because little data were available for these groups, highlighting an important gap in existing research. Our results present an opportunity to reframe the public discourse on international migration and health in high-income countries. FUNDING Wellcome Trust, National Institute for Health Research, Medical Research Council, Alliance for Health Policy and Systems Research, Department for International Development, Fogarty International Center, Grand Challenges Canada, International Development Research Centre Canada, Inter-American Institute for Global Change Research, National Cancer Institute, National Heart, Lung and Blood Institute, National Institute of Mental Health, Swiss National Science Foundation, World Diabetes Foundation, UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, and European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group Research Funding for the ESCMID Study Group for Infections in Travellers and Migrants.
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Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
| | - Laura B Nellums
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases, Imperial College London, London, UK
| | - Sean Bartlett
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Parth Patel
- School of Public Health, Imperial College London, London, UK
| | - Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Sally Hargreaves
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases, Imperial College London, London, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases and Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Jon S Friedland
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases, Imperial College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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