Mortality among US-born and immigrant Hispanics in the US: effects of nativity, duration of residence, and age at immigration

The problematic nature of existing explanations for differential immigrant mortality: Insights from a comparative cross-national systematic review and meta-analysis

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.

Cumulative All-Cause Mortality in Diverse Hispanic/Latino Adults : A Prospective, Multicenter Cohort Study

BACKGROUND

All-cause mortality among diverse Hispanic/Latino groups in the United States and factors underlying mortality differences have not been examined prospectively.

OBJECTIVE

To describe cumulative all-cause mortality (and factors underlying differences) by Hispanic/Latino background, before and during the COVID-19 pandemic.

DESIGN

Prospective, multicenter cohort study.

SETTING

Hispanic Community Health Study/Study of Latinos.

PARTICIPANTS

15 568 adults aged 18 to 74 years at baseline (2008 to 2011) of Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and other backgrounds from the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California.

MEASUREMENTS

Sociodemographic, acculturation-related, lifestyle, and clinical factors were assessed at baseline, and vital status was ascertained through December 2021 (969 deaths; 173 444 person-years of follow-up). Marginally adjusted cumulative all-cause mortality risks (11-year before the pandemic and 2-year during the pandemic) were examined using progressively adjusted Cox regression.

RESULTS

Before the pandemic, 11-year cumulative mortality risks adjusted for age and sex were higher in the Puerto Rican and Cuban groups (6.3% [95% CI, 5.2% to 7.6%] and 5.7% [CI, 5.0% to 6.6%], respectively) and lowest in the South American group (2.4% [CI, 1.7% to 3.5%]). Differences were attenuated with adjustment for lifestyle and clinical factors. During the pandemic, 2-year cumulative mortality risks adjusted for age and sex ranged from 1.1% (CI, 0.6% to 2.0%; South American) to 2.0% (CI, 1.4% to 3.0%; Central American); CIs overlapped across groups. With adjustment for lifestyle factors, 2-year cumulative mortality risks were highest in persons of Central American and Mexican backgrounds and lowest among those of Puerto Rican and Cuban backgrounds.

LIMITATION

Lack of data on race and baseline citizenship status; correlation between Hispanic/Latino background and site.

CONCLUSION

Differences in prepandemic mortality risks across Hispanic/Latino groups were explained by lifestyle and clinical factors. Mortality patterns changed during the pandemic, with higher risks in persons of Central American and Mexican backgrounds than in those of Puerto Rican and Cuban backgrounds.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Differences in the risk of premature cancer mortality between natives and immigrants in Spain

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.

Similarities and Dissimilarities in Diet Quality Differences by Acculturation Level between Mexican Americans and Other Hispanic Americans: National Health and Nutrition Examination Survey 2015-2018

BACKGROUND

Evidence suggests dietary acculturation can increase obesity and chronic disease risks. However, acculturation effects on diet quality among subgroups of Hispanic Americans is not well studied.

OBJECTIVES

Estimating percentages of Hispanic Americans with low, moderate, and high acculturation using 2 proxy measures with different language variables was the first objective. Identifying similarities and dissimilarities in diet quality differences by acculturation level between Mexican Americans and other Hispanic Americans was the second objective.

METHODS

The study sample included 1733 Mexican American and 1191 other Hispanic participants aged ≥16 y from National Health and Nutrition Examination Survey 2015-2018. Proxy measures included in the 2 acculturation scales were nativity/United States residence length, immigration age, language spoken at home (home), and language of dietary recall (recall). Replicate 24-h dietary recalls were conducted, and diet quality was assessed using the 2015 Healthy Eating Index. Analyses included statistical methods for complex survey designs.

RESULTS

For Mexican Americans, 8%, 35%, and 58% had low, moderate, and high acculturation on the home scale compared with 8%, 30%, and 62% on the recall scale. For other Hispanics, 17%, 39%, and 43% had low, moderate, and high acculturation on the home scale compared with 18%, 34%, and 48% on the recall scale. Similarities between ethnicities included higher acculturation associated with lower intakes of fruits, vegetables, total protein foods, seafood and plant proteins, and saturated fats and greater intake of sodium. Dissimilarities included higher acculturation associated with more whole grains and added sugars intakes and less refined grains intake (Mexican Americans), and less total dairy and fatty acids intakes (other Hispanic Americans).

CONCLUSIONS

Higher acculturation is associated with worsening diet quality for fruits, vegetables, and protein foods in all Hispanic Americans. However, associations of higher acculturation with worsening diet quality for grains, added sugars, dairy, and fatty acids were present only in specific subgroups of Hispanic Americans.

Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature

Background

There are over seven million older adult immigrants in the United States, and that number is expected to increase. Older adult immigrants in the United States have unique factors that influence their health.

Methods

In this integrative review, we systematically review 20 years of peer-reviewed literature on the barriers (i.e. isolation, lack of English Language Proficiency, low health literacy, lack of SES resources, discrimination) and facilitators (i.e. English Language Proficiency and maintaining ones native language, social support, culturally sensitive providers, healthcare access) of health among older adult immigrants in the United States.

Results

We found differing uses of the term ‘older adult’, emphasis on the lack of homogeneity among older adult immigrants, social support and isolation as significant barriers and facilitators of older adult immigrant health, and inconsistencies in uses and definitions of acculturation. We also examined relevant theories in the literature. Based on the literature review, focusing on Acculturation Theory, Social Cognitive Theory, and Successful Aging Theory, combining these three theories with findings from the literature to create the Older Adult Immigrant Adapted Model for Health Promotion.

Conclusions

Public health strives to promote health and prevent adverse health outcomes. Our integrative review not only systematically and thoroughly explicates 20 years of literature, but the Older Adult Immigrant Adapted Model for Health Promotion, provides guidance for future research and interventions.

Drug overdose mortality by race/ethnicity across US-born and immigrant populations

BACKGROUND

The present study examined racial/ethnic differences in US drug overdose mortality among US-born and foreign-born men and women.

METHODS

In this cross-sectional analysis of 2010-2019 data from the National Center for Health Statistics, Bayesian hierarchical models predicted drug overdose mortality based on the interaction of race/ethnicity, nativity, and sex, adjusting for age, for 518,553 drug overdose deaths among individuals ages 15-74 identified as Non-Hispanic (NH) White, NH Black, Hispanic, or NH Asian/Pacific Islander (PI). Rate ratios with 95% Highest Posterior Density Intervals (HPDIs) were examined by race/ethnicity and nativity.

RESULTS

In the US-born population, 2017-2019 estimated overdose mortality rates were higher for NH Black than NH White men (ratio 1.48 [95% HPDI 1.28-1.72]), similar between NH Black and NH White women (ratio 1.03 [95% HPDI 0.89-1.20]), similar between Hispanic and NH White men (ratio 0.96 [95% HPDI 0.82-1.10]), and lower for NH Asian/PI than NH White men and women. In the foreign-born population, both for men and women, estimated overdose mortality rates were lower in every racial/ethnic group relative to the NH White group. For men and women of all racial/ethnic groups examined, estimated overdose mortality rates were higher in US-born than foreign-born subpopulations, yet the extent of this nativity differential was least pronounced in the NH White group.

CONCLUSIONS

In the US-born population, NH Black men experienced the highest recent rates of overdose mortality; in the foreign-born population, the highest rates of overdose mortality were observed among NH White men and women.

Typologies of Sexual Health Vulnerability Predicting STI Preventive Behaviors Among Latinx Adults in the U.S.: A Latent Class Analysis Approach

Vulnerability to poor sexual health among U.S. Latinx populations is poorly understood, despite high STI rates. We examined how vulnerability typologies differ in their STI preventive behaviors. Using data from the 2016 National Health Interview Survey, we performed latent class analysis to test the association between sexual health vulnerability and HIV testing, hepatitis testing or vaccination, and HPV vaccination from a subsample of Latinx adults. Three classes emerged: Under-Employed Females with Health Care Access, Slightly Under-Employed Females with Some Health Care Access, and Employed Males without Health Care Access. Slightly Under-Employed Females with Some Health Care Access were associated with lack of HIV testing, hepatitis B and C testing, and HPV vaccination. Employed Males without Health Care Access were associated with lack of HIV testing and HPV vaccination. Sexual health vulnerability may be associated with certain STI preventive behaviors, which can inform and refine sexual health promotion programming.

The prognostic significance of race in nasopharyngeal carcinoma by histological subtype

BACKGROUND

Race has been shown to have variable prognostic importance in nasopharyngeal carcinoma (NPC). However, previous studies are limited by a lack of comprehensive treatment, epidemiologic, and comorbidity data.

METHODS

This was a retrospective cohort study utilizing the National Cancer Database from 2004 to 2016. Multivariable Cox proportional hazards regressions were used to calculate adjusted hazard ratios (aHR) for overall survival.

RESULTS

A cohort of 9995 patients met inclusion and exclusion criteria. Race, insurance, comorbidity, treatment, stage, age, and histology were independent prognosticators. Among patients with keratinizing NPC, Asians and Hispanics had superior survival (aHR 0.58 [95% confidence interval (CI) 0.48-0.69], aHR 0.76 [95% CI 0.61-0.96]) compared to white patients. Among patients with non-keratinizing differentiated NPC, Asians and black patients had improved survival (aHR 0.71 [95% CI 0.56-0.91], aHR 0.72 [95% CI 0.54-0.95]) compared to white patients. Race was not prognostic in non-keratinizing undifferentiated NPC.

CONCLUSION

The prognostic significance of race varies across histological subtypes of NPC.

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.

Africans Who Arrive in the United States before 20 Years of Age Maintain Both Cardiometabolic Health and Cultural Identity: Insight from the Africans in America Study

The overall consensus is that foreign-born adults who come to America age < 20 y achieve economic success but develop adverse behaviors (smoking and drinking) that lead to worse cardiometabolic health than immigrants who arrive age ≥ 20 y. Whether age of immigration affects the health of African-born Blacks living in America is unknown. Our goals were to examine cultural identity, behavior, and socioeconomic factors and determine if differences exist in the cardiometabolic health of Africans who immigrated to America before and after age 20 y. Of the 482 enrollees (age: 38 ± 1 (mean ± SE), range: 20–65 y) in the Africans in America cohort, 23% (111/482) arrived age < 20 y, and 77% (371/482) arrived age ≥ 20 y. Independent of francophone status or African region of origin, Africans who immigrated age < 20 y had similar or better cardiometabolic health than Africans who immigrated age ≥ 20 y. The majority of Africans who immigrated age < 20 y identified as African, had African-born spouses, exercised, did not adopt adverse health behaviors, and actualized early life migration advantages, such as an American university education. Due to maintenance of cultural identity and actualization of opportunities in America, cardiometabolic health may be protected in Africans who immigrate before age 20. In short, immigrant health research must be cognizant of the diversity within the foreign-born community and age of immigration.

Gender and race interact to influence survival disparities in head and neck cancer

Gender and race disparities in head and neck squamous cell carcinoma (HSNCC) survival are independently well documented, but no prior studies have examined the joint effect of these factors on HSNCC outcomes. We aim to comprehensively estimate the effect of gender and race on overall survival in HNSCC. We constructed a retrospective cohort from the National Cancer Database for primary HNSCC of the larynx, hypopharynx, oral cavity, and oropharynx from 2010 to 2015. We used Kaplan-Meier curves and Cox proportional hazards regressions to calculate hazard ratios adjusting for treatment type, age, insurance, staging classifications, and comorbidities. Oral cavity cancer was significantly more common among Hispanic and White females compared to other sites. Female non-oropharyngeal HNSCC cases had better five-year overall survival than males (56.3% versus 54.4%, respectively), though Black females (52.8%) had poorer survival than both White (56.2%) and Hispanic (57.9%) males. There were significant differences in oropharyngeal cancer by HPV status. Notably, Black females with HPV-positive oropharyngeal OPSCC had far worse survival than any other race and gender group. These results persisted even when adjusting for potential mediating factors. Clearly gender is a significant prognosticator for HNSCC and has meaningful interactions with race. The distinct site distributions across gender and race reveal important insights into HNSCC among females. Taking into account these gender disparities while considering race is essential to providing appropriate care to head and neck patients and accurately counselling these individuals on prognosis and outcomes.

Gender and Age of Migration Differences in Mortality Among Older Mexican Americans

OBJECTIVES

Using a gendered life course perspective, we examine whether the relationship between age of migration and mortality is moderated by gender among a cohort of older Mexican Americans.

METHODS

Data from the Hispanic Established Populations for the Epidemiological Study of the Elderly and recently matched mortality data are used to estimate Cox proportional hazard models.

RESULTS

Our findings indicate that the relationship between age of migration and mortality is moderated by gender, suggesting a more nuanced perspective of the immigrant mortality paradox. Among men, midlife migrants exhibit an 18% lower risk of mortality compared to their U.S.-born co-ethnics, possibly due to immigrant selectivity at the time of migration. Conversely, late-life migrant women exhibit a 17% lower risk of mortality relative to U.S.-born women, attributed in part to socio-cultural characteristics that influence lifestyle risk factors across the life course.

DISCUSSION

Selection mechanisms and acculturation processes associated with the immigrant experience are contingent on both age and gender, suggesting the utility of an integrated life course approach to contextualize the mortality profiles of older immigrants. These findings demonstrate the heterogeneity among immigrants and highlight the need to understand gender differences in the migration process when assessing the immigrant mortality paradox.

Immigration Status and Substance Use Disorder-related Mortality in Sweden: A National Longitudinal Registry Study

OBJECTIVES

First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

METHODS

A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

RESULTS

Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

DISCUSSION

Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer's Disease and Related Dementias

BACKGROUND

Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer's disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis.

METHODS

We used Medicare claims data linked with survey information from 1,090 participants (mean age of death 85.1 years) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Multivariable logistic regression models were used to estimate the odds for hospitalization, intensive care unit use, and ventilator use in the last 30 days of life for decedents with ADRD than those without ADRD. Generalized linear models were used to estimate the risk ratio (RR) for length of stay in hospital.

RESULTS

Within the last 30 days of life, 64.5% decedents had an acute hospitalization (59.1% ADRD, 68.3% no ADRD), 33.9% had an intensive care unit stay (31.3% ADRD, 35.8% no ADRD), and 17.2% used a ventilator (14.9% ADRD, 18.8% no ADRD). ADRD was associated with significantly lower hospitalizations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.50-0.89) and shorter length of stay in hospital (RR = 0.77, 95% CI = 0.65-0.90).

CONCLUSION

Hospitalization, intensive care unit stay, and ventilator use are common at the end of life for older Mexican Americans. The lower hospitalization and shorter length of stay in hospital of decedents with ADRD indicate a modest reduction in acute care use. Future research should investigate the impact of end-of-life planning on acute-care use and quality of life in terminally ill Mexican American older adults.

Age of Migration and Cognitive Function Among Older Latinos in the United States

BACKGROUND

Age of migration has been shown to have a robust association with Latino immigrant health outcomes; however, the relationship between timing of migration and cognition is less understood.

OBJECTIVE

To examine associations between race/ethnicity, nativity, age of migration, and cognitive aging among US-born (USB) non-Latino Whites (NLW) and USB and foreign-born Latinos 50 years and older.

METHODS

We used longitudinal biennial data from the Health and Retirement Study (HRS; 2006-2014) to fit generalized linear and linear latent growth curve models for: 1) global cognition (Modified Telephone Interview for Cognitive Status; TICS-M); 2) memory and attention subdomains of TICS-M; and 3) cognitive dysfunction. We also tested for sex modifications.

RESULTS

In age and sex adjusted models, all Latino subgroups, independent of nativity and age of migration, had lower global and domain-specific cognitive scores and higher propensity of cognitive impairment classification compared to USB-NLWs. Differences between USB Latinos, but not other Latino subgroups, and USB-NLWs remained after full covariate adjustment. Latinas, independent of nativity or age of migration, had poorer cognitive scores relative to NLW females. Differences between all Latinos and USB-NLWs were principally expressed at baseline. Racial/ethnic, nativity, and age of migration grouping was not associated with slope (nor explained variance) of cognitive decline.

CONCLUSION

Older US-born Latinos, regardless of sex exhibit poorer cognitive function than older USB-NLWs and foreign-born Latinos. Social determinants that differentially affect cognitive function, particularly those that compensate for education and sex differences among US-born Latinos and foreign-born Latinos, require further exploration.

Trauma and cultural values in the health of recently immigrated families

This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.

Sex differences in mortality in migrants and the Swedish-born population: Is there a double survival advantage for immigrant women?

OBJECTIVES

In the present study, we examine whether the relationships between country of origin or reason for migration and mortality differ between men and women.

METHODS

We apply hazard regression models on high-quality Swedish register data with nationwide coverage.

RESULTS

Relative to their Swedish counterparts, migrants from Nordic and East European (EU) countries and former Yugoslavia have higher mortality. This excess mortality among migrants relative to Swedes is more pronounced in men than in women. Migrants from Western and Southern European countries; Iran, Iraq, and Turkey; Central and South America; and Asia, have lower mortality than Swedes, and the size of the mortality reduction is similar in both sexes. The predictive effects of the reason for migration for mortality are also similar in migrant men and women.

CONCLUSIONS

This study provides little support for the hypothesis of a double survival advantage among immigrant women in Sweden. However, it does show that the excess mortality in migrants from Nordic and EU countries and former Yugoslavia relative to the Swedish-born population is more pronounced in men than in women.

The definition of immigrant status matters: impact of nationality, country of origin, and length of stay in host country on mortality estimates

BACKGROUND

Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain.

METHODS

Cross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012-2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death.

RESULTS

The age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7-45.2) for the Spanish-born population, 29.3 (95%CI 26.7-32.1) for the foreign-born population, and 18.4 (95%CI 15.6-21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5-0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years.

CONCLUSIONS

Mortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.

All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study

Background

A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden.

Methods

Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25–64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality.

Results

Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence.

Conclusions

The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed.

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Age at arrival and duration of residence modify immigrant’s risk of mortality.

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There is an excess mortality risk among immigrants who arrived in Sweden as minors.

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This excess risk was less evident in immigrants with 15 years or more of residence in Sweden.

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Age at arrival and duration of residence can be used to identify sensitive periods.

Increased cardiovascular disease risk in international migrants is independent of residence duration or cultural orientation: the HELIUS study

BACKGROUND

International migrants differ from host populations in cardiovascular disease (CVD) risk. It has been postulated that these disparities narrow with longer residence duration. Our aim was to determine whether CVD risk still differs between migrants and host population after decades of residence and to determine whether this potential convergence of CVD risk would occur mainly among migrants with a strong cultural orientation towards the host culture.

METHODS

In the Healthy Life in an Urban Setting study, we obtained data regarding residence duration, cultural orientation as estimated by the Psychological Acculturation Scale and CVD risk as estimated by SCORE among the Dutch host population and first generation migrants from South-Asian Surinamese, African Surinamese, Moroccan and Turkish ethnic background residing in Amsterdam. Estimated CVD risk was compared with the Dutch, separately for medium-term residence (15-30 years) or long-term residence (>30 years) migrants, and by strong/weak cultural orientation towards the Dutch culture, using age-adjusted regression analyses.

RESULTS

Among 8672 participants without prior CVD, estimated CVD risk was higher among migrant groups relative to the Dutch. CVD risk relative to the Dutch did not differ by residence duration (betas ranging from 0.1 to 3.4 for medium-term and from 0.6 to 3.3 for long-term residence, respectively). Furthermore, these patterns did not differ by cultural orientation towards the Dutch culture.

CONCLUSION

We find no indication that CVD risk among South-Asian Surinamese, African Surinamese, Turkish or Moroccan migrants converges to that of the Dutch host population with increasing residence duration, not even among those with strong cultural orientation towards the host culture.

An observational study of immigrant mortality differences in Norway by reason for migration, length of stay and characteristics of sending countries

BACKGROUND

Knowledge of mortality differentials in immigrant groups depending on their reason for migration, length of stay in host countries and characteristics of sending countries may be beneficial for policy interventions aimed to improve various immigrant groups' health and welfare.

METHODS

We employed discrete-time hazard regression models with time-varying covariates to compare the death risk of immigrants to those of Norwegian-born natives using linked register data on the Norwegian population aged 25-79 during 1990-2015. More than 492,000 deaths occurred in around 4.6 million individuals. All analyses were adjusted for sex, age, calendar time and sociodemographic characteristics.

RESULTS

Immigrants had an 11% survival advantage overall. Those immigrating due to work or education had the lowest death risk, whereas refugees had the highest death risk (albeit lower than that of natives). Death risks increased markedly with length of stay, and were most pronounced for those having spent more than 40% of their lives in Norway. Net of reason for migration, only minor differences were observed depending on Human Development Index characteristics of sending countries.

CONCLUSION

Independent of reason for migration and characteristics of sending countries, those who immigrate to Norway in adulthood appear to be particularly healthy. The higher death risk associated with prolonged lengths of stay suggests that disadvantageous 'acculturation' or stress factors related to the post-migration period may play a role in the long run. The health and welfare of long-term immigrants thus warrants further research.

Immigration Basics for Nurses

The United States is known as a nation of immigrants and a land of promise that welcomes the needy, poor, and oppressed. Immigrants represent some of the most vulnerable in society. It is vital that nurses and other health care providers possess knowledge of social, economic, and political factors related to health care for immigrant populations. This article provides definitions of the various immigrant populations, addresses health needs within this group, and offers suggestions for nursing practice and advocacy.

A comprehensive analysis of the mortality experience of hispanic subgroups in the United States: Variation by age, country of origin, and nativity

Although those identifying as "Hispanic or Latino" experience lower adult mortality than the more socioeconomically advantaged non-Hispanic white population, the ethnic category Hispanic conceals variation by country of origin, nativity, age, and immigration experience. The current analysis examines adult mortality differentials among 12 Hispanic subgroups by region of origin and nativity, and non-Hispanic whites, adjusting for socioeconomic and demographic characteristics. We use the National Health Interview Survey Linked Mortality Files pooled 1990-2009 to obtain sufficient sample of each subgroup to calculate mortality estimates by sex and age group (25-64, 65+). Among adults aged 65 and over, all foreign born subgroups have an advantage over non-Hispanic whites, and many USB subgroups exhibit an advantage in the adjusted model. Foreign-born Dominicans, Central/South Americans, and other Hispanics exhibit consistent advantages across models for both men and women, aged 25-64 and 65 and over, and both unadjusted and adjusted for socioeconomic covariates. Both US-born and foreign-born Mexicans between ages 25 and 64 have mortality disadvantaged relative to non-Hispanic whites, while older Mexicans exhibit clear advantages. Our results complicate the traditional formulation of the Hispanic Paradox and cast doubt on the singularity of the mortality experience of those of Hispanic origin.

Region of origin diversity in immigrant health: Moving beyond the Mexican case

Research suggests that Mexican immigrants arrive in the United States with equivalent or better health than native-born whites but lose their advantage over time. We seek to examine systematically how well the patterns of initial advantage and deteriorating health apply to immigrants originating from other regions of the world - regions that represent a growing proportion of U.S. immigrants. We begin by identifying which of the groups in our study have a health advantage compared to U.S.-born whites and to Mexican immigrants. We then we assess changes in health over time, controlling for variation in the health profiles of cohorts upon arrival. We use logistic regression of self-rated health and heart conditions with data from the 2004-2013 National Health Interview Survey. The results reveal diversity and similarity in health outcomes across world regions of origin, both on arrival and over time. By comparing and contrasting cases previously examined in isolation, we clarify and qualify theories of the immigrant health paradox and health deterioration.

The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science

Similar to non-Hispanic Blacks, Hispanics/Latinos experience a range of psychosocial and physical health challenges, including high rates of poverty, neighborhood segregation, discrimination, poor healthcare access, and high rates of obesity, diabetes, and undiagnosed and late-stage diagnosed diseases. Despite such risks, Hispanics generally experience better physical health and lower mortality than non-Hispanic Whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. With the basic phenomenon increasingly well-established, attention now turns to the sources of such resilience. The current aims are to briefly examine the epidemiological paradox and highlight potential sociocultural resilience factors that may contribute to the paradoxical effects. We conclude with presentation of a framework for modeling sociocultural resilience and discuss future directions for psychological contributions.