Health risks of immigration: the Yemenite and Ethiopian cases in Israel

Self-employment and health inequality of migrant workers

Background

Self-employment is one of the most common forms of employment for migrant workers in China. However, migrant workers’ lifestyle and behavior, as well as health disparities among them, would be impacted by self-employment. This research aims to explore the mechanism and group differences of the effect of self-employment on health inequality among Chinese migrant workers.

Materials and methods

To explore the effect of self-employment on health inequalities among migrant workers, this research uses the data from the 2018 China Migrant Workers Dynamic Monitoring Survey, and the RIF-I-OLS decomposition method.

Results

We find that self-employment will reduce the health inequality of Chinese migrant workers significantly, especially among migrant workers with low education, low income, and low social integration. A further examination reveals that self-employment can directly promote the self-rated health of migrant workers. Additionally, it indirectly alleviates the health inequality among migrant workers by mediating effect of expanding access to public welfare, such as by establishing health records and strengthening health education.

Conclusion

The government should permit and encourage migrant workers to engage in self-employment. It is necessary to provide public services such as health education, health records, and health rights for migrant workers, and focus on the employment of migrant workers in city, especially those with low income and low education. we believe that measures should be taken to enhance migrant workers’ sense of belonging in urban China Only on this basis can health inequality among migrant workers be truly reduced.

Adolescent Immigration and Type-2 Diabetes

PURPOSE OF REVIEW

Type-2 diabetes (T2D) in children and adolescents has become an increasingly important public health concern, currently accounting for nearly half of all diabetes cases in this age group in some countries. With immigration growing worldwide, immigrants as a subpopulation warrant special attention. Although the association of immigration and T2D has been explored in older persons, few studies have examined it in adolescent immigrants.

RECENT FINDINGS

Of 64 studies, only 8 were relevant and elaborated on in this review. Our findings show that adolescent immigrants to Western countries seem to benefit an overall favorable metabolic profile that is associated with lower odds to dysmetabolism. However, this protective effect wanes over time with longer years of residency and plateaus at approximately a decade from arrival. As immigration becomes a global phenomenon, pediatric T2D in these special populations has major public health and socioeconomic implications. Improving immigrants' access to healthcare, healthcare education and utilization, and specific cultural programs for prevention and treatment of T2D are important to ensure the accessibility of preventive medical services to young immigrants. Further research should be considered to help identify at-risk youth.

Hypertension and childhood migration: a nationwide study of 2.7 million adolescents

OBJECTIVES

Immigration studies can shed light on hypertension development and reveal high-risk populations. To this end, we investigated the association between age at immigration and hypertension occurrence at adolescence among immigrants to Israel.

METHODS

We analyzed cross-sectional data on 2 681 294 adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2016. The study population constituted of 410 488 immigrants with origins in Ethiopia, Middle East and North Africa, Former USSR and Western Countries. Age at immigration was categorized into 0-5, 6-11 and 12-19 years. Odds ratios (ORs) for hypertension were calculated according to age at immigration with Israel-born participants as controls. Models were made to account for possible confounders. Additionally, the study population was stratified by country of origin and each immigrant group referenced to Israel-born participants of the same origin.

RESULTS

In the fully-adjusted model, immigrants arriving until age 11 years had comparable ORs for hypertension to the Israeli-born reference group, whereas recent immigrants, arriving at age 12-19 years had a marked lower OR of 0.30 (95% CI 0.27-0.33; P < 0.001). The lower hypertension odds among recent immigrants persisted in all models and when the study sample was stratified by sex and origin, with all but those of Western origin showing a graded decrease with increasing age at migration categories.

CONCLUSION

Immigrants arriving earlier in childhood lose their protection against hypertension at adolescence relative to the Israeli-born, likely because of lifestyle acculturation. Prevention programs are needed, beginning upon arrival and placing emphasis on nutritional and physical activity habits.

Identification and characterization of HIV positive Ethiopian elite controllers in both Africa and Israel

OBJECTIVES

HIV elite controllers (ECs) are a unique subgroup of HIV-positive patients who are long-term virologically suppressed in the absence of antiretroviral treatment (ART). The prevalence of this subgroup is estimated to be < 1%. Various cohorts of ECs have been described in developed countries, most of which have been demographically heterogeneous. The aim of this study was to identify ECs in two large African cohorts and to estimate their prevalence in a relatively genetically homogenous population.

METHODS

We screened two cohorts of HIV-positive Ethiopian patients. The first cohort resided in Mekelle, Ethiopia. The second was comprised of HIV-positive Ethiopian immigrants in Israel. In the Mekelle cohort, ART-naïve subjects with stable CD4 counts were prospectively screened using two measurements of viral load 6 months apart. Subjects were defined as ECs when both measurements were undetectable. In the Israeli cohort, subjects with consistently undetectable viral loads (mean of 17 viral load measurements/patient) and stable CD4 count > 500 cells/μL were defined as ECs.

RESULTS

In the Mekelle cohort, 16 of 9515 patients (0.16%) fitted the definition of EC, whereas seven of 1160 (0.6%) in the Israeli cohort were identified as ECs (P = 0.011).

CONCLUSIONS

This is the first large-scale screening for HIV-positive ECs to be performed in entirely African cohorts. The overall prevalence of ECs is within the range of that previously described in developing countries. The significant difference in prevalence between the two cohorts of similar genetic background is probably a consequence of selection bias but warrants further investigation into possible environmental factors which may underlie the EC state.

The immigration effect on obesity and overweight in Israeli Jewish male adolescents born 1970-1993

PURPOSE

The aim of the study was to assess the relationship between age of arrival of male pediatric immigrant populations in Israel and their risk for subsequent high-weight morbidity at adolescence.

METHODS

The study analyzed a pooled cross section of 89,744 foreign-born male Jewish study participants, who were born in the former Soviet Union or Ethiopia (1970-1993) and immigrated in childhood to Israel. Each participant's body mass index was measured at approximately 17 years of age. Odds ratios were calculated for obesity and overweight according to age on arrival to Israel. A total of 52,503 Israel-born participants with origins in those same countries were measured at the same age and used as references. A total of 52,258 native Israelis without known immigrating ancestry were also used for comparison. The risk stratification accounted for possible socio-demographic confounders and birth year.

RESULTS

Foreign-born immigrants had decreased risk for obesity and overweight relative to Israeli-born immigrants when measured at the age of 17 years. However, those who arrived in Israel during infancy and early childhood (before the age of 3 years) had greater risk for high weight compared with those immigrating during late childhood and adolescence.

CONCLUSIONS

Although generally protective against obesity and overweight relative to native, these beneficial effects of immigration are diminished for those arriving in early childhood rather than later in adolescence.

Disparities in obesity temporal trends of Israeli adolescents by ethnic origin

OBJECTIVE

To analyze the temporal trends of obesity over time among male adolescents of different ethnic origins.

METHODS

Population-based national data of subjects presenting at recruitment centers for medical examinations as part of screening for military draft. Subjects were 17-year-old Jewish males (n=1 140 937) born in the years 1950-1986. Data on body mass index (BMI) were measured (without clothing and shoes) by physicians. We calculated the prevalence of obesity (BMI 29.4 or higher) for each year by ethnic origin group. A Multinomial logistic regression model was used to estimate the effects of ethnic origin and other risk factors on the likelihood of obesity.

RESULTS

Over time, obesity rates have risen among all ethnic groups of adolescents. Multinomial regression analysis showed a lower likelihood of obesity among those of Asia-Africa origin as compared with other groups. However, obesity rates have increased more significantly over time among this ethnic group compared with the other groups.

CONCLUSION

A significant finding of this study is the disparities in temporal trends in the likelihood of obesity over time. Among adolescents of Asia-Africa origin the likelihood of obesity increased more steeply over time compared with other groups of adolescents. Health services in Israel should thus consider Asia-African origin as a distinct risk factor and target interventions to prevent future obesity among these adolescents.

Dietary carbohydrates and dental-systemic diseases

Two contradictory hypotheses on the role of dietary carbohydrates in health and disease shape how dental-systemic associations are regarded. On one side, Cleave and Yudkin postulated that excessive dietary fermentable carbohydrate intake led-in the absence of dental interventions such as fluorides-first to dental diseases and then to systemic diseases. Under this hypothesis, dental and systemic diseases shared-as a common cause-a diet of excess fermentable carbohydrates. Dental diseases were regarded as an alarm bell for future systemic diseases, and restricting carbohydrate intake prevented both dental and systemic diseases. On the opposite side, Keys postulated the lipid hypothesis: that excessive dietary lipid intake caused systemic diseases. Keys advocated a diet high in fermentable carbohydrate for the benefit of general health, and dental diseases became regarded as local dietary side effects. Because general health takes precedence over dental health when it comes to dietary recommendations, dental diseases became viewed as local infections; interventions such as fluorides, sealants, oral hygiene, antimicrobials, and dental fillings became synonymous with maintaining dental health, and carbohydrates were no longer considered as a common cause for dental-systemic diseases. These opposing dietary hypotheses have increasingly been put to the test in clinical trials. The emerging trial results favor Cleave-Yudkin's hypothesis and may affect preventive approaches for dental and systemic diseases.

Migration and its impact on adiposity and type 2 diabetes

In this review, we discuss the impact of migration on the incidence and prevalence of obesity and type 2 diabetes mellitus (T2DM) in different ethnic groups and populations. We also analyze the determinants of such phenomena in view of the global increase in the migration and escalating prevalence of obesity and T2DM. The risk escalation of the obesity and T2DM followed a gradient, as migrants (Blacks, Hispanics, Chinese, South Asians, etc.) became more affluent and urbanized, indicating an important role of environmental factors. A stepwise increase in the prevalence of obesity in Blacks along the path of migration (5% in Nigeria, 23% in Jamaica, and 39% in the United States) is a classic example. Furthermore, South Asian migrants, who are particularly predisposed to develop insulin resistance and T2DM, showed nearly four times prevalence rates of T2DM than rural sedentee populations. Similar observations were also reported in intracountry migrants and resettled indigenous populations. The determinants were found to include nutrition transition, physical inactivity, gene-environment interaction, stress, and other factors such as ethnic susceptibility. However, certain contradictory trends were also seen in some migrant communities and have been explained by various phenomena such as healthy migrant effect, "salmon bias", and adherence to traditional diets. A review of the evidence suggests a critical role of environmental factors in conferring an increased risk of obesity and T2DM. The important contributory factors to this phenomenon were urbanization, mechanization, and changes in nutrition and lifestyle behaviors, but the role of stress and as yet unknown factors remain to be determined.