Health status and mortality rates of adolescents and young adults in the Brussels-Capital Region: differences according to region of origin and migration history

Design and validation of a questionnaire to measure the attitudes of health professionals towards immigrants (AHPI)

Objective

The aim of the article is to describe the validation process of a research tool used to measure the intensity and direction of medical personnel's attitudes towards immigrant patients.

Design

An instrument validation design with a cross-sectional survey was conducted. The validation process was carried out in two phases. In phase 1, the content validity of the tool was analyzed. The competent judges method was used. The reliability of the judges was verified in terms of the consistency of evaluations (the I-CVI index was calculated). In phase 2, the questionnaire was tested among 340 healthcare professionals who have professional contact with immigrants, in terms of its factorial validity (exploratory and confirmatory factor analysis), internal consistency (reliability measured by Cronbach's alpha coefficient) and absolute stability (measured by the test-retest method).

Results

The research results indicate satisfactory content validity of the tool (I-CVI>0.8). The reliability of the tool measured by Cronbach's alpha coefficient was high (0.86). The reliability study based on the test - retest method (after 3 weeks) showed high consistency of measurements (0.75). Exploratory factor analysis allowed extracting 1 factor, which explains 55.7% of the variance. The validity of the one-factor solution was confirmed by confirmatory factor analysis. Satisfactory goodness of fit indices were obtained (RMSEA = 0.038; PCLOSE = 0.624; AGFI = 0.966; GFI = 0.990; CFI = 0.996).

Conclusion

The presented tool has satisfactory psychometric properties. The AHPI is a tool that can be used for quick assessment of the intensity and direction of attitudes of medical students and healthcare professionals towards immigrant patients, which can help shape educational and training processes.

Understanding the Intergenerational Impact of Migration: An Adult Mortality Advantage for the Children of Forced Migrants?

BACKGROUND

Children of immigrants often have excess mortality rates, in contrast to the low mortality typically exhibited by their parents' generation. However, prior research has studied children of immigrants who were selected for migration, thereby rendering it difficult to isolate the intergenerational impact of migration on adult mortality.

METHODS

We use semiparametric survival analysis to carry out a total population cohort study estimating all-cause and cause-specific mortality among all adult men and women from age of 17 years among all men and women born in 1953-1972 and resident in Finland in 1970-2020. We compare children of forced migrants from ceded Karelia, an area of Finland that was ceded to Russia during the Second World War, with the children of parents born in present-day Finland.

RESULTS

Children with two parents who were forced migrants have higher mortality than children with two parents born in Northern, Southern, and Western Finland, but similar or lower mortality than the subpopulation of children whose parents were born in the more comparable areas of Eastern Finland. For women and men, a mortality advantage is largest for external causes and persists after controlling for socioeconomic factors.

CONCLUSION

Our findings suggest that forced migration can have a beneficial impact on the mortality of later generations, at least in the case where forced migrants are able to move to contextually similar locations that offer opportunities for rapid integration and social mobility. The findings also highlight the importance of making appropriate comparisons when evaluating the impact of forced migration.

Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review

INTRODUCTION

The 'second-generation' (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds.

SOURCES OF DATA

Peer-reviewed publications.

AREAS OF AGREEMENT

Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks.

AREAS OF CONTROVERSY

It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear.

GROWING POINTS

The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now.

AREAS TIMELY FOR DEVELOPING RESEARCH

Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.

Mortality Advantage Reversed: The Causes of Death Driving All-Cause Mortality Differentials Between Immigrants, the Descendants of Immigrants and Ancestral Natives in Sweden, 1997-2016

A small but growing body of studies have documented the alarming mortality situation of adult descendants of migrants in a number of European countries. Nearly all of them have focused on all-cause mortality to reveal these important health inequalities. This paper takes advantage of the Swedish population registers to study all-cause and cause-specific mortality among men and women aged 15-44 in Sweden from 1997 to 2016 to a level of granularity unparalleled elsewhere. It adopts a multi-generation, multi-origin and multi-cause-of-death approach. Using extended, competing-risks survival models, it aims to show (1) how the all-cause mortality of immigrants arriving as adults (the G1), immigrants arriving as children (the G1.5) and children of immigrants born in Sweden to at least one immigrant parent (the G2) differs versus ancestral Swedes and (2) what causes-of-deaths drive these differentials. For all-cause mortality, most G1 (not Finns or Sub-Saharan Africans) have a mortality advantage. This contrasts with a near systematic reversal in the mortality of the G1.5 and G2 (notably among men), which is driven by excess accident and injury, suicide, substance use and other external cause mortality. Given that external causes-of-death are preventable and avoidable, the findings raise questions about integration processes, the levels of inequality immigrant populations are exposed to in Sweden and ultimately, whether the legacy of immigration has been positive. Strengths of the study include the use of quality data and advanced methods, the granularity of the estimates, and the provision of evidence that highlights the precarious mortality situation of the seldom-studied G1.5.

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.

Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review

BACKGROUND

Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities.

OBJECTIVE

To provide up-to-date systematic evidence on migrant women's experiences of pregnancy, childbirth and maternity care in their destination European country.

SEARCH STRATEGY

CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017.

SELECTION CRITERIA

Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe.

DATA COLLECTION AND ANALYSIS

Qualitative data were extracted and analysed using thematic synthesis.

RESULTS

The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: 'Finding the way-the experience of navigating the system in a new place', 'We don't understand each other', 'The way you treat me matters', and 'My needs go beyond being pregnant'.

CONCLUSIONS

Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.

Divergent mortality patterns for second generation men of North-African and South-European origin in France: Role of labour force participation

INTRODUCTION

In France, second generation men of South-European origin were recently found to experience a mortality advantage, as opposed to second generation men of North-African origin, subjected to a large amount of excess mortality. We analyze the roles of education and labor force participation in the explanation of these contrasting mortality patterns.

MATERIALS AND METHODS

Our data consisted of a nationally-representative sample of individuals aged 18-64 years derived from the 1999 census, with mortality follow-up until 2010.

RESULTS

The two groups of second generation men, and particularly those of North-African origin, were less educated than the native-origin population, but only the latter was disadvantaged in terms of labor force participation. Relative to the native-origin population, the mortality hazard ratio for second generation men of North-African origin (HR = 1.71 [1.09-2.70]) remained significant after adjusting for level of educational attainment (HR = 1.59 [1.01-2.50]), but not after adjusting for economic activity (HR = 1.20 [0.76-1.89]) or for both variables (1.16 [0.74-1.83]). Conversely, the mortality hazard ratio for second generation men of South-European origin (HR = 0.64 [0.46-0.90]) remained unchanged after adjustment for level of educational attainment and/or economic activity.

CONCLUSION

The findings shed light on the salient role of labor market disadvantage in the explanation of the mortality excess of second generation men of North-African origin in France, and on the favorable situation of second-generation men of South-European origin in terms of labour market position and mortality. The theoretical and policy implications of the findings are discussed.

Immigration and adolescent health: the case of a multicultural population

OBJECTIVES

Previous research indicates that the impact of immigration on health tends to be specific as it is influenced by many factors such as life stage and host country. The aim of this study was to examine the relationship between immigration and adolescent health within the multicultural context of the Brussels-Capital Region in Belgium.

STUDY DESIGN

The study was based on the 2014 Health Behaviour in School-aged Children survey. The sample consisted of 2962 adolescents from the fifth grade of primary to the last grade of secondary schools in Brussels.

METHODS

Associations between health indicators and immigration status were analysed using multivariable logistic regression models adjusted for sociodemographic characteristics.

RESULTS

Natives, first-generation immigrants, second-generation immigrants with both parents born abroad and second-generation immigrants with one parent born abroad represented 19%, 23%, 36% and 22% of the respondents, respectively. Sociodemographic characteristics and health behaviours varied according to immigrant status. Young immigrants were more likely to present overweight (odds ratio [OR] _{first-generation immigrants vs. natives} = 1.76 [95% confidence interval {CI} = 1.16-2.65]; OR _{second-generation immigrants with both parents born abroad vs. natives} = 2.06 [95% CI = 1.41-3.02]; OR _{second-generation immigrants with one parent born abroad vs. natives} = 1.69 [95% CI = 1.12-2.56]). This effect turned out to be partially explained by sociodemographic status and health-related behaviours. No association was detected between immigration and self-rated health and multiple recurrent symptoms.

CONCLUSIONS

Discrepancies in health behaviours and weight status were identified between adolescents of different immigration background, whereas this was not the case for well-being. Socio-economic status, cultural characteristics and specific behaviours partly explained these findings. Future research is needed to better understand immigration-related risk and protective factors, at individual and school levels.

Adult mortality among second-generation immigrants in France: Results from a nationally representative record linkage study

BACKGROUND

France has a large population of second-generation immigrants (i.e., native-born children of immigrants) who are known to experience important socioeconomic disparities by country of origin. The extent to which they also experience disparities in mortality, however, has not been previously examined.

METHODS

We used a nationally representative sample of individuals 18 to 64 years old in 1999 with mortality follow-up via linked death records until 2010. We compared mortality levels for second-generation immigrants with their first-generation counterparts and with the reference (neither first- nor second-generation) population using mortality hazard ratios as well as probabilities of dying between age 18 and 65. We also adjusted hazard ratios using educational attainment reported at baseline.

RESULTS

We found a large amount of excess mortality among second-generation males of North African origin compared to the reference population with no migrant background. This excess mortality was not present among second-generation males of southern European origin, for whom we instead found a mortality advantage, nor among North African-origin males of the first-generation. This excess mortality remained large and significant after adjusting for educational attainment.

CONTRIBUTION

In these first estimates of mortality among second-generation immigrants in France, males of North African origin stood out as a subgroup experiencing a large amount of excess mortality. This finding adds a public health dimension to the various disadvantages already documented for this subgroup. Overall, our results highlight the importance of second-generation status as a significant and previously unknown source of health disparity in France.

Migrant mortality differences in the 2000s in Belgium: interaction with gender and the role of socioeconomic position

Background

Belgium has a long history of migration. As the migrant population is ageing, it is crucial thoroughly to document their health. Many studies that have assessed this, observed a migrant mortality advantage. This study will extend the knowledge by probing into the interaction between migrant mortality and gender, and to assess the role of socioeconomic position indicators in this paradox.

Methods

Individually linked data of the 2001 Belgian Census, the National Register and death certificates for 2001–2011 were used. Migrant origin was based on both own and parents’ origin roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Absolute and relative mortality differences by migrant origin were calculated for the most common causes of death. Moreover, the Poisson models were adjusted for educational attainment, home ownership and employment status.

Results

We observed a migrant mortality advantage for most causes of death and migrant groups, which was strongest among men. Adjusting for socioeconomic position generally increased the migrant mortality advantage, however with large differences by gender, migrant origin, socioeconomic position indicator and causes of death.

Conclusions

Adjusting for socioeconomic position even accentuated the migrant mortality advantage although the impact varied by causes of death, migrant origin and gender. This highlights the importance of including multiple socioeconomic position indicators when studying mortality inequalities. Future studies should unravel morbidity patterns too since lower mortality not necessarily implies better health. The observed migrant mortality advantage suggests there is room for improvement. However, it is essential to organize preventative and curative healthcare that is equally accessible across social and cultural strata.

Site-specific cancer mortality inequalities by employment and occupational groups: a cohort study among Belgian adults, 2001-2011

OBJECTIVE

This study probes into site-specific cancer mortality inequalities by employment and occupational group among Belgians, adjusted for other indicators of socioeconomic (SE) position.

DESIGN

This cohort study is based on record linkage between the Belgian censuses of 1991 and 2001 and register data on emigration and mortality for 01/10/2001 to 31/12/2011.

SETTING

Belgium.

PARTICIPANTS

The study population contains all Belgians within the economically active age (25-65 years) at the census of 1991.

OUTCOME MEASURES

Both absolute and relative measures were calculated. First, age-standardised mortality rates have been calculated, directly standardised to the Belgian population. Second, mortality rate ratios were calculated using Poisson's regression, adjusted for education, housing conditions, attained age, region and migrant background.

RESULTS

This study highlights inequalities in site-specific cancer mortality, both related to being employed or not and to the occupational group of the employed population. Unemployed men and women show consistently higher overall and site-specific cancer mortality compared with the employed group. Also within the employed group, inequalities are observed by occupational group. Generally manual workers and service and sales workers have higher site-specific cancer mortality rates compared with white-collar workers and agricultural and fishery workers. These inequalities are manifest for almost all preventable cancer sites, especially those cancer sites related to alcohol and smoking such as cancers of the lung, oesophagus and head and neck. Overall, occupational inequalities were less pronounced among women compared with men.

CONCLUSIONS

Important SE inequalities in site-specific cancer mortality were observed by employment and occupational group. Ensuring financial security for the unemployed is a key issue in this regard. Future studies could also take a look at other working regimes, for instance temporary employment or part-time employment and their relation to health.

Readiness to Use Psychoactive Substances Among Second-Generation Adolescent Immigrants and Perceptions of Parental Immigration-Related Trauma

OBJECTIVES

This research explores the relationship between parental immigration-related trauma and second-generation adolescent substance abuse. To examine this relationship, we focused on Ethiopian adolescents in Israel who are at risk for substance abuse. Many immigrants from Ethiopia experienced severe immigration trauma and research indicates the existence of transgenerational trauma transmission. The current research focuses on the connection between Ethiopian adolescents' perceptions of their parents' immigration trauma and their readiness to use psychoactive substances.

DESIGN

Five hundred and ten second-generation Ethiopian adolescents (Israeli-born children of Ethiopian immigrants) filled out questionnaires examining socio-demographic characteristics, immigration impact and readiness to consume alcoholic beverages and use illegal drugs.

RESULTS

Our findings show that readiness levels among Ethiopian adolescents to use psychoactive substances are relatively low, and that parental trauma only affects the readiness to consume alcohol. The levels of readiness to consume drugs were partially related to parental trauma. Conclusions/Importance: Transgenerational trauma transmission should be considered when implementing alcohol and substance abuse treatment and prevention policies among second generation immigrants. This should be done on all levels including personal, interpersonal and community levels.

Evolution of educational inequalities in site-specific cancer mortality among Belgian men between the 1990s and 2000s using a "fundamental cause" perspective

BACKGROUND

According to the "fundamental cause" theory, emerging knowledge on health-enhancing behaviours and technologies results in health disparities. This study aims to assess (trends in) educational inequalities in site-specific cancer mortality in Belgian men in the 1990s and the 2000s using this framework.

METHODS

Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on mortality. The study population comprised all Belgian men aged 50-79 years during follow-up. Both absolute and relative inequality measures have been calculated.

RESULTS

Despite an overall downward trend in cancer mortality, educational differences are observed for the majority of cancer sites in the 2000s. Generally, inequalities are largest for mortality from preventable cancers. Trends over time in inequalities are rather stable compared with the 1990s.

CONCLUSIONS

Educational differences in site-specific cancer mortality persist in the 2000s in Belgium, mainly for cancers related to behavioural change and medical interventions. Policy efforts focussing on behavioural change and healthcare utilization remain crucial in order to tackle these increasing inequalities.

Mortality in adult immigrants in the 2000s in Belgium: a test of the 'healthy-migrant' and the 'migration-as-rapid-health-transition' hypotheses

OBJECTIVE

Firstly, to map out and compare all-cause and cause-specific mortality patterns by migrant background in Belgium; and secondly, to probe into explanations for the observed patterns, more specifically into the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories.

METHODS

Data comprise individually linked Belgian census-mortality follow-up data for the period 2001-2011. All official inhabitants aged 25-54 at time of the census were included. To delve into the different explanations, differences in all-cause and chronic- and infectious-disease mortality were estimated using Poisson regression models, adjusted for age, socioeconomic position and urbanicity.

RESULTS

First-generation immigrants have lower all-cause and chronic-disease mortality than the host population. This mortality advantage wears off with length of stay and is more marked among non-Western than Western first-generation immigrants. For example, Western and non-Western male immigrants residing 10 years or more in Belgium have a mortality rate ratio for cardiovascular disease of 0.72 (95% CI 0.66-0.78) and 0.59 (95% CI 0.53-0.66), respectively (vs host population). The pattern of infectious-disease mortality in migrants is slightly different, with rather high mortality rates in first-generation sub-Saharan Africans and rather low rates in all other immigrant groups. As for second-generation immigrants, the picture is gloomier, with a mortality disadvantage that disappears after control for socioeconomic position.

CONCLUSION

Findings are largely consistent with the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. The convergence of the mortality profile of second-generation immigrants towards that of the host population with similar socioeconomic position indicates the need for policies simultaneously addressing different areas of deprivation.

Educational inequalities in young-adult mortality between the 1990s and the 2000s: regional differences in Belgium

Background

This study addresses educational inequalities in young-adult mortality between the 1990s and the 2000s by comparing trends in the three different regions in Belgium stratified by sex. Social inequalities in mortality are of major concern to public health but are rarely studied at young ages. Substantial health differences have been found between the Flemish (FR) and Walloon region (WR) concerning (healthy) life expectancy and avoidable mortality, but little is known about regional differentials in young-adult mortality, and comparisons with the Brussels-Capital Region (BCR) have thus far never been made.

Methods

Data are derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on death and emigration for the periods 01/03/1991-01/03/1999 and 01/10/2001-01/10/2009. Analyses are restricted to young adults aged 25 to 34 years at the moment of each of the censuses. Absolute (directly standardized mortality rates (ASMRs)) and relative (mortality rate ratio using Poisson regression) measures were calculated.

Results

There is a significant drop in young-adult mortality between the 1990s and the 2000s in all regions and both sexes, with the strongest decline in the BCR (e.g. ASMR of men declined from 165.6 [151.1-180.1] per 100,000 person years to 73.8 [88.3-98.3]). The mortality rates remain highest in the WR in the 2000s Between the 1990s and the 2000s, a remarkable change in the educational distribution occurred as well, with much lower proportions of primary educated in all regions in the 2000s in favour of higher proportions in all other educational levels, especially in higher education. All educational groups show lower mortality over time, except for lower educated men in the FR.

Conclusions

There is a positive evolution towards lower mortality among the young-adult Belgian population. The WR trails behind in this evolution, which calls for tailored preventive actions. Educational inequalities are marked in all regions and time periods. A more general discussion is needed on the responsibility of society in rendering support and capability to enhance the state of well-being of those not able to achieve a high social position.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-014-0059-3) contains supplementary material, which is available to authorized users.