Integration policies and immigrants’ mortality: an explorative European study

Integration policies and immigrants’ mortality: an explorative European study

Umar Ikram1, Davide Malmusi2, Knud Juel3, Gregoire Rey4, Anton Kunst1

1Department of Public Health, Academic Medical Center, Amsterdam; 2Agència de Salut Pública de Barcelona; 3National Institute of Public Health, University of Southern Denmark, Copenhagen; 4INSERM, CépiDc, Le Kremlin-Bicêtre, France

This work was supported by European Commission DG SANCO (grant number 2005122) and 7th Framework Programme (SOPHIE project, grant number 278173) Correspondence: Umar Ikram, u.ikram@amc.nl

Methods •  Mortality and population data from the Migrant Ethnic Health

Observatory project (Netherlands 1996-2006 open cohort; France 2005-07 unlinked mortality register and census data; Denmark 1992-2001 open cohort)

•  Immigrants from Turkey and Morocco, and local-born populations aged 20-69 years

•  Age-standardised mortality rates by sex, country of residence and country of birth

•  Mortality rate ratios calculated using Poisson regression

Objective To assess mortality differences among Turkish- and Moroccan-born immigrants living in three European countries with distinct types of integration policies

•  Netherlands à multiculturalist •  France à assimilationist •  Denmark à exclusionist

Background •  European countries have followed

different models of integration policy

•  Integration policies may influence migrants’ health through social determinants

•  Recently an association has been shown between country integration policy model and immigrants’ self-rated health (Malmusi 2014)

Within-country inequalities in mortality Age-adjusted Mortality Rate Ratios. Ref: Local-born population

Conclusion •  This study suggests that different macro-level policy contexts may influence immigrants' health. •  Comparable mortality registrations in Europe with detailed socio-demographic information on immigrants might help

disentangle this association

Men Women

Age-standardised mortality rate by sex, country of birth and country of residence

Migrant Integration Policy Index 2007 LCA (Meuleman & Reeskens 2008). Blue=Multiculturalist, Orange=Assimilationist, Red= Exclusionist

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Women Results •  Compared with their peers in the Netherlands, Turkish-born had

higher mortality in Denmark (MRR men 1.92; 95% CI 1.74-2.13 and women 2.11; 1.80-2.47) but lower in France (men 0.64; 0.59-0.69 and women 0.58; 0.51-0.67).

•  The mortality differences between immigrants and local-born population were largest in Denmark and lowest in France.

•  These patterns were consistent across all age groups, and more marked for cardiovascular diseases.

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