Integration policies and immigrants’ mortality: an explorative European study Umar Ikram 1 , Davide Malmusi 2 , Knud Juel 3 , Gregoire Rey 4 , Anton Kunst 1 1 Department of Public Health, Academic Medical Center, Amsterdam; 2 Agència de Salut Pública de Barcelona; 3 National Institute of Public Health, University of Southern Denmark, Copenhagen; 4 INSERM, 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, [email protected] 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 multiculturalist • France assimilationist • Denmark 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 0,5 1,0 2,0 Netherlands France Denmark Netherlands France Denmark Turkish born Moroccan-born MRR Men 0,5 1,0 2,0 Netherlands France Denmark Netherlands France Denmark Turkish born Moroccan-born MRR 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. 0 100 200 300 400 500 600 700 800 900 1000 Age-standardised mortaltiy rate (per 100,000 PY) Netherlands France Denmark