The MEHO project Mortality of migrant groups in different European countries Anton Kunst for the MEHO mortality working group Departments of Public Health.

The MEHO projectThe MEHO project

Mortality of migrant groups in Mortality of migrant groups in different European countriesdifferent European countries

Anton Kunst Anton Kunst

for the MEHO mortality working groupfor the MEHO mortality working group Departments of Public Health ofDepartments of Public Health ofAMC AmsterdamAMC Amsterdam& Erasmus MC Rotterdam& Erasmus MC Rotterdam

This project is funded under the framework of Public Health Programme 2003-2008 of the European Commission (contract number 2005122)

Migrants are usually compared to Migrants are usually compared to native populations: headlines of native populations: headlines of newspapersnewspapers

““Young Moroccans have 10 times more risk of Young Moroccans have 10 times more risk of schizophrenia” schizophrenia”

““ More suicide attempts by Turkish and Surinamese”

““Elderly migrants more often depressive” Elderly migrants more often depressive”

Looking at other European Looking at other European countries: countries: what can be learned?what can be learned?

If migrant-native inequalities are similar across If migrant-native inequalities are similar across Europe:Europe:- identify common European patterns- identify common European patterns- generalise results from individual countries- generalise results from individual countries

If migrant-native inequalities differ between If migrant-native inequalities differ between countries:countries:- learn from countries with small inequalities- learn from countries with small inequalities- identify the role of “national” factors - identify the role of “national” factors

ObjectiveObjective

Specific objective:Specific objective:To assess whether European countries have To assess whether European countries have similar migrant-native inequalities in mortalitysimilar migrant-native inequalities in mortality

General aim:General aim:To explore the potentials of an international To explore the potentials of an international data set created in the MEHO projectdata set created in the MEHO project

Data sets constructed in MEHO (1)Data sets constructed in MEHO (1)

Countries: Scotland, England/Wales, Denmark, Sweden, Countries: Scotland, England/Wales, Denmark, Sweden, Netherlands, Belgium, France, Spain, Italy, Estonia, Netherlands, Belgium, France, Spain, Italy, Estonia, Latvia Latvia

Mostly cross-sectional studies, around the year 2000Mostly cross-sectional studies, around the year 2000Longitudinal studies: Denmark, Sweden, Netherlands, Longitudinal studies: Denmark, Sweden, Netherlands, BelgiumBelgium

Nationally representative populationsNationally representative populations

Data problems carefully evaluated Data problems carefully evaluated

Data sets constructed in MEHO (2)Data sets constructed in MEHO (2)

Measure of ethnicity and migrant status: Measure of ethnicity and migrant status: – self-identity (Estonia, Latvia)self-identity (Estonia, Latvia)– nationality (Italy)nationality (Italy)– country of birth of subjects and their parents (other)country of birth of subjects and their parents (other)

Country-of-birth groupingsCountry-of-birth groupings– aimed to cover largest immigrants groups per aimed to cover largest immigrants groups per

countrycountry

– great diversity between European countriesgreat diversity between European countries

Preliminary data analysisPreliminary data analysis

Age group 40 to 54 yearsAge group 40 to 54 years

Age-standardised mortality rates Age-standardised mortality rates (indirect standardisation)(indirect standardisation)

Ratio to the rates for native population (=SMR)Ratio to the rates for native population (=SMR)

All-cause mortality onlyAll-cause mortality only

Results (1) Migrant-native Results (1) Migrant-native inequalities: migrants from Latin inequalities: migrants from Latin America and ChinaAmerica and China

00.10.20.30.40.50.60.70.80.91

Sp

ain

Fra

nce

Sco

tlan

d

Sp

ain

Fra

nce

Sco

tlan

d

Den

mar

k

Latin America China

Rat

e ra

tio (n

atio

n =

1.0

)

Results (2) Migrant-native Results (2) Migrant-native inequalities: migrants from Turkey inequalities: migrants from Turkey and Moroccoand Morocco

0

0.2

0.4

0.6

0.8

1

1.2F

ran

ce

Bel

giu

m

Net

her

l

Den

mar

k

Sp

ain

Fra

nce

Bel

giu

m

Net

her

l

Den

mar

k

Turkey Morocco

Rat

e ra

tio (n

atio

n =

1.0

)

Results (3) Absolute mortality rates Results (3) Absolute mortality rates of Moroccan and native populationsof Moroccan and native populations

0

0.5

1

1.5

2

2.5

3

3.5

Spain France Belgium Netherlands Denmark

Dea

th r

ate

(per

100

0)

Moroccan Native

Results (4) Migrant-native Results (4) Migrant-native inequalities: migrants from SSA and inequalities: migrants from SSA and PolandPoland

0.8

1

1.2

1.4

1.6

1.8

2

2.2

2.4S

pai

n

Fra

nce

En

gla

nd

Sco

tlan

d

Sp

ain

Fra

nce

Bel

giu

m

Den

mar

k

Sub-Saharan Africa Poland

Rat

e ra

tio (n

atio

n =

1.0

)

Results (4) Migrant-native Results (4) Migrant-native inequalities: migrants from SSA and inequalities: migrants from SSA and PolandPoland

0.8

1

1.2

1.4

1.6

1.8

2

2.2

2.4S

pai

n

Fra

nce

En

gla

nd

Sco

tlan

d

Sp

ain

Fra

nce

Bel

giu

m

Den

mar

k

Sub-Saharan Africa Poland

Rat

e ra

tio (n

atio

n =

1.0

)

Results (5) Absolute mortality rates Results (5) Absolute mortality rates of SSA migrants and native of SSA migrants and native populationspopulations

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Spain France England Scotland

Dea

th r

ate

(per

100

0)

African Native

Results (6) Absolute mortality rates Results (6) Absolute mortality rates of migrants from specific SSA of migrants from specific SSA countriescountries

0

1

2

3

4

5

6

Eas

tA

fric

a

Sou

thA

fric

a

Oth

erS

SA

Cam

erou

n

Con

go

Cot

ed'

Ivoi

re Mal

i

Sen

egal

Oth

erS

SA

England France

Mor

talit

y ra

te (p

e 10

00)

SummarySummary

• Do European countries have similar migrant-Do European countries have similar migrant-native inequalities in mortality?native inequalities in mortality?

- yes: migrants from Latin America, China- yes: migrants from Latin America, China

- partly: migrants from Morocco and Turkey - partly: migrants from Morocco and Turkey (larger in Denmark) (larger in Denmark)

- no: migrants from Poland (larger in Spain)- no: migrants from Poland (larger in Spain) Sub-Saharan Africa (larger in France) Sub-Saharan Africa (larger in France)

Looking at other European Looking at other European countries: countries: what can be learned?what can be learned?

If migrant-native inequalities are similar across If migrant-native inequalities are similar across Europe:Europe:- identify common European patterns- identify common European patterns- generalise results from individual countries- generalise results from individual countries

If migrant-native inequalities differ between If migrant-native inequalities differ between countries:countries:- learn from countries with small inequalities- learn from countries with small inequalities- identify the role of “national” factors - identify the role of “national” factors

Does it matter Does it matter where migrants where migrants

move to?move to?

Further work in the MEHO mortality Further work in the MEHO mortality partpart

Analyses of specific causes of death: Analyses of specific causes of death: - infectious diseases- infectious diseases- cancer- cancer- cardiovascular diseases- cardiovascular diseases- diabetes mellitus- diabetes mellitus

Analysis of specific groupsAnalysis of specific groups- Polish immigrants to 7 countries - Polish immigrants to 7 countries - Russians in Estonia, Latvia and adjacent Russia- Russians in Estonia, Latvia and adjacent Russia

Factors that may influence migrant-Factors that may influence migrant-native inequalitiesnative inequalities

Factors related to migration flows:Factors related to migration flows:- different origins: countries, or groups with - different origins: countries, or groups with countries countries - different migration flows: e.g. Polish- different migration flows: e.g. Polish

Factors related to host country:Factors related to host country:- general host environment, including - general host environment, including epidemiologyepidemiology- position of migrants with host society- position of migrants with host society