Healthy migrants but unhealthy offspring? A retrospective cohort study among Italians in Switzerland.

Silvan Tarnutzer,Matthias Bopp

doi:10.1186/1471-2458-12-1104

Abstract

BackgroundIn many countries, migrants from Italy form a substantial, well-defined group with distinct lifestyle and dietary habits. There is, however, hardly any information about all-cause mortality patterns among Italian migrants and their offspring. In this paper, we compare Italian migrants, their offspring and Swiss nationals.MethodsWe compared age-specific and age-standardized mortality rates and hazard ratios (adjusted for education, marital status, language region and period) for Swiss and Italian nationals registered in the Swiss National Cohort (SNC), living in the German- or French-speaking part of Switzerland and falling into the age range 40–89 during the observation period 1990–2008. Overall, 3,175,288 native Swiss (48% male) and 224,372 individuals with an Italian migration background (57% male) accumulated 698,779 deaths and 44,836,189 person-years. Individuals with Italian background were categorized by nationality, country of birth and language.ResultsFirst-generation Italians had lower mortality risks than native Swiss (reference group), but second-generation Italians demonstrated higher mortality risks. Among first-generation Italians, predominantly Italian-speaking men and women had hazard ratios (HRs) of 0.89 (95% CI: 0.88-0.91) and 0.90 (0.87-0.92), respectively, while men and women having adopted the regional language had HRs of 0.93 (0.88-0.98) and 0.96 (0.88-1.04), respectively. Among second-generation Italians, the respective HRs were 1.16 (1.03-1.31), 1.06 (0.89-1.26), 1.10 (1.05-1.16) and 0.97 (0.89-1.05). The mortality advantage of first-generation Italians decreased with age.ConclusionsThe mortality risks of first- and second-generation Italians vary substantially. The healthy migrant effect and health disadvantage among second-generation Italians show characteristic age/sex patterns. Future investigation of health behavior and cause-specific mortality is needed to better understand different mortality risks. Such insights will facilitate adequate prevention and health promotion efforts.

Highlights

In many countries, migrants from Italy form a substantial, well-defined group with distinct lifestyle and dietary habits
With the Swiss National Cohort, we substantially reduce the over-coverage and other numerator/denominator problems occurring in mortality analyses among migrant populations
We investigate the hypotheses that compared to native Swiss (1) Italian immigrants possess an all-cause mortality advantage whereas (2) their offspring demonstrate higher all-cause mortality risk, but differences in mortality are (3) moderated by the adoption of Swiss regional languages

Summary

Introduction

Migrants from Italy form a substantial, well-defined group with distinct lifestyle and dietary habits. Low SES has been shown to be related to unfavorable health behavior, opportunities and outcomes (e.g., physical inactivity, smoking, unhealthy dietary habits, difficulties in accessing health services, morbidity and mortality) [6,7,8]. This phenomenon of lower mortality in the socioeconomically disadvantaged Latino population in the U.S was called the “Latino mortality paradox” [9]. This term was later modified in the European context to “Mediterranean migrants’ mortality paradox” [10]

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