Abstract
BackgroundMortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain.MethodsCross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012–2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death.ResultsThe age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7–45.2) for the Spanish-born population, 29.3 (95%CI 26.7–32.1) for the foreign-born population, and 18.4 (95%CI 15.6–21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5–0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years.ConclusionsMortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.
Highlights
Mortality is a robust indicator of health and offers valuable insight into the health of immigrants
428 deaths corresponded to non-nationals who were born outside Spain, while 376 corresponded to Spanish nationals who were born outside Spain
Differences were non-existent or minimal for individuals of European, North American and Asian origin, but significant for other geographical areas, with higher mortality estimates observed when immigrant status was based on place of birth versus nationality
Summary
Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. Mortality estimates can vary significantly depending on the manner in which immigrant status is defined. We assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain. Recent years have seen growing interest in the health status and health determinants of immigrant populations [3,4,5,6], the impact of their care on health systems [7, 8], and the design of strategies to improve their health [9]. Other authors use more general definitions, e.g., a person who has established a (semi-) permanent new residence in a “place” other than that in which they habitually lived [11]. The terms immigrant and foreigner or foreign-born are used interchangeably
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