Foreign-born People Research Articles

Experiences of discrimination in Finnish healthcare services

Abstract Background It has been found that foreign-born people report more discrimination than the general population. This study examines experiences of discrimination in Finnish healthcare, with a focus on individuals with a foreign background. Methods Two nationally representative cross-sectional data sets were used: MoniSuomi (n = 7838; response rate 44.1%) and Healthy Finland Surveys (n = 28154; response rate 46.3%). The outcome variable, experiences of discrimination, was predicted by means of stepwise logistic regression models covering (1) socioeconomic factors, (2) factors related to healthcare service need and use, and (3) migration-related factors. Results In healthcare services, migrants experienced discrimination more than twice as frequently as the general population (8.9% versus 3.6%, 95% CI = 8.0-9.8, 3.2-4.1). According to regression models, relevant factors were insufficient income, being female, studying as the main occupation and poor mental and physical health. Foreign background was not independently associated with discrimination. However, higher educational attainment, chronic disease, and use of occupational healthcare services increased the likelihood of experiencing discrimination only among those of foreign background and showed the opposite trend for the general population. All migration-related factors increased the risk of discrimination. Conclusions The findings underline the need for training on explaining the service system, overcoming language barriers, and working with forced migrants. The occupational healthcare workforce would particularly benefit from these interventions. The results inform the development of professionals’ training. Key messages • Migrants experience higher levels of discrimination in healthcare compared to the general population. Multiple factors explain this difference. • Healthcare professionals require training to better inform patients about the service system, to improve communication and to address the situation of forced migrants.

Experiences of victimization before resettlement and chronic disease among foreign-born people in the United States

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003–04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease.

Bortom servicefronten. E-handelsarbetets platser och ojämlikhetsmönster

The digitalization of retailing is restructuring consumption as well as retail work. Unlike front-line service work in stores, online retail work is defined by indirect service work at a distance from customers at warehouse sites. The rapid pace of change means that knowledge about online retail workplaces and its employees is still fragmentary. Empirically drawing on Swedish national statistics and an ongoing study of five online retail warehouses, this article explores intersections of online retail warehousing, gender and racialization, and meanings of place therein. National statistics show that online retail employs more men and more foreign-born than retailing in general. While retailing is dominated by small workplaces, online retail warehouses are either small or large and the proportion of women and Swedish-born is lower at the larger warehouses than the small ones. Occupational data show that the proportion of women and foreign-born people is significantly lower among online retail managers than among warehouse workers. Further nuances are provided by the qualitative insights from the five studied warehouses. Almost only women worked in the two smaller warehouses, which was explained by references to the nature of the work. At the larger, more gender-balanced warehouses, examples of segregation between employees of the same category were found, as was the importance of place for hierarchies between workers and managers. More so, the study makes evident that place matters also for the boundary making around and between online retail workplaces, especially in relation to racialization processes. While inequality, place and work in retail stores are about conditional access to employment, in online retail warehouses the matter seems to be more about how certain bodies’ lack of mobility and opportunities in the labor market at large left them “stuck” in online retailing.

Social support as perceived, provided and needed by family-members of migrants with type 2 diabetes – a qualitative study

BackgroundSocial support provided by a family member has been found to have a buffering effect on distress and is associated with better diabetes self-care. This study explores the meaning of social support, as described by close family members of foreign-born people living with type 2 diabetes (PWDM) in Sweden. It also explores the support provided by family members, and the support they need to be able to support the PWDM.MethodsQualitative explorative study, semi-structured interviews for data collection. Qualitative content analysis based on a theoretical framework on social support. Purposive sample of 13 family members, 18–52-years-old, born in countries in the Middle East, Africa, and Russia.ResultsThe meaning of support was described as social and emotional. Most participants described a stressful situation; feelings of sadness/worry about the risk of the PWDM developing complications added to a strained life situation from which one could not opt out. Frequent daily contacts in a family network were evident, particularly by children trained as healthcare professionals. Caring for a family member was considered a filial piety, but it was also a chance to reciprocate. The support provided was mainly informational (e.g., reminders about nutritional intake), but it was also instrumental/practical (administering medicines, helping with economy/logistics, planning/cooking meals, basic care) and emotional (sharing meals, thoughts, and activities). The support the family members needed was getting first-hand information by attending the physician visits, being able to book appointments themselves at suitable times, and preventing the withholding of important information about the PWDM. They also desired an open telephone-line, oral and written information, particularly on diet.ConclusionsTo family-members, supporting the PWDM was normal and a filial piety. Support provided and needed was not only informational but also instrumental/practical and emotional. In diabetes care, addressing foreign-born individuals, diabetes education needs to be developed, also including family members. Informational material, particularly on diet, and improved access to healthcare and information about the healthcare system have the potential to increase family members’ control over the situation and prevent a negative trajectory in caregiving with perceived demands causing high levels of stress.

Assessing Racial and Ethnic Disparities in Timing of Pregnancy Related Deaths.

Existing research documents significant racial disparities in pregnancy-related deaths in the United States. Recently, the National Center for Health Statistics (NCHS) identified inconsistencies in maternal mortality data due to irregularities in previous data collection. Yet, corrections of the data still highlight stark differences across racial identity. Additionally, data indicates that while many people die during labor and delivery, a considerable percentage of people die up to a year postpartum. To assess disparities in the timing of pregnancy-related deaths using corrected data, we analyzed aggregated vital statistics data from 2015 to 2018 (n = 4,261). We present relative risk ratios from multinomial logistic regressions to examine the association between race and ethnicity and the timing of pregnancy-related deaths (pregnant at the time of death, 42 days post pregnancy, and 43 days to one-year post pregnancy). Results highlight significant differences in the distribution of timing of pregnancy-related deaths across nativity status and geographic region. Findings document a disproportionate percentage of pregnancy-related deaths among foreign-born people who give birth. Overall, results suggest extending our framing of postpartum care beyond a hospital stay.

Testing the Hypothesis of the Economic Assimilation of Immigrants: Türkiye Case

The labor market adaptation of foreign-born individuals in Türkiye is examined in this research. It tests the Immigrant Assimilation Hypothesis for Türkiye with this aim. The primary research question of this work is, " In Türkiye, could foreign-born people improve their labor market outcomes more rapidly than native people?" Thus, this paper's goals include determining the wage disparity between native-born workers and immigrants and the takeover point. TurkStat's Household Labour Force Surveys, conducted between 2009 and 2020, are used for this purpose. First, the logistic regression method assesses the disparities between labor force participation and employment rates of natives and immigrants. Then, the ordinary least squares method assesses the wage disparity between native-borns and foreign-borns. The main results of this approach are that immigrants' earnings are equalized in 20-25 years after migration, which is also the takeover point against natives. This investigation shows that the wage penalty for recent immigrants is 20%. As a result, after spending years in Türkiye, immigrants integrate into the labor market.

A qualitative study on diverse experiences of medication safety among foreign-born persons living in Sweden

BackgroundThe ongoing global migration has led to multicultural societies, with many migrants who do not speak the official language in the host country. This could contribute to communication problems with staff in healthcare and a risk to patient safety. Research on patient safety in medication use in migrants is an under-researched area. The aim was to explore diverse foreign-born people’s experiences and perceptions of self-management of medication and determine if home-based practice patterns have implications on medication safety, and what factors may support safe medication use.MethodsA qualitative explorative study, with individual semi-structured interviews and participant observations in the patients’ home. Qualitative content analysis was applied.ResultsA purposeful sample of 15 foreign-born persons identified by healthcare staff as having language difficulties in Swedish that may pose a safety risk in connection with medication use at home, was selected. Three categories were identified. The first category showed respondents being dependent on another person, having experiences of not receiving information about their medications due to language barriers, having difficulties getting access to the healthcare centre and feeling distrusted/misunderstood. The second category showed respondents being independent and self-motivated Although they struggled, they managed to get access/contact with the healthcare centre themselves and felt understood/listened to by the staff. The last category concerned factors that facilitating medication use; such as having a medication list in the respondents’ own language and offering a choice of language on the answering machine at the healthcare centre. Although they knew it was impossible to get an interpreter at the pharmacy, they felt safe knowing there was always a solution for receiving understandable information.ConclusionThe findings highlighted that language barriers can complicate the communication between migrants and the healthcare, which can affect the medication safety. Understanding of this group is essential to improve the cooperation between patients and staff, leading to culturally congruent care. This knowledge should be used in healthcare to understand the gap in communication to increase patient safety. Further research from other angles, e.g. pharmacy/healthcare staff and relatives is needed to identify and evaluate facilitation to improve the outcome of the intended medication treatment.

Ethnic closure and immigrant residential segregation in Spanish working-class neighbourhoods

Given the difficulties of integration of the immigrant population and the demographic importance that this population is set to have in European society, this research uses an initial territorial approach and a subsequent qualitative analysis to study the internal residential dynamics of immigrants in five Spanish working-class neighbourhoods with a significant presence of foreign-born people. The analysis focuses on the role that ethnic prejudice and other factors, such as social class, play in the processes of initiation and maintenance of residential segregation of the immigrant population. Our results show a residential division characterised by advantages for the native population and, especially, by the acceptance of inequality by the immigrant population, which may be contributing to the fact that levels of ethnic prejudice from the native population are, so far, not very high in these neighbourhoods.

Satisfaction With Primary Care Among the Foreign-Born and the General Population in Finland: A Survey-Based study.

Foreign-born people have been found to be less satisfied with health care than native populations across countries. However, studies on differences in satisfaction with treatment between different foreign-born groups are lacking. This study explores differences in satisfaction with primary health care between the foreign-born population from different regions of origins and the general population of Finland. The study uses survey data on foreign-born population (n = 2708) and general population (n = 6671) living in Finland who report using health services. Satisfaction with experienced respect for privacy during treatment, benefit of treatment and smoothness of treatment are predicted by region of origin using logistic regression. Almost all foreign-born groups were less likely to consider treatment appointments beneficial as compared to the general population. Some foreign-born groups (people from Southeast Asia and South and Central Asia) were more satisfied with smoothness of care compared to general population. People from East Asia were less likely than the general population to consider that their privacy had been respected during the examinations and treatment. While we made the positive finding of high overall satisfaction with treatment, we also found important differences between groups. In particular, appointments were found less useful among the foreign-born population. Perceived unusefulness of treatment might lead to underuse of health care, which might result in accumulation of untreated health problems. The results point toward potential development points in the health care system. Addressing these issues might help decrease health disparities between population groups.

The prevalence of tuberculosis infection among foreign-born Canadians: a modelling study.

The prevalence of tuberculosis infection is critical to the design of tuberculosis prevention strategies, yet is unknown in Canada. We estimated the prevalence of tuberculosis infection among Canadian residents born abroad. We estimated the prevalence of tuberculosis infection by age and year of migration to Canada for people from each of 168 countries by constructing country-specific and calendar year-specific trends for annual risk of infection using a previously developed model. We combined country-specific prevalence estimates with Canadian Census data from 2001, 2006, 2011, 2016 and 2021 to estimate the overall prevalence of tuberculosis infection among foreign-born Canadian residents. The estimated overall prevalence of tuberculosis infection among foreign-born people in Canada was 25% (95% uncertainty interval [UI] 20%-35%) for census year 2001, 24% (95% UI 20%-33%) for 2006, 23% (95% UI 19%-30%) for 2011, 22% (95% UI 19%-28%) for 2016 and 22% (95% UI 19%-27%) for 2021. The prevalence increased with age at migration and incidence of tuberculosis in the country of origin. In 2021, the estimated prevalence of infection among foreign-born residents was lowest in Quebec (19%, 95% UI 16%-24%) and highest in Alberta (24%, 95% UI 21%-28%) and British Columbia (24%, 95% UI 20%-30%). Among all foreign-born Canadian residents with tuberculosis infection in 2021, we estimated that only 1 in 488 (95% UI 185-1039) had become infected within the 2 preceding years. About 1 in 4 foreign-born Canadian residents has tuberculosis infection, but very few were infected within the 2 preceding years (the highest risk period for progression to tuberculosis disease). These data may inform future tuberculosis infection screening policies.

1883. Features and Outcomes of Tuberculosis in Documented versus Undocumented Migrants in Israel

Abstract Background In countries with low tuberculosis (TB) incidence, most TB cases are observed in foreign-born individuals, including permanent immigrants, and undocumented migrants. There is limited information regarding the differences within these groups. In Israel, where TB prevalence is &amp;lt; 2 cases/100,000 persons, 85% of TB cases occur in foreign-born people. We examined risk factors, clinical course, and outcomes between documented and undocumented immigrants hospitalized with active TB. Methods A retrospective analysis of medical records from foreign-born active TB patients admitted to a 700-bed hospital in the center of Israel between January 1st, 2019, to March 31st, 2023. We included patients who initiated TB treatment during hospitalization and were discharged by April 2023. Undocumented migrants were defined as non-Israeli citizens without medical insurance. We summarized their clinical characteristics, course, and outcomes. Results 48 patients were included, 21 (43.8%) were undocumented migrants. Undocumented migrants were younger (mean age 40.9 vs. 53.0 years, P&amp;lt; 0.001) and predominantly arrived from Africa (95.2% vs. 29.6%, P&amp;lt; 0.001). The prevalence of HIV was similar between both groups. Presenting symptoms, duration of symptoms before admission, rates of bilateral and cavitary pulmonary disease, and extrapulmonary disease were comparable. Multi-drug resistant TB was rare (0% vs. 11.5%, P=0.242). Among patients with positive sputum smears and follow-up, undocumented migrants experienced a longer time to achieve negative sputum cultures (76.0 days vs. 36.8 days, P=0.004), and hospitalizations lasting over 30 days were also more common among undocumented migrants (71.4% vs. 40.7%, P=0.045). Multivariate analysis identified undocumented migrant status, thrombocytosis, and bilateral and cavitary pulmonary disease as risk factors for prolonged hospitalization. Conclusion Although the clinical features of TB were similar between documented and undocumented migrants, the response to treatment was slower, and hospital stays were longer among undocumented migrants. This may be due to undocumented migrants presenting with more advanced disease or lack of suitable conditions for isolation and treatment at home. Disclosures Yasmin Maor, MD, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Honoraria|Gilead: Honoraria|GSK: Honoraria|kamada: Honoraria|Medison: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria

Tuberculosis incidence in foreign-born people residing in European countries in 2020.

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

Migration Spurs Changes in the Human Microbiome: a Review.

International migration often results in major changes in living environments and lifestyles, and these changes may lead to the observed increases in obesity and diabetes among foreign-born people after resettling in higher-income countries. A possible mechanism linking changes in living environments to the onset of health conditions may be changes in the microbiome. Previous research has shown that unfavorable changes in the composition of the microbiome can increase disposition to diseases such as diabetes, obesity, kidney disease, and inflammatory bowel disease. We investigated the relationship between human migration and microbiome composition through a review using microbiome- and migration-related search terms in PubMed and Web of Science. We included articles examining the gut, oral, or oropharyngeal microbiome in people who migrated internationally. Nine articles met eligibility criteria. All but one examined migration from a non-Western to a Western country. Four of these found a difference in the microbiome of migrants compared with non-migrating residents of their country of birth, seven found differences in the microbiome of migrants compared with the native-born population in the country of resettlement, and five found microbiome differences associated with duration of stay in the country of resettlement. Microbiome composition varies with country of birth, age at migration, time since immigration, and country of resettlement. The results suggest that migration may lead to changes in the microbiome; thus, microbiome characteristics are a plausible pathway to examine changes in health after resettlement in a new country.

Mellan empowerment och disempowerment

Between empowerment and disempowerment – coordinating work for the establishment of newly-arrived migrants and foreign-born people in the labour market within local activation policy Increasing the employment rate and community establishment, as well as decreasing economic and social vulnerability, among newly-arrived migrants and foreign-born jobseekers are the objectives behind several local activation initiatives and projects around Sweden. This article is based on a study of a local activation project, primarily consisting of analyses of interviews with professional coordinators and other project actors. The aim of the article is to deepen the knowledge of the coordinated working method in local activation policy by critically analysing how different ideas about empowerment are part of the method and what significance this has in relation to newly-arrived migrants and foreign-born job seekers. The results show that the coordinating approach is based on principles that place the job-seeking individual's needs at the centre and that there is a tension in the working method between activation and labour market establishment, and social support and care. The studied activation project is based on both a liberal and radical ideology of empowerment. In practising the coordinating approach, however, a liberal ideology and understanding of empowerment dominate through its strong individual focus. The radical empowerment ideology with its structure-changing ambitions regarding the participants’ increased self-sufficiency, independence and empowerment are to a limited extent enforced within the project. The authors argue for the difficulties of using the concept of empowerment and its far-reaching liberation ambitions within the context of activation policy. Nevertheless, disciplining requirements and rules around self-sufficiency, individualised responsibility takeover and requirements for reciprocity within the activation of activities rather risk consolidating conditions of disempowerment for already vulnerable groups of job seekers.

Toward an emerging model of healthcare access: A theoretical framework.

To conceptualize an emerging framework of healthcare access for foreign-born persons based on well-known access models in the United States. The COVID-19 outbreak significantly impacted all global communities, disproportionately affecting people of color and highlighting preexisting health disparities. Health and immigration policies concerning healthcare access for foreign-born people were examined. Regarding access to social benefits in the United States, the Affordable Care Act underscored initial restrictions imposed by the Deficit Reduction Act of 2005 and the Personal Responsibility and Work Opportunity Reconciliation Act in 1996 on certain underserved groups. Guided by the study's aim, electronic databases, including Scopus, PubMed, Web of Science, and CINAHL, were queried for relevant nursing-related literature published on Penchansky's and Andersen's models from 1968 to 2022. Compared with Penchansky's model, Andersen's model outcome measures have evolved over the years in response to dynamic health policy issues. Penchansky's model has five constructs in its original form, whereas Andersen's model has three. The current study shows that each existing access model provides a unique method for evaluating various policies. In some cases, the studies are limited to a simple application of the original model with few modifications in studies specific to foreign-born groups in the United States. There is a dearth of systematic theorization of access that incorporates social justice and health equity. Health disparities were further explained using metrics from existing access models. An emerging access model conceptualizing existing access models was proposed, using constructs framed within the basic tenets of health equity and social justice. Applying the emerging model's constructs to future studies is anticipated to highlight opportunities for stakeholders such as policymakers, healthcare providers, nursing professionals, and community leaders to support programs that could further reduce health disparities.

Comparing Risk Factors for Prison Victimization Between Foreign-Born and Native-Born Incarcerated People

Prior research on violent victimization in prison suggests noncitizens may be less likely to experience violence while incarcerated. In an attempt to better understand this relationship, this study examined whether citizenship status predicts risk among a subsample of foreign-born incarcerated people. In addition, we modeled violent victimization separately for foreign-born and native-born individuals to identify any differences in risk factors between groups. We tested these relationships using a sample of 7,326 individuals incarcerated in Minnesota state prisons. The results of Cox regression models showed foreign-born citizens and foreign-born noncitizens had similar risk for violent prison victimization. We also found that some risk factors for victimization differed across native-born and foreign-born incarcerated people.

Slaves, Migrants and the Stateless

Proponents of barring the children of undocumented immigrants from birthright citizenship allege that the United States (‘US’) Constitution’s 14th Amendment was intended to give full citizenship to former slaves and their progeny, and not to benefit the children of foreign-born people. A real-world example that illustrates the dangers of so restricting birthright citizenship is the Dominican Republic, where legal measures have already excluded the children of out-of-status immigrants (who are mostly of Haitian ancestry) from eligibility for birthright citizenship. The effect of this has not been ethnically cleansing Haitian descendants from the Dominican Republic so much as confining them within the country as a stateless underclass of people. The Dominican case therefore shows that US opponents of birthright citizenship for the children of out-of-status non-citizens must answer to the danger that their proposal would create a legally approved hereditary underclass on US soil, more than a century after the abolition of chattel slavery.

Understanding Health Care Utilization and Occupational Exposures of Labor-Trafficked People

Abstract: Objectives. To describe health care utilization and occupational exposures during trafficking among foreign-born people labor-trafficked in the U.S. Methods. Retrospective analysis of immigration files for health data among 114 labor-trafficked individuals. Results. Mean age was 30. Files of 38% mentioned accessing medical services at least once, mostly via hospitals (73%-81%). Forty-three percent (43%) had U.S. citizen children—indicating their children and spouses interacted with social and medical systems during exploitation. Almost all (97%) had limited English proficiency, and 75% did not have legal immigration status. Employers/traffickers interfered with access to health care and forced victims to work while injured. Half (50%) had sick family members. Victims reported physical and sexual abuse, toxic and environmental occupational exposures, and sleep disturbances. Conclusions. This is the largest study to elucidate health concerns and care utilization patterns among labor-trafficked people. Concerted resources must be dedicated to understanding health needs and health systems intervention opportunities for labor-trafficked people.

“Healthy immigrant effect” among individuals experiencing homelessness in Spain?: Foreign-born individuals had higher average age at death in 15-year retrospective cohort study

BackgroundIndividuals experiencing homelessness (IEHs) suffer from severe health inequities. Place of origin is linked to health and mortality of IEHs. In the general population the “healthy immigrant effect” provides a health advantage to foreign-born people. This phenomenon has not been sufficiently studied among the IEH population. The objectives are to study morbidity, mortality, and age at death among IEHs in Spain, paying special attention to their origin (Spanish-born or foreign-born) and to examine correlates and predictors of age at death.MethodsRetrospective cohort study (observational study) of a 15-year period (2006–2020). We included 391 IEHs who had been attended at one of the city’s public mental health, substance use disorder, primary health, or specialized social services. Subsequently, we noted which subjects died during the study period and analyzed the variables related to their age at death. We compared the results based on origin (Spanish-born vs. foreign-born) and fitted a multiple linear regression model to the data to establish predictors of an earlier age at death.ResultsThe mean age at death was 52.38 years. Spanish-born IEHs died on average almost nine years younger. The leading causes of death overall were suicide and drug-related disorders (cirrhosis, overdose, and chronic obstructive pulmonary disease [COPD]). The results of the linear regression showed that earlier death was linked to COPD (b = − 0.348), being Spanish-born (b = 0.324), substance use disorder [cocaine (b =-0.169), opiates (b =.-243), and alcohol (b =-0.199)], cardiovascular diseases (b = − 0.223), tuberculosis (b = − 0.163), high blood pressure (b =-0.203), criminal record (b =-0.167), and hepatitis C (b =-0.129). When we separated the causes of death for Spanish-born and foreign-born subjects, we found that the main predictors of death among Spanish-born IEHs were opiate use disorder (b =-0.675), COPD (b =-0.479), cocaine use disorder (b =-0.208), high blood pressure (b =-0.358), multiple drug use disorder (b =-0.365), cardiovascular disease (b =-0.306), dual pathology (b =-0.286), female gender (b =-0.181), personality disorder (b =-0.201), obesity (b =-0.123), tuberculosis (b =-0.120) and having a criminal record (b =-0.153). In contrast, the predictors of death among foreign-born IEHs were psychotic disorder (b =-0.134), tuberculosis (b =-0.132), and opiate (b =-0.119) or alcohol use disorder (b =-0.098).ConclusionsIEHs die younger than the general population, often due to suicide and drug use. The healthy immigrant effect seems to hold in IEHs as well as in the general population.

All-Cause, Cardiovascular, and Stroke Mortality Among Foreign-Born Versus US-Born Individuals of African Ancestry.

Background Little is known about the effect of region of origin on all-cause mortality, cardiovascular mortality, and stroke mortality among Black individuals. We examined associations between nativity and mortality (all-cause, cardiovascular, and stroke) in Black individuals in the United States. Methods and Results Using the National Health Interview Service 2000 to 2014 data and mortality-linked files through 2015, we identified participants aged 25 to 74 years who self-identified as Black (n=64 717). Using a Cox regression model, we examined the association between nativity and all-cause, cardiovascular, and stroke mortality. We recorded 4329 deaths (205 stroke and 932 cardiovascular deaths). In the model adjusted for age and sex, compared with US-born Black individuals, all-cause (hazard ratio [HR], 0.44 [95% CI, 0.37-0.53]) and cardiovascular mortality (HR, 0.66 [95% CI, 0.44-0.87]) rates were lower among Black individuals born in the Caribbean, South America, and Central America, but stroke mortality rates were similar (HR, 1.01 [95% CI, 0.52-1.94]). African-born Black individuals had lower all-cause mortality (HR, 0.43 [95% CI, 0.27-0.69]) and lower cardiovascular mortality (HR, 0.42 [95% CI, 0.18-0.98]) but comparable stroke mortality (HR, 0.48 [95% CI, 0.11-2.05]). When the model was further adjusted for education, income, smoking, body mass index, hypertension, and diabetes, the difference in mortality between foreign-born Black individuals and US-born Black individuals was no longer significant. Time since migration did not significantly affect mortality outcomes among foreign-born Black individuals. Conclusions In the United States, foreign-born Black individuals had lower all-cause mortality, a difference that was observed in recent and well-established immigrants. Foreign-born Black people had age- and sex-adjusted lower cardiovascular mortality than US-born Black people.