Vandenheede Hadewijch, Willaert Didier, De Grande Hannelore, Simoens Steven, Vanroelen Christophe
Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
Community Health Centre De Sleep, Ghent, Belgium.
Trop Med Int Health. 2015 Dec;20(12):1832-45. doi: 10.1111/tmi.12610. Epub 2015 Oct 12.
Firstly, to map out and compare all-cause and cause-specific mortality patterns by migrant background in Belgium; and secondly, to probe into explanations for the observed patterns, more specifically into the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories.
Data comprise individually linked Belgian census-mortality follow-up data for the period 2001-2011. All official inhabitants aged 25-54 at time of the census were included. To delve into the different explanations, differences in all-cause and chronic- and infectious-disease mortality were estimated using Poisson regression models, adjusted for age, socioeconomic position and urbanicity.
First-generation immigrants have lower all-cause and chronic-disease mortality than the host population. This mortality advantage wears off with length of stay and is more marked among non-Western than Western first-generation immigrants. For example, Western and non-Western male immigrants residing 10 years or more in Belgium have a mortality rate ratio for cardiovascular disease of 0.72 (95% CI 0.66-0.78) and 0.59 (95% CI 0.53-0.66), respectively (vs host population). The pattern of infectious-disease mortality in migrants is slightly different, with rather high mortality rates in first-generation sub-Saharan Africans and rather low rates in all other immigrant groups. As for second-generation immigrants, the picture is gloomier, with a mortality disadvantage that disappears after control for socioeconomic position.
Findings are largely consistent with the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. The convergence of the mortality profile of second-generation immigrants towards that of the host population with similar socioeconomic position indicates the need for policies simultaneously addressing different areas of deprivation.
第一，描绘并比较比利时不同移民背景人群的全因死亡率和特定病因死亡率模式；第二，探究观察到的这些模式的成因，更具体地说是探究健康移民理论、文化适应理论以及移民即快速健康转变理论。
数据包括2001年至2011年比利时人口普查与死亡率的个体关联随访数据。纳入了普查时年龄在25至54岁的所有官方居民。为深入探究不同的解释，使用泊松回归模型估计全因死亡率以及慢性病和传染病死亡率的差异，并对年龄、社会经济地位和城市化程度进行了调整。
第一代移民的全因死亡率和慢性病死亡率低于本地居民。这种死亡率优势会随着居留时间的延长而减弱，并且在非西方第一代移民中比西方第一代移民中更为明显。例如，在比利时居住10年或更长时间的西方和非西方男性移民，心血管疾病的死亡率比值分别为0.72（95%可信区间0.66 - 0.78）和0.59（95%可信区间0.53 - 0.66）（与本地居民相比）。移民中传染病死亡率模式略有不同，第一代撒哈拉以南非洲人的死亡率相当高，而其他所有移民群体的死亡率相当低。至于第二代移民，情况更为严峻，在控制社会经济地位后，其死亡率劣势消失。
研究结果在很大程度上与健康移民理论、文化适应理论以及移民即快速健康转变理论一致。第二代移民死亡率状况与具有相似社会经济地位的本地居民趋同，这表明需要制定政策同时解决不同领域的贫困问题。
