Wallace Matthew, Kulu Hill
University of Liverpool, United Kingdom.
University of Liverpool, United Kingdom.
Soc Sci Med. 2015 Dec;147:209-21. doi: 10.1016/j.socscimed.2015.10.060. Epub 2015 Nov 10.
Recent research has found a migrant mortality advantage among immigrants relative to the UK-born population living in England and Wales. However, while all-cause mortality is useful to show differences in mortality between immigrants and the host population, it can mask variation in mortality patterns from specific causes of death. This study analyses differences in the causes of death among immigrants living in England and Wales. We extend previous research by applying competing-risks survival analysis to study a large-scale longitudinal dataset from 1971 to 2012 to directly compare causes of death. We confirm low all-cause mortality among nearly all immigrants, except immigrants from Scotland, Northern Ireland and the Republic of Ireland (who have high mortality). In most cases, low all-cause mortality among immigrants is driven by lower mortality from chronic diseases (in nearly all cases by lower cancer mortality and in some cases by lower mortality from cardiovascular diseases (CVD)). This low all-cause mortality often coexists with low respiratory disease mortality and among non-western immigrants, coexists with high mortality from infectious diseases; however, these two causes of death contribute little to mortality among immigrants. For men, CVD is the leading cause of death (particularly among South Asians). For women, cancer is the leading cause of death (except among South Asians, for whom CVD is also the leading cause). Differences in CVD mortality over time remain constant between immigrants relative to UK-born, but immigrant cancer patterns shows signs of some convergence to the cancer mortality among the UK-born (though cancer mortality is still low among immigrants by age 80). The study provides the most up-to-date, reliable UK-based analysis of immigrant mortality.
最近的研究发现，相对于生活在英格兰和威尔士的英国本土人口，移民群体存在死亡率优势。然而，虽然全因死亡率有助于显示移民与东道国人口在死亡率上的差异，但它可能掩盖特定死因导致的死亡率模式差异。本研究分析了生活在英格兰和威尔士的移民的死因差异。我们通过应用竞争风险生存分析来扩展先前的研究，以研究1971年至2012年的大规模纵向数据集，从而直接比较死因。我们证实，几乎所有移民的全因死亡率都较低，但来自苏格兰、北爱尔兰和爱尔兰共和国的移民除外（他们的死亡率较高）。在大多数情况下，移民全因死亡率较低是由慢性病死亡率较低所致（几乎在所有情况下是癌症死亡率较低，在某些情况下是心血管疾病（CVD）死亡率较低）。这种低全因死亡率往往与低呼吸道疾病死亡率并存，在非西方移民中，还与传染病高死亡率并存；然而，这两种死因对移民死亡率的贡献不大。对于男性，CVD是主要死因（尤其是在南亚裔中）。对于女性，癌症是主要死因（南亚裔除外，他们的主要死因也是CVD）。随着时间推移，移民与英国本土出生者相比，CVD死亡率差异保持不变，但移民的癌症模式显示出一些与英国本土出生者癌症死亡率趋同的迹象（尽管到80岁时移民的癌症死亡率仍然较低）。该研究提供了基于英国的、关于移民死亡率的最新、可靠分析。
