Chaabna Karima, Cheema Sohaila, Mamtani Ravinder
Institute for Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
PLoS One. 2017 Jun 20;12(6):e0179711. doi: 10.1371/journal.pone.0179711. eCollection 2017.
The Gulf Cooperation Council (GCC) countries namely, Bahrain, Kuwait, Oman, Qatar, United Arab Emirates (UAE), and Saudi Arabia, have experienced unique demographic changes. The major population growth contributor in these countries is young migrants, which has led to a shift in the population age pyramid. Migrants constitute the vast proportion of GCC countries' population reaching >80% in Qatar and UAE. Using Global Burden of Disease Study 2015 (GBD 2015) and United Nations data, for the GCC countries, we assessed the association between age-standardized mortality and population size trends with linear and polynomial regressions. In 1990-2015, all-cause age-standardized mortality was inversely proportional to national population size (p-values: 0.0001-0.0457). In Bahrain, Qatar, Oman, and Saudi Arabia, the highest annual decrease in mortality was observed when the annual population growth was the highest. In Qatar, all-cause age-specific mortality was inversely proportional to age-specific population size. This association was statistically significant among the 5-14 and 15-49 age groups, which have the largest population size. Cause-specific age-standardized mortality was also inversely proportional to population size. This association was statistically significant for half of the GBD 2015-defined causes of death such as "cirrhosis and other chronic liver diseases" and "HIV/AIDS and tuberculosis". Remarkably, incoming migrants to Qatar have to be negative for HIV, hepatitis B and C, and tuberculosis. These results show that decline in mortality can be partly attributed to the increase in GCC countries' population suggesting a healthy migrant effect that influences mortality rates. Consequently, benefits of health interventions and healthcare improvement are likely to be exaggerated in such countries hosting a substantial proportion of migrants compared with countries where migration is low. Researchers and policymakers should be cautious to not exclusively attribute decline in mortality within the GCC countries as a result of the positive effects of health interventions or healthcare improvement.
海湾合作委员会(GCC)国家,即巴林、科威特、阿曼、卡塔尔、阿拉伯联合酋长国(阿联酋)和沙特阿拉伯,经历了独特的人口结构变化。这些国家人口增长的主要贡献者是年轻移民,这导致了人口年龄金字塔的转变。移民在海湾合作委员会国家人口中占很大比例,在卡塔尔和阿联酋超过80%。利用2015年全球疾病负担研究(GBD 2015)和联合国数据,对于海湾合作委员会国家,我们用线性和多项式回归评估了年龄标准化死亡率与人口规模趋势之间的关联。在1990 - 2015年期间,全因年龄标准化死亡率与国家人口规模成反比(p值:0.0001 - 0.0457)。在巴林、卡塔尔、阿曼和沙特阿拉伯,当年度人口增长最高时,观察到死亡率的年度下降幅度最大。在卡塔尔,全因特定年龄死亡率与特定年龄人口规模成反比。这种关联在人口规模最大的5 - 14岁和15 - 49岁年龄组中具有统计学意义。特定病因年龄标准化死亡率也与人口规模成反比。对于2015年全球疾病负担定义的一半死因,如“肝硬化和其他慢性肝病”以及“艾滋病毒/艾滋病和结核病”,这种关联具有统计学意义。值得注意的是,前往卡塔尔的移民必须艾滋病毒、乙肝和丙肝以及结核病检测呈阴性。这些结果表明,死亡率的下降部分可归因于海湾合作委员会国家人口的增加,这表明存在影响死亡率的健康移民效应。因此,与移民率低的国家相比,在有大量移民的此类国家,健康干预和医疗改善的益处可能被夸大。研究人员和政策制定者应谨慎,不要将海湾合作委员会国家死亡率的下降完全归因于健康干预或医疗改善的积极影响。