Kaucher Simone, Deckert Andreas, Becher Heiko, Winkler Volker
Unit of Epidemiology and Biostatistics, Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany.
Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMJ Open. 2017 Dec 19;7(12):e019213. doi: 10.1136/bmjopen-2017-019213.
We aimed to investigate all-cause and cause-specific mortality among ethnic German migrants from the former Soviet Union by different immigration periods to describe associations with migration pattern and mortality.
We used pooled data from three retrospective cohort studies in Germany.
Ethnic German migrants from the former Soviet Union (called resettlers), who immigrated to Germany since 1990 to the federal states North Rhine-Westphalia and Saarland and to the region of Augsburg (n=59 390).
All-cause and cause-specific mortality among resettlers in comparison to the general German population, separated by immigration period.
Immigration periods were defined following legislative changes in German immigration policy (1990-1992, 1993-1995, 1996+). Resettlers' characteristics were described accordingly. To investigate mortality differences by immigration period, we calculated age-standardised mortality rates (ASRs) and standardised mortality ratios (SMRs) of resettlers in comparison to the general German population. Additionally, we modelled sex-specific ASRs with Poisson regression, using age, year and immigration period as independent variables.
The composition of resettlers differed by immigration period. Since 1993, the percentage of resettlers from the Russian Federation and non-German spouses increased. Higher all-cause mortality was found among resettlers who immigrated in 1996 and after (ASR 628.1, 95% CI 595.3 to 660.8), compared with resettlers who immigrated before 1993 (ASR 561.8, 95% CI 537.2 to 586.4). SMR analysis showed higher all-cause mortality among resettler men from the last immigration period compared with German men (SMR 1.11, 95% CI 1.04 to 1.19), whereas resettlers who immigrated earlier showed lower all-cause mortality. Results from Poisson regression, adjusted for age and year, corroborated those findings.
Mortality differences by immigration period suggest different risk-factor patterns and possibly deteriorated integration opportunities. Health policy should guard the consequences of immigration law alterations with respect to changing compositions of migrant groups and their health status.
我们旨在通过不同的移民时期，调查来自前苏联的德裔移民的全因死亡率和特定病因死亡率，以描述与移民模式和死亡率的关联。
我们使用了德国三项回顾性队列研究的汇总数据。
自1990年以来移民到德国北莱茵 - 威斯特法伦州、萨尔兰州以及奥格斯堡地区的来自前苏联的德裔移民（称为重新定居者）（n = 59390）。
按移民时期划分，重新定居者的全因死亡率和特定病因死亡率与德国普通人群相比。
根据德国移民政策的立法变化定义移民时期（1990 - 1992年、1993 - 1995年、1996年及以后）。相应地描述重新定居者的特征。为了按移民时期调查死亡率差异，我们计算了重新定居者与德国普通人群相比的年龄标准化死亡率（ASR）和标准化死亡比（SMR）。此外，我们使用年龄、年份和移民时期作为自变量，通过泊松回归对特定性别的ASR进行建模。
重新定居者的构成因移民时期而异。自1993年以来，来自俄罗斯联邦的重新定居者和非德国配偶的比例增加。与1993年之前移民的重新定居者相比，1996年及以后移民的重新定居者全因死亡率更高（ASR 628.1，95%CI 595.3至660.8）（ASR 561.8，95%CI 537.2至586.4）。SMR分析显示，最后一个移民时期的重新定居者男性全因死亡率高于德国男性（SMR 1.11，95%CI：1.04至1.19），而较早移民的重新定居者全因死亡率较低。经年龄和年份调整的泊松回归结果证实了这些发现。
不同移民时期的死亡率差异表明存在不同的风险因素模式，并且融入机会可能恶化。卫生政策应关注移民法变更对移民群体构成变化及其健康状况的影响。
