瑞典背景下的健康移民效应：基于登记的纵向队列研究。
Healthy migrant effect in the Swedish context: a register-based, longitudinal cohort study.
机构信息
Division of Insurance Medicine, Department of Clinical Neuroscience, Stockholm SE-171 77, Karolinska Institutet.
Occupational- and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala.
出版信息
BMJ Open. 2019 Mar 15;9(3):e026972. doi: 10.1136/bmjopen-2018-026972.
OBJECTIVES
Studies have found a 'healthy-migrant effect' (HME) among arriving migrants, that is, a better health status compared with others in the home country, but also in comparison with the population in the host country. The aims were to investigate whether the HME hypothesis is applicable to the Swedish context, that is, if health outcomes differed between a group of mainly labour migrants (Western migrants) and a group of mainly refugee/family reunion migrants (non-Western migrants) compared with the native Swedish population, and if there were any correlations between labour market attachment (LMA) and these health outcomes.
DESIGN
Register-based, longitudinal cohort study.
PARTICIPANTS
The cohort was defined on 31 December 1990 and consisted of all migrants aged 18-47 years who arrived in Sweden in 1985-1990 (n=74 954) and a reference population of native Swedes (n=1 405 047) in the same age span. They were followed for three consecutive 6-year periods (1991-1996, 1997-2002 and 2003-2008) and were assessed for five measures of health: hospitalisation for cardiovascular and psychiatric disorders, mortality, disability pension, and sick leave.
RESULTS
Western migrants had, compared with native Swedes, lower or equal HRs for all health measures during all time periods, while non-Western migrants displayed higher or equal HRs for all health measures, except for mortality, during all time periods. Age, educational level, occupation and LMA explained part of the difference between migrants and native Swedes. High LMA was associated with higher HRs for cardiovascular disorders among Western migrants, higher HRs of psychiatric disorders among non-Western migrants and higher HRs of mortality among both migrant groups compared with native Swedes.
CONCLUSIONS
There were indications of a HME among Western migrants, while less proof of a HME among non-Western migrants. Stratification for LMA and different migrant categories showed some interesting differences, and measurements of the HME may be inconclusive if not stratified by migrant category or other relevant variables.
目的
研究发现，到达的移民存在“健康移民效应”（HME），即与原籍国的其他人相比，他们的健康状况更好，与东道国的人口相比也是如此。本研究旨在调查 HME 假设是否适用于瑞典背景，即主要是劳动力移民（西方移民）和主要是难民/家庭团聚移民（非西方移民）的一组移民的健康结果是否与本地瑞典人口不同，以及劳动力市场参与度（LMA）与这些健康结果之间是否存在相关性。
设计
基于登记的纵向队列研究。
参与者
该队列于 1990 年 12 月 31 日确定，由 1985 年至 1990 年抵达瑞典的所有 18-47 岁移民（n=74954）和同一年龄范围内的本地瑞典人（n=1405047）组成。他们连续三个 6 年期间（1991-1996 年、1997-2002 年和 2003-2008 年）进行了随访，并评估了 5 项健康指标：心血管和精神障碍住院治疗、死亡率、残疾抚恤金和病假。
结果
与本地瑞典人相比，西方移民在所有时间段的所有健康指标的 HR 均较低或相等，而非西方移民在所有时间段的除死亡率外的所有健康指标的 HR 均较高或相等。年龄、教育程度、职业和 LMA 解释了移民与本地瑞典人之间差异的一部分。高 LMA 与西方移民的心血管疾病 HR 较高、非西方移民的精神障碍 HR 较高以及与本地瑞典人相比，两组移民的死亡率 HR 较高相关。
结论
西方移民中存在 HME 的迹象，而非西方移民中则证据较少。根据 LMA 和不同移民类别进行分层显示出一些有趣的差异，如果不按移民类别或其他相关变量分层，HME 的测量可能没有定论。
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