Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Institut d'analyse du changement dans l'histoire et les sociétés contemporaines (IACCHOS), Centre De Recherches En Démographie, Université Catholique De Louvain, Louvain-la-Neuve, Belgium.
Glob Health Action. 2021 Jan 1;14(1):1930655. doi: 10.1080/16549716.2021.1930655.
: Despite the greater attention given to international migration, internal migration accounts for the majority of movements globally. However, research on the effects of internal migration on health is limited, with this relationship examined predominantly in urban settings among working-age adults, neglecting rural populations and younger and older ages.: Using longitudinal data from 29 mostly rural sub-Saharan African Health and Demographic Surveillance Systems (HDSS), this study aims to explore life-course differences in mortality according to migration status and duration of residence.Cox proportional hazards models are employed to analyse the relationship between migration and mortality in the 29 HDSS areas. The analytical sample includes 3 836,173 people and the analysis spans 25 years, from 1990 to 2015. We examine the risk of death by sex across five broad age groups (from ages 1 to 80), and consider recent and past in- and return migrants.: In-migrants have a higher risk of mortality compared to permanent rural residents, with return migrants at greater risk than in-migrants across all age-groups. Female migrants have lower survival chances than males, with greater variability by age. Risk of dying is highest among recent return migrant females aged 30-59: 1.86 (95% CI 1.69-2.06) times that of permanent residents. Only among males aged 15-29 who move to urban areas is there evidence of a 'healthy migrant' effect (HR = 0.62, 95% CI 0.51-0.77). There is clear evidence of an adaptation effect across all ages, with the risk of mortality reducing with duration following migration.: Findings suggest that adult internal migrants, particularly females, suffer greater health disadvantages associated with migration. Policy makers should focus on improving migrant's interface with health services, and support the development of health education and promotion interventions to create awareness of localised health risks for migrants.
尽管国际移民受到了更多关注，但全球范围内的人口流动主要还是以国内移民为主。然而，对于国内移民对健康的影响的研究却很有限，主要集中在工作年龄段的城市成年人中，忽视了农村人口和年轻及老年人群。本研究利用来自 29 个主要位于撒哈拉以南非洲的农村健康和人口动态监测系统（HDSS）的纵向数据，旨在探索根据迁移状况和居住时间的不同，生命历程中死亡率的差异。使用 Cox 比例风险模型分析了 29 个 HDSS 地区的迁移与死亡率之间的关系。分析样本包括 3836173 人，分析时间跨度为 25 年，从 1990 年到 2015 年。我们按性别和五个年龄组（1 至 80 岁）考察了死亡风险，并考虑了近期和过去的流入和回流移民。移民的死亡率高于永久性农村居民，回流移民的风险高于所有年龄组的流入移民。女性移民的生存机会低于男性移民，且年龄差异更大。30-59 岁的近期回流女性移民的死亡风险最高，为永久性居民的 1.86 倍（95%CI 1.69-2.06）。只有在 15-29 岁的男性移民到城市地区时，才存在“健康移民”效应的证据（HR=0.62，95%CI 0.51-0.77）。所有年龄段都有明显的适应效应，随着移民后的时间延长，死亡率的风险降低。研究结果表明，成年国内移民，尤其是女性，因移民而面临更大的健康劣势。决策者应关注改善移民与卫生服务的接口，并支持开展卫生教育和促进干预措施，以提高移民对当地健康风险的认识。
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