巴西600多万国内和国际移民的死亡率：一项使用1亿巴西队列的研究。
Mortality among over 6 million internal and international migrants in Brazil: a study using the 100 Million Brazilian Cohort.
作者信息
Pescarini Julia M, Goes Emanuelle F, Pinto Priscila Fernanda Porto Scaff, Dos Santos Beatriz Pinheiro Schindler, Machado Daiane B, Abubakar Ibrahim, Rodrigues Laura C, Brickley Elizabeth B, Smeeth Liam, Barreto Mauricio L
机构信息
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
出版信息
Lancet Reg Health Am. 2023 Feb 27;20:100455. doi: 10.1016/j.lana.2023.100455. eCollection 2023 Apr.
BACKGROUND
To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course.
METHODS
We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.
FINDINGS
The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05).
INTERPRETATION
Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants.
FUNDING
The Wellcome Trust.
背景
为了解低收入和中等收入国家（LMICs）中生活贫困的移民是否比非移民人口具有更低的死亡率，我们调查了巴西国内和国际移民在其生命历程中的死亡风险模式。
方法
我们将2011年1月1日至2018年12月31日期间1亿巴西队列中的社会经济和死亡率数据进行关联，并根据男女的移民身份计算全因和特定病因的年龄标准化死亡率。使用Cox回归模型，我们估计了国内移民（即出生在巴西但居住在与其出生地不同的巴西州的个人）与巴西出生的非移民相比，以及国际移民（即出生在其他国家的人）与巴西出生的个人相比，经年龄和性别调整后的死亡风险比（HR）。
结果
该研究随访了45,051,476人，其中6,057,814人为国内移民，277,230人为国际移民。国内移民的全因死亡率与巴西非移民相似（校正风险比[aHR]=0.99，95%置信区间[CI]=0.98 - 0.99），缺血性心脏病死亡率略高（aHR = 1.04，95% CI = 1.03 - 1.05），中风死亡率更高（aHR = 1.11，95% CI = 1.09 - 1.13）。与巴西出生的个人相比，国际移民的全因死亡率低18%（aHR = 0.82，95% CI = 0.80 - （此处原文有误，应为0.84）），男性人际暴力死亡率低达50%（aHR = 0.50，95% CI = 0.40 - 0.64），但与孕产妇健康相关的可避免病因导致的死亡率更高（aHR = 2.17，95% CI = 1.17 - 4.05）。
解读
尽管国内移民的全因死亡率相似，但国际移民的全因死亡率低于非移民。有必要采用交叉性方法进行进一步调查，以了解因移民身份、年龄和性别导致的特定死因的显著差异，例如国际移民中孕产妇死亡率升高以及男性人际暴力相关死亡率较低的情况。
资助
惠康信托基金会。
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