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Edward Ng, Claudia Sanmartin, Jack V. Tu and Doug G. Manuel

Variations in hospitalization rates across first generation immigrants and their descendants are investigated in the context of Canada. The authors examine immigrant generations of United Kingdom, Chinese and other Asian origins with respect to all-cause and circulatory disease related hospitalization rates. Compared with third-generation and beyond descendants (that is, native-born Canadians), age-adjusted odds of all-cause hospitalization among first-generation recent immigrants in Canada for less than 10 years were significantly lower than for longer-term immigrants in Canada for more than ten years, and for second-generation descendants. Controls for group variations in socioeconomic status attenuated these differentials but the lower circulatory disease hospitalization risk among first- and second-generation immigrants of Chinese origin persisted, while among those of South Asian descent, only the first generation showed a lowered risk but not the second generation.

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Olga Anikeeva and Peng Bi

Cancer mortality differences between immigrants and the Australian population are investigated in the context of how diet, lifestyle factors and acculturation affect the risk of death. In general, immigrants have lower cancer mortality rates. Greeks and Italians in particular, enjoy a significant mortality advantage in relation to other Australians. It also found that there are a number of specific cancers where mortality rates are higher for some migrant groups. Upon arrival, East and South East Asian immigrants have an approximately thirty-fold higher age-adjusted risk of dying from nasopharyngeal cancer compared to their Australian-born counterparts, but this differential reduces to nine-fold after 30 years of living in Australia. Migrants from the United Kingdom, the former Yugoslavia, Greece and Italy have higher age-adjusted mortality rates from cancer of the stomach and pancreas, which decreases with increasing duration of residence in Australia. It is thought that these differentials reflect group variability in dietary and lifestyle habits and degree of retention of Old World traditions.

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Myriam Khlat and Michel Guillot

The historical evolution of migrant studies in France is outlined. Over the past three decades there has been a shift in research orientation from an early period in the 1980s, when the focus was mostly on cancer epidemiology concerning the foreign born, to a more recent period since 2000 focused largely on the social determinants of health and mortality inequalities. The French literature agrees in many respects with the literatures of other immigrant-receiving countries in the western world that younger migrants in the pre-labor force ages tend to show higher death rates whereas those in the prime labor force ages enjoy a notably low mortality risk. An interesting differential observed is the higher mortality of female migrants from the sub-Saharan Africa region. It is suggested that in this case the underlying factor for this is the unusually high rates of maternal mortality in African women, particularly those from Morocco. This raises the interesting juxtaposition that within the immigrant population – usually found to be in better health than the native born – there exists some vulnerable subgroups with unusually poor health and survival prospects. As reported by the authors, in France the ‘healthy migrant effect’ universally reported in the international literature is visible in only a subset of studies.

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Frank Trovato

The immigrant mortality advantage is examined from the perspectives of the health selection and acculturation hypotheses. Differential mortality between immigrant and native born populations is studied across 19 causes of death encompassing chronic and external types of mortality. With few exceptions, the immigrant population showed lower death rates on virtually all causes of death. Acculturation (years in Canada since immigration) was found to have an eroding effect on the immigrant mortality advantage for most causes of death. The protective effect of health selection on survival probabilities is shown to last for 25 years or more for some causes of death, particularly ischemic heart disease among males. For diseases such as diabetes and breast cancer the health selection effect seems to be relatively short lived, lasting only between five and ten years, respectively. In females the selectivity effect on mortality risk is virtually lost by 35 years’ duration. In males, at this stage of the migration experience there is a persisting small protective effect of health selection. Taken together the findings suggest that immigrants experience health erosion the longer the period of residence in Canada, but the degree of erosion varies depending on the type of disease examined.

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Brit Oppedal

A comprehensive assessment is undertaken concerning Norwegian studies on the mental health of immigrant children, youths, and young adults spanning the ages of 10 to 26 years. The principal aim is to assess inter-group as well as intra-group variations in symptoms of mental health problems (not clinically diagnosed psychiatric disorders) among preadolescents, adolescents and young adults who are either foreign born (first-generation immigrants) or born in Norway to two foreign-born parents (second generation). Included in the overview are studies based on the general immigrant populations as well as refugee groups, and unaccompanied minors arriving as asylum-seekers. It is determined that immigrant boys are especially vulnerable with respect to internalizing problems in elementary and junior high school years, while senior high school seems to be a sensitive period for immigrant girls. National group differences in reported internalizing problems were noted, particularly among the younger youths. In the older samples there was in general no support for the concept of a ‘migration morbidity association’. Thus, it appears that the question as to whether immigrant children and youth have more mental health problems than non-immigrants is highly dependent on national background and age group. It is recommends that future research should take a holistic, developmental approach in the study of psychosocial adjustment and mental health of immigrant background children and youth. In the Norwegian context, concepts such as ‘the immigrant paradox’ and ‘the migration morbidity association’ are generally of limited application toward shedding light on the topic of mental health of migrant children and youth.

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Lori Wilkinson and David Ponka

The authors challenge many misperceptions people have about mental health and newcomers. In particular, they dismiss the notion that the experience of migration, particularly among refugees, is somehow psychologically and irreversibly damaging to newcomers. After summarizing the state of knowledge in Canada concerning the mental health outcomes of immigrant and refugee adults, children and youth, they examine in detail a number of interrelated dimensions: (1) complexities associated with identifying and tracking over time the mental health of refugees from the point of entry to Canada throughout their post-settlement experience; (2) the nature of the immigrant medical examination as a screening mechanism and its limitations; (3) the necessity for medical practitioners to treat refugees as a special case given their pre-migration experience with trauma and, for many, their post-settlement experience with post-traumatic stress disorder (PTSD); and (4), major challenges associated with ensuring proper access for refugees to the health-care system and needed systemic accommodations to better treat refugee mental health concerns in Canada.

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Nicholas Biddle and Samuel G. Weldeegzie

The most recent data from the Household, Income and Labour Dynamics in Australia is examined to study self-assessed health among immigrants and whether their self-assessed health deteriorates the longer they stay in Australia. Immigrants from English-speaking countries have higher self-assessed health than native-born Australians, while migrants from ‘other’ countries tend to have no difference or worse health relative to the Australian born. Multivariate analysis confirms that immigrant health deteriorates with increasing duration of residence.

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Graziella Caselli, Silvia Loi and Salvatore Strozza

Since the late 1970s, Italy has become a country of immigration after being one of the main European countries of emigration for more than a century. Notwithstanding the significant growth of the foreign population, there is limited knowledge on the health conditions and mortality levels of immigrants, and no information is available on refugees and asylum seekers. The authors rely on a variety of data sources including regional based surveys and studies, administrative records, and hospital data to form a picture of the health condition of immigrants in Italy. Based on the evidence assembled, it is found that, similar to other studies based on the experience of other countries, in Italy the health status of foreigners seems to be better than that of the Italian population. However, as is often noted in the literature, over time this advantage is reduced, changing toward convergence with the host population. It is suggested that in future research the mortality of foreigners needs to be examined with reference to the various nationalities, as these bring with them different social and cultural life histories, and, above all, different lifestyles and work histories, which have an important role in determining the various risks of disease and death.

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Matthew Wallace

Mortality differences among immigrants and their descendants in England and Wales are studied. The analysis involves an assessment of the hypothesis that data errors, particularly under-registration of migrant deaths, lies at the root of the immigrant mortality advantage. Test results suggest that the healthy migrant effect cannot be explained away by data errors, nor does the ‘salmon bias’ effect (that is, return selectivity) account for this mortality differential. The author discusses the accelerated health transition thesis in connection with immigrants from developing countries. Mortality variations by cause of death in first generation migrants and their second generation and beyond descendants are also explored. It is concluded that low mortality among migrants is mainly driven by low cancer mortality, and in some groups low cardiovascular disease mortality. The descendants of immigrants are not observed to share a mortality advantage.