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Differences in mortality by immigrant status in Italy. Results of the Italian Network of Longitudinal Metropolitan Studies

  • SOCIAL EPIDEMIOLOGY
  • Published:
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Abstract

Despite a rapid increase in immigration from low-income countries, studies on immigrants’ mortality in Italy are scarce. We aimed to describe differences in all and cause-specific mortality among immigrants and Italians residing in Turin and Reggio Emilia (Northern Italy), two cities participating in the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS). We used individual data from the municipal population registers linked to the cause of death registers. All people aged 1–64 years residing between 2001 and 2010 were enrolled (open cohort) and followed up until 2013. The mortality of citizens from high migratory pressure countries (as a whole, and for each macro-area group) was compared with that of Italians; differences were estimated by Poisson regression adjusted by age and calendar year mortality rate ratios (MRRs), and by age-standardized mortality ratios for the analysis of cause-specific mortality. Compared with Italians, immigrants had lower overall mortality (MRR for men: 0.82, 95 % CI: 0.75–0.90; for women: 0.71, 95 % CI: 0.63–0.81). Sub-Saharan Africans experienced a significant higher mortality than Italians (MRR for men 1.29, 95 % CI: 1.03–1.61; for women: 1.70, 95 % CI: 1.22–2.36). Higher mortality for immigrants compared to Italians was observed for infectious diseases, congenital anomalies, some site-specific tumours and homicide mortality. Our study showed heterogeneity in mortality across the macro-areas of origin, and in particular Sub-Saharan Africans seemed to be a vulnerable population. The extension to other cohorts of IN-LiMeS will allow the health status of immigrants and vulnerable groups to be studied and monitored in more depth.

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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

HMPC:

High migratory pressure countries

HDC:

Highly developed countries

ICD:

International classification of diseases

IN-LiMeS:

Italian Network of Longitudinal Metropolitan Studies

LRT:

Likelihood ratio test

MRR:

Mortality rate ratio

SMR:

Standardised mortality ratio

TB:

Tuberculosis

UADT:

Upper aero-digestive tract

References

  1. Norredam M, Olsbjerg M, Petersen JH, et al. Inequalities in mortality among refugees and immigrants compared to native Danes–a historical prospective cohort study. BMC Public Health. 2012;12:757.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gadd M, Johansson S-E, Sundquist J, et al. Are there differences in all-cause and coronary heart disease mortality between immigrants in Sweden and in their country of birth? A follow-up study of total populations. BMC Public Health. 2006;6:102.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Razum O, Twardella D. Time travel with Oliver Twist–towards an explanation foa a paradoxically low mortality among recent immigrants. Trop Med Int Health. 2002;7:4–10.

    Article  PubMed  Google Scholar 

  4. Parkin DM. Studies of cancer in migrant populations: methods and interpretation. Rev Epidemiol Sante Publique. 1992;40:410–24.

    CAS  PubMed  Google Scholar 

  5. Razum O, Zeeb H, Rohrmann S. The ‘healthy migrant effect’–not merely a fallacy of inaccurate denominator figures. Int J Epidemiol. 2000;29:191–2.

    Article  CAS  PubMed  Google Scholar 

  6. Ullmann SH, Goldman N, Massey DS. Healthier before they migrate, less healthy when they return? The health of returned migrants in Mexico. Soc Sci Med. 2011;73:421–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Abraído-Lanza AF, Dohrenwend BP, Ng-Mak DS, et al. The Latino mortality paradox: a test of the ‘salmon bias’ and healthy migrant hypotheses. Am J Public Health. 1999;89:1543–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Razum O. Commentary: of salmon and time travellers–musing on the mystery of migrant mortality. Int J Epidemiol. 2006;35:919–21.

    Article  PubMed  Google Scholar 

  9. Wallace M, Kulu H. Low immigrant mortality in England and Wales: A data artefact? Soc Sci Med. 2014;120:100–9.

    Article  PubMed  Google Scholar 

  10. Lara M, Gamboa C, Kahramanian MI, et al. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–97.

    Article  PubMed  Google Scholar 

  11. Malmusi D, Borrell C, Benach J. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010;71:1610–9.

    Article  PubMed  Google Scholar 

  12. Bos V, Kunst AE, Keij-Deerenberg IM, et al. Ethnic inequalities in age- and cause-specific mortality in The Netherlands. Int J Epidemiol. 2004;33:1112–9.

    Article  PubMed  Google Scholar 

  13. Regidor E, de La Fuente L, Martínez D, et al. Heterogeneity in cause-specific mortality according to birthplace in immigrant men residing in Madrid, Spain. Ann Epidemiol. 2008;18:605–13.

    Article  PubMed  Google Scholar 

  14. Ikram UZ, Mackenbach JP, Harding S, et al. All-cause and cause-specific mortality of different migrant populations in Europe. Eur J Epidemiol. Published Online First: 11 Sep 2015.

  15. Ott JJ, Paltiel AM, Winkler V, et al. Chronic disease mortality associated with infectious agents: a comparative cohort study of migrants from the Former Soviet Union in Israel and Germany. BMC Public Health. 2008;8:110.

    Article  PubMed  PubMed Central  Google Scholar 

  16. ISTAT. Indicatori demografici.Stime per l’anno 2014. 2015. http://www.istat.it/it/archivio/149003. Accessed 6 Jun 2016.

  17. AGENAS, La salute della popolazione immigrata: il monitoraggio da parte dei Sistemi Sanitari Regionali. 2013. http://www.agenas.it/lea-spesa-sanitaria/la-salute-della-popolazione-immigrata-il-monitoraggio-da-parte-dei-sistemi-sanitari-regionali. Accessed 6 Jun 2016.

  18. Martini A, Chellini E, Sala A. Mortality in immigrants in Tuscany. Epidemiol Prev. 2011;35:275–81.

    PubMed  Google Scholar 

  19. Fedeli U, Ferroni E, Pigato M, et al. Causes of mortality across different immigrant groups in Northeastern Italy. PeerJ. 2015;69:e975.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stringhini S, Spadea T, Stroscia M, et al. Decreasing educational differences in mortality over 40 years: evidence from the Turin Longitudinal Study (Italy). J Epidemiol Community Health. 2015;69:1208–16.

  21. Candela S, Cavuto S, Luberto F, et al. Condizioni socioeconomiche e mortalità nella popolazione di Reggio Emilia. http://www.epicentro.iss.it/territorio/CondizioniocioeconomicheMortalit%E0_ReggioEmilia.pdf. Accessed 6 Jun2 016.

  22. Kibele E, Scholz R, Shkolnikov VM. Low migrant mortality in Germany for men aged 65 and older: Fact or artifact? Eur J Epidemiol. 2008;23:389–93.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ministero dell’Interno. Diritti, doveri, identità, partecipazione. Come diventare cittadini italiani. http://www.interno.gov.it/it/temi/cittadinanza-e-altri-diritti-civili/cittadinanza. Accessed 6 Jun 2016.

  24. Arnold M, Razum O, Coebergh JW. Cancer risk diversity in non-western migrants to Europe: an overview of the literature. Eur J Cancer. 2010;46:2647–59.

    Article  PubMed  Google Scholar 

  25. de Martel C, Ferlay J, Franceschi S, et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012;13:607–15.

    Article  PubMed  Google Scholar 

  26. Boulogne R, Jougla E, Breem Y, et al. Mortality differences between the foreign-born and locally-born population in France (2004–2007). Soc Sci Med. 2012;74:1213–23.

    Article  PubMed  Google Scholar 

  27. Norredam M, Hansen OH, Petersen JH, et al. Remigration of migrants with severe disease: myth or reality?–a register-based cohort study. Eur J Public Health. 2015;25:84–9.

    Article  PubMed  Google Scholar 

  28. Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, Brotons M, Mena M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO information centre on HPV and cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary report 2016-02-25. http://www.hpvcentre.net/statistics/reports/XWX.pdf. Accessed 6 June 2016.

  29. Sharma S, Carballo M, Feld JJ, et al. Immigration and viral hepatitis. J Hepatol. 2015;63:515–22.

    Article  PubMed  Google Scholar 

  30. Coppola N, Alessio L, Pisaturo M, et al. Hepatitis B virus infection in immigrant populations. World J Hepatol. 2015;7:2955–61.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rondelli R, Dini G, De Rosa M, et al. Foreign children with cancer in Italy. Ital J Pediatr. 2011;37:44.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cacciani L, Asole S, Polo A, et al. Perinatal outcomes among immigrant mothers over two periods in a region of central Italy. BMC Public Health. 2011;11:294.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mastrangelo G, Rylander R, Buja A, et al. Work related injuries: estimating the incidence among illegally employed immigrants. BMC Res Notes. 2010;3:331.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Farchi S, Mantovani J, Borgia P, et al. Tuberculosis incidence, hospitalisation prevalence and mortality in Lazio, Italy, 1997–2003. Int J Tuberc Lung Dis. 2008;12(6):193–8.

    CAS  PubMed  Google Scholar 

  35. Arshad S, Bavan L, Gajari K, et al. Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J. 2010;35:1336–45.

    Article  CAS  PubMed  Google Scholar 

  36. Giorgi Rossi P, Mantovani J, Ferroni E, et al. Incidence of bacterial meningitis (2001–2005) in Lazio, Italy: the results of a integrated surveillance system. BMC Infect Dis. 2009;9:13.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Porta D, Perucci CA, Forastiere F, et al. Temporal trend of HIV infection: an update of the HIV surveillance system in Lazio, Italy, 1985–2000. Eur J Public Health. 2004;14:156–60.

    Article  PubMed  Google Scholar 

  38. Regidor E, Astasio P, Calle ME, et al. The association between birthplace in different regions of the world and cardiovascular mortality among residents of Spain. Eur J Epidemiol. 2009;24:503–12.

    Article  PubMed  Google Scholar 

  39. Centro Studi e Ricerche IDOS. Dossier Statistico Immigrazione 2015. Roma: IDOS Edizioni 2015. http://www.dossierimmigrazione.it/libro.php?cid=47_100&pid=180 Accessed 6 Jun 2016.

  40. Nazroo JY. The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. Am J Public Health. 2003;93:277–84.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Luberto Ferdinando, Massimo Vicentini (Interinstitutional Epidemiology Unit, Azienda Unita Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy, Arcispedale S. Maria Nuova, National Institute for Research and Treatment, Reggio Emilia, Italy), Silvia Franceschi (IARC), Delia Furio (University of Bologna), Lorenza Catellani (Population register office, Municipality of Reggio Emilia).

IN-LiMeS Group

Alessio:

Petrelli

Anna Maria:

Bargagli

Annibale:

Biggeri

Barbara:

Pacelli

Concetta:

Mirisola

Cristina:

Canova

Ferdinando:

Luberto

Gianfranco:

Costanzo

Gianna:

Terni

Giulia:

Cesaroni

Giuseppe:

Costa

Laura:

Bonvicini

Laura:

Cacciani

Laura:

Cestari

Laura:

Grisotto

Lorenzo:

Simonato

Luisa:

Mondo

Marina:

Davoli

Nera:

Agabiti

Nicola:

Caranci

Nicolás:

Zengarin

Paola:

Ballotari

Paolo:

Carnà

Paolo Giorgi:

Rossi

Serena:

Broccoli

Teresa:

Spadea

Contributors

BP, NZ, SB, NC, TS, CDG, AP and PGR contributed to the study concepts and study design. BP, LCacciani and TS retrieved initial references for the background. BP and NZ worked on quality control of data and linkage between datasets and BP analysed data. All the authors participated to the interpretation of the results. BP drafted the manuscript and NZ, SB, NC, TS, CDG, LB, AP, LCacciani, PB and PGR revised important contents in the article. BP worked on manuscript editing. All the authors have seen and approved the final version of the manuscript. BP is the guarantor.

Author information

Authors and Affiliations

  1. Regional Health and Social Care Agency of Emilia-Romagna, via A. Moro 21, Bologna, 40127, Italy

    Barbara Pacelli & Nicola Caranci

  2. Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, TO, Italy

    Nicolás Zengarini & Teresa Spadea

  3. Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy

    Serena Broccoli, Paola Ballotari & Paolo Giorgi Rossi

  4. Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

    Serena Broccoli, Paola Ballotari & Paolo Giorgi Rossi

  5. Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Chiara Di Girolamo

  6. Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK

    Chiara Di Girolamo

  7. Department of Epidemiology, Lazio Regional Health Service, Rome, Italy

    Laura Cacciani

  8. National Institute for Health, Migration and Poverty (INMP), Rome, Italy

    Alessio Petrelli

  9. Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, Padua, Italy

    Laura Cestari

  10. Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy

    Laura Grisotto

Authors
  1. Barbara Pacelli
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  2. Nicolás Zengarini
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  3. Serena Broccoli
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  4. Nicola Caranci
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  5. Teresa Spadea
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  6. Chiara Di Girolamo
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  7. Laura Cacciani
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  8. Alessio Petrelli
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  9. Paola Ballotari
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  10. Laura Cestari
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  11. Laura Grisotto
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  12. Paolo Giorgi Rossi
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Consortia

The IN-LiMeS Group

  • Alessio Petrelli
  • , Anna Maria Bargagli
  • , Annibale Biggeri
  • , Barbara Pacelli
  • , Concetta Mirisola
  • , Cristina Canova
  • , Ferdinando Luberto
  • , Gianfranco Costanzo
  • , Gianna Terni
  • , Giulia Cesaroni
  • , Giuseppe Costa
  • , Laura Bonvicini
  • , Laura Cacciani
  • , Laura Cestari
  • , Laura Grisotto
  • , Lorenzo Simonato
  • , Luisa Mondo
  • , Marina Davoli
  • , Nera Agabiti
  • , Nicola Caranci
  • , Nicolás Zengarini
  • , Paola Ballotari
  • , Paolo Carnà
  • , Paolo Giorgi Rossi
  • , Serena Broccoli
  •  & Teresa Spadea

Corresponding author

Correspondence to Barbara Pacelli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics

The record linkage procedures were performed with an anonymized individual key, complying with privacy protection rules. The IN-LiMeS is included in the Italian Statistical Program; privacy and ethical issues has been assessed by the Italian Data Protection Authority and the State and Region Conference.

Funding

This study was funded by the National Institute for Health, Migration and Poverty (INMP).

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Pacelli, B., Zengarini, N., Broccoli, S. et al. Differences in mortality by immigrant status in Italy. Results of the Italian Network of Longitudinal Metropolitan Studies. Eur J Epidemiol 31, 691–701 (2016). https://doi.org/10.1007/s10654-016-0177-z

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  • DOI: https://doi.org/10.1007/s10654-016-0177-z

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