Advertisement

Journal of Immigrant and Minority Health

, Volume 18, Issue 1, pp 42–50 | Cite as

Exploring the ‘Healthy Migrant Paradox’ in Sweden. A Cross Sectional Study Focused on Perinatal Outcomes

  • Sol Pía Juárez
  • Bárbara A. Revuelta-Eugercios
Original Paper

Abstract

Evidence shows that in some contexts immigrants have better health than natives in spite of coming from poorer socioeconomic contexts and of facing socioeconomic disadvantages in the host country. However, this is a country or origin- and outcome-specific phenomenon. This study compares different health outcomes derived from birthweight and gestational age among different migrant groups residing in Sweden. Cross-sectional study based on the Swedish Medical Birth Register for years 1987–1993. Multinomial regression models were performed to obtain crude and adjusted Odd Ratios and their 95 % Confidence Intervals. Overall, immigrants show a higher risk of LBW and preterm and a lower risk of macrosomia and post-term. Moreover, some groups performed worse than natives even in indicators at the two ends of the distribution. The healthy migrant paradox is also outcome-specific within different perinatal indicators and the selection explanation cannot fully account for this phenomenon.

Keywords

Birthweight Gestational age Sweden Macrosomia Post-term Migrants 

Notes

Acknowledgments

Authors thank Prof. Juan Merlo for the access to the dataset. This work was supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) (Dnr 2012-1367, PI Kirk Scott); Centre for Economic Demography, Lund University and SIMSAM early-life, Lund University (funded by VR#2013-5474. PI, A. Rignell-Hydbom); and from the Labex iPOPs (Pres heSam), reference ANR-10-LABX-0089, laboratoire INED.

References

  1. 1.
    Markides KS, Coreil J. The health of Hispanics in the southwestern United State: an epidemiologic parado. Public Health Rep. 1986;101(3):253–65.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Hummer RA, et al. Paradox found (again): infant mortality among the Mexican-origin population in the United States. Demography. 2007;44(3):441–57.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Razum O, et al. Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect? Trop Med Int Health. 1998;3(4):297–303.PubMedCrossRefGoogle Scholar
  4. 4.
    Ronellenfitsch U, et al. All-cause and cardiovascular mortality among ethnic German inmigrants from the Former Soviet Union: a cohort study. BMC Public Health. 2006;6:16.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Hessol NA, Fuentes-Afflick E. The perinatal advantage of Mexican-origin latina women. Ann Epidemiol. 2000;10:516–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Fuentes-Afflick E, Hessol NA, Pérez-Stable E. Testing the epidemiologic paradox of low birth weight in Latinos. Arch Pediatr Adolesc Med. 1999;153:147–53.PubMedCrossRefGoogle Scholar
  7. 7.
    Rosenberg TJ, Raggio Paggan T, Chiasson AM. A further examination of the “epidemiologic paradox”: birth outcomes among Latinas. J Natl Med Assoc. 2005;97:4.Google Scholar
  8. 8.
    Brown HL, et al. The “Hispanic Paradox”: an investigation of racial disparity in pregnancy outcomes at tertiary care medical center. Am J Obstet Gynecol. 2006;197:197.E1–9.CrossRefGoogle Scholar
  9. 9.
    Guendelman S, et al. Birth outcomes of immigrant women in the United States, France, and Belgium. Matern Child Health J. 1999;3(4):177–87.PubMedCrossRefGoogle Scholar
  10. 10.
    Milewski N, Peters F. Too low or too high? On birthweight differentials of immigrants in Germany. Comp Popul Stud. 2014;39(1):3–22.Google Scholar
  11. 11.
    Speciale AM, Regidor E. Understanding the universality of the immigrant health paradox: the Spanish perspective. J Immigr Minor Health. 2010.Google Scholar
  12. 12.
    Malamitsi-Puchner A, et al. Preterm delivery and low birthweight among refugees in Greece. Paediatr Perinat Epidemiol. 1994;8(4):384–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Wingate M, Alexander S, Greg R. The Healthy Migrant Theory: variation in pregnancy outcomes among US-born migrants. Soc Sci Med. 2006;62:491–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Jansà JM, de Olalla García P. Salud e inmigración: nuevas realidades y nuevos retos. Gac Sanit. 2004;18(1):207–13.PubMedCrossRefGoogle Scholar
  15. 15.
    Juárez S, Ploubidis GB, Clark L. Revisiting the ‘Low BirthWeight paradox’ using a model-based definition. Gac Sanit. 2014;28(2):160–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Urquia ML, O’Campo PJ, Heaman MI. Revisiting the immigrant paradox in reproductive health: the roles of duration of residence and ethnicity. Soc Sci Med. 2012;74(10):1610–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Rasmussen F, et al. Preterm birth and low birthweight among children of Swedish and immigrant women between 1978 and 1990. Paediatr Perinat Epidemiol. 1995;9(4):441–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Li X, Sundquist J, Sundquist K. Immigrants and preterm births: a nationwide epidemiological study in Sweden. Matern Child Health J. 2013;17(6):1052–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Li X, Sundquist K, Sundquist J. Risks of small-for-gestational-age births in immigrants: a nationwide epidemiological study in Sweden. Scand J Public Health. 2012;40(7):634–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Juárez S, Revuelta-Eugercios B. Too heavy, too late: investigating perinatal health outcomes in immigrants residing in Spain. A cross-sectional study (2009–2011). JECH. 2014;28(9):863–8.Google Scholar
  21. 21.
  22. 22.
    Ravenstein EG. The laws of migration. J Roy Stat Soc. 1885;48:167–227.Google Scholar
  23. 23.
    Facts about Sweden. Equal access–the key to keeping Sweden healthy, The Swedish Institute 2014; 1–4.Google Scholar
  24. 24.
    Cnattingius S, et al. A quality study of a medical birth registry. Scand J Soc Med. 1990;18:143–8.PubMedGoogle Scholar
  25. 25.
    Cunningham FG, et al. Williams obstetrics. 23rd ed. United States of America: McGraw-Hill; 2005.Google Scholar
  26. 26.
    Källén B. A birth weight for gestational age standard based on data in the Swedish Medical Birth Registry, 1985–1989. Eur J Epidemiol. 1995;11(5):601–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Org. 1987;65(5):663–737.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Swamy GK, et al. Maternal age, birth order, and race: differential effects on birthweight. J Epidemiol Community Health. 2012;66(2):136–42.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse repreductive outcomes. N Engl J Med. 1995;332(17):1113–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Odibo A, et al. Advanced maternal age is an independent risk factor for intrauterine growth restriction. Am J Perinatol. 2006;23(5):325–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Shah PS, et al. Maternal marital status and birth outcomes: a systematic review and meta-analyses. Matern Child Health J. 2011;15(7):1097–109.PubMedCrossRefGoogle Scholar
  32. 32.
    Auger N, et al. Educational inequalities in preterm and term small-for-gestational-age birth over time. Ann Epidemiol. 2012;22(3):160–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Juárez S, Revuelta-Eugercios B. Socioeconomic differences in low birthweight: revisiting epidemiological approaches. REIS. 2013;144:73–96.Google Scholar
  34. 34.
    Juárez S, Merlo J. Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden. PLoS One. 2013;8:e61734.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta Obstet Gynecol Scand. 2008;87(2):134–45.PubMedCrossRefGoogle Scholar
  36. 36.
    Catov JM, et al. Chronic hypertension related to risk for preterm and term small for gestational age births. Obstet Gynecol. 2008;112(2):290–6.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Schultz R, et al. Genitourinary tract infections in pregnancy and low birth weight: case-control study in Australian aboriginal women. BMJ. 1991;303(6814):1369–73.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Flores MES, et al. The “Latina epidemiologic paradox”: contrasting patterns of adverse birth outcomes in US-born and foreign-born Latinas. Women’s Health Issues. 2012;22(5):e501–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Li X, Sundquist J, Sundquist K. Immigrants and preterm births: a nationwide epidemiological study in Sweden. Matern Child Health J. 2013;17(6):1052–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Calvo JM. The consequences of restricted health care access for immigrants: lessons from Medicaid and SCHIP. Ann Health Law. 2008;17(2):175–212.Google Scholar
  41. 41.
    Healthcare in Sweden. Swedish Institute. [cited 2014. Access: http://sweden.se/society/healthcare-in-sweden/ 10-05].
  42. 42.
    Ny P, et al. Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö Sweden. Acta Obstet Et Gynecol Scand. 2007;86(7):805–13.CrossRefGoogle Scholar
  43. 43.
    Malin M, Gissler M. Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health. 2009;9:1–14.CrossRefGoogle Scholar
  44. 44.
    Pedersen GS, et al. Preterm birth and birthweight-for-gestational age among immigrant women in Denmark 1978–2007: a nationwide registry study. Paediatr Perinat Epidemiol. 2012;26(6):534–42.PubMedCrossRefGoogle Scholar
  45. 45.
    Harding S, Rosato MG, Cruickshank KJ. Lack of change in birthweight of infants by generational status among Indian, Pakistani, Bangladeshi, Black Caribbean, and Black African mothers in a British cohort study. Int J Epidemiol. 2004;33:1279–85.PubMedCrossRefGoogle Scholar
  46. 46.
    Bevelander P. The employment integration of resettled refugees, asylum claimants and family reunion migrants in Sweden. Refug Surv Quat. 2011;30(1):22–43.CrossRefGoogle Scholar
  47. 47.
    Koyanagi A, et al. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet. 2013;9(381):476–83.CrossRefGoogle Scholar
  48. 48.
    Fadl HE, Hanson USB, Östlund IKM. Outcomes of gestational diabetes in Sweden depending on country of birth. Acta Obstet Gynecol Scand. 2012;91(11):1326–30.PubMedCrossRefGoogle Scholar
  49. 49.
    Urquia ML, O’Campo PJ, Heaman MI. Revisiting the immigrant paradox in reproductive health: the roles of duration of residence and ethnicity. Soc Sci Med. 2012;74(10):1610–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Liu C, et al. Migration and preterm birth in war refugees: a Swedish cohort study. Eur J Epidemiol. 2014;29:141–3.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sol Pía Juárez
    • 1
    • 2
  • Bárbara A. Revuelta-Eugercios
    • 3
  1. 1.Centre for Health Equity StudiesStockholms Universitet/Karolinska InstitutetStockholmSweden
  2. 2.Division of Environmental and Occupational Medicine, Faculty of MedicineLund UniversityStockholmSweden
  3. 3.Saxo-InstituttetUniversity of CopenhagenCopenhagen SDenmark

Personalised recommendations