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Association between Integration Policies and Immigrants’ Mortality: An Explorative Study across Three European Countries

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  • Umar Z Ikram
  • Davide Malmusi
  • Knud Juel
  • Grégoire Rey
  • Anton E Kunst

Abstract

Background: To integrate immigrants into their societies, European countries have adopted different types of policies, which may influence health through both material and psychosocial determinants. Recent studies have suggested poorer health outcomes for immigrants living in countries with poorly rated integration policies. Objective: To analyse mortality differences of immigrants from the same country of origin living in countries with distinct integration policy contexts. Methods: From the mortality dataset collected in the Migrant Ethnic Health Observatory (MEHO) project, we chose the Netherlands (linked data from 1996-2006), France (unlinked; 2005-2007) and Denmark (linked; 1992-2001) as representatives of the inclusive, assimilationist and exclusionist policy models, respectively, based on the Migrant Integration Policy Index. We calculated for each country sex- and age-standardized mortality rates for Turkish-, Moroccan- and local-born populations aged 20-69 years. Poisson regression was used to estimate the mortality rate ratios (MRRs) for cross-country and within-country comparisons. The analyses were further stratified by age group and cause of death. Results: Compared with their peers in the Netherlands, Turkish-born immigrants had higher all-cause mortality in Denmark (MRR men 1.92; 95% CI 1.74-2.13 and women 2.11; 1.80-2.47) but lower in France (men 0.64; 0.59-0.69 and women 0.58; 0.51-0.67). A similar pattern emerged for Moroccan-born immigrants. The relative differences between immigrants and the local-born population were also largest in Denmark and lowest in France (e.g., Turkish-born men MRR 1.52; 95% CI 1.38-1.67 and 0.62; 0.58-0.66, respectively). These patterns were consistent across all age groups, and more marked for cardiovascular diseases. Conclusions: Although confounders and data comparability issues (e.g., French cross-sectional data) may affect the findings, this study suggests that different macro-level policy contexts may influence immigrants’ mortality. Comparable mortality registration systems across Europe along with detailed socio-demographic information on immigrants may help to better assess this association.

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  • Umar Z Ikram & Davide Malmusi & Knud Juel & Grégoire Rey & Anton E Kunst, 2015. "Association between Integration Policies and Immigrants’ Mortality: An Explorative Study across Three European Countries," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-14, June.
    • Handle: RePEc:plo:pone00:0129916
    DOI: 10.1371/journal.pone.0129916
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    References listed on IDEAS

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    1. Carme Borrell & Laia Palència & Xavier Bartoll & Umar Ikram & Davide Malmusi, 2015. "Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies," IJERPH, MDPI, vol. 12(9), pages 1-13, August.
    2. Blom, Niels & Huijts, Tim & Kraaykamp, Gerbert, 2016. "Ethnic health inequalities in Europe. The moderating and amplifying role of healthcare system characteristics," Social Science & Medicine, Elsevier, vol. 158(C), pages 43-51.
    3. Sonja Haustein & Maarten Kroesen & Ismir Mulalic, 2020. "Cycling culture and socialisation: modelling the effect of immigrant origin on cycling in Denmark and the Netherlands," Transportation, Springer, vol. 47(4), pages 1689-1709, August.
    4. Dourgnon, Paul & Pourat, Nadereh & Rocco, Lorenzo, 2023. "European immigrant health policies, immigrants’ health, and immigrants’ access to healthcare," Health Policy, Elsevier, vol. 127(C), pages 37-43.

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