Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden

Abstract Background Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. Methods By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. Results Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26–1.73] or child of a migrant (OR 1.27; 95% CI 1.10–1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51–2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17–1.81), non-Nordic European (OR 1.27; 95% CI 1.01–1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03–1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06–1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02–1.24). Conclusions Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.

Download Full-text

Inequalities in psychiatric service use and mortality by migrant status following a first diagnosis of psychotic disorder: a Swedish cohort study of 1.3m people

Schizophrenia Bulletin Open ◽

10.1093/schizbullopen/sgab009 ◽

2021 ◽

Author(s):

Dafni Katsampa ◽

Syeda F Akther ◽

Anna-Clara Hollander ◽

Henrik Dal ◽

Christina Dalman ◽

...

Keyword(s):

Length Of Stay ◽

Psychotic Disorder ◽

Service Use ◽

Psychiatric Service ◽

Mental Healthcare ◽

Migrant Status ◽

Region Of Origin ◽

Icd 10 ◽

Sub Saharan ◽

First Diagnosis

Abstract It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (i) mortality (including by major causes of death); (ii) admission type (in- or out-patient), and; (iii) in-patient length of stay at first diagnosis for psychotic disorder presentation, and; (iv) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants and by region-of-origin. We established a cohort of 1,335,192 people born 1984-1997 and living in Sweden from 1st January 1998, followed from their 14 th birthday or arrival to Sweden, until death, emigration, or 31 December 2016.People with ICD-10 psychotic disorder (F20-33; N=9,399) were 6.7 (95%CI: 5.9-7.6) times more likely to die than the general population, but this did not vary by migrant status (p=0.15) or region-of-origin (p=0.31). This mortality gap was most pronounced for suicide (adjusted hazard ratio [aHR]: 12.2; 95% CI: 10.4-14.4), but persisted for deaths from other external (aHR: 5.1; 95%CI: 4.0-6.4) and natural causes (aHR: 2.3; 95%CI: 1.6-3.3). Non-refugee (adjusted odds ratio [aOR]: 1.4, 95%CI: 1.2-1.6) and refugee migrants (aOR: 1.4, 95%CI: 1.1-1.8) were more likely to receive inpatient care at first diagnosis. No differences in inpatient length of stay at first diagnosis were observed. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (adjusted sub-HR: 1.2; 95%CI: 1.1-1.4). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

Download Full-text

Inequalities in psychiatric service use and mortality by migrant status following a first diagnosis of psychotic disorder: a Swedish cohort study of 1.3m people

10.31234/osf.io/8x5wy ◽

2021 ◽

Author(s):

Dafni Katsampa ◽

Syeda Akther ◽

Anna-Clara Hollander ◽

Henrik Dal ◽

Christina Dalman ◽

...

Keyword(s):

Length Of Stay ◽

Psychotic Disorder ◽

Service Use ◽

Psychiatric Service ◽

Mental Healthcare ◽

Survival Models ◽

Migrant Status ◽

Region Of Origin ◽

Sub Saharan ◽

First Diagnosis

It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (i) mortality; (ii) admission type (in- or out-patient), and; (iii) in-patient length of stay at first diagnosis for psychotic disorder presentation, and; (iv) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants and by region-of-origin. We established a cohort of 1,335,192 people aged up to 33 years old, born 1984-1997, and living in Sweden from 1st January 1998, followed from their 14th birthday or arrival to Sweden, until death, emigration, or 31 December 2016. The cohort included 9,399 individuals first diagnosed with ICD-10 psychotic disorder (F20-33) during follow-up. Logistic, linear and competing risks regression survival models were used to estimate disparities in outcomes by migrant status or region-of-origin, adjusted for covariates. People with psychotic disorder were 6.70 (95%CI: 5.93-7.58) times more likely to die than the general population, but this did not vary by migrant status (p=0.15) or region-of-origin (p=0.31). Non-refugee (odds ratio [OR]: 1.40, 95%CI: 1.21-1.61) and refugee migrants (OR: 1.42, 95%CI: 1.09-1.84) were more likely to receive inpatient care at first diagnosis. No differences in inpatient length of stay at first diagnosis were observed. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (sub-Hazard ratio: 1.19; 95% CI: 1.05-1.35). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

Download Full-text

Risk of schizophrenia, schizoaffective, and bipolar disorders by migrant status, region of origin, and age-at-migration: a national cohort study of 1.8 million people

Psychological Medicine ◽

10.1017/s0033291718003227 ◽

2018 ◽

Vol 49 (14) ◽

pp. 2354-2363 ◽

Cited By ~ 11

Author(s):

Jennifer Dykxhoorn ◽

Anna-Clara Hollander ◽

Glyn Lewis ◽

Cecelia Magnusson ◽

Christina Dalman ◽

...

Keyword(s):

Psychotic Disorders ◽

Proportional Hazards ◽

Bipolar Disorders ◽

Cox Proportional Hazards ◽

Migrant Status ◽

Region Of Origin ◽

Related Factors ◽

Increased Risk ◽

Age At Migration ◽

National Cohort

AbstractBackgroundWe assessed whether the risk of various psychotic disorders and non-psychotic bipolar disorder (including mania) varied by migrant status, a region of origin, or age-at-migration, hypothesizing that risk would only be elevated for psychotic disorders.MethodsWe established a prospective cohort of 1 796 257 Swedish residents born between 1982 and 1996, followed from their 15th birthday, or immigration to Sweden after age 15, until diagnosis, emigration, death, or end of 2011. Cox proportional hazards models were used to model hazard ratios by migration-related factors, adjusted for covariates.ResultsAll psychotic disorders were elevated among migrants and their children compared with Swedish-born individuals, including schizophrenia and schizoaffective disorder (adjusted hazard ratio [aHR]migrants: 2.20, 95% CI 1.96–2.47; aHRchildren : 2.00, 95% CI 1.79–2.25), affective psychotic disorders (aHRmigrant1.42, 95% CI 1.25–1.63; aHRchildren: 1.22 95% CI 1.07–1.40), and other non-affective psychotic disorders (aHRmigrant: 1.97, 95% CI 1.81–2.14; aHRchildren: 1.68, 95% CI 1.54–1.83). For all psychotic disorders, risks were generally highest in migrants from Africa (i.e. aHRschizophrenia: 5.24, 95% CI 4.26–6.45) and elevated at most ages-of-migration. By contrast, risk of non-psychotic bipolar disorders was lower for migrants (aHR: 0.58, 95% CI 0.52–0.64) overall, and across all ages-of-migration except infancy (aHR: 1.20; 95% CI 1.01–1.42), while risk for their children was similar to the Swedish-born population (aHR: 1.00, 95% CI 0.93–1.08).ConclusionsIncreased risk of psychiatric disorders associated with migration and minority status may be specific to psychotic disorders, with exact risk dependent on the region of origin.

Download Full-text

Malaria and risk of lymphoid neoplasms and other cancer: a nationwide population-based cohort study

BMC Medicine ◽

10.1186/s12916-020-01759-8 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Katja Wyss ◽

Fredrik Granath ◽

Andreas Wångdahl ◽

Therese Djärv ◽

Michael Fored ◽

...

Keyword(s):

Cox Regression ◽

Health Agency ◽

Malaria Diagnosis ◽

B Cell Lymphoma ◽

Population Based ◽

Sub Saharan Africa ◽

Lymphoid Neoplasms ◽

Hazard Ratios ◽

Increased Risk ◽

Sub Saharan

Abstract Background Malaria is associated with Burkitt lymphoma among children in Sub-Saharan Africa. No longitudinal studies have assessed the long-term risk of other lymphoma or cancer overall. Here, we investigated the risk of lymphoid neoplasms and other cancer after malaria. Methods We included 4125 patients diagnosed with malaria in Sweden in 1987–2015, identified either through the National Surveillance Database at the Public Health Agency of Sweden, the National Inpatient and Outpatient Register, or by reports from microbiology departments. A comparator cohort (N = 66,997) matched on sex, age and birth region was retrieved from the general population and an additional cohort with all individuals born in Sub-Saharan Africa registered in the Total Population Register in 1987–2015 (N = 171,756). Incident lymphomas and other cancers were identified through linkage with the Swedish Cancer Register. Hazard ratios (HRs) were assessed using Cox regression with attained age as the timescale. Results A total of 20 lymphoid neoplasms and 202 non-haematological cancers were identified among malaria patients during a mean follow-up of 13.3 and 13.7 years, respectively. The overall risk of lymphoid neoplasms was not significantly increased (hazard ratio [HR] 1.24, 95% confidence interval [CI] 0.79–1.94), neither did we find any association with all-site non-haematological cancer (HR 0.89, 95% CI 0.77–1.02). However, in the Sub-Saharan Africa cohort, we observed an increased risk of lymphoid neoplasms after malaria diagnosis (HR 2.39, 95% CI 1.06–5.40), but no difference in the risk of other cancer (HR 1.01, 95% CI 0.70–1.45). The association could not be explained by co-infection with HIV or chronic hepatitis B or C, since the risk estimate was largely unchanged after excluding patients with these comorbidities (HR 2.63, 95% CI 1.08–6.42). The risk became more pronounced when restricting analyses to only including non-Hodgkin and Hodgkin lymphomas (HR 3.49, 95% CI 1.42–8.56). Conclusion Individuals born in malaria-endemic areas and diagnosed with malaria in Sweden had an increased risk of lymphoid neoplasms, especially B cell lymphoma. There was no association with cancer overall nor did single malaria episodes confer an increased risk in travellers.

Download Full-text

Risk of schizophrenia, schizoaffective, and bipolar disorders by migrant status, region of origin, and age-at-migration: A national cohort study of 1.8 million people

10.31234/osf.io/b7gys ◽

2018 ◽

Author(s):

Jen Dykxhoorn ◽

Anna-Clara Hollander ◽

Glyn Lewis ◽

Cecelia Magnusson ◽

Christina Dalman ◽

...

Keyword(s):

Psychotic Disorders ◽

Proportional Hazards ◽

Bipolar Disorders ◽

Cox Proportional Hazards ◽

Migrant Status ◽

Region Of Origin ◽

Related Factors ◽

Increased Risk ◽

Age At Migration ◽

National Cohort

Background: We assessed whether risk of various psychotic disorders and non-psychotic bipolar disorder (including mania) varied by migrant status, region of origin, or age-at-migration, hypothesizing that risk would only be elevated for psychotic disorders. Methods: We established a prospective cohort of 1,796,257 Swedish residents born between 1982-97, followed from their 15th birthday, or immigration to Sweden after age 15, until diagnosis, emigration, death, or end of 2011. Cox proportional hazards models were used to model hazard ratios by migration-related factors, adjusted for covariates. Results: All psychotic disorders were elevated among migrants and their children compared with Swedish-born individuals, including schizophrenia and schizoaffective disorder (adjusted hazard ratio [aHR] - migrants: 2.20, 95%CI: 1.96-2.47; aHR-children: 2.00, 95%CI: 1.79-2.25), affective psychotic disorders (aHR-migrant: 1.42, 95%CI: 1.25-1.63; aHR-children: 1.22 95%CI: 1.07-1.40), and other non-affective psychotic disorders (aHR-migrant: 1.97, 95%CI: 1.81-2.14; aHR-children: 1.68, 95%CI: 1.54-1.83). For all psychotic disorders, risks were generally highest in migrants from Africa (i.e. aHR-schizophrenia: 5.24, 95%CI: 4.26-6.45) and elevated at most ages-of-migration. By contrast, risk of non-psychotic bipolar disorders was lower for migrants (aHR: 0.58, 95%CI: 0.52-0.64) overall, and across all ages-of-migration except infancy (aHR: 1.20; 95%CI: 1.01-1.42), while risk for their children was similar to the Swedish-born population (aHR: 1.00, 95%CI: 0.93-1.08). Conclusions: Increased risk of psychiatric disorders associated with migration and minority status may be specific to psychotic disorders, with exact risk dependent on region of origin.

Download Full-text

Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population

The British Journal of Psychiatry ◽

10.1192/bjp.2019.220 ◽

2019 ◽

Vol 217 (6) ◽

pp. 686-692 ◽

Cited By ~ 5

Author(s):

Anna-Clara Hollander ◽

Alexandra Pitman ◽

Hugo Sjöqvist ◽

Glyn Lewis ◽

Cecilia Magnusson ◽

...

Keyword(s):

Suicide Risk ◽

Cox Regression ◽

Population Based ◽

Host Population ◽

Hazard Ratio ◽

Additional Risk Factor ◽

Migrant Status ◽

Increased Risk ◽

Majority Population ◽

Over Time

BackgroundIt has been hypothesised that refugees have an increased risk of suicide.AimsTo investigate whether risk of suicide is higher among refugees compared with non-refugee migrants from the same areas of origin and with the Swedish-born population, and to examine whether suicide rates among migrants converge to the Swedish-born population over time.MethodA population-based cohort design using linked national registers to follow 1 457 898 people born between 1 January 1970 and 31 December 1984, classified by migrant status as refugees, non-refugee migrants or Swedish-born. Participants were followed from their 16th birthday or date of arrival in Sweden until death, emigration or 31 December 2015, whichever came first. Cox regression models estimated adjusted hazard ratios for suicide by migrant status, controlling for age, gender, region of origin and income.ResultsThere were no significant differences in suicide risk between refugee and non-refugee migrants (hazard ratio 1.28, 95% CI 0.93–1.76) and both groups had a lower risk of suicide than Swedish born. During their first 5 years in Sweden no migrants died by suicide; however, after 21–31 years their suicide risk was equivalent to the Swedish-born population (hazard ratio 0.94, 95% CI 0.79–1.22). After adjustment for income this risk was significantly lower for migrants than the Swedish-born population.ConclusionsBeing a refugee was not an additional risk factor for suicide. Our findings regarding temporal changes in suicide risk suggest that acculturation and socioeconomic deprivation may account for a convergence of suicide risk between migrants and the host population over time.Declaration of interestNone.

Download Full-text

Increased Inflammatory Potential of Diet is Associated with Increased Risk of Prostate Cancer in Iranian Men

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000395 ◽

2016 ◽

Vol 86 (5-6) ◽

pp. 161-168 ◽

Cited By ~ 11

Author(s):

Nitin Shivappa ◽

James R. Hébert ◽

Faezeh Askari ◽

Mehdi Kardoust Parizi ◽

Bahram Rashidkhani

Keyword(s):

Prostate Cancer ◽

Middle Eastern ◽

Population Based ◽

P Value ◽

Inflammatory Index ◽

Time Period ◽

Dichotomous Variable ◽

Increased Risk ◽

Matched Case ◽

Incident Cases

Purpose: Various aspects of diet, including specific foods and nutrients, have been implicated to play a role in modulating inflammation and in the etiology of prostate cancer. Studies examining this association have been conducted primarily in Western countries; but none in Middle Eastern Countries. Method: We examined the association between the dietary inflammatory index (DII) and prostate cancer in an ageand BMI-matched case-control study among 40-78 year-old Iranian males. A total of 50 incident cases and 100 controls attending the same hospital as the cases during the same time period were recruited. The DII is a literature-derived population-based dietary index developed to determine the inflammatory potential of individuals' diets and was computed based on dietary intake assessed using a previously validated semi-quantitative food frequency questionnaire (FFQ) that was expanded to assess diet and cancer in the Iranian population. Logistic regression was used to estimate odds ratios, with DII score fit as continuous and as a dichotomous variable. Results: Multivariable-adjusted analyses revealed that men with higher DII score (>0.23) to be at higher risk of prostate cancer [odds ratio (OR) = 3.96; 95% CI =1.29–12.16, p-value = 0.02)] compared to men with lower DII scores (≤0.23). Conclusion: These data suggest a pro-inflammatory diet, as indicated by increasing DII score, may be a risk factor for prostate cancer in Iranian men..

Download Full-text

Risk for COVID-19 among Migrants from different areas of the World in Spain: A population-based cohort study in a country with universal health coverage

10.1101/2020.05.25.20112185 ◽

2020 ◽

Author(s):

Carlos Guijarro ◽

Elia Pérez-Fernández ◽

Beatriz González-Piñeiro ◽

Victoria Meléndez ◽

Maria José Goyanes ◽

...

Keyword(s):

Latin America ◽

Universal Health Coverage ◽

Population Based ◽

Sub Saharan Africa ◽

Health Coverage ◽

Relative Risks ◽

Increased Risk ◽

The World ◽

Sub Saharan ◽

Universal Health

AbstractObjectiveTo evaluate the COVID-19 incidence among migrants from different areas of the world as compared to Spaniards living in AlcorcónDesignPopulation-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 cases until April 25 (2020) among adult residents at Alcorcón (Spain) attended at the only public hospital serving this city. Crude incident rates for Spaniards and migrants from different areas of the world were estimated. Age and sex-adjusted relative risks for COVID19 were estimated by negative bomial regression.SettingUniversity public Hospital at Alcorcón, Madrid, SpainParticipantsAll adult residents living in Alcorcon classified by their country and region of the world of origin.Main outcomePCR confirmed COVID-19.ResultsPCR confirmed COVID-19 cumulative incidence was 6.81 cases per 1000 inhabitants among residents of Alcorcón. The crude incidence among migrants (n=20419) was higher than among Spaniards (n=131599): 8.81 and 6.51 and per 1000 inhabitants respectively (p<0.001).By regions of the world, crude cumulative COVID-19 incidence rates were: European Union 2.38, Asia 2.01,, Northern Africa 3.59, East ern Europe 4.37, Sub-Saharan Africa 11.24, Caribbean 18.26 and Latin-America 20.77 8 per 1000 inhabitants. Migrant residents were markedly younger than Spaniards (median age 52 vs 73 years, p<0.001). By negative binomial regression, adjusted for age and sex, relative risks (RR) for COVID-19 were not significantly different from Spaniards for individuals from Europe, Asia or Northern Africa. In contrast, there was an increased risk for Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p=0.007), Caribbean (RR 6.35, 95% CI 3.83-10.55, p<0.001) and Latin-America (RR 6.92, 95% CI 4.49-10.67, p <0.001).ConclusionsThere was a marked increased risk for COVID-19 among migrants from Sub-Saharan Africa, Caribbean and Latin-America residing in Spain. The reasons underlying this increased risk and health and social implications deserve further attention.What is known about the topicRecent reports suggest an increased burden of COVID-19 among migrants or ethnic minorities in the United Kingdom and the USA, particularly regarding mortality. Reports have failed to dissociate clinical outcomes from differences in access to medical care or pre-existing medical conditions. There is no information regarding COVID risk for latinos in countries with universal health coverageWhat this study addMigrants from subsaharian Africa resident in Spain exhibit an increased risk for COVID-19. This risk is further increased for migrants from the Caribbean and Latin-America and cannot be attributed to unequal access to medical care. Studies in countries with universal health coverage may help to dissociate COVID burden in migrants and ethnic populations from access to health care.

Download Full-text

Incidence and Predictors of Mental Health Outcomes Among Survivors of Adolescent and Young Adult Cancer: A Population-Based Study Using the IMPACT Cohort

Journal of Clinical Oncology ◽

10.1200/jco.20.02019 ◽

2021 ◽

pp. JCO.20.02019

Author(s):

Riddhita De ◽

Rinku Sutradhar ◽

Paul Kurdyak ◽

Suriya Aktar ◽

Jason D. Pole ◽

...

Keyword(s):

Mental Health ◽

Young Adult ◽

Health Outcomes ◽

Psychotic Disorder ◽

Population Based ◽

Mental Health Outcomes ◽

Adolescent And Young Adult ◽

Increased Risk ◽

The Impact

PURPOSE Risk and predictors of long-term mental health outcomes in survivors of adolescent and young adult (AYA) cancers are poorly characterized. Mental health is consequently neglected in long-term follow-up. METHODS We identified all AYA in Ontario, Canada age 15-21 years when diagnosed with one of six common cancers between 1992-2012 using a population-based database, and compared them with matched controls. Linkage to provincial healthcare data allowed analysis of rates of outpatient (family physician and psychiatrist) visits for psychiatric indications and time to severe psychiatric events (emergency room visit, hospitalization, and suicide). Demographic-, disease-, and treatment-related predictors of adverse outcomes, including treatment setting (adult v pediatric), were examined. RESULTS Among 2,208 survivors and 10,457 matched controls, 5-year survivors experienced higher rates of outpatient mental health visits than controls (671 visits per 1,000 person-years v 506; adjusted rate ratio [RR] 1.3; 95% CI, 1.1 to 1.5; P = .006). Risk of a severe psychiatric episode was also increased among survivors (adjusted hazard ratio [HR], 1.2; 95% CI, 1.1 to 1.4, P = .008). Risk of a psychotic disorder–associated severe event was doubled in survivors (HR, 2.0, 95% CI, 1.3 to 2.4; P = .007) although absolute risk remained low (15-year cumulative incidence 1.7%; 95% CI, 1.0 to 2.7). In multivariable analysis, survivors treated in adult centers experienced substantially higher outpatient visit rates compared with those treated in pediatric settings (RR 1.8; 95% CI, 1.0 to 3.1; P = .04). CONCLUSION Survivors of AYA cancer are at substantially increased risk of adverse mental health outcomes, with those treated in adult centers at particular risk. Although absolute incidence was low, survivors were at increased risk of psychotic disorder–associated severe events. Long-term mental health surveillance is warranted, as is research into effective interventions during or after cancer treatment.

Download Full-text

Maternal immigrant status and signs of neurodevelopmental problems in early childhood

European Journal of Public Health ◽

10.1093/eurpub/ckz185.272 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Schmengler ◽

F El-Khoury Lesueur ◽

A Yermachenko ◽

M Taine ◽

D Cohen ◽

...

Keyword(s):

Parent Report ◽

Population Based ◽

Sub Saharan Africa ◽

Immigrant Status ◽

Region Of Origin ◽

Immigrant Mothers ◽

Generation Immigrant ◽

French Speaking ◽

Sub Saharan ◽

Neurodevelopmental Problems

Abstract Background A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of two-year-old children using standardized parent-report instruments. Methods We used data from the French representative ELFE birth cohort, initiated in 2011. The study sample included 9,900 children of non-immigrant French, 1,403 children of 2nd, and 1,171 children of 1st generation immigrant women followed-up to age two years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI). Results In fully adjusted linear regression models, maternal immigrant status was positively associated with M-CHAT scores, with stronger associations in children of 1st (β-coefficient: 0.19; 95% CI 0.08-0.29) than 2nd generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of 1st generation immigrant mothers native of North Africa (vs. non-immigrant French: 0.33; 0.16-0.49) or French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of 1st generation immigrant mothers, particularly from mostly non-francophone regions. Children of 1st generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores. Conclusions Our findings suggest that maternal immigrant status is associated with higher risks of early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Standardized screening instruments may aid the early detection and treatment of these difficulties, helping to address inequalities in neurodevelopmental health in children of immigrants. Key messages Children of immigrant mothers in a population-based sample appear to have elevated neurodevelopmental risks, as assessed by maternal report. This is in line with evidence from clinical samples. We found strong variations according to maternal region of origin, with the highest risks in children of 1st generation immigrant mothers from North Africa and French-speaking Sub-Saharan Africa.

Download Full-text