Spatial-Temporal Distribution and Key Drivers of Inequalities in the Gap Between Health-Adjusted Life Expectancy and Life Expectancy: Evidence from a Megacity in China, 2010-2019.

Purpose The improvement of the quality of life (QoL) is reflected in the narrowing of the GAP between health-adjusted life expectancy (HALE) and life expectancy (LE). Less is known about the effect that the expansion of megacities may have on narrowing the gap. The purpose of this study was to disclose this potential relationship.Methods Annual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou, China, 2010-2019. Joinpoint regression was used for evaluating the time trends and global Moran’s Ⅰ and local Moran’s Ⅰ was used for evaluating spatial autocorrelation at the county-level during the entire study period. Generalized principal component analysis and multilevel models were used to examine the county-level association between the GAP and socioeconomic, health services, population structure, and population dynamics.Results From 2010 to 2019, LE increased by 2.8 years (2.8 years for males and 2.9 years for females) and total HALE increased by 2.4 years (2.5 years for males and 2.2 years for females). The counties with higher or lower LE, HALE, and their GAP were presented spatial agglomeration distribution characteristics. The central city and the neighboring counties had higher LE and HALE, and lower GAP. The ratio of male to female and the natural population growth rate were positively correlated with the GAP, while the gross domestic product per area, the density of resident population, the number of practicing (assistant) physicians per thousand, the number of hospital beds per thousand, the per capita disposable income, the ratio of child to old people, the net migration rate and the total migration rate were negatively correlated with the GAP.Conclusion In megacities, LE and HALE were higher and their GAP was lower in the central city than in the urban fringe. Socio-economic and health services were key to narrow the GAP. The widening GAP can be explained by a high proportion of females and old people, who were longevity but unhealthy. Population density within the urban carrying capacity produced a positive effect on narrow the GAP, and these were attributed to the healthy immigrant effect.

High prevalence of comorbidities at diagnosis in immigrants with multiple sclerosis

Background: Multiple sclerosis (MS) has been associated with certain comorbidities in general population studies, but it is unknown how comorbidity may affect immigrants with MS. Objective: To compare prevalence of comorbidities in immigrants and long-term residents at MS diagnosis, and in matched control populations without MS. Methods: We identified incident MS cases using a validated definition applied to health administrative data in Ontario, Canada, from 1994 to 2017, and categorized them as immigrants or long-term residents. Immigrants and long-term residents without MS (controls) were matched to MS cases 3:1 on sex, age, and geography. Results: There were 1534 immigrants and 23,731 long-term residents with MS matched with 4585 and 71,193 controls, respectively. Chronic obstructive pulmonary disease (COPD), diabetes, hypertension, ischemic heart disease, migraine, epilepsy, mood/anxiety disorders, schizophrenia, inflammatory bowel disease (IBD), and rheumatoid arthritis were significantly more prevalent among immigrants with MS compared to their controls. Prevalence of these conditions was generally similar comparing immigrants to long-term residents with MS, although COPD, epilepsy, IBD, and mood/anxiety disorders were less prevalent in immigrants. Conclusion: Immigrants have a high prevalence of multiple comorbidities at MS diagnosis despite the “healthy immigrant effect.” Clinicians should pay close attention to identification and management of comorbidity in immigrants with MS.

Effect of Health Comorbidities on Death from COVID-19 in Immigrants in Mexico

BackgroundComorbidities increase the risk of death for patients with COVID-19, however, little is known about how comorbidities affect immigrants, as well as their prognosis in the case of contracting the virus. Therefore, this article aims to determine which comorbidities are associated with the probability of death among immigrants in Mexico. Methods We use a sample of migrants (N = 3,567) registered in the public database published in the National Epidemiological Surveillance System of the Mexican Ministry of Health; the technique used was a Probit regression. Results The results show that comorbidities commonly associated with death from COVID-19, are not significant when present in immigrants, also, migrants have fewer comorbidities than the native born. These findings could be explained by the Healthy Immigrant Effect, which states that migration is a self-selection process, in which those who migrate are the healthiest. However, the cases of migrants who have died from COVID-19 are related to the time they have taken to go to hospitals and to problems of access to health care.ConclusionsThe immigrant populations (especially those in transit and refugees) do pose certain challenges to public policies in the countries of destination, so specific measures need to be taken in order to protect immigrant communities from the spread of the virus. It is important to improve the conditions during the migratory journey, avoiding overcrowding, as well as testing in various places (shelters, immigration controls, among others) in order to determine the levels of positivity in this group. ​However, the detection of more cases of COVID-19 among immigrants, should not equal to the denial for entry. Formal mechanisms should be put into place to guarantee the right to asylum and non-refoulement, even for migrants who test positive for the virus.

A Global Meta-analysis of the Immigrant Mortality Advantage

A large body of research on the “Healthy Immigrant Effect” (or “Paradox”) has reported an immigrant mortality advantage. However, other studies do not find such significant effects, and some even present contradictory evidence. This article is the first systematic meta-analysis that investigates the immigration-mortality relationship from a global perspective, examining 1,933 all-cause and cardiovascular mortality risk estimates from 103 publications. Our comprehensive analysis allows us to assess interactions between origin and destination regions and to reexamine, on a global scale, some of the most notable explanations for the immigrant mortality advantage, including suggestions that this paradox may be primarily the result of selection effects. We find evidence for the existence of a mild immigrant mortality advantage for working-age individuals. However, the relationship holds only for immigrants who moved between certain world regions, particularly those who immigrated from Northern Africa, Asia, and Southern Europe to richer countries. The results highlight the need in the broader migration literature for an increased focus on selection effects and on outcomes for people who chose not to migrate or who were denied entry into their planned destination country.

Chronic health conditions, healthcare experience and life satisfaction among immigrant and native-born women in Canada

PurposeTo compare chronic health status, utilization of healthcare services and life satisfaction among immigrant women and their Canadian counterparts.Design/methodology/approachA secondary analysis of national data from the Canadian Community Health Survey (CCHS), 2015–2016 was conducted. The survey data included 109,659 cases. Given the research question, only female cases were selected, which resulted in a final sample of 52,560 cases. Data analysis was conducted using multiple methods, including logistic regression and linear regression.FindingsRecent and established immigrant women were healthier than native-born Canadian women. While the Healthy Immigrant Effect (HIE) was evident among immigrant women, some characteristics related to ethnic origin and/or unhealthy dietary habits may deteriorate immigrant women's health in the long term. Immigrant women and non-immigrant women with chronic illnesses were both more likely to increase their use of the healthcare system. Notably, the present study did not find evidence that immigrant women under-utilized Canada's healthcare system. However, the findings showed that chronic health issues were more likely to decrease women's life satisfaction.Originality/valueThis analysis contributes to the understanding of immigrant women's acculturation by comparing types of chronic illnesses, healthcare visits, and life satisfaction between immigrant women and their Canadian counterparts.

Relationship of Preeclampsia With Maternal Place of Birth and Duration of Residence Among Non-Hispanic Black Women in the United States

Background: Preeclampsia is one of the leading causes of maternal mortality in the United States. It disproportionately affects non-Hispanic Black (NHB) women, but little is known about how preeclampsia and other cardiovascular disease risk factors vary among different subpopulations of NHB women in the United States. We investigated the prevalence of preeclampsia by nativity (US born versus foreign born) and duration of US residence among NHB women. Methods: We analyzed cross-sectional data from the Boston Birth Cohort (1998–2016), with a focus on NHB women. We performed multivariable logistic regression to investigate associations between preeclampsia, nativity, and duration of US residence after controlling for potential confounders. Results: Of 2697 NHB women, 40.5% were foreign born. Relative to them, US-born NHB women were younger, in higher percentage current smokers, had higher prevalence of obesity (body mass index ≥30 kg/m 2 ) and maternal stress, but lower educational level. The age-adjusted prevalence of preeclampsia was 12.4% and 9.1% among US-born and foreign-born women, respectively. When further categorized by duration of US residence, the prevalence of all studied cardiovascular disease risk factors except for diabetes was lower among foreign-born NHB women with <10 versus ≥10 years of US residence. Additionally, the odds of preeclampsia in foreign-born NHB women with duration of US residence <10 years was 37% lower than in US-born NHB women. In contrast, the odds of preeclampsia in foreign-born NHB women with duration of US residence ≥10 years was not significantly different from that of US-born NHB women after adjusting for potential confounders. Conclusions: The prevalence of preeclampsia and other cardiovascular disease risk factors is lower in foreign-born than in US-born NHB women. The healthy immigrant effect, which typically results in health advantages for foreign-born women, appears to wane with longer duration of US residence (≥10 years). Further research is needed to better understand these associations.

Cognitive Aging in the United States and Mexico

The Latino population is rapidly aging, with the number of adults 65 and older expected to increase by more than six times to 17.5 million by 2050. Mexico’s population is also aging and will increase by 227 percent over the next 25 years. We focus on the consequences of rising longevity and increasing numbers of older Latinos living with dementia both in the U.S. and in Mexico. Providing cost-effective and appropriate services to aging Latinos with dementia will require a clear understanding of the intra-diversity among this group in different social and national circumstances. The purpose of this symposium is the understand how migration between and within countries and other social and health factors (e.g., diabetes) impact risk for cognitive impairment and dementia using three national datasets: the HRS, MHAS, and HEPESE. Four paper presentations and one discussant will examine several thematic issues as they relate to cognitive aging for Latinos, including: (1) cross-national estimates of dementia prevalence in Mexico and the U.S.; (2) the healthy immigrant effect and health convergence hypothesis for cognitive impairment for Latinos in the U.S. and Mexico; and (3) implications of these trends for long-term care service needs for Latinos living with dementia in the U.S. and Mexico. The resulting discussion will provide new empirical and theoretical insights on the determinants of cognitive aging for this population. It will also inform debates and aid in implementing innovative strategies and solutions to mitigate risk for impairment and improve dementia care for older Latinos.