A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective

Abstract

Background During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH). Methods We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean). Results International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44–0.84; P = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors. Conclusions Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.

Longitudinal health survey of women from Venezuela in Colombia (ELSA-VENCOL): First report

“…This might be due to the relatively young age of the women surveyed. A “healthy migrant” phenomenon, might also be in place in this population, as has been reported all over the world and in Latin America [ 29 ]. Alternatively, since the questionnaire asked about previous diagnosis of the chronic diseases, lack of access to health care could also play a part.…”

Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile

“…It is commonly attributed to a self-selection process, where younger, healthier, and wealthier people are more prone to migrating [41]. In Chile, previous evidence has reported a possible "healthy migrant effect" on various health indicators, such as disability, chronic diseases, accidents, and hospitalization rates [24,[42][43][44][45]. Furthermore, as previously mentioned, those who have spent more time in the country tend to see their health deteriorate, possibly due to assimilation processes, suggesting the loss of their health advantage over time [46].…”

“…Specifically, chronic morbidity was associated with public and private health system affiliation, probably due to higher access to diagnosis and treatment. Additionally, migrants from Argentina had higher odds of having chronic conditions, while migrants from Haiti showed higher risks of negative self-perceived health and disability [24]. Although these studies bring attention to the issues of access and health risk among migrants in Chile, the data are limited to the CASEN 2017 survey and do not reflect the migratory trends and composition of migrant groups over the years.…”

Burden of Other Musculoskeletal Disorders in Latin America and the Caribbean

“…Disparities in health services for elderly individuals have been reported in the Chilean health system 24 . This is important in terms of the mean age of the population with other MSK disorders 25 …”