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

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.

Physical and mental health inequalities between native and immigrant Swedes

“…First, in our initial analyses, no significant differences were found between native and immigrant Swedes in their reporting of PI (Table ); however, after accounting for status inconsistency and social support, immigrants from ENAO had reduced OR of reporting PI compared to natives, which became significant (Table ). Second, previous research indicates that the HME is not as applicable to refugees (Domnich et al., ; Juárez and Revuelta‐Eugercios, ; Norredam et al., ). In our study, the reduced OR for reporting PI was found only for immigrants from ENAO and not for those from AASA, that is, from where most asylum seekers to Sweden originate (Swedish Migration Agency, ).…”

“…The healthy migrant effect found in some studies (HME; the hypothesis that immigrants report better health than natives because those who migrate are a population's healthiest individuals) appears, therefore, not to be as applicable in the Swedish context. This is not so surprising, given that previous research indicates that the healthy migrant effect is not applicable to all types of migrants and in particular not so applicable to refugees (Domnich et al., ; Juárez and Revuelta‐Eugercios, ; Norredam et al., ), and refugees, including refugee family reunifications, is one of the largest migrant categories in Sweden (other categories primarily include other family reunifications, labour market immigrants, students, and EEA agreements; Swedish Migration Agency, ).…”

The influence of acculturation on the risk of stillbirth in migrant women residing in Western Australia

“…In our study, migrant women who utilised an interpreter had a significantly lower risk of stillbirth compared to those who did not. Given the majority of migrants who utilised an interpreter were from regions with higher rates of stillbirth than Australia and had a residence length of <5 years in Australia, this may be evidence of a "healthy migrant paradox" [38]. This implies observing better health outcomes among newly arrived migrants than the host population, despite the disadvantages migrants encounter, which slowly converges to the host population levels over time [38].…”

“…Given the majority of migrants who utilised an interpreter were from regions with higher rates of stillbirth than Australia and had a residence length of <5 years in Australia, this may be evidence of a "healthy migrant paradox" [38]. This implies observing better health outcomes among newly arrived migrants than the host population, despite the disadvantages migrants encounter, which slowly converges to the host population levels over time [38]. Not utilising an interpreter was a particularly strong risk factor for nonwhite-non-Māori migrant women who had an overseas-born partner and delivered during the first five years of residing in Australia, suggesting lower levels of acculturation.…”

Introduction: migration, health and survival – international perspectives

“…Over recent years the European literature beyond these countries has been expanding rapidly. To some extent, this is a reflection of these countries' growing experience with immigration brought on by the combined forces of globalization, expansion of the European Union, and periodic refugee crises in the regions surrounding Europe (for example, Geddes et al, 1993;Balzi et al, 1994;Courbage and Khlat, 1996;Wild and McKeigue, 1997;Johansson, 1997a, 1997b;Razum et al, 1998;Uitenbroek and Verhoeff, 2002;Harding, 2004;Stiribu et al, 2006;Regidor et al, 2011;Agyemang, de-Graft Aikins and Bhopal, 2012;Boulogne et al, 2012;Spallek et al, 2012;Hollander, 2013;Wallace and Kulu, 2013, 2014a, 2014bNorredam et al, 2014;Moncho et al, 2015;Ikram et al, 2015;Vandenheede et al, 2015;Juárez and Revuelta-Eugercios, 2016;Verropoluou and Tsimbos, 2016;Wallace, 2016).…”