Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change

Abstract

The first objective of this study was to determine and quantify variations in diabetes mortality by migrant status in different European countries. The second objective was to investigate the hypothesis that diabetes mortality is higher in migrant groups for whom the country of residence (COR) is more affluent than the country of birth (COB). We obtained mortality data from 7 European countries. To assess migrant diabetes mortality, we used direct standardization and Poisson regression. First, migrant mortality was estimated for each country separately. Then, we merged the data from all mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations. Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8-2.0) and 2.2 (95% CI 2.1-2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests that socio-economic change may be one of the key aetiological factors.

Health and mortality patterns among migrants in France

“…Six publications belong to this subset (Bhopal et al, 2011;Ikram, Mackenbach, et al, 2015;Ikram, Malmusi, et al, 2015;Rafnsson et al, 2013;Spallek et al, 2012;Vandenheede et al, 2012).…”

“…smoking, high-fat diet), with the suggestion that this paradox may also apply to some extent to France's foreign-born population. For diabetes mortality, a general pattern of disadvantage was visible in migrants, and the lower the gross domestic product of the country of origin, the larger the disadvantage, which led to the suggestion of a major role of socio-economic change, and in particular lifestyle changes including diet and exercise (Vandenheede et al, 2012).…”

‘A chronic disease is a disease which keeps coming back … it is like the flu’: chronic disease risk perception and explanatory models among French- and Swahili-speaking African migrants

“…African migrants to Europe are known to experience increased mortality and 70 morbidity from major chronic diseases such as circulatory diseases, including stroke and diabetes (Harding et al 2008, Vandenheede et al 2012. Major cancers such as breast, colon and prostate cancers are also leading causes of cancer deaths (Harding et al 2009).…”

“…There is a large body of evidence for the social patterning of ethnic differences in chronic disease mortality and morbidity in the UK (Davey-Smith et al 2000), in Europe (Harding et al 2008, Vandenheede et al 2012) and the USA (Krieger 2000).…”

Migrants and Refugees in Europe: Challenges, Experiences and Contributions

“…In line with communicable diseases, the country of origin accounts for specific epidemiologic profiles also for non-communicable diseases. Diabetes mortality rates are higher in migrants from North Africa, the Caribbean, and South Asia [17,22,38]. Migrants from West Africa have a higher incidence of cerebrovascular disease, and those originating from Afghanistan, Iraq, and North Africa suffer more often from coronary heart disease [5,17,39].…”