Mortality Advantage Reversed: The Causes of Death Driving All-Cause Mortality Differentials Between Immigrants, the Descendants of Immigrants and Ancestral Natives in Sweden, 1997–2016

Abstract

A small but growing body of studies have documented the alarming mortality situation of adult descendants of migrants in a number of European countries. Nearly all of them have focused on all-cause mortality to reveal these important health inequalities. This paper takes advantage of the Swedish population registers to study all-cause and cause-specific mortality among men and women aged 15–44 in Sweden from 1997 to 2016 to a level of granularity unparalleled elsewhere. It adopts a multi-generation, multi-origin and multi-cause-of-death approach. Using extended, competing-risks survival models, it aims to show (1) how the all-cause mortality of immigrants arriving as adults (the G1), immigrants arriving as children (the G1.5) and children of immigrants born in Sweden to at least one immigrant parent (the G2) differs versus ancestral Swedes and (2) what causes-of-deaths drive these differentials. For all-cause mortality, most G1 (not Finns or Sub-Saharan Africans) have a mortality advantage. This contrasts with a near systematic reversal in the mortality of the G1.5 and G2 (notably among men), which is driven by excess accident and injury, suicide, substance use and other external cause mortality. Given that external causes-of-death are preventable and avoidable, the findings raise questions about integration processes, the levels of inequality immigrant populations are exposed to in Sweden and ultimately, whether the legacy of immigration has been positive. Strengths of the study include the use of quality data and advanced methods, the granularity of the estimates, and the provision of evidence that highlights the precarious mortality situation of the seldom-studied G1.5.

Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review

“…15+, 36 17+, 54 18+, 38 20+ 53 ); others limit their analyses to fixed intervals (e.g. 16–42, 55 15–44, 1 25–54, 41 18–64 50 , 51 ). We did not find any studies of ‘old age’ mortality (i.e.…”

“…Studies of all-cause mortality find evidence of higher adult mortality risks among second-generation with migrant parent(s) born outside of Europe relative to adults born in the host country to two parents born in the host country. 1 , 39 , 41 , 49–51 , 53 Most of this higher mortality risk is concentrated among men 1 , 39 , 41 , 50 , 51 , 55 and it presents most consistently among second-generation with migrant parent(s) born in the Middle East, North Africa (MENA) 1 , 39 , 41 , 49–51 , 55 and Sub-Saharan Africa. 41 , 49 , 53 , 55 In contrast, there is less evidence of higher mortality among the European-origin second-generation.…”

“…This change is so great that the children of migrants (the so-called ‘second-generation’) comprise some of the fastest growing subpopulations of the infant, child and young adult populations across the world today. 1 This includes Europe, where 31% of the world’s immigrants currently reside. 2 This lasting demographic transformation has profound implications for population health, public health policy, clinical medicine, social policy, and research.…”

Socioeconomic position indicators and risk of alcohol-related medical conditions: A national cohort study from Sweden

“…Finland is included in the so-called “vodka belt,” i.e., those Northern countries where the use of stronger alcoholic beverages (spirits) and binge drinking are more common than in other countries [ 43 ]. Prior studies also document Finns’ excess mortality in Sweden across multiple medical conditions [ 44 ] and their self-reported poor health compared to other Swedes and to Finns living in Finland [ 45 ], which together suggests their greater risk of AMC signals wider health inequities. Additionally, immigrant groups may be less likely to use medical care, even in nations where it is broadly accessible.…”

New insights on testicular cancer prevalence with novel diagnostic biomarkers and therapeutic approaches

“…In the subsequent generation, the vulnerability remained elevated if both parents were of Danish descent, whereas it corresponded with the average populace of Sweden if only one parent possessed Danish heritage. 49 Hence, these investigations do not unequivocally eliminate the possibility of a hereditary predisposition, yet they consistently suggest that environmental elements exerting their influence during the early stages of existence play a pivotal role in the development of TC.…”