Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

Elshahat, Sarah; Moffat, Tina; Newbold, K. Bruce

doi:10.1007/s10903-021-01313-5

Cited by 36 publications

(16 citation statements)

References 98 publications

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“…The most prominent explanation for Venezuelans’ consistently lower age-standardized death rates is the "healthy immigrant effect," the tendency of immigrants to be healthier than the corresponding host populations. Researchers generally ascribe this to a selection effect—healthy people desire and are better able to migrate internationally [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the mobility component of this family of studies found that weekend mobility (when patrons might visit bars and clubs) appeared to be a greater contributor to COVID-19 transmission than mid-week mobility (presumably for work and necessary errands), Venezuelans may have been less mobile due to lower disposable income or less confidence, and thus less exposed [ 10 – 12 , 15 , 16 ]. Finally, Venezuelans may have become more resilient as they were forced to adapt to the stresses of discrimination, adverse economic conditions, and a foreign environment [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of COVID-19 on healthcare utilization, cases, and deaths of citizens and displaced Venezuelans in Colombia: Complementary comprehensive and safety-net systems under Colombia’s constitutional commitment

et al. 2023

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Objective Colombia hosts 1.8 million displaced Venezuelans, the second highest number of displaced persons globally. Colombia’s constitution entitles all residents, including migrants, to life-saving health care, but actual performance data are rare. This study assessed Colombia’s COVID-era achievements. Methods We compared utilization of comprehensive (primarily consultations) and safety-net (primarily hospitalization) services, COVID-19 case rates, and mortality between Colombian citizens and Venezuelans in Colombia across 60 municipalities (local governments). We employed ratios, log transformations, correlations, and regressions using national databases for population, health services, disease surveillance, and deaths. We analyzed March through November 2020 (during COVID-19) and the corresponding months in 2019 (pre-COVID-19). Results Compared to Venezuelans, Colombians used vastly more comprehensive services than Venezuelans (608% more consultations), in part due to their 25-fold higher enrollment rates in contributory insurance. For safety-net services, however, the gap in utilization was smaller and narrowed. From 2019 to 2020, Colombians’ hospitalization rate per person declined by 37% compared to Venezuelans’ 24%. In 2020, Colombians had only moderately (55%) more hospitalizations per person than Venezuelans. In 2020, rates by municipality between Colombians and Venezuelans were positively correlated for consultations (r = 0.28, p = 0.04) but uncorrelated for hospitalizations (r = 0.10, p = 0.46). From 2019 to 2020, Colombians’ age-adjusted mortality rate rose by 26% while Venezuelans’ rate fell by 11%, strengthening Venezuelans’ mortality advantage to 14.5-fold. Conclusions The contrasting patterns between comprehensive and safety net services suggest that the complementary systems behaved independently. Venezuelans’ lower 2019 mortality rate likely reflects the healthy migrant effect (selective migration) and Colombia’s safety net healthcare system providing Venezuelans with reasonable access to life-saving treatment. However, in 2020, Venezuelans still faced large gaps in utilization of comprehensive services. Colombia’s 2021 authorization of 10-year residence to most Venezuelans is encouraging, but additional policy changes are recommended to further integrate Venezuelans into the Colombian health care system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on healthcare utilization, cases, and deaths of citizens and displaced Venezuelans in Colombia: Complementary comprehensive and safety-net systems under Colombia’s constitutional commitment

et al. 2023

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“…The effect is typically attributed to a positive selection of health characteristics, but it is possible that selection for healthy immigrants also selects for immigrants with stricter hygiene. However, the effect has mainly been found for chronic and lifestyle-associated diseases and tends to decrease over time, which seems to indicate that it has more to do with health status at the time of arrival than with stable personality traits or hygiene preferences that may protect against infection ( Newbold, 2006 ; Gushulak, 2007 ; Elshahat et al, 2021 ). Nonetheless, future studies could further investigate possible connections between stricter hygiene norms and immigrant health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Acculturation of hygiene norms among immigrants to Sweden

Krueger

Eriksson²,

Hazin³

et al. 2023

Front. Psychol.

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Hygiene norms in Sweden are generally loose compared to most other countries. Does this looseness affect the hygiene norms among people who immigrate to Sweden from other countries? In a study of hygiene norms among immigrants to Sweden, the change in the physical environment and material living conditions, acculturation to Swedish culture and norms, and selection effects were all expected to lead immigrant hygiene norms to be closer to Swedish looseness. However, in a sample of 447 immigrants from 12 different countries, immigrants reported hygiene norms that were even stricter than those found in their countries of origin. We propose an explanation based on a combination of uncertainty about prevailing hygiene norms and the social risk and stigma associated with being perceived as unhygienic. We conclude that acculturation processes may rely on mechanisms that are domain specific.

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“…Aside from that, the Iraqi immigrants do not really fulfil the definition of “healthy” as they have a prevalence of T2D double that of Swedish-born as well as a higher prevalence of obesity, insulin resistance and higher prevalence of poor self-rated health as compared to Swedish-born 5 , 39 . Hence the healthy immigrant paradox is far from being fully understood and more research is needed to study eventual mental health benefits among immigrants and eventual correlation to the lower ACM rates observed among immigrants 40 . The fact that the mortality rates of second-generation immigrants merge toward the host population suggests possible gene-environment interactions may occur during adaptation to western lifestyles 14 .…”

Section: Discussionmentioning

confidence: 99%

Cancer, cardiovascular disease, and all-cause mortality in Iraqi- and Swedish-born individuals in Sweden: the MEDIM cohort study

Dhaher

Pikkemaat

Shaat

et al. 2023

Sci Rep

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Immigrants from the Middle East to Sweden have a twice as high prevalence of type 2 diabetes (T2D) and obesity as native-born Swedes. Both obesity and T2D have been linked to increased incidence of cancer, cardiovascular disease (CVD) and all-cause mortality (ACM); however, data on differences between ethnicities are scarce. In a population-based cohort we aimed to study the impact of Middle Eastern and European ethnicity on ACM, cancer- and CVD related mortality, incidence of cancer and CVD in an eight-year follow-up study. Methods: People born in Iraq or Sweden, who were 30–75 years of age, were invited from 2010 to 2012 to participate in the population based MEDIM study including a health exam, fasting blood sampling, assessment of insulin secretion and action (through oral glucose tolerance test) and questionnaires assessing history of CVD, cancer and T2D. Register data were retrieved from baseline until the 31st of December 2018 from the Swedish National Patient Register and Cause of Death register regarding CVD diagnosis, cancer diagnosis and cause of death. Information regarding diabetes diagnosis was retrieved from the National Diabetes Register. Individuals with a history of cancer or CVD at baseline were excluded. Cox regression analysis was assessed to study the adjusted hazard ratios (HR) for the relationships between ethnicity and ACM, cancer events, CVD events, death from cancer, and death from CVD, with adjustments for age, sex, anthropometrical measures, T2D and lifestyle. A total of 1398 Iraqi- and 757 Swedish-born residents participated in the study. ACM was considerably lower in Iraqi- compared to Swedish-born individuals HR 0.32 (95% CI 0.13–0.79) (p < 0.05). Furthermore, cancer related morbidity and mortality HR 0.39 (0.22–0.69) (p < 0.01) as well as CVD related morbidity and mortality HR 0.56 (0.33–0.95) (p < 0.05) were lower in the Iraqi-born group compared to the Swedish-born group for. The differences in mortality and cancer rates across ethnicities are not fully explained by anthropometric, environmental or metabolic measures but lie elsewhere. Further studies are needed to increase the understanding of contributing mechanisms.

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Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

Cited by 36 publications

References 98 publications

Impact of COVID-19 on healthcare utilization, cases, and deaths of citizens and displaced Venezuelans in Colombia: Complementary comprehensive and safety-net systems under Colombia’s constitutional commitment

Impact of COVID-19 on healthcare utilization, cases, and deaths of citizens and displaced Venezuelans in Colombia: Complementary comprehensive and safety-net systems under Colombia’s constitutional commitment

Acculturation of hygiene norms among immigrants to Sweden

Cancer, cardiovascular disease, and all-cause mortality in Iraqi- and Swedish-born individuals in Sweden: the MEDIM cohort study

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