This paper investigates age variations in foreign-born vs. native-born mortality ratios in an international comparative perspective, with the purpose of gaining insight into the mechanisms underlying ...the so-called migrant mortality advantage. We examine the four main explanations that have been proposed in the literature for the migrant mortality advantage (i.e., in-migration selection effects, out-migration selection effects, cultural effects, and data artifacts), and formulate expectations as to whether they should generate an increase, a decrease, or no change in relative mortality over the life course. Using data from France, the US and the UK for periods around 2010, we then examine typical age patterns of foreign-born vs. native-born mortality ratios in light of this theoretical framework. We find that these mortality ratios vary greatly by age, with important similarities across migrant groups and host countries. The most systematic age pattern we find is a U-shape pattern: at the aggregate level, migrants often experience excess mortality at young ages, then exhibit a large advantage at adult ages (with the largest advantage around age 45), and finally experience mortality convergence with natives at older ages. The explanation most consistent with this pattern is the "in-migration selection effects" explanation. By contrast, the "out-migration selection effects" explanation is poorly supported by the observed patterns. Our age disaggregation also shows that migrants at mid-adult ages experience mortality advantages that are often far greater than typically documented in this literature. Overall, these results reinforce the notion that migrants are a highly-selected population exhibiting mortality patterns that poorly reflect their living conditions in host countries.
The migrant mortality advantage is generally interpreted as reflecting the selection of atypically healthy individuals from the country of origin followed by the wearing off of selection effects over ...time, a process theorised to be accelerated by progressive and negative acculturation in the host country. However, studies examining how migrant mortality evolves over duration of stay, which could provide insight into these two processes, are relatively scarce. Additionally, they have paid little attention to gender-specific patterns and the confounding effect of age. In this study, we analyze all-cause mortality according to duration of stay among male and female migrants in France, with a particular focus on the role of age in explaining duration of stay effects.
We use the Échantillon Démographique Permanent (Permanent Demographic Sample; EDP), France's largest socio-demographic panel and a representative 1% sample of its population. Mortality was followed-up from 2004 to 2014, and parametric survival models were fitted for males and females to study variation in all-cause mortality among migrants over duration of stay. Estimates were adjusted for age, duration of stay, year, education level and marital status. Duration of stay patterns were examined for both open-ended and fixed age groups.
We observe a migrant mortality advantage, which is most pronounced among recent arrivals and converges towards the mortality level of natives with duration of stay. We show this pattern to be robust to the confounding effect of age and find the pattern to be consistent among males and females.
Our novel findings show an intrinsic pattern of convergence of migrant mortality towards native-born mortality over time spent in France, independent from the ages at which mortality is measured. The consistent pattern in both genders suggests that males and females experience the same processes associated with generating the migrant mortality advantage. These patterns adhere to the selection-acculturation hypothesis and raise serious concerns about the erosion of migrant health capital with increasing exposure to conditions in France.
This study investigates the evolution of educational disparities in smoking uptake across cohorts for men and women in three countries. Nationally representative surveys of adults in France, Germany ...and the United States in 2009–2010 include retrospective measures of age of uptake that are compared for three cohorts (born 1946–1960, 1961–1975, and 1976–1992). Discrete logistic regressions and a relative measure of education are used to model smoking histories until age 34. The following patterns are found: a strengthening of educational disparities in the timing of uptake from older to younger cohorts; an earlier occurrence of the strengthening for men than women and for the United States than France or Germany; a faster pace of the epidemic in France than in the United States, and; a divide between the highest level of education and the others in the United States, as opposed to a gradient across categories in France. Those differences in smoking disparities across cohorts, genders and countries help identify the national and temporal circumstances that shape the size and direction of the relationship between education and health and the need for policies that target educational disparities.
•Earlier emergence of educational disparities in smoking in the United States than in France and Germany.•Faster pace of the tobacco epidemic in France than in the United States.•Divide between the highest level of college education and the others in the United States.•Gradient across the educational categories in France.•Remaining gender differences greatest in the United States.
France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family ...living arrangement and parental socioeconomic group.
The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression.
Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55-1.84), 1.29 (1.14-1.45) and 2.31 (1.95-2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22-1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64-0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use.
Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.
Although the French population comprises large and diverse immigrant groups, there is little research on smoking disparities by geographical origin. The aim of this study is to investigate in this ...country smoking among immigrants born in either north Africa, sub-Saharan Africa or French overseas départements.
The data originate from the 2010 Health Barometer survey representative of metropolitan France. The subsample of 20,211 individuals aged 18-70 years (born either in metropolitan France or in the above-mentioned geographical regions) was analysed using logistic regression.
Both immigrants from sub-Saharan Africa and immigrants from overseas départements were protected from smoking compared to the reference population, and the former had a distinctive strongly reversed educational gradient in both genders. Returned former settlers from the French colonies in North Africa (repatriates) had the highest smoking levels. Natives from the Maghreb (Maghrebins) showed considerable gender discordance, with men having both a higher prevalence (borderline significance) and a reversed gradient and women having lower prevalence than the reference population.
Immigrants from regions of the world in stage 1 of the cigarette epidemic had relatively low smoking levels and those from regions in stage 2 had relatively high smoking levels. Some groups had a profile characteristic of late phases of the cigarette epidemic, and others, some of which long-standing residents, seemed to be positioned at its early stages. The situation for Maghrebins reflected the enduring influence of gendered norms post-migration. Based on their educational gradients, immigrants from overseas départements (particularly men) and Maghrebin women may be at risk of losing their particularly low prevalence. Immigrants from sub-Saharan Africa could retain it. In-depth analysis of smoking profiles of immigrants' groups is essential for a better targeting of smoking prevention and cessation programs.
France has a large population of second-generation immigrants (i.e., native-born children of immigrants) who are known to experience important socioeconomic disparities by country of origin. The ...extent to which they also experience disparities in mortality, however, has not been previously examined.
We used a nationally representative sample of individuals 18 to 64 years old in 1999 with mortality follow-up via linked death records until 2010. We compared mortality levels for second-generation immigrants with their first-generation counterparts and with the reference (neither first- nor second-generation) population using mortality hazard ratios as well as probabilities of dying between age 18 and 65. We also adjusted hazard ratios using educational attainment reported at baseline.
We found a large amount of excess mortality among second-generation males of North African origin compared to the reference population with no migrant background. This excess mortality was not present among second-generation males of southern European origin, for whom we instead found a mortality advantage, nor among North African-origin males of the first-generation. This excess mortality remained large and significant after adjusting for educational attainment.
In these first estimates of mortality among second-generation immigrants in France, males of North African origin stood out as a subgroup experiencing a large amount of excess mortality. This finding adds a public health dimension to the various disadvantages already documented for this subgroup. Overall, our results highlight the importance of second-generation status as a significant and previously unknown source of health disparity in France.
This study aims to ascertain occupations potentially at greatest risk of exposure to SARS-CoV-2 based on pre-lockdown working conditions in France. We combined two French population-based surveys ...documenting workplace exposures to infectious agents, face-to-face contact with the public, and working with colleagues just before the pandemic. Then, for each 87-level standard French occupational grouping, we estimated the number and percentage of the French working population reporting these occupational exposure factors, by gender, using survey weights. As much as 40 % (11 million) of all workers reported at least two exposure factors. Most workers concerned were in the healthcare sector. However, army/police officers, firefighters, hairdressers, teachers, cultural/sports professionals, and some manual workers were also exposed. Women were over-represented in certain occupations with potentially higher risks of exposure, such as home carers, childminders, and hairdressers. Our gender-stratified matrix can be used to assign pre-lockdown work-related exposures in cohorts implemented during the pandemic.
We investigated the mortality patterns of chronic obstructive pulmonary disease (COPD) patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019.
COPD ...patient and sex, age and residence matched control cohorts were created from the French National Health Data System. Survival was analyzed using Cox regressions and standardized rates.
All-cause mortality increased in 2020 compared to 2019 in the COPD population (+4%), but to a lesser extent than in the control population (+10%). Non-COVID-19 mortality decreased to a greater extent in COPD patients (-5%) than in the controls (-2%). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs. 279 per 100,000 person-years).
The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.
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