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Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the ‘healthy migrant effect’ hypothesis
Author(s) -
Norredam Marie,
Agyemang Charles,
Hoejbjerg Hansen Oluf K.,
Petersen Jørgen H.,
Byberg Stine,
Krasnik Allan,
Kunst Anton E.
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12340
Subject(s) - medicine , residence , demography , hazard ratio , immigration , danish , refugee , stroke (engine) , gerontology , pediatrics , confidence interval , geography , mechanical engineering , linguistics , philosophy , archaeology , sociology , engineering
Objectives The ‘healthy migrant effect’ ( HME ) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. Methods We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 ( n = 114 331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios ( HR s) were modelled for disease incidence by residence duration since arrival (0–5 years; 0–10 years; 0–18 years) adjusting for age and sex. Results Compared with Danish‐born individuals, refugees and family reunited immigrants had lower HR s of stroke and breast cancer within 5 years after arrival; however, HR s increased at longer follow‐up. For example, HR s of stroke among refugees increased from 0.77 (95% CI : 0.66; 0.91) to 0.96 (95% CI : 0.88; 1.05). For ischaemic heart disease ( IHD ) and diabetes, refugees and family reunited migrants had higher HR s within 5 years after arrival, and most HR s had increased by end of follow‐up. For example, HR s of IHD among family reunited migrants increased from 1.29 (95% CI : 1.17; 1.42) to 1.43 (95% CI : 1.39; 1.52). In contrast, HR s for TB and HIV / AIDS showed a consistent decrease over time. Conclusion Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included.