Cancer is a leading cause of death among individuals with type 2 diabetes (T2D), and immigrants in Europe face a higher T2D risk than native populations. We investigated mortality disparities in overall and eight specific T2D-related cancers among immigrants and native Swedes diagnosed with T2D between 2006 and 2021. An open cohort of 478,607 individuals aged ≥ 35 years at the time of T2D diagnosis (28% first-generation [G1] and 6% second-generation [G2] immigrants) was followed until December 31, 2023. Flexible parametric survival models were used to estimate hazard ratios (HRs), stratified by age at arrival and duration of residence for G1 immigrants. G1 immigrants, except those from Nordic countries, generally had lower overall cancer mortality than natives. However, mortality risks for specific cancers converged toward those of natives with longer residence in Sweden, and notably liver and endometrial cancer mortality were higher among those who arrived early in life compared with natives. In G2 immigrants, kidney and endometrial cancer mortality rates were elevated, particularly for those with Western (HR = 1.63) and Nordic (HR = 1.82) parental origins, respectively. Mortality rates from colorectal and liver cancers also appeared to increase among those more recently diagnosed with T2D. These findings underscore the need for strengthening integrated diabetes and cancer care and tailored support services for high-risk immigrant populations.

Studies on health selectivity around the time of migration that account for different sources of heterogeneity in results, such as different types of migrants, internal and external migration, and places of origin and destination, are lacking.

In this population-based data linkage study in the province of Manitoba, Canada (1985-2023), we matched outmigrants and returnees with stayers within three birthplace groups of Manitoba-born (411,290), interprovincial immigrants (71,393) and international immigrants (101,192). We compared hospitalizations before outmigration and hospitalizations and mortality after return migration, stratified by the destination of leavers and the origin of returnees.

During the year before outmigration, compared to those who did not migrate (stayers) Manitobans who migrated to another country had half the risk of being hospitalized (Relative Risk (RR): 0.48; 95% confidence interval (CI): 0.40-0.58) but those who migrated to another province did not. Interprovincial immigrants who returned to their province of origin had higher hospitalizations than stayers (RR: 1.21; 95% CI: 1.12-1.32) but those who remigrated did not. In the three years after return migration, returnees had lower risk of death compared to stayers in all three groups. The association was stronger for Manitobans who returned from another country (RR: 0.46; 95% CI: 0.27-0.80) than for those who returned from another province (RR: 0.83; 95% CI: 0.74-0.93).

Health selectivity varies according to the birthplace of migrants and, within them, to the places of destination at outmigration and of origin at return migration. The more extreme the migration (international more extreme than interprovincial) the stronger the health selectivity.

Introduction During the global pandemic, the elderly, foreign-born and socioeconomically deprived experienced disproportionately higher rates of COVID-19 morbidity and mortality than general populations. However, these groups have typically been analysed in isolation, without considering how social factors jointly influenced COVID-19-related health. Thus, the aim of this study is to quantify intersectional inequalities in COVID-19 morbidity and mortality in Sweden.Methods In this retrospective cohort study, national registers were used to identify 35-to-100-year-old residents of Sweden in January 2020 (n=6 014 164), tracking COVID-19 hospitalisations and deaths (International Classification of Diseases-10 Codes U07.1/U07.2, plus B34.2 for deaths) until December 2022. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy was applied with logistic regression, nesting individuals within intersectional strata based on age, gender, migrant status and region of origin, and income. Measures of discriminatory accuracy (area under the receiver operating characteristic curve or AUC), predicted probabilities and random effects were calculated.Results During follow-up, 77 844 (1.29%) individuals were hospitalised and 18 126 (0.30%) died due to COVID-19. Intersectional models explained 2.22% of the variation in mortality (AUC=0.835) vs 0.60% in hospitalisations (AUC=0.728). Predicted probabilities were lowest in 35-44-year-old Swedish-born women with high income at 0.19% (95% CI 0.16% to 0.21%) for hospitalisations, and 0.01% (95% CI 0.01% to 0.02%) for mortality; and highest among 85-100-year-old foreign-born men from the Global South with low income at 14.85% (95% CI 12.84% to 17.10%) for hospitalisations, and 8.25% (95% CI 6.32% to 10.70%) for mortality. Random effects indicated wider income inequalities in both outcomes in the youngest and narrower in the oldest, native-born and foreign-born groups from the Global North.Conclusions Intersectional inequalities in COVID-19 outcomes consistently increased with age, decreased with income and were higher for men and foreign-born individuals. The results emphasise the need to consider universal public health strategies to reach vulnerable populations during a pandemic.

BACKGROUND Parenting leave policies shape how caregiving and paid work can be reconciled around the time of childbirth. They have important implications for fertility, employment, and gender equality. Still, there are limited quantitative cross-country data capturing long-term policy changes that impact how long parents can temporarily be away from work to care for their children, and how leave can be shared between them. OBJECTIVE The European Parenting Leave Policies (EPLP) Dataset provides harmonised regulations on maternity, co-parent, paid parental, and job-protected leave across 21 European countries from 1970 to 2024. It focuses on policies that shape how long birth mothers and their co-parents can take leave. METHODS Statutory leave entitlements were compiled from national legal sources, official government publications, and secondary literature. We followed a consistent set of data collection rules to enable comparison across countries and over time. Because the dataset focuses on time away from the job, it considers only rights for employed parents. It includes 33 variables and also documents country-specific reform timelines. CONTRIBUTION The EPLP Dataset fills a gap in existing data sources by providing quantitative data across 55 years on policies that shape how long parents stay at home around birth and how leave is shared between them. In addition to leave duration and benefits, it covers recent policy instruments such as incentives for parents to share leave, and timing and flexibility of leave use. The dataset enables cross-national comparisons and the analysis of changes over time, and can be used to study the effects of policy reforms.

Background  Immigrants in Sweden, particularly those from low- and middle-income countries, had higher risks of COVID-19 mortality and morbidity compared to the Swedish-born. However, prior studies have not quantified the contribution of the differential distribution of health and social determinants to the increased risks.

Methods  We used total population registers from Sweden to investigate disparities in COVID-19 hospitalization between five groups of immigrants and Swedish-born, using a cohort 577911 working-age adults (18–65 years) living in Stockholm during the first two waves of the COVID-19 pandemic. Applying a decomposition analysis, we quantified the relative contribution of age, sex, income, education, occupation type, residential area, and pre-existing medical conditions to these disparities.

Results  Our study shows that immigrants have higher risks of hospitalization compared to Swedish-born, and that the investigated factors accounted for these disparities to varying degrees across immigrant groups. For the most affected immigrant groups (from Africa and Middle East), the examined factors together account for only a minor part of the disparities (21% and 18% for Wave 1; 16% and 11% for Wave 2), with occupation type and residential area contributing substantially.

Conclusions  Common observable social determinants of health account for a moderate share of the overall disparities in COVID-19 hospitalizations between Swedish-born individuals and immigrant from the most affected regions of origin.

Strong social protections are essential for reducing health inequalities in society. Sweden has long been recognised for having one of the world’s most generous social welfare systems, which to date has been available to all residents regardless of their length of residency or citizenship status, but even this system has not been immune to political change.1The Swedish government has proposed a reform that would introduce new residence-based rules for accessing social security benefits. Although framed as a way to incentivise employment and reduce long-term benefit dependency, the reform is expected to disproportionately affect migrant residents by excluding them from core welfare protections. As a result, these rules are likely to exacerbate the well-documented health and social inequalities between people with and without migrant backgrounds in Sweden. By conditioning access to social protection on duration of residence or prior income, the reform introduces mechanisms of selective inclusion and exclusion that disproportionately affect individuals in more precarious socioeconomic positions.

This study aimed to compare differences in low birthweight (LBW, < 2500 g) between the offspring of Swedish-born women and migrant women from the Global North and Global South, while simultaneously considering the role of other social factors. We used total population registers to study resident women who gave birth in Sweden between 1997 and 2016, representing a total of 1,917,171 live births. Logistic regression analyses were performed using two analytical approaches: (1) a standard approach, applying regression models to assess the association between region of birth and LBW while adjusting for social factors; and (2) an intersectional approach, with an additive combination of region of birth, income, and parental support variables. Both approaches yielded odds ratios (OR) with 95% confidence intervals (CI) and were adjusted for year of birth, maternal age, and parity. Results from both approaches showed differences in the odds of LBW according to maternal background. Importantly, findings from the intersectional approach demonstrated that women from the Global South had consistently higher odds of LBW across income levels, but with risks amplified among those living alone. These findings show that maternal migration background is a strong determinant of LBW, and that its impact is differentially compounded by social factors.

Background Maternal age and cohabitation (women living with a partner in marriage or in a common-law relationship) are known to be associated with adverse birth outcomes. However, how these two factors jointly contribute to birth outcomes is not well understood, particularly among minor mothers. Methods All live births that occurred in Argentina 2001–2021 (N=13 807 028) were used to estimate the prevalence of births to minor mothers (<18 years). In analyses restricted to mothers aged ≤24 years (N=5 159 231), multinomial and binary logistic models were used to obtain crude and adjusted ORs (aOR) for the joint association between cohabitation status and maternal age groups (minors: ≤15 and 16–17 years, and young adults: 18–19 years and 20–24 years) with preterm birth (PTB), small-for-gestational age (SGA) groups and repeat birth. Results Minor mothers accounted for 6% of all births (n=791 731), lived in poor regions and were more likely to have incomplete primary education and no employment. Among mothers aged <24 years, adverse outcomes jointly varied according to cohabitation status and maternal age (p value for interaction <0.001 in all models). Adverse outcomes were more frequent among minors. Compared with non-cohabiting mothers aged 20–24 years, cohabiting mothers aged 20–24 years had lower odds of very PTB (0.82% vs 1.19%), moderately PTB (7.15% vs 6.33%), extreme SGA (1.98% vs 2.56%) and moderately SGA (3.63% vs 4.48%, respectively). However, compared with non-cohabiting mothers aged 20–24 years, cohabiting minor mothers, particularly those aged ≤15 years had higher odds of very PTB (24–31 gestation weeks) (AOR: 1.86 (95% CI 1.76, 1.97)), moderately PTB (32–36 weeks) (AOR: 1.53 (95% CI 1.49, 1.57)), extreme SGA (<3rd percentile) (AOR: 1.10 (95% CI 1.06, 1.14)) and moderately SGA (3rd to <10th percentile) (AOR: 1.05 (95% CI 1.01, 1.08)). Conclusions The cohabitation advantage among young adults was not observed among minor mothers, particularly those aged ≤15 years.

The intricate relationship between immigration and health, a complex and multidimensional phenomenon, presents challenges for both receiving and sending countries of immigrants. Given the complex mechanisms involved, understanding and assessing the factors associated with disparities in immigrants’ health is a theoretical, methodological, and empirical challenge. Acknowledging and systematically understanding this phenomenon is crucial for the social cohesion of increasingly diverse countries. This introductory chapter reflects on the multifaceted nature of immigrant health, a theme that subsequent chapters in the book delve into from a more empirical perspective. This chapter first identifies current challenges in studies on immigrant health, offering reflections on these challenges’ effects on contemporary societies. Secondly, it provides an overview of immigration to Spain in recent decades, shedding light on the associated challenges in health policy management. Following this, the conceptual frameworks that guide most of the studies included in this book are presented. Special attention is given to the perspective of the healthy immigrant, discussing their ability to describe and explain phenomena related to immigrant health, along with the recognition of its limitations. The chapter concludes by presenting the main objectives of the book.

There is a scarcity of studies examining the impact of the COVID-19 pandemic on the descendants of immigrants, a group representing a growing segment of the population in many countries. This study utilized a national cohort event history analysis in Sweden, consisting of all residents aged over 20 years at the end of 2019 (n = 7 871 444), with a follow-up period from 31 December 2019 to 1 June 2021. Poisson regression was used to estimate incidence rate ratios for severe COVID-19 morbidity [hospitalization, intensive care unit (ICU) admission] and COVID-19-related mortality based on generation status [first generation (G): foreign-born, arrived as adults; the 1.5 generation: foreign-born, arrived as a child; second generation: native-born to two foreign-born parent; and 2.5 generation: native-born to one foreign-born parents] stratified by their region of origin (Nordics, Global South, and Global North) using the majority population (two native-born parents) as reference. All immigrant generations experienced higher rates for severe COVID-19 morbidity compared to the majority population. While this pattern is observed across all regions of origin, the largest differences appear among individuals with a Global South background. Adjusting for social and health factors moderately attenuates the estimates for the descendants of immigrants. Mixed results are found regarding COVID-19 mortality by region of origin and generational status. All immigrant generations experience a COVID-19 morbidity burden comparable to first-generation immigrants and should thus be considered when planning preventive measures to prepare for future pandemics and health crises.